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1.
JNMA J Nepal Med Assoc ; 59(240): 741-744, 2021 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-34508488

RESUMO

INTRODUCTION: Endodontics is the study of prevention, diagnosis and treatment of diseases or injuries to the dental pulp. The ultimate goal of modern dental care is tooth preservation and root canal therapy/treatment is an available therapeutic strategy to retain teeth. The aim of the study is to find the prevalence of patients visiting a tertiary care center who had endodontic indications. METHODS: The descriptive cross-sectional study included 516 patients accepted for endodontic treatment, between August 2019 and December 2019 in a tertiary care center. Ethical approval was taken from the ethical review board of Nepal Health Research Council (reference number: 425-2019). Convenience sampling method was used. The data were entered in Statistical Package for Social Sciences version 20 software and analysed using descriptive statistics. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 1740 patients, 516 (29.66%) (95% Confidence Interval= 21.46% - 27.51%) had endodontic indications. Symptomatic irreversible pulpitis 306 (59.30%) was the most prevalent pulpal disease. Maxillary teeth 300 (58.13%) had more endodontic diseases. While in individual dental elements most affected by endodontic diseases was the mandibular molar teeth 149 (28.87%). Females 348 (67.44%) were predominant for demanding endodontic management than males 168 (32.5%). CONCLUSIONS: More female patients and of younger age group in this study population demanded endodontic treatment. Irreversible pulpitis was responsible for the majority of the cases treated and more affected were the posterior teeth.


Assuntos
Pulpite , Estudos Transversais , Feminino , Humanos , Masculino , Dente Molar , Pulpite/epidemiologia , Pulpite/terapia , Tratamento do Canal Radicular , Centros de Atenção Terciária
2.
Compend Contin Educ Dent ; 42(9): 498-502; quiz 503, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34555909

RESUMO

Foundational to the diagnosis of endodontic disease is the ability for clinicians to replicate a patient's pain via clinical testing. Patients experiencing degenerative pulp diseases, like an acutely symptomatic irreversible pulpitis,may present with poorly localized pain that cannot be clinically replicated. Selective anesthesia techniques can aid clinicians in the accurate diagnosis of these patients' symptoms. This article reviews the application of selective anesthesia and presents cases in which these techniques were used to facilitate the accurate diagnosis of endodontic disease.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Anestésicos Locais , Polpa Dentária , Método Duplo-Cego , Humanos , Nervo Mandibular , Dor , Pulpite/diagnóstico , Pulpite/cirurgia
3.
Quintessence Int ; 52(9): 820-826, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34369941

RESUMO

OBJECTIVES: This study was designed as a prospective randomized single-blind clinical trial to compare the anesthetic efficacy of inferior alveolar nerve block (IANB), IANB plus buccal infiltration, and IANB plus lingual infiltration of 4% articaine with 1:100,000 epinephrine in mandibular molars with irreversible pulpitis. METHOD AND MATERIALS: Sixty healthy volunteers who had a first or second mandibular molar diagnosed with irreversible pulpitis participated in the present study. This study was composed of three arms for the first molar and three arms for the second molar. Subjects in test arm A received two IANB injections (3.6 mL). Subjects in test arm B received 1.8 mL IANB injection plus 1.8 mL buccal infiltration. Subjects in test arm C received 1.8 mL IANB injection plus 1.8 mL lingual infiltration. Articaine (4%) with 1:100,000 epinephrine was used for all injections. The subject's pain during access preparation and pulp extirpation was recorded on the Heft-Parker visual analog scale. Success was defined as "none" or "mild" pain during treatment. Kruskal-Wallis test was used to compare pain categories in three groups of interventions for each mandibular molar. RESULTS: IANB with a supplemented buccal infiltration provided more success than IANB alone or IANB plus lingual infiltration, in first molars (P = .019). There were no significant differences between the three injection techniques in second molars (P = .795). CONCLUSIONS: Adding a supplemental buccal infiltration to a standard IANB was more successful in providing pain-free treatment for patients experiencing irreversible pulpitis in mandibular first molars.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Anestésicos Locais , Carticaína , Método Duplo-Cego , Humanos , Lidocaína , Nervo Mandibular , Dente Molar , Estudos Prospectivos , Pulpite/cirurgia , Método Simples-Cego
4.
Int Endod J ; 54(11): 1982-1992, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34347895

