Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double-blind placebo-controlled clinical trial.

AIM: The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome. METHODOLOGY: Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain. RESULTS: There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (p < .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (p < .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (p > .05). There was no significant difference amongst the groups at 12 h (p > .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (p < .001). CONCLUSION: The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.

Análise histológica da limpeza apical de canais radiculares após instrumentaçäo / Histological analysis of the apical cleaning of the root canal system after instrumentation

A limpeza do sistema de canais radiculares assume especial relevância no sucesso do tratamento endodôntico. O objetivo deste trabalho foi avaliar histologicamente a capacidade das técnicas step-back, movimentos contínuos de rotaçäo alternada (MRA) e do sistema Quantec de promover a limpeza do terço apical de canais radiculares. Os resultados demonstraram que näo houve diferença estatisticamente significante entre as técnicas testadas, sendo que, na maioria das vezes, os canais ainda apresentavam remanescentes teciduais, mormente em áreas de variaçöes da anatomia interna

Estudo dos efeitos de instrumentaçäo do canal radicular, em três diferentes técnicas através da microscopia eletrônica de varredura / Study of the effects of hand instrumentation of the root canal in three differents techniques by scanning electron microscope

Os efeitos da instrumentaçäo manual no preparo químico-mecânico do sistema de canal radicular em três técnicas diferentes foram analisados através da microscopia eletrônica de varredura. Os dentes foram preparados adequadamente e em seguida, seccionados em três terços para permitir uma observaçäo minuciosa da superfície dentinária dos canais radiculares