Asymptomatic Irreversible Pulpitis Research Articles

Potential application of a combined extract of Channa striata and calcium hydroxide for inhibiting lymphocytes and interleukin-1β cells in the asymptomatic irreversible pulpitis of Wistar rats (Rattus norvegicus)

Aim: This study aimed to evaluate the effectiveness of combining Channa striata extract with calcium hydroxide (Ca(OH)2) in reducing lymphocyte counts and interleukin (IL)-1β levels in inflamed pulp teeth. Materials and Methods: A laboratory experimental setup with a posttest control group (CG) design was employed. Thirty-two rat incisor teeth were divided into four groups: a positive CG (100% Ca(OH)2), treatment 1 (25% C. striata extract + 75% Ca(OH)2), treatment 2 (50% C. striata extract + 50% Ca(OH)2), and treatment 3 (75% C. striata extract + 25% Ca(OH)2). These test materials were applied to Class 1 cavities extending to the pulp roof, with samples collected on days 1, 3, 5, and 7. Data were analyzed using analysis of variance and post hoc least significant difference tests. Results: In all the groups, the highest levels of lymphocytes and IL-1β were observed on day 3, followed by a decline on days 5 and 7. The combination of C. striata extract with Ca(OH)2 significantly reduced inflammatory markers, particularly lymphocyte and IL-1β levels. Conclusion: The extract of C. striata holds significant potential as an innovative therapeutic approach for managing inflamed dental pulp.

An exploratory study to understand the relationship between diabetes and various pulpal conditions: An Indian perspective.

Diabetes mellitus (DM) affects an estimated 100 million Indians, ranking second globally in diabetic prevalence. Despite this, the correlation between DM and specific pulpal diagnoses remains underexplored. This study compares pulpal conditions in DM patients and nondiabetic controls. The study was started after taking ethical approval. Two thousand and five hundred and sixty teeth were examined over 4 months at the institute, evenly distributed between diabetic and nondiabetic cases, we assessed diagnoses - normal pulp, reversible pulpitis (RP), symptomatic irreversible pulpitis, asymptomatic irreversible pulpitis, pulp necrosis (PN), missing teeth (MT), and root canal-treated teeth (RCT). Statistical analysis used the Chi-square test. PN and MT prevalence in DM patients significantly exceeded the control group. Conversely, the control group showed higher RP prevalence in the older subgroup. PN prevalence was higher in diabetics, suggesting reduced pulp sensitivity in individuals over 60 years. This diminished sensitivity might lead to delayed dental treatment, increasing PN prevalence.

Exploring the Painless Nature and Potential Mechanisms of Asymptomatic Irreversible Pulpitis: A Narrative Review

Exploring the Painless Nature and Potential Mechanisms of Asymptomatic Irreversible Pulpitis: A Narrative Review

Post-endodontic pain in curved canals prepared with different rotary instrumentation techniques: A randomized controlled trial.

Curved root canals are associated with the highest number of procedural errors during endodontic instrumentation. Recently, numerous rotary instruments have been developed, with both manual and automated mechanisms, to facilitate endodontic treatment and manage the complications related to it. The aim of the study was to assess post-endodontic pain after using the HyFlex® EDM OneFile (HEDM), WaveOne® Gold (WOG) and XP-endo® Shaper (XPS) systems in the preparation of curved canals in patients with asymptomatic irreversible pulpitis. A total of 45 molars with curved canals and asymptomatic irreversible pulpitis were randomly divided into 3 equal groups based on the instrumentation used: HEDM (group A); WOG (group B); and XPS (group C). All teeth were prepared according to the manufacturers' instructions. Postendodontic pain was assessed using the visual analog scale (VAS) at 6, 12, 18, 24, 48, and 72 h after root canal instrumentation. The data was analyzed using the one-way analysis of variance (ANOVA) and the paired-samples t test with the Bonferroni correction, with a p-value of 0.05 set for statistical significance. The highest levels of post-endodontic pain were recorded at 6 h after treatment. Then, the values gradually decreased until the pain nearly vanished after 72 h. No statistically significant differences were observed in the VAS scores between groups A and B. At the same time, group C showed the lowest VAS scores at all follow-up time points. The use of the XPS system resulted in the lowest pain scores at all follow-ups. The HEDM and WOG groups showed no differences in the pain scores throughout the whole follow-up period.