RESUMO

AIM: To establish the effects of submucosal tramadol, dexamethasone and articaine on the success of inferior alveolar nerve blocks (IANB) during root canal treatment of mandibular molars with symptomatic irreversible pulpitis (SIP). METHODOLOGY: In this randomized double-blind, controlled clinical trial, 120 patients with the diagnosis of SIP in their mandibular first or second molars were included and randomly divided into four groups (n = 30). The control group received normal saline and three experimental groups received a single dose of dexamethasone (8 mg/2 mL), or tramadol (100 mg/2 mL) or articaine (4% / 2 mL). The pre-operative pain levels of the patients were measured with the Heft-Parker visual analogue scale (HP VAS). All patients received standard IANB of 4% articaine with 1:200000 epinephrine. Following the observation of lip numbness, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars. After 15 min, standard root canal treatment was initiated, and the pain intensity levels recorded from the access cavity preparation to pulp extirpation were measured with HP VAS. The duration of the anaesthesia was also evaluated. The experimental groups were compared using one-way ANOVA or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using the Tukey Multiple Comparison test. The Chi-square test was used to compare the categorical variables. RESULTS: The submucosal administration of articaine significantly increased the success rate to 63% in comparison with the control group that received submucosal saline (p < .05). The success rate of pulpal anaesthesia was 37% in the control group, 57% in the tramadol group and 47% in the dexamethasone group, with no significant difference in the success rate among these groups. In the dexamethasone group, the duration of the anaesthetic effect of IANB was significantly longer than those in the other groups (p < .001). CONCLUSIONS: In patients with SIP, pre-operative submucosal administration of articaine increased the success rate of IANB, while administration of dexamethasone increased the duration of anaesthesia. These agents can be used in cases where effective anaesthesia cannot be obtained during root canal treatments.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Tramadol , Anestésicos Locais , Carticaína , Dexametasona , Método Duplo-Cego , Humanos , Lidocaína , Nervo Mandibular , Dente Molar/cirurgia , Pulpite/cirurgia
5.
Biomed Res Int ; 2021: 5599724, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34327231

RESUMO

Objectives: The objective of the study was to understand and analyze the prescription patterns of dentists across various demographic locations for managing oral infections and pain with antibiotics and explore the evidence-based practices by clinicians as well as the need for further education. Materials and methods. This cross-sectional study was carried out using an online questionnaire framed to explore the knowledge, attitude, and practices among dentists with varying levels of experience and qualifications, regarding antimicrobial prescription. The questions were validated from previous published studies that explored the knowledge, attitude, and practice (KAP) with respect to antimicrobial prescription. In total, N = 300 of dentists from four different countries responded to the online questionnaire out of which 53% were specialists while 47% were general dentists. After data collection, descriptive analysis was carried out along with a one-sided hypothesis test to depict the power of the sample. Results: It was seen from the results of the study that the first-choice antibiotics for 67.8% of dentists were found to be the ß-lactam group while sulfonamides and tetracyclines at 20% were the second most prescribed group. Another important finding was that 45.6% of dentists ignored hypersensitivity testing before prescription of antibiotics even though 83.3% of the total dentists interviewed were aware of the increase in antibiotic resistance. Conclusion: In conclusion, the dentists are partially aware of the guidelines but need further training and education on antimicrobial prescription that enables evidence-based decision-making for better practices and outcomes.


Assuntos
Antibacterianos/farmacologia , Diversidade Cultural , Demografia , Educação Continuada , Educação em Odontologia , Prescrições , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Humanos , Padrões de Prática Odontológica , Pulpite/tratamento farmacológico , Tamanho da Amostra , Superinfecção/tratamento farmacológico , Inquéritos e Questionários
6.
Int Endod J ; 54(10): 1720-1726, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34241896

