RESUMEN

OBJECTIVES: This randomized, double-blind study was to determine whether dexmedetomidine (DEX) helped to improve the inferior alveolar nerve block's (IANB) success in patients with asymptomatic irreversible pulpitis (AIP). We hypothesized that adding DEX to lidocaine enhances the anesthetic effect of lidocaine to a satisfactory level by localizing anesthesia in a safer way. MATERIALS AND METHODS: Fifty adult volunteers with AIP in a first or second mandibular molar were randomly assigned to two groups to either receive 1.4 ml 2% plain lidocaine or 1.4 ml 2% lidocaine + 0.4 ml (40 µg) DEX, for standard IANB injection. Access cavity preparation initiated 10-15 min postinjection when the patient reported lower lip numbness and had two negative electric pulp tests (EPTs) with 5-min intervals. Heft-Parker visual analog scale (VAS) was used to report pain in three steps: during caries and dentin removal, access cavity preparation, and canal working-length determinations; EPT and VAS were analyzed by Friedman test; and success rates were analyzed by Mann-Whitney and Fisher's exact test using SPSS software version 20. RESULTS: Successful anesthesia (defined as no or mild pain during any of steps and no need for additional injection) is obtained in 12% of patients in the lidocaine group, while DEX-lidocaine group increased the success rate of IANB to 72% (p-value = 0.0001). CONCLUSIONS: DEX significantly increases the anesthetic effect of lidocaine in IANB injection in patients with AIP. CLINICAL RELEVANCE: DEX would be a safe adjunct to lidocaine to increase the success rate in IANB and could be a suitable alternative for conventional vasoconstrictors in sensitive groups.

Asunto(s)

Anestesia Dental , Dexmedetomidina , Bloqueo Nervioso , Pulpitis , Adulto , Anestésicos Locales/farmacología , Dexmedetomidina/farmacología , Método Doble Ciego , Humanos , Lidocaína , Nervio Mandibular , Dolor , Pulpitis/cirugía

RESUMEN

INTRODUCTION: Video-assisted clinical instruction (VACID) has been found to be a beneficial teaching tool for various fields in dentistry. The aim of this interventional study was to compare the efficacy of live conventional demonstration (CD), video teaching, and VACID (video with explanation) methods in teaching of root canal treatment to undergraduate dental students. METHODS AND MATERIALS: Forty-two undergraduate senior dental students participated in this study. The students experienced this course for the first time and were randomly divided into three groups (n=14). Group A attended live CD on a patient; group B watched a professionally produced demonstration video without any verbal explanation during 1 h; and finally group C watched the same video alongside live explanation by a mentor during the 1.5 h (VACID). The whole process was performed by an experienced endodontist on maxillary central incisors. All of The students carried out a multiple choice question exam to evaluate their comprehension. The mean score of the experimental groups were compared using ANOVA test and multiple comparisons were carried out with Tamhane test. The level of significance was set at 0.05. RESULTS: There was significant difference among three groups according to the ANOVA test (P<0.05). Group VACID had the highest mean scores. There was significant difference between the groups VACID and VT (P=0.011); no significant differences were found in other inter-group comparisons. CONCLUSION: According to the results, VACID may improve the quality of endodontic training in undergraduate dental students.

RESUMEN

Long-term success of endodontic treatment is dependent on adequate and appropriate cleaning and shaping of the root canal along with proper and correct obturation of the entire prepared space. This article aims to report an exceptional non-surgical and orthograde endodontic treatment of maxillary right central incisor with an extensive radiolucent lesion in a 17-year-old male. Six and 20-month follow-ups showed significant changes, including bone formation and periapical healing within the lesion. The patient was asymptomatic. After 20 months, complete radiographic and clinical healing of the periapical lesion was observed.

RESUMEN

Autogenous tooth transplantation (ATT) is a simple and reasonable choice for replacing the missing teeth when a proper donor tooth is available. This report presents a case of successful ATT of a maxillary right third molar for replacement of mandibular right second molar with a concomitant endodontic-periodontal disease. The mandibular second molar was believed to be hopeless due to a severe damage to coronal tooth structure, inappropriate root canal treatment and apical radiolucency. After extraction of mandibular second molar and maxillary third molar (the donor), the tooth was re-implanted into the extracted socket of second molar site. Root canal therapy was then performed. After 3 years, clinical and radiographic examinations revealed satisfying results, with no signs and symptoms. The patient is asymptomatic and the transplanted tooth is still functional with no signs of marginal periodontal pathosis. Radiographies showed bone regeneration in the site of previous extensive periapical lesion, normal periodontal ligament with no signs of root resorption.

RESUMEN

OBJECTIVE: Canal preparation generates a substantial amount of debris and smear layer (SL). The size and taper of the Master Apical File (MAF) affects on penetration of irrigants and subsequently canal cleaning efficacy. The aim of this study was to evaluate the effect of MAF size and taper on penetration of irrigants to the apical third of curved mesiobuccal (MB) canals of mandibular first molars. MATERIALS AND METHODS: Eighty-nine human mandibular first molars were divided into one control group (n=5) without rotary instrumentation and 6 experimental groups (n=14 each) that were prepared with the following RaCe rotary files as MAF: 25.04 (group1), 25.06 (group 2), 30.04 (group 3), 30.06 (group 4), 35.04 (group 5) and 35.06 (group 6). All the experimental groups were rinsed with 2 ml of 17 % EDTA followed by 2 ml of 5.25% NaOCl. Debridement of the MB canals was evaluated using scanning electron microscope (SEM). The data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests (P<0.05). RESULTS: Group 6 (MAF=35.06) showed 100% acceptable debridement. This rate was 92.9% for MAF=35.04. In group 4 (MAF=30.06) smear layer (SL) was removed in the three-forth of the samples and debris was removed in 92.9% of them. Acceptable debridement was not achieved in most samples of groups 1 and 2 (25.04 and 25.06, respectively) and the mentioned two groups had statistically significant difference in this respect with the other groups (P<0.05). CONCLUSION: Based on this study, 30.06 may be considered as the minimum MAF size for acceptable debridement.

RESUMEN

INTRODUCTION: Bacteria and their byproducts are major etiologic factors in endodontic diseases. Prevention or reduction of root canal bacterial contamination is the main aim of endodontic treatment. The purpose of this in vitro study was to evaluate the effect of size and taper of master apical file (MAF) in reducing bacteria from the apical third of the curved canals using a quantitative scanning electron microscope (SEM) study. METHODS AND MATERIALS: Eighty-nine human mandibular first molars with curved MB canals (20(º)-35(º)) were divided into one control group (n=5) (without rotary instrumentation) and 6 experimental groups (n=14). The canals were prepared using RaCe rotary files to the MAF sizes 25/0.04, 25/0.06, 30/0.04, 30/0.06, 35/0.04 and 35/0.06, in groups 1 to 6, respectively. All the experimental groups were finally rinsed with 2 mL of 17% EDTA followed by 3 mL of 5.25% NaOCl. The mesial roots were split longitudinally. Remaining bacteria in the apical third of MB canals were evaluated using SEM (2000×). Data analysis was performed using one way ANOVA with Tukey's post hoc test. The level of significance was set at 0.05. RESULTS: All the experimental groups showed significant bacterial reduction (P<0.001). Although the greater size and/or taper resulted in decrease in bacteria, differences between the groups were not significant. CONCLUSION: Based on this in vitro study the MAF #25/0.04 had no significant difference compared to other groups with greater apical size/taper; all groups could effectively reduce intra-canal bacteria.