Evaluation of levels of salivary alpha-amylase stress biomarker in symptomatic and asymptomatic irreversible pulpitis patients: A clinico-biochemical study

Introduction: Since pulpal pain causes distress to patients, therefore, evaluation of salivary alpha amylase (SAA) which is a stress biomarker in such cases helps evaluate the degree of stress; therefore, the present study aims to estimate SAA levels as stress biomarkers in patients with symptomatic and asymptomatic irreversible pulpitis. Materials and Methods: Forty-five individuals were included in the study and obtained informed written consent. Patients with symptomatic and asymptomatic irreversible pulpitis were selected based on history and clinical and radiographic examination, and participants were further separated into three groups (n = 15) such as Group 1: healthy individuals with no history of pulpal pain, Group 2: patients with symptomatic irreversible pulpitis, and Group 3: patients with asymptomatic irreversible pulpitis. Unstimulated saliva samples were collected using the spit method, and SAA levels were estimated after centrifugation of saliva samples using a colorimetric method known as the 3,5-dinitrosalicylic acid method. The intensity of color change was measured using a spectrophotometer at 540 nm for estimating SAA levels. The collected data were later subjected to statistical analysis using one-way ANOVA and post hoc Tukey’s multiple comparison tests (P ≤ 0.05). Results: Group 2 showed the highest values followed by Group 3 and least in Group 1. Multiple comparisons between the groups using post hoc Tukey’s test showed a significant difference between all the groups. Conclusion: A direct correlation was found between SAA levels and the severity of pulpal diseases indicating the highest stress in patients with symptomatic irreversible pulpitis compared to asymptomatic irreversible pulpitis and least in individuals with no pulp disease.

Immunohistochemical Analysis of S100 Proteins in Normal and Irreversibly Inflamed Human Dental Pulps

IntroductionS100 proteins convey important roles in innate immune responses to infection and regenerative processes. However, their role in inflammatory or regenerative processes of the human dental pulp is poorly elucidated. The aim of the present study was to detect, localize, and compare the occurrence of 8 S100 proteins in normal, symptomatic, and asymptomatic irreversibly inflamed dental pulp specimens. MethodsHuman dental pulp specimens from 45 individuals were clinically assigned to 3 groups of pulpal diagnosis: normal pulp (NP, n = 17), asymptomatic irreversible pulpitis (AIP, n = 13), and symptomatic irreversible pulpitis (SIP, n = 15). The specimens were prepared and immunohistochemically stained for proteins S100A1, -A2, -A3, -A4, -A6, -A7, -A8, and -A9. Staining was classified using semiquantitative analysis and a 4-degree staining score (ie, no, decent, medium, and intense staining) at 4 different anatomic or functional regions (ie, the odontoblast layer [OL], pulpal stroma [PS], border area of calcifications [BAC], and vessel walls). The distribution of staining degrees between the 3 diagnostic groups was calculated using the Fisher exact text (P ≤ .05) at the 4 regions. ResultsSignificant differences in staining were observed mainly in the OL and PS and at the BAC. The most significant differences were detected in the PS and when comparing NP with 1 of the 2 irreversibly inflamed pulpal tissues (AIP or SIP). The inflamed tissues were then invariably stained more intensely than their normal counterparts at this location (S100A1, -A2, -A3, -A4, -A8, and -A9). In the OL, NP tissue was significantly stronger stained for S100A1, -A6, -A8, and -A9 compared with SIP and for S100A9 when compared with AIP. Differences between AIP and SIP in direct comparison were rare and were found only for 1 protein (S100A2) at the BAC. Also, at the vessel walls, only 1 statistical difference in staining was observed (SIP was stronger stained than NP for protein S100A3). ConclusionsThe occurrence of proteins S100A1, -A2, -A3, -A4, -A6, -A8, and -A9 is significantly altered in irreversibly inflamed compared with normal dental pulp tissue at different anatomic localizations. Some members of S100 proteins obviously participate in focal calcification processes and pulp stone formation of the dental pulp.