RESUMO

AIM: To evaluate the effect of low-level laser therapy (LLLT) on the success rate of inferior alveolar nerve blocks (IANB) in mandibular molar teeth with symptomatic irreversible pulpitis (SIP). METHODOLOGY: Eighty-eight patients who were diagnosed with SIP were randomly divided into two groups: the group in which only IANB was applied and the group in which IANB + LLLT was applied. IANB was applied to patients in the control group with 4% articaine. LLLT was applied to the patients in the experimental group in addition to IANB. The pain experienced during the operation was evaluated using a visual analog scale. If the patients reported moderate or severe pain during the treatment, the IANB was defined as unsuccessful. Pearson's chi-square test was used to analyse anaesthetic success rates. RESULTS: Whilst the anaesthesia success rate was 34% in the group where only IANB was applied, it was 57% in the group in which LLLT was applied in addition to IANB. There was a significant difference between the groups (p = .032). CONCLUSIONS: The application of LLLT to support IANB in mandibular molar teeth with SIP increased the success of anaesthesia. However, it was insufficient for a complete pulpal anaesthesia.


Assuntos
Anestesia Dentária , Terapia com Luz de Baixa Intensidade , Bloqueio Nervoso , Pulpite , Anestésicos Locais , Método Duplo-Cego , Humanos , Lidocaína , Nervo Mandibular , Dente Molar , Pulpite/cirurgia
7.
Int Endod J ; 54(10): 1727-1737, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34245604

RESUMO

AIM: This prospective clinical study evaluated the clinical performance of managing cracked teeth with reversible pulpitis through a combination of internal and external splinting and investigated factors that can affect pulp survival after splinting. METHODOLOGY: Thirty-four teeth diagnosed with cracks and reversible pulpitis were enrolled and treated with bidirectional crack splinting: 1) immediate splinting with a stainless-steel band, 2) internal splinting with crack line removal and resin filling and 3) external splinting with a temporary crown followed by final crown placement. If the symptoms remained/recurred, root canal treatment was performed. Patients were followed up at 3, 6 and 12 months, then annually thereafter. Kaplan-Meier survival analysis to calculate the survival of the treated teeth and Cox univariate proportional hazards regression model to investigate prognostic factors were performed. RESULTS: Twenty-nine (97%) teeth were followed up for up to 4 years. The pulp survival rate was 72% after banding and 91% after final crown cementation. No tooth was extracted (100% tooth survival rate). In the univariate Cox proportional hazard test, pain on percussion was the only statistically significant factor (hazard ratio = 11.77). Teeth with pain on percussion at the first visit had a pulp survival rate of 46% during the follow-up period. In comparison, their counterparts without pain had a 94% pulp survival rate. CONCLUSIONS: Bidirectional splinting successfully managed cracked teeth with reversible pulpitis. Pain on percussion (mechanical allodynia) may be an important factor in deciding whether to attempt root canal treatment on symptomatic cracked teeth. A step-by-step approach with bidirectional crack splinting should be encouraged for a cracked tooth with a vital pulp without mechanical allodynia rather than pre-emptive root canal treatment.


Assuntos
Síndrome de Dente Quebrado , Pulpite , Síndrome de Dente Quebrado/terapia , Humanos , Prognóstico , Estudos Prospectivos , Pulpite/terapia , Tratamento do Canal Radicular
8.
J Endod ; 47(9): 1376-1382, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34256059

RESUMO

INTRODUCTION: Thorough pain assessment and thermal and mechanical testing are the primary diagnostic tools used to assess the status of pulp and periapical tissues in teeth with potential endodontic pathology. This study evaluated predictors of acute odontogenic pain to better understand the relationship between endodontic pain, clinical testing, endodontic disease, and diagnoses. METHODS: Participants (N = 228) presenting with acute odontogenic pain underwent standardized clinical testing and reported their pain intensity. Univariate and multiple regression analyses were performed to evaluate the predictors of acute endodontic pain. Chi-square tests with Bonferroni adjustments were conducted to measure the frequency of endodontic diagnostic test findings and clinical observations in patients with different pulpal diagnoses. RESULTS: A negative response to cold stimulation on the causative tooth and percussion hypersensitivity on the healthy adjacent tooth were the strongest predictors of higher levels of acute endodontic pain. Percussion hypersensitivity on the healthy adjacent tooth was present in a quarter of the cohort and was reported with equal frequency in teeth diagnosed with irreversible pulpitis, necrotic pulp, and previously initiated/treated teeth. Although painful percussion on the causative tooth was more frequently reported in teeth diagnosed with necrotic pulp, painful palpation was more frequently reported on teeth diagnosed with previously initiated/treated teeth. CONCLUSIONS: Percussion hypersensitivity on the healthy adjacent tooth may reveal a lowered pain threshold and heightened pain sensitization. It is also possible that the 2 commonly performed mechanical sensory tests, percussion and palpation hypersensitivity, may detect different aspects of endodontic pathophysiology and pain processing.


