Effect of magnesium sulphate added to lidocaine on inferior alveolar nerve block success in patients with symptoms of irreversible pulpitis: a prospective, randomized clinical trial.

AIM: To investigate the effect of magnesium sulphate used as an adjuvant to lidocaine with epinephrine local anaesthetic on the success of inferior alveolar nerve blocks (IANB) in patients with symptoms of irreversible pulpitis undergoing root canal treatment. METHODOLOGY: In a double-blind clinical trial, following power calculation, 124 patients with symptoms of irreversible pulpitis in mandibular molar teeth were selected, and initial pain data were collected using a Heft-Parker (Pain, 19, 1984 and 153) visual analogue scale. The first group (control) received IANB with 1.8 mL of a local anaesthetic solution containing 1.8% lidocaine with 1 : 88 000 epinephrine while the second group (test) received IANB with 1.8 mL of an anaesthetic solution containing 1% magnesium sulphate, and 1.8% lidocaine with 1 : 88 000 epinephrine. Pain data were collected after access cavity and penetration of files in the canals using a Heft-Parker visual analogue scale. Two patients were not included in the study as they did not consent, and a further 54 patients were excluded as they did not report lip numbness within 15 min after IANB administration; thus, the data presented in this study are related to 68 patients. The data were analysed using chi-square and t-test (α = 0.05). RESULTS: The success of pulpal anaesthesia with IANB was 82% for the magnesium sulphate group and 53% for the control group. There was a significant difference in the effectiveness of the IANB between the two groups (P < 0.001). There was no significant difference between the magnesium sulphate and control groups regarding gender (P = 0.598) or age (P = 0.208) or initial pain scores (P = 0.431). CONCLUSIONS: The addition of 1% magnesium sulphate to 1.8% lidocaine with 1 : 88 000 epinephrine resulted in a positive impact for the success of IANB in patients with a diagnosis of irreversible pulpitis related to mandibular molar teeth undergoing root canal treatment. Thus magnesium sulphate may be used as adjuvant for achieving profound pulpal anaesthesia in challenging cases. However, more studies with larger sample size and different concentration doses must be carried out to establish an appropriate conclusion before its routine clinical use.

A comparison of tissue-engineered bone from adipose-derived stem cell with autogenous bone repair in maxillary alveolar cleft model in dogs.

This study was designed to compare bone regeneration of tissue-engineered bone from adipose-derived stem cell and autogenous bone graft in a canine maxillary alveolar cleft model. In this prospective clinical trial, mesenchymal stem cells (MSCs) were isolated from subcutaneous canine adipose tissue. Undifferentiated cells were incubated with a 3mm×3mm×3mm hydroxyapatite/beta-tricalcium phosphate scaffold, in specific osteogenic medium for 21 days. Four mongrel dogs were prepared by removal of two of the three incisors bilaterally and a 15mm defect in bone was created from crest to nasal floor. After healing, repair was followed by a tissue engineered bone graft from adipose-derived stem cells on one side and corticocancellous tibial auto graft on the other side. Bone regeneration was evaluated by histomorphometry on days 15 and 60 after implantation. The data were analysed with descriptive and t test methods (α=0.05). Bone formation on the autograft sides was higher than on the stem cell sides at 15 and 60 days, 45% and 96% versus 5% and 70%, respectively. Differences between the two groups at 15 and 60 days were significant (p=0.004 and 0.001, respectively). Although autograft is still the gold standard for bone regeneration, tissue engineered bone may provide an acceptable alternative.