Comparison of Ibuprofen and Dexamethasone Premedication on Inferior Dental Nerve Block in Irreversible Pulpitis

Aim: To compare premedication with dexamethasone as compared to ibuprofen in the effectiveness of IDNB in lower molars with asymptomatic irreversible pulpal infection. Study design: A Randomized Control Clinical Trial. Place & duration: Department of Operative Dentistry, Akhtar Saeed Medical and Dental College, Lahore, from October 2022 to November 2022 Methodology: A total of 30 cases in each group were taken, using an expected success rate of Dexamethasone group and Ibuprofen group 38.2% and 78% respectively, taking 5% level of significance 80% power of study. Therefore, sixty endodontic subjects were taken and divided into two equal groups of thirty patients each, group 1 was given 0.5 mg dexamethasone and group 2, was given 400 mg ibuprofen as pre-medication prior to endodontic therapy. Results: The results showed mean pain scores 24.38±15.41 in group 1 and 35.63±18.74 in group 2 (P<0.05). According to pain score, 11 patients (36.7%) have pain score between 0.0-20 (successful) and 21 patients (63.3%) has pain score 21.0-100.0 (unsuccessful) in group 1 with mean±standard deviation of 24.38±15.41. While in group 2, 5 patients (16.7%) have pain score 0.0-20 and 25 patients (83.3%) have pain score 21.0-100.0 with mean±standard deviation of 35.63±18.74. Conclusion: The premedication with dexamethasone as compared to ibuprofen, increased the effectiveness of inferior dental nerve block in lower molars with asymptomatic irreversible pulpitis. Keywords: IDNB, Irreversible pulpitis, Nerve block, Endodontics.

Incidence of postoperative pain after using single continuous, single reciprocating, and full sequence continuous rotary file system: a prospective randomized clinical trial.

Extrusion of debris is a major factor that results in postoperative pain during root canal treatment with various instruments and instrumentation techniques. Therefore, instrumentation techniques that extrude minimal debris into the periapical area while reducing pain are desirable. This study aimed to compare the incidence of postoperative pain and intake of analgesic medication (frequency and quantity) after endodontic treatment of mandibular posterior teeth using two single files and full-sequence continuous rotary systems with different kinematic motions. Thirty-five of 105 patients were assigned equally to three groups according to the instrumentation system used: ProTaper Next (PN) X2, 25/06 (Dentsply, Maillefer, Ballaigues, Switzerland), One Shape (OS), #0.25/06 (Micro Mega, Besancon, France), and Wave One Gold (WG), Red - #0.25, 0.07 (Dentsply, Maillefer, Ballaigues, Switzerland). Five specialists were included in this study design; each professional prepared 21 teeth, and randomly selected 7 per instrument system. The VAS sheet ranging from 0 to 10 was used to record the initial and postoperative pains at 24, 48, and 72 h, and 7th day after single visit endodontic treatment in mandibular premolars and molars with a diagnosis of asymptomatic irreversible pulpitis with or without apical periodontitis. Postoperatively, an analgesic, ibuprofen 400 mg was administered for intolerable pain at a dose of 1 tablet for 6 h. The patients were asked over the telephone regarding postoperative pain at intervals of 24, 48, and 72 h, and 7th day using a visual analogue scale. There were no statistically significant differences among the PN, OS, and WG systems (P > 0.05) with regard to the incidence of postoperative pain at any of the four time points assessed. The intensity of postoperative pain, frequency, and analgesic intake were similar across all three types of instrument systems; however, the reciprocating single file (WG) was associated with less postoperative pain than the full sequence continuous rotary file.

One-visit root canal treatment of the mandibular right second molar teeth

One-visit root canal treatment (OV-RCT) aims to preserve damaged teeth by fulfilling the principles of the