Assuntos
Doenças da Polpa Dentária , Pulpite , Estudos Transversais , Doenças da Polpa Dentária/complicações , Teste da Polpa Dentária , Humanos , Dor , Pulpite/complicações
9.
J Endod ; 47(9): 1365-1375, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34260959

RESUMO

INTRODUCTION: Molecular diagnosis may overcome the limitations of clinical and histologic diagnosis in pulpitis, thereby benefiting many treatment techniques, such as vital pulp therapies. In this study, integrated microarray data on pulpitis were used to obtain a list of normalized differentially expressed (DE) genes for analyzing the molecular mechanisms underlying pulpitis and identifying potential diagnostic biomarkers. METHODS: A systematic search of public microarray and sequencing databases was performed to obtain expression data of pulpitis. Robust rank aggregation (RRA) was used to obtain DE gene lists (RRA_DEmRNAs and RRA_DElncRNAs) between inflamed pulp and normal samples. DE genes were evaluated by functional enrichment analyses, correlation analyses for inflammation-related RRA_DEmRNAs, and protein-protein interaction and competing endogenous RNA network construction. Quantitative real-time polymerase chain reaction validation was applied in snap-frozen pulp tissues. RESULTS: Using the GSE77459 and GSE92681 data sets, 280 RRA_DEmRNAs and 90 RRA_DElncRNAs were identified. RRA_DEmRNAs were significantly enriched in inflammation-related biological processes and osteoclast differentiation and tumor necrosis factor, chemokine, and B-cell receptor signaling pathways. The molecular complex detection and cytoHubba methods identified 2 clusters and 10 hub genes in the protein-protein interaction network. The competing endogenous RNA network was composed of 2 long noncoding RNAs (ADAMTS9-AS2 and LINC00290), 2 microRNAs (hsa-miR-30a-5p and hsa-miR-128-3p), and 3 messenger RNAs (ABCA1, FBLN5, and SOCS3). The expression between most top inflammation-related RRA_DEmRNAs in pulpitis showed positive correlations. Quantitative real-time polymerase chain reacation validated the expression trends of selected genes, including ITGAX, TREM1, CD86, FCGR2A, ADAMTS9-AS2, LINC00290, hsa-miR-30a-5p, hsa-miR-128-3p, RASGRP3, IL3RA, CCDC178, CRISPLD1, LINC01857, AC007991.2, ARHGEF26-AS1, and AL021408.1. CONCLUSIONS: The identified biomarkers provide insight into the pathology and may aid in the molecular diagnosis of pulpitis.


Assuntos
MicroRNAs , Pulpite , RNA Longo não Codificante , Redes Reguladoras de Genes/genética , Humanos , MicroRNAs/genética , Pulpite/genética , RNA Mensageiro
10.
Medicina (Kaunas) ; 57(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34205149

RESUMO

Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle-Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as 'high' or 'serious', 'fair', and 'low' for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.


Assuntos
Pulpite , Dentição Permanente , Humanos , Estudos Prospectivos , Pulpite/terapia , Pulpotomia , Resultado do Tratamento
12.
BMC Oral Health ; 21(1): 339, 2021 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246278

RESUMO

BACKGROUND: According to the diagnosis criteria of the American Association of Endodontists (AAE), sensitive responses to cold and/or heat tests of suspected teeth compared with those of control teeth can be used for the diagnosis of pulpitis, but the role of electric pulp test (EPT) is not mentioned. It is believed that EPT has some limitations in determining the vitality of the pulp. The aim of this study was to explore the association between the difference in EPT values and the differential diagnoses of reversible pulpitis (RP) and symptomatic irreversible pulpitis (SIRP) caused by dental caries. METHODS: A total of 203 cases with pulpitis caused by dental caries were included. A diagnosis of pulpitis was made on the basis of the diagnostic criteria of AAE. Patient demographic and clinical examination data were collected. The EPT values of the suspected teeth and control teeth were measured, and the differences between them were calculated. The correlation between the difference in the EPT values and diagnosis of pulpitis was analyzed using univariate and multivariate logistic regression. RESULTS: In the 203 cases (78 males and 125 females; 115 cases of RP, 88 cases of SIRP; 9 anterior teeth, 59 premolars, and 135 molars), the mean patient age was 34.04 ± 13.02 (standard deviation) years. The unadjusted (crude) model, model 1 (adjusted for age), model 2 (adjusted for age and sex), and model 3 (adjusted for age, sex, and tooth type) were established for the statistical analyses. In model 3 [odds ratio (OR) = 1.025; 95% confidence interval (CI) 1.002-1.050; P = 0.035], the difference in EPT values between RP and SIRP was statistically significant. However, the areas under the curve of predictive probability of the crude model, model 1, model 2, and model 3 were 0.565, 0.570, 0.585, and 0.617, respectively, showing that the model accuracy was low. The P-value for the trend in differences between the EPT values as a categorical variable showed that the differences in the EPT values, comparing RP and SIRP, were not statistically significant. CONCLUSIONS: Based on the present data, the difference in EPT values was not sufficient to differentiate RP from SIRP.


Assuntos
Cárie Dentária , Pulpite , Adulto , Cárie Dentária/diagnóstico , Polpa Dentária , Teste da Polpa Dentária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dente Molar , Pulpite/diagnóstico , Adulto Jovem
13.
Anesth Prog ; 68(2): 69-75, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34185865

RESUMO

The inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia. Nitrous oxide may increase the success of the IANB. The purpose of this investigation was to study the effect of nitrous oxide/oxygen (N2O/O2) on IANB injection pain and mandibular pulpal anesthesia in asymptomatic subjects. One hundred five asymptomatic subjects received an IANB after the administration of N2O/O2 or room air/oxygen (air/O2) at 2 separate appointments. After the IANB, subjects rated their level of pain for each phase of the injection (needle insertion, needle placement, and solution deposition) using a Heft Parker visual analog scale. Pulpal anesthesia was evaluated with an electric pulp tester for 60 minutes. The mean pain rating for all 3 injection phases showed a statistically significant reduction in pain when N2O/O2 was used compared with Air/O2 (P < .05). Odds ratios demonstrated a statistically significant increase in IANB success for the N2O/O2 group compared with the air/O2 group. N2O/O2 administration statistically decreased pain for all 3 injection phases of the IANB. In addition, nitrous oxide statistically increased the likelihood of pulpal anesthesia for posterior mandibular teeth. However, the incidence of pulpal anesthesia was not 100%.


Assuntos
Anestesia Dentária , Bloqueio Nervoso , Pulpite , Anestésicos Locais , Humanos , Nervo Mandibular , Bloqueio Nervoso/efeitos adversos , Óxido Nitroso , Oxigênio , Dor
14.
Int Endod J ; 54(10): 1699-1707, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34101859

RESUMO

AIM: To assess the influence of occlusal and proximal deep carious lesions on the outcome of full pulpotomy performed in mandibular teeth with pulpal diagnosis of symptomatic partial irreversible pulpitis. METHODOLOGY: Eighty deep carious mandibular molar teeth with clinical and radiographic diagnosis of symptomatic partial irreversible pulpitis without periapical rarefaction from patients of either gender between the age of 16-35 years were included. Depending upon the location of deep carious lesion, the teeth were distributed equally into occlusal (n = 40) and proximal caries groups (n = 40). Full pulpotomy was performed under local anaesthesia and aseptic conditions. The pulp tissue was removed until the root canal orifices, and 2.5% sodium hypochlorite (NaOCl) was applied to arrest pulpal bleeding. Mineral trioxide aggregate (MTA) was compacted over the radicular pulp. Teeth were restored with resin-modified glass ionomer cement (RMGIC) and bulk-fill composite resin. Pre- and post-operative pain was assessed at 24, 48 and 72 h using a 11-point Numerical Rating Scale (NRS). Patients were followed at 6 and 12 months for clinical and radiographic evaluation. Asymptomatic teeth without any radiographic evidence of periapical rarefaction were considered successful. The data were analysed using the Shapiro-Wilk W test, two-sample Wilcoxon rank-sum test, Pearson chi-square test, Fisher's exact test and Kappa coefficient. The significance level was predetermined at p < .05. RESULT: An intergroup comparison revealed that the pre- and post-operative pain scores at 24, 48 and 72 h were not significantly different (p > .05). At the end of follow-up period (12 months), success of full pulpotomy in occlusal and proximal caries group was 95% and 92.5%, respectively (p = .644). For both groups, the combined success rate of full pulpotomy was 93.75%. CONCLUSION: The site of carious lesions (i.e., occlusal or proximal) did not affect the clinical and radiographic outcome of full pulpotomy performed in mature permanent mandibular teeth with symptomatic partial irreversible pulpitis.


