Re-Evaluating the Effect of Preoperative Tranexamic Acid on Blood Loss and Field Quality During Rhinoplasty: A Randomized Double-Blinded Controlled Trial.

BACKGROUND: Nowadays, minimizing the surgical complications of rhinoplasty has gained more importance. Results from previous trials show that Tranexamic acid (TXA) reduces intraoperative bleeding, one of the major complicating factors during rhinoplasty. OBJECTIVE: To contribute to previous evidence by re-evaluating the efficacy of TXA, specifically in reducing intraoperative blood loss and increasing surgical field quality in rhinoplasty. STUDY DESIGN AND METHODS: A randomized placebo-controlled trial was conducted (IRCT20111219008458N2). The outcomes included total intraoperative blood loss, measured by the total volume of fluid collected by suction and gauzes, subtracted by volume of used irrigation fluids, and the quality of surgical field, measured by surgeon's satisfaction on a 5-point Likert scale. Demographics, blood coagulation measures, and clinical data were also collected and were held as covariates in analysis. After blinding, randomization, and group allocations, the intervention group received TXA 10mg/kg and the placebo group normal saline in equal volumes. RESULTS: Data of a total of 80 patients were gathered and analyzed. The total intraoperative blood loss was insignificantly lower (mean difference [95% CI]: - 3.6 ( - 19.19, 11.99), P = 0.65) and surgeon's satisfaction was insignificantly higher (mean difference [95% CI]: 0.18 ( - 0.11, 0.46), P = 0.22) in TXA group. Results were confirmed by multivariable analysis. CONCLUSION: In contrast to most of the previous studies, this study showed only a statistically insignificant decrease in total intraoperative blood loss in patients receiving TXA compared to placebo. Further studies are required to more precisely estimate the efficacy of TXA in reducing blood loss during rhinoplasty. LEVEL OF EVIDENCE: LEVEL I, RANDOMIZED CONTROLLED TRIAL.: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Randomized Controlled Clinical Trial Comparing Clinical and Radiographic Success Rates of MTA and rhBMP2 in Pulpotomy of Primary Teeth.

Objectives: In an ideal pulpotomy, the radicular pulp remains vital, healthy, and fully encased within an odontoblastic layer. Mineral trioxide aggregate (MTA) and bone morphogenetic proteins (BMPs) have been suggested to facilitate this outcome. We aimed to compare the clinical and radiographic failure and success rates of MTA and rhBMP2 as pulpotomy medicaments. Materials and Methods: Sixty-eight teeth from 3-6-year-old children were randomly assigned to two groups using a split-mouth design. Cervical pulpotomy was performed using MTA in one group and rhBMP2 in the other. Subsequently, the teeth were restored with stainless-steel crowns. Clinical and radiographic assessments were performed at 3, 6, 9, and 12-month follow-up intervals to evaluate success and failure rates. Data were analyzed using Chi-square test and Kaplan-Meier survival analysis (P<0.05) Results: At six and nine months, one tooth in the BMP2 group and one tooth in the MTA group showed internal resorption, respectively. After 12 months, one tooth in the BMP2 group exhibited PDL widening. The radiographic success rate was 100% for the MTA- and 97.1% for the BMP2-group at six months, 96.7% for both groups at nine months, and 96.7% and 93.3%, respectively, at 12 months. No clinical failure criteria were observed in any of the teeth. Survival analysis revealed no significant difference between the two groups. Conclusion: The study reveals comparable outcomes between rhBMP2 and MTA, suggesting rhBMP2 as a viable alternative for pulpotomy in primary teeth. With minimal incidences of complications and no significant differences noted, rhBMP2 demonstrates potential for clinical use.

Effect of Intracanal Irrigants on Coronal Fracture Resistance of Endodontically Treated Teeth Undergoing Combined Bleaching Protocol: An In Vitro Study.

OBJECTIVES: Irrigation plays a critical role in endodontic treatment. Various single and combined irrigants and irrigation protocols are available. The aim of this study was to evaluate the effect of some common irrigation protocols on the coronal fracture resistance of endodontically treated teeth undergoing bleaching. MATERIALS AND METHODS: After preparation of access cavities in 120 maxillary premolars, the teeth were divided into five groups (n=24) based on the irrigation protocol; G1:2.5% sodium hypochlorite (NaOCl), G2: 2% chlorhexidine (CHX), G3: NaOCl+CHX, G4: NaOCl+ethylenediaminetetraacetic acid (EDTA), G5: NaOCl+EDTA+CHX. Each group was subdivided into 2 subgroups of A: non-bleached (NB) and B: bleached (B). In subgroup B, the teeth underwent in-office and at-home bleaching techniques using 38% hydrogen peroxide and 20% carbamide peroxide gels for 3 weeks. The teeth were restored with composite resin, thermocycled, incubated for 24 hours, and underwent fracture resistance tests. Data were analyzed with one-way analysis of variance (ANOVA) and t-test (α=0.05). RESULTS: T-test showed significant differences between every two corresponding groups (P<0.0001). In subgroup A, the minimum fracture resistance was recorded in G1. Also, G2 specimens exhibited a significantly higher fracture resistance compared to G1, G4, and G5. In subgroup B, G2 specimens exhibited a significantly higher fracture resistance compared to G1 and G4 that were irrigated using NaOCl and NaOCl+EDTA. CONCLUSIONS: It can be concluded that irrigation protocols can affect the coronal fracture resistance of bleached endodontically treated teeth, and specific irrigation protocols can be recommended for teeth undergoing bleaching.

Influence of Intracanal Irrigants on Coronal Fracture Resistance of Endodontically Treated and Bleached Teeth: An In vitro Study.

BACKGROUND: Irrigation has a key role in the success of endodontic treatment. Intracanal irrigant solutions have adverse effects on the physical properties of dentin. AIM: The present study aimed to evaluate the effect of different irrigation protocols on coronal fracture resistance of endodontically treated teeth undergoing bleaching treatment. DESIGN AND MATERIALS AND METHODS: Access cavities were prepared in 120 maxillary premolars which were divided into two groups (n = 60) - Group A: nonbleached, Group B: bleached (B). Each group was subdivided into five subgroups based on irrigation protocol (n = 12); G1: normal saline (NS), G2: 2.5% sodium hypochlorite (NaOCl), G3: 10% citric acid (CA), G4: 17% ethylene diamine tetra acetic acid, and G5: NaOCl plus CA. In Group B, the teeth were bleached using 38% hydrogen peroxide and 20% carbamide peroxide gels as in-office and at-home bleaching techniques for 3 weeks. All the teeth were restored with composite resin, thermocycled, and incubated for 24 h. The specimens underwent fracture resistance tests. Data were analyzed with ANOVA, Tukey honestly significant difference test, t-test, and Chi-squared test (α =0.05). RESULTS: T-test showed significant differences between each two corresponding subgroups (P < 0.0001). In Group A, NS demonstrated significantly higher fracture resistance compared to others; however, minimum fracture resistance recorded in G2. In Group B, the maximum fracture resistance was recorded in G1, with the minimum being recorded in G5. Samples irrigated with NaOCl and NaOCl plus CA exhibited significantly lower fracture resistance compared to NS subgroup (P < 0.05). CONCLUSIONS: Within the limitations of this study, it can be concluded that the irrigation protocol used during endodontic treatment with/without bleaching can affect the coronal fracture resistance.