Prevalence of dens invaginatus and its association with periapical lesions in a Western Indian population-a study using cone-beam computed tomography.

OBJECTIVES: This study aimed to assess the prevalence of dens invaginatus (DI) and its association with periapical lesions (PLs) in a Western Indian population by means of cone-beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT volumes of 5201 subjects were evaluated. Associations among gender, tooth type, DI type (Oehler's classification), and presence of PL were investigated. PL was codified using Estrela's Cone Beam Computed Tomography Periapical Index (CBCTPAI). Chi-square tests and descriptive statistics were used at p = 0.05. RESULTS: Overall, 7048 CBCTs were assessed, containing 19,798 maxillary and mandibular anteriors, of which 77 maxillary teeth demonstrated DI (0.39% of all anteriors). Of all 5201 subjects, 57 had DI (1.1%). Bilateral DI was more common in females than in males (p = 0.046). DI type distribution was as follows: type I (22.1%), type II (61.03%), type IIIa (10.4%), and type IIIb (6.5%), which was significantly different (p < 0.001). Maxillary lateral incisors were the most associated with PL (p < 0.001). Type I was frequently associated with CBCTPAI scores 1 and 2 (absence of PL), whereas types II, IIIa, and IIIb were associated with CBCTPAI scores 3, 4, and 5 (presence of PL). CONCLUSIONS: A prevalence of 1.1% identifies DI as a common developmental tooth anomaly in a Western Indian subpopulation. The percentage of maxillary anteriors affected by DI and associated PLs should be considered before diagnosis and treatment planning. CLINICAL RELEVANCE: Knowledge about the prevalence of DI and its subtypes, and their association with/without periapical pathosis may aid clinicians in treatment planning and execution to improve patient outcomes.

Effect of Preoperative Oral Steroids in Comparison to Anti-inflammatory on Anesthetic Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis-A Double-blinded Randomized Clinical Trial.

INTRODUCTION: This randomized double-blinded trial aimed to compare the anesthetic success of inferior alveolar nerve blocks (IANBs) with 2% lidocaine in mandibular molars with symptomatic irreversible pulpitis (SIP) after oral premedication of prednisolone, dexamethasone, and ketorolac with placebo. METHODS: One hundred eighty-four patients diagnosed with SIP in mandibular molars randomly received prednisolone, dexamethasone, ketorolac, or placebo (n = 46 each) 60 minutes before the administration of an IANB. The access cavity preparation was initiated after successfully confirming lip numbness and two consecutive negative responses to electric pulp testing. The success of the anesthesia was clinically confirmed when pain was absent during the endodontic access or instrumentation. A one-way analysis of variance test was used to compare quantitative variables among the groups, and chi-square tests were used for comparing categorical variables. Binary logistic regression was performed to analyze the relationship of age, preoperative pain, and preoperative medications. RESULTS: When premedicated with oral dexamethasone, ketorolac, prednisolone, and placebo, the success rate of IANB was determined to be 60.86 %, 65.21 %, 56.52 %, and 21.73 %, respectively. Compared to the placebo, the success rate of IANB was significantly increased when patients were premedicated with prednisolone, dexamethasone, or ketorolac. However, there were no statistically significant differences among prednisolone, dexamethasone, and ketorolac. One individual in the ketorolac group reported gastritis, whereas no adverse effects were reported in the dexamethasone or prednisolone groups. CONCLUSIONS: Preoperative use of oral ketorolac, dexamethasone, or prednisolone may increase the anesthetic efficacy of IANB in mandibular molars with SIP.