Assuntos
Cárie Dentária , Pulpite , Adolescente , Adulto , Compostos de Cálcio , Cárie Dentária/terapia , Suscetibilidade à Cárie Dentária , Combinação de Medicamentos , Humanos , Dente Molar/diagnóstico por imagem , Dente Molar/cirurgia , Óxidos , Estudos Prospectivos , Pulpite/terapia , Pulpotomia , Silicatos/uso terapêutico , Resultado do Tratamento , Adulto Jovem
15.
Stomatologiia (Mosk) ; 100(3): 30-34, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34180622

RESUMO

THE AIM OF THE STUDY: Was the assessment of the efficacy of using non-steroidal anti-inflammatory drug Ketorol Express as a preventive analgesia in the treatment of acute pulpitis in molars. MATERIALS AND METHODS: The study comprised 128 individuals, 76 (59.4%) women and 52 (40.6%) men. The mean age was 37.4 years. Two different visual-analog scales were used to evaluate the effectiveness of pain relief and the general well-being of the patient and the doctor. THE RESULTS: Of the study proved that the preventive analgesia with Ketorol Express at a dosage of 20 mg 15 minutes before local anesthesia with 4% articaine with epinephrine 1:200 000 in patients diagnosed with acute pulpitis of molars was effective since local anesthesia high effectiveness, absence of necessity for alternate anesthesia were registered by patients, which coincided with the dentist's opinion. CONCLUSION: Preventive analgesia with Ketorol Express improves the efficacy of local anesthesia in the treatment of acute pulpitis in molars.


Assuntos
Analgesia , Anestesia Dentária , Bloqueio Nervoso , Pulpite , Adulto , Anestesia Local , Anestésicos Locais , Carticaína , Método Duplo-Cego , Feminino , Humanos , Masculino , Dente Molar , Dor , Pulpite/tratamento farmacológico
16.
Wiad Lek ; 74(6): 1341-1345, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34159916

RESUMO

OBJECTIVE: The aim: The research was to evaluate the effectiveness of acute traumatic pulpitis treatment with the use of bioceramics according to the results of a clinical study. PATIENTS AND METHODS: Materials and methods: Acute traumatic pulpitis of 25 teeth in 25 patients aged 18-25 years were treated by biological direct pulp capping. In 13 patients of the main group, bioceramics was placed on the exposed pulp, and in 12 patients of the control group, calcium hydroxide paste was applied on the exposed pulp. Treatment effectiveness was evaluated according to the following criteria: the absence of clinical signs of pulpal inflammation, on X-ray - signs of dentinal bridge formation, the absence of periapical changes. RESULTS: Results: The use of bioceramic material in patients of the main group provided a positive dynamic of treatment in 12 teeth. The need for re-treatment was diagnosed only in 1 clinical case (7.7%), in the control group - in 4 cases (33.3%). CONCLUSION: Conclusions: Pulpitis treatment with the use of bioceramics provides preserving the functional properties of pulp, creation of a calcified barrier - dentin bridge and prevents the periodontal complications compared to the pulp capping with a material based on calcium hydroxide. The effectiveness of treatment in the main group was 92.3%, in the control - 66.7%.


Assuntos
Dentina Secundária , Pulpite , Adolescente , Adulto , Hidróxido de Cálcio , Humanos , Pulpite/terapia , Adulto Jovem
17.
J Ayub Med Coll Abbottabad ; 33(2): 192-197, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34137527

RESUMO

BACKGROUND: Inferior Alveolar Nerve Block (IANB) with Buccal Infiltration (BI) anaesthesia is required to completely anesthetize the mandibular molars with symptomatic irreversible pulpitis. 4% Articaine and 2% Lidocaine provide local anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Objective of the study was to compare the effect of Articaine and Lidocaine in the combination of Inferior alveolar nerve block with buccal infiltration anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic Irreversible Pulpitis. METHODS: One hundred and sixty participants with Symptomatic Irreversible Pulpitis of permanent mandibular molars were divided randomly in two groups. Group A was given Articaine 4% IANB along with BI whereas group B was given Lidocaine 2%. Pain was assessed after 15 minutes of administration of local anaesthesia. Anaesthetic success of the agents is defined as, absence of pain or mild pain first during the access cavity preparation then instrumentation of the canals of tooth. Chi-square test was applied to analyse data for statistical significance. RESULTS: Anaesthetic success of Articaine was 96.2% during access cavity preparation compared to Lidocaine (86.2%). Success during instrumentation of canals was also found to be high in Articaine (90.2%) compared to Lidocaine (76.2%). This difference of anaesthetic efficacy between Articaine and Lidocaine was found statistically significant. (p=0.02). CONCLUSIONS: Articaine is found to be better than Lidocaine regarding anaesthetic efficacy and hence, it can be a safer alternative to Lidocaine.


Assuntos
Anestésicos Locais/farmacologia , Carticaína/farmacologia , Lidocaína/farmacologia , Mandíbula , Dente Molar/cirurgia , Manejo da Dor/métodos , Pulpite/cirurgia , Adulto , Método Duplo-Cego , Humanos , Masculino , Nervo Mandibular/efeitos dos fármacos , Pessoa de Meia-Idade , Bloqueio Nervoso
18.
Int Endod J ; 54(9): 1571-1580, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33964033

RESUMO

AIM: To create an irreversible pulpitis gene signature from microarray data of healthy and inflamed dental pulps, followed by a bioinformatics approach using connectivity mapping to identify therapeutic compounds that could potentially treat pulpitis. METHODOLOGY: The Gene Expression Omnibus (GEO) database, an international public repository of genomics data sets, was searched for human microarray datasets assessing pulpitis. An irreversible pulpitis gene expression signature was generated by differential expression analysis. The statistically significant connectivity map (ssCMap) method was used to identify compounds with a highly correlating gene expression pattern. qPCR was used to validate novel pulpitis genes. An ex vivo pulpitis model was used to test the effects of the compounds identified, and the level of inflammatory cytokines was measured with qPCR, ELISA and multiplex array. Means were compared using the t-test or ANOVA with the level of significance set at p ≤ .05. RESULTS: Pulpitis gene signatures were created using differential gene expression analysis at cutoff points p = .0001 and .000018. Top upregulated genes were selected as potential pulpitis biomarkers. Among these, IL8, IL6 and MMP9 were previously identified as pulpitis biomarkers. Novel upregulated genes, chemokine (C-C motif) ligand 21 (CCL21), metallothionein 1H (MT1H) and aquaporin 9 (AQP9) were validated in the pulp tissue of teeth clinically diagnosed with irreversible pulpitis using qPCR. ssCMap analysis identified fluvastatin (Statin) and dequalinium chloride (Quaternary ammonium) as compounds with the strongest correlation to the gene signatures (p = .0001). Fluvastatin reduced IL8, IL6, CCL21, AQP9 (p < .001) and MMP9 (p < .05) in the ex vivo pulpitis model, while dequalinium chloride reduced AQP9 (p < .001) but had no significant effect on the other biomarkers. CONCLUSIONS: AQP9, MT1H and CCL21 were identified and validated as novel biomarkers for pulpitis. Fluvastatin and dequalinium chloride identified by the ssCMap as potential therapeutics for pulpitis reduced selected pulpitis biomarkers in an ex vivo pulpitis model. In vivo testing of these licenced drugs is warranted.


Assuntos
Pulpite , Biomarcadores , Biologia Computacional , Polpa Dentária , Humanos , Pulpite/tratamento farmacológico , Reação em Cadeia da Polimerase em Tempo Real
19.
BMC Oral Health ; 21(1): 276, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030680

RESUMO

Endodontics is the branch of dentistry concerned with the morphology, physiology, and pathology of the human dental pulp and periradicular tissues. Human dental pulp is a highly dynamic tissue equipped with a network of resident immunocompetent cells that play major roles in the defense against pathogens and during tissue injury. However, the efficiency of these mechanisms during dental pulp inflammation (pulpitis) varies due to anatomical and physiological restrictions. Uncontrolled, excessive, or unresolved inflammation can lead to pulp tissue necrosis and subsequent bone infections called apical periodontitis. In most cases, pulpitis treatment consists of total pulp removal. Although this strategy has a good success rate, this treatment has some drawbacks (lack of defense mechanisms, loss of healing capacities, incomplete formation of the root in young patients). In a sizeable number of clinical situations, the decision to perform pulp extirpation and endodontic treatment is justifiable by the lack of therapeutic tools that could otherwise limit the immune/inflammatory process. In the past few decades, many studies have demonstrated that the resolution of acute inflammation is necessary to avoid the development of chronic inflammation and to promote repair or regeneration. This active process is orchestrated by Specialized Pro-resolving lipid Mediators (SPMs), including lipoxins, resolvins, protectins and maresins. Interestingly, SPMs do not have direct anti-inflammatory effects by inhibiting or directly blocking this process but can actively reduce neutrophil infiltration into inflamed tissues, enhance efferocytosis and bacterial phagocytosis by monocytes and macrophages and simultaneously inhibit inflammatory cytokine production. Experimental clinical application of SPMs has shown promising result in a wide range of inflammatory diseases, such as renal fibrosis, cerebral ischemia, marginal periodontitis, and cancer; the potential of SPMs in endodontic therapy has recently been explored. In this review, our objective was to analyze the involvement and potential use of SPMs in endodontic therapies with an emphasis on SPM delivery systems to effectively administer SPMs into the dental pulp space.


Assuntos
Endodontia , Periodontite Periapical , Pulpite , Humanos , Inflamação , Mediadores da Inflamação , Lipídeos , Periodontite Periapical/tratamento farmacológico , Pulpite/tratamento farmacológico
20.
BMC Oral Health ; 21(1): 260, 2021 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-33985486

RESUMO

BACKGROUND: Thermography is a contemporary imaging modality based on acquiring and analyzing thermal data using non-contact devices. The aim of the present study was to assess the validity of thermography, compared with that of the reference-standard, for the diagnosis of periapical inflammatory lesions and to evaluate the temperature ranges for acute pulpitis with apical periodontitis (AAP), acute periapical abscess (AA) and chronic periapical abscess (CA). METHODS: AAP, AA and CA were diagnosed based on clinical and radiographic criteria. Thermographic data were acquired using the FLIR E-5 Infrared Camera. Extraoral thermal images were taken from the front and right and left sides of patients whose mouths were closed, and one intraoral thermal image was taken from the palatal perspective. Agreement in the diagnoses based on the combination of clinical and radiographic assessments and the thermographic evaluation was calculated. The temperature ranges of the three diagnostic subgroups were also measured. RESULTS: A total of 80 patients were enrolled in this study. The mean intraoral thermal image temperature for AA was 37.26 ± 0.36, that for CA was 35.03 ± 0.63 and that for AAP was 36.07 ± 0.45. The differences between the mean intraoral thermal temperatures of the three diagnostic groups were statistically significant (P < 0.001). The result of the Kappa coefficient of agreement between the combination of clinical and radiographic assessments and the thermographic evaluation was significant (P < 0.001). CONCLUSIONS: Thermography is an effective, quantitative and nonionizing approach that can be used for the diagnosis of periapical inflammatory lesions. The results of the present study indicated that the highest thermal image temperatures were recorded for AA. Thermography might be able to detect inflammatory reactions during the preclinical stage, leading to early diagnosis.


Assuntos
Abscesso Periapical , Periodontite Periapical , Pulpite , Humanos , Inflamação , Periodontite Periapical/diagnóstico por imagem , Termografia
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