Effect of back-pressure anesthesia on postoperative pain after the endodontic treatment in patients with symptomatic irreversible pulpitis: randomized double-blind clinical trial.

INTRODUCTION: The present study evaluated the effect of two different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis. METHODS: One-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance. RESULTS: The initial IANB was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%) and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them. CONCLUSIONS: Patients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.

Management of Palatogingival Groove in Maxillary Lateral Incisor: A Report of a Rare Case With a Brief Review of Literature.

Several morphological abnormalities may occur during tooth development and may be a predisposing factor for periodontal destruction. Palatogingival groove (PGG) is a developmental deformity that may cause localized periodontitis and endodontic complexities. The groove usually originates as a root indentation in the central fossa of the palatal root of maxillary lateral incisors. Cone beam computed tomography (CBCT) is an excellent radiographic imaging technique capable of identifying PGGs and provides details about the exact site, extent, and depth characteristics of this deformity. Early diagnosis and management of PGGs are of utmost importance, particularly due to their diagnostic intricacies that can pose both clinical and therapeutic challenges. This article aims to report a rare case of palatogingival groove associated with an on-and-off discharge from the maxillary left lateral incisor tooth (#22). Nonsurgical endodontic treatment was carried out with #22, and the palatogingival groove was sealed with composite restoration after a deep curettage. Excellent radiographic healing was observed after a six-month follow-up.

Nationwide Trends of Modern Endodontic Practices Related to Working Length, Instrumentation, Magnification, and Obturation: A Comparative Cross-Sectional Survey Comparing Endodontic and Non-Endodontic Specialties Practicing Root Canal Treatment in India.

Aim: The present study was designed to assess trends in contemporary endodontic practice regarding the techniques and materials used in endodontic therapy among dental practitioners from various regions of India. Methods: A cross-sectional questionnaire-based study was conducted amongst dentists who were pursuing postgraduates in endodontics (PG Endo) and other branches (PG-OB), specialists from other branches (MDS-OB) and specialists in endodontics (MDS-Endo) in various dental colleges representing East, West, North, South, and Central zones through an e-survey using Google forms. State-wise postgraduate dental college lists were obtained from the Dental Council of India (DCI) website. Using a multistage cluster random sampling method and considering the unanticipated response rate, emails were sent to 2100. A 29-item close-ended questionnaire, framed according to different aspects of endodontic treatment, was used to record the responses. Results: When the distribution of the groups of dentists was compared, the central zone had the highest number of PG-OB (44.2%) and the lowest number of MDS-Endo (8.4%). The electronic apex locator (EAL) method of working length determination has been reported less among MDS-Endo than MDS-OB. The difference between the usage of various methods for working length determination was significant among the different groups in all the zones. (p < 0.0001) Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. The majority of dental practitioners preferred a combination method of instrumentation. Conclusion: Zone-wise comparisons among dentists showed the majority of general dental practitioners preferred the combination method (radiographs and electronic apex locator) for working length determination. Most MDS-Endo preferred the rotary method of instrumentation over the combination method for different zones. All dental practitioners did not so commonly use magnification in all the zones. The single cone technique was the most opted by dental practitioners of all the zones.

Management of a Rare Tessier 30 Median Mandibular Cleft Anomaly: A Comprehensive Review.

Introduction: The median mandibular cleft (MMC) is a rare craniofacial anomaly manifesting as a cleft of the lower lip and mandible, which may extend to the neck to a variable extent and severity. Its management involves a timely, staged, and multidisciplinary approach. Unlike for maxillary cleft lip and palate, the literature on this anomaly is scarce and scattered. Also, guidelines for the management of mandibular cleft are not clearly outlined. This narrative review aims to consolidate the prevalence, classification, pathophysiology, and management of MMC. Materials and methods: A literature search was performed on PubMed, SCOPUS, and Web of Science for terms "Mandibular cleft" OR "Tessier 30." From the preliminary search, n = 68 articles were hand-filtered as per relevance to MMC from the title and abstract. Results: Among these articles, n = 56 were case reports, n = 2 were articles related to genetic associations, n = 4 syndromes associated, n = 3 discussed the classification of craniofacial clefts, and n = 3 were literature reviews. The findings from the literature are presented under subheadings embryonic origin, clinical presentation, diagnostic workup, and multidisciplinary management of MMC. Conclusion: Traditionally, MMC was treated by multistep surgical procedures; however, the contemporary approach promotes early and single-step correction of both soft and hard tissue defects for better growth outcomes. These cases demand comprehensive workup and timely management. Newer innovations, such as the use of BMPs and resorbable reduction plates, need further validation. How to cite this article: Katyal S, Mohanty S, Miglani S, et al. Management of a Rare Tessier 30 Median Mandibular Cleft Anomaly: A Comprehensive Review. Int J Clin Pediatr Dent 2023;16(6):875-881.

Diagnostic Accuracy of Pulp Vitality Tests and Pulp Sensibility Tests for Assessing Pulpal Health in Permanent Teeth: A Systematic Review and Meta-Analysis.

The current systematic review and meta-analysis was carried out to compare the diagnostic accuracy of pulp vitality and pulp sensibility tests in assessing pulpal health. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar and Open Grey databases were searched and after assessing eligibility criteria the data were extracted. True-positive, false-positive, true-negative, false-negative, sensitivity and specificity values were extracted or calculated if not presented. Quality of studies was evaluated based on the QUADAS 2 tool. Meta-analysis was performed in MetaDTA (v2.0; Shinyapps, RStudio PBC, Boston, MA, USA) and Review Manager 5.3 (RevMan web; The Cochrane Collaboration, London, UK). Ten articles were included for qualitative synthesis and five for meta-analysis. The pooled diagnostic odds ratio for pulse oximeter (PO), electric pulp tester (EPT), cold test (CT) and heat test (HT) was 628.5, 10.75, 17.24 and 3.47, respectively. Pairwise comparison demonstrated a higher pooled mean sensitivity and specificity with PO compared with EPT. Comparison between PO and CT and between PO and HT also demonstrated a higher pooled mean sensitivity and specificity for PO. Summary points on receiver operating characteristic curves confirmed the ability of PO to correctly screen negatives in presenting patients as compared to EPT, CT and HT but no study was rated as good on quality assessment. PO can be considered as the most accurate diagnostic method as compared to EPT, CT and HT. This review provides information about the reliability and diagnostic accuracy of using pulp vitality and sensibility tests for assessing pulp status.

Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis.

OBJECTIVE: The goal of this systematic review and meta-analysis is to determine the performance of 4% Articaine vs. 2% Lidocaine for mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis (IP). METHODS: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Gray were used to conduct a thorough literature search. A manual search of the reference lists of the publications found was also carried out. Two reviewers critically evaluated the papers for inclusion and exclusion criteria, and data extraction was done on the selected publications. The Cochrane Collaboration Tool and the Minors checklist were used to assess the quality of the selected studies for randomised controlled trials (RCTs) and non-randomised studies, respectively. The RevMan software was used to perform a meta-analysis of the pooled data and subgroups according to the technique of anaesthetic solution delivery, as well as a sensitivity analysis (P < 0.05). RESULTS: A total of twenty-six papers were included in the qualitative synthesis, with twenty-two of them being included in the meta-analysis. There were fifteen studies with a low potential for bias, three with a moderate potential for bias, and seven with a high potential for bias. The combined results of the 19 trials in the tooth level unit revealed that 4% articaine had a success rate 1.37 times greater than 2% lidocaine for mandibular teeth (RR, 1.37; 95% CI [1.17-1.62]; P = 0.0002). For the maxillary buccal infiltration method, the combined results from the three trials revealed that 4% articaine resulted in a success rate 1.06 times greater than 2% lidocaine (RR, 1.06; 95% CI [0.95-1.2]; P = 0.3). Excluding subgroups with a single study in sensitivity analysis for mandibular teeth revealed a substantial improvement in the success rate of the articaine group in treating IP when compared to the lidocaine group. CONCLUSION: The findings of this meta-analysis back up the claim that articaine is more effective than lidocaine in providing anaesthesia in patients with IP. PROSPERO Registration No.: CRD42020204606 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020204606).

Biosynthesized selenium nanoparticles: characterization, antimicrobial, and antibiofilm activity against Enterococcus faecalis.

BACKGROUND: Control over microbial growth is a crucial factor in determining the success of endodontic therapy. Enterococcus faecalis is the most resistant biofilm-forming species leading to endodontic failure. Hence, the current researches are directed towards discovering materials with superior disinfection properties and lesser cytotoxicity. This study aimed to synthesize and characterize biogenically produced Selenium Nanoparticles, and to evaluate the antimicrobial and antibiofilm efficacy, against Enterococcus Faecalis, for the following test groups: Group I: Distilled water (control), Group II: SeNPs (1 mg/ml), Group III: Calcium hydroxide (1 mg/ml), Group IV: 2% Chlorhexidine gluconate (CHX), Group V: 5.25% Sodium hypochlorite (NaOCl). MATERIALS AND METHODS: Selenium nanoparticles were derived using fresh guava leaves (Psidium guajava) and were characterized. The antibacterial efficacy against E. faecalis was evaluated by agar well diffusion method. The antibiofilm efficacy of the test groups was observed by viable cell count, antibiofilm assay, and Anthrone and Bradford's tests. The morphology of the biofilms was analysed using the Scanning Electron Microscope and Fourier Transform Infrared spectroscopy. RESULTS: Antibacterial and antibiofilm efficacy of all tested solutions showed superior antibacterial and antibiofilm efficacy when compared to the control group. Overall, SeNPs (Group II) was the most effective against E. faecalis biofilm, followed by NaOCl (Group V), CHX (Group IV), and Ca(OH)2 (Group III). CONCLUSION: Biogenically produced SeNPs emerged as a novel antibacterial and antibiofilm agent against E. faecalis. This nano-formulation demonstrates the potential to be developed as a root canal disinfectant combating bacterial biofilm in endodontics after the results have been clinically extrapolated.

Microneedles and Nanopatches-Based Delivery Devices in Dentistry.

Needle-based devices are evolving as a promising diagnostic and therapeutic tool in the field of medicine. They can be used for drug delivery, as well as extraction of fluids, for systemic and local effects. The conventional methods of drug delivery require repeated dosing in the oral cavity due to the presence of saliva. Hence delivery systems, such as needle-based devices that could provide sustained release of the drug in the oral cavity, are required. These devices could also be a useful adjunct in diagnosis and therapy of oral cancers, delivering anti-cariogenic and antiplaque agents, for remote monitoring of oral health, and for administering painless and fearless local anesthesia. Since they offer many advantages, such as increased compliance, absence of needle phobia, they are painless, safe, self-applicable and are minimally invasive, they will have a major impact in the field of dentistry. This paper summarizes the various types of needle-based devices and their manufacturing technologies. The manuscript aims to serve as a foundational review that highlights and proposes several current and prospective impactful applications of these devices in various fields of dentistry.

Burden of Dental Caries in India: Current Scenario and Future Strategies.

INTRODUCTION: Dental caries, commonly known as tooth decay or cavity, is among the most widespread oral diseases globally. It is one of the prime causative agents of oral discomfort and reason for patients to visit dental clinics or hospitals. If detected timely, the tooth can be restored and if left untreated it can eventually lead to tooth loss or other serious sequelae. OBJECTIVE: This article draws attention to why dental caries is a global oral health concern and problems faced in India in managing this pandemic disease. It also attempts to suggest a few preventive strategies and future research directions needed to control this national oral health concern. MATERIALS AND METHODS: A narrative overview of the current literature is presented and a few suggestions on preventive and research strategies are highlighted. RESULTS: Oral health that is an essential component of overall well-being is often neglected in India. Basic region-wise data in the form of well-controlled surveys regarding the prevalence of dental caries across India are also not available. This is needed to frame robust preventive strategies, policies, and manpower allocation, suitable for different subgroups of the population. CONCLUSION: State-level data should be collected to know the prevalence of this disease, identify the high-risk areas and customize region-wise preventive and treatment strategies. India has the maximum number of dental schools, efforts at individual levels are needed since everything cannot be left for the government to work upon. HOW TO CITE THIS ARTICLE: Miglani S. Burden of Dental Caries in India: Current Scenario and Future Strategies. Int J Clin Pediatr Dent 2020;13(2):155-159.

Efficacy of Articaine Versus Lidocaine Administered as Supplementary Intraligamentary Injection after a Failed Inferior Alveolar Nerve Block: A Randomized Double-blind Study.

INTRODUCTION: The present study comparatively evaluated the anesthetic efficacy of 4% articaine versus 2% lidocaine given as supplemental intraligamentary injections after a failed inferior alveolar nerve block. METHODS: One hundred six adult patients with symptomatic irreversible pulpitis in a mandibular first or second molar received an initial inferior alveolar nerve block with 2% lidocaine with 1:80,000 epinephrine. Pain during the endodontic treatment was assessed using the Heft-Parker visual analog scale. Eighty-two patients with unsuccessful anesthesia were randomly allocated to 2 treatment groups: 1 group received 0.6 mL/root of supplementary intraligamentary injection of 4% articaine with 1:100,000 epinephrine, and the second group received 2% lidocaine with 1:80,000 epinephrine. Endodontic treatment was reinitiated. Success after the primary injection or supplementary injection was defined as no or mild pain (less than 55 mm on the Heft-Parker visual analog scale) during access preparation and root canal instrumentation. Patients' heart rate was monitored using a finger pulse oximeter. The anesthetic success rates were analyzed with the Pearson chi-square test at 5% significance levels. The heart rate changes were analyzed using the t test. RESULTS: The patients receiving supplementary intraligamentary injections of 4% articaine had a success rate of 66%, whereas 2% lidocaine injections were successful in 78% of cases. The difference was statistically nonsignificant (χ2 = 1.51, P = .2). There was no significant effect of the different anesthetic agents on the heart rate. CONCLUSIONS: Both 4% articaine and 2% lidocaine improved the success rates after a failed primary anesthetic injection, with no significant difference between them.

Effect of polyethylene fiber reinforcement on marginal adaptation of composite resin in Class II preparations.

The aim of this study was to evaluate the effect of polyethylene fibers incorporated in a composite resin matrix on the gingival marginal adaptation of Class II slot restorations. Sixty Class II slot cavity preparations were divided into 2 groups. A fiber-reinforced resin (FRR) group received restorations of composite resin mixed with strips of polyethylene fiber, and an unreinforced resin (UR) group was restored with only composite resin. The groups were subdivided on the basis of the adhesive system (etch-and-rinse or self-etch) that was used. Shrinkage stress was evaluated by placing a strain gauge at the buccal surface of the teeth. A scanning electron microscope was used to evaluate marginal adaptation in terms of a continuous margin (CM) at the gingival margin. Statistical analysis included a 2-way analysis of variance with the Holm-Sidak correction for multiple comparisons at a significance level of 0.05. The mean strain value was significantly smaller in the FRR group (185 [SD 37] µm/m) than in the UR group (295 [SD 21] µm/m). The FRR group presented with a mean CM value of 80.2% (SD 4.6%), which was significantly higher than that of the UR group, which had an overall CM value of 64.4% (SD 4.2%). There was no statistically significant difference between the adhesive subgroups with regard to strain or percentage of CM. The results showed that the incorporation of polyethylene fibers in a composite resin matrix can help to improve gingival marginal adaptation in Class II cavities.

Effect of root canal obturation with calcium silicate materials on pH change in simulated root resorption defects.

This study evaluated the effect of 3 commercially available calcium silicate materials (CSMs) on pH changes in simulated root resorption defects. Simulated root resorption defects were prepared on the facial root surface of 40 mandibular premolars. The depth of each defect was individually calculated to standardize the remaining dentin thickness to 1 mm. Prepared canals were obturated with the 3 CSMs. Ten specimens were kept as controls, filled with unbuffered normal saline. The pH measurements were taken at 1 hour, 6 hours, 1 day, 1 week, 2 weeks, 3 weeks, 1 month, and 2 months. All CSM groups exhibited an initial alkaline pH of 9.0-9.7. The pH decreased to 8.0-8.5 after 2 months of storage. There were no significant differences between pH measurements at other time intervals. The CSM groups exhibited higher pH levels than the control group. The results showed that intracanal placement of the CSMs maintained initial pH levels of 9.0-9.7 inside the simulated resorption defects; these measurements gradually decreased to 8.0-8.5 over the span of 2 months.

Effect of relative head position on the anesthetic efficacy of inferior alveolar nerve block during endodontic treatment of patients with irreversible pulpitis.

BACKGROUND: The purpose of this prospective randomized single-blind clinical trial was to evaluate the effect of tilting the head on the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. METHODS: Ninety-two patients were divided into two groups: the first group received IANB and the head was tilted in the direction of the block for 15 min, whereas the second group received IANB and the head was tilted to the opposite side. Access cavity preparation was initiated after 15 min. Success was defined as no pain or faint/weak/mild pain during endodontic access preparation and instrumentation. The anesthetic success rates were analyzed by Pearson chi-square test at 5% significance levels. RESULTS: The same side position and opposite side position yielded 41% and 30% anesthetic success rates, respectively; there was no significant difference between the two sides. CONCLUSIONS: Relative head position has no effect on the anesthetic success rate of IANB.

Comparative Evaluation of Anesthetic Efficacy of 2% Lidocaine, 4% Articaine, and 0.5% Bupivacaine on Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Clinical Trial.

AIMS: To compare the anesthetic efficacy of 1.8 mL of 2% lidocaine with 1:200,000 epinephrine, 4% articaine with 1:100,000 epinephrine, and 0.5% bupivacaine with 1:200,000 epinephrine on producing inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. METHODS: A total of 91 adult patients who were actively experiencing mandibular molar pain were involved in this study. The patients were randomly divided into three groups on the basis of the anesthetic solution used. The first group received IANB with 1.8 mL of 2% lidocaine with 1:200,000 epinephrine, the second group received IANB with 4% articaine with 1:100,000 epinephrine, and the third group received IANB with 0.5% bupivacaine with 1:200,000 epinephrine. After 15 minutes of IANB, conventional endodontic access preparation was started. The pain during the treatment was noted on a Heft-Parker visual analog scale (HP VAS). The primary outcome measure was anesthetic success, and anesthesia was considered successful if the patient reported no pain or weak/mild pain (HP VAS score < 55 mm) during endodontic treatment (pulp access and canal preparation procedures). The data were analyzed with one-way analysis of variance and chi-square test. RESULTS: The anesthetic success rates of 2% lidocaine, 4% articaine, and 0.5% bupivacaine were 23%, 33%, and 17%, respectively. The differences were statistically insignificant (P > .05). CONCLUSION: The 2% lidocaine solution used for IANB had similar success rates when compared with 4% articaine and 0.5% bupivacaine.

Effects of simplified ethanol-wet bonding technique on immediate bond strength with normal versus caries-affected dentin.

AIM: The aim of the present study was to evaluate whether the use of simplified ethanol-wet bonding (EWB) technique improved the immediate microtensile bond strength (µTBS) between resin composite and caries-affected dentin (CAD). MATERIALS AND METHODS: Twenty-four extracted carious human permanent molars were sectioned to expose the carious lesion. The carious dentin was excavated until CAD was exposed. The samples were divided into two groups: water-wet bonding with Adper Scotchbond Multi-Purpose and a simplified EWB (three 100% ethanol applications for 30 s each), followed by application of an experimental hydrophobic primer and restoration. The samples were vertically sectioned to produce 1 mm × 1 mm thick slabs. The normal dentin (ND) slabs and CAD slabs were identified and were subjected to µTBS evaluation. Slabs from four teeth (two from each group) were evaluated under microscope. Data were analyzed using two-way ANOVA and post hoc Holm-Sidak test at P < 0.05. RESULTS: EWB improved the µTBS in ND but not in CAD group. The dentinal tubules in CAD group showed sclerotic activity with minimal or no hybrid layer. CONCLUSIONS: Simplified ethanol bonding does not improve the bond strength in CAD.

Comparative Evaluation of Mental Incisal Nerve Block, Inferior Alveolar Nerve Block, and Their Combination on the Anesthetic Success Rate in Symptomatic Mandibular Premolars: A Randomized Double-blind Clinical Trial.

INTRODUCTION: The purpose of this study was to compare the effectiveness of mental incisive nerve block (MINB) and inferior alveolar nerve block (IANB) that were given alone or in combination to provide anesthesia to symptomatic mandibular premolars. METHODS: One hundred fifty-three patients participated in this randomized, double-blind clinical trial. The patients were divided into 3 groups; first group received MINB with 2 mL 2% lidocaine with 1:200,000 epinephrine and a mock IANB with 2 mL sterile saline, patients in group 2 received mock MINB and an IANB with 2 mL 2% lidocaine, and patients in group 3 received both MINB and IANB with 2 mL each of 2% lidocaine. Access cavity preparation was initiated after 10 minutes. Success was defined as no pain or faint/weak/mild pain during endodontic access preparation and instrumentation. The anesthetic success rates were analyzed with Pearson χ(2) test at 5% significance levels. RESULTS: The MINB and IANB gave 53% and 47% anesthetic success rates, respectively, with no significant difference between them. Adding an IANB to MINB significantly improved the success rates to 82%. CONCLUSIONS: A combination of MINB and IANB can provide improved local anesthesia for symptomatic mandibular premolars.

Comparative evaluation of push-out bond strength of ProRoot MTA, Biodentine, and MTA Plus in furcation perforation repair.

PURPOSE: Few studies have comparatively evaluated the push-out bond strength of different calcium silicate-based materials (CSMs) used in furcal perforation repair. The objective of this in vitro study was to comparatively evaluate the push-out bond strength of commercially available CSMs used as furcation repair materials, in the presence of blood contamination. MATERIALS AND METHODS: Furcal perforations were made in 120 molars and were divided on the basis of the repair material used (ProRoot MTA, Biodentine, and MTA Plus), blood contamination, and duration of setting time (24 h vs. 7 days). Push-out bond strength was measured and analyzed by three-way analysis of variance (ANOVA) test. RESULTS: Push-out bond strength increased with time. The 24-h push-out strength of MTA was less than that of Biodentine. Blood contamination affected the push-out bond strength of MTA Plus irrespective of the setting time. CONCLUSION: Caution should be taken while condensing restorative materials over furcation repair materials.