Comparative Assessment of Pain during Infiltration by a Two-stage Infiltration Technique: A Double-blind Clinical Trial.

AIM: The aim of this study was to assess and compare the pain during infiltration by a modified two-stage local anesthetic infiltration technique under topical anesthesia (TA). MATERIALS AND METHODS: In this cross-over double-blind study, 30 volunteers participated, where two groups were given single-stage infiltration and the other two had two-stage infiltrations. Depending upon the infiltration technique (one- or two-stage) and the use of TA, the patients were randomly divided into four groups. Local anesthesia (LA) was administered by infiltration into the mucobuccal fold of the maxillary central incisor, and the pain perceived during the infiltration in each group was recorded. The volunteers were recalled after 24 hours to assess the tenderness at the injection site. The volunteers were recalled 2 weeks after infiltration for the subsequent groups to assess the pain for this cross-over study. RESULTS: A statistically significant difference was observed in the pain perceived when TA was used and when the infiltration was done in two stages. Regarding the pain at the site of injection after 24 hours, no significant difference was observed among the volunteers. CONCLUSION: Topical anesthesia was effective in reducing the pain of injection when compared to placebo. The pain of injection is further reduced with a two-stage infiltration technique after TA application. CLINICAL SIGNIFICANCE: Topical anesthesia can be used routinely before infiltration, and LA infiltration injections are less painful if administered in two stages.

Bactericidal and Smear Layer Removal Efficacy of Herbal Alternatives Against Enterococcus Faecalis Dentinal Biofilm - An ex-vivo Study

Abstract Objective: To assess the antibacterial and smear layer removal ability of Trigonella foenum, Syzygium cumini, Terminalia chebula seed extracts against E. faecalis dentinal biofilm. Material and Methods: Agar well diffusion, micro broth dilution assay and time-kill curve assay were performed to determine the antibacterial activity. The ability of the herbal extracts to remove the smear layer on the root canal surface was assessed by scanning electron microscopy. Results: Antibacterial activity was observed for the extracts of S. cumini and T. chebula on E. faecalis dentinal biofilm and its planktonic counterparts. The smear layer was efficiently removed by the seed extracts of T. chebula alone. Seed extracts of T. foenum neither possessed antibacterial effect nor smear layer removal ability. Conclusion: The extracts of T. chebula seeds may replace conventional irrigant due to its antibacterial properties and smear layer removing the ability. The extracts of S. cumini may be used as an intracanal medicament as it exhibited a bactericidal effect against the E. faecalis dentinal biofilm following 18 hours of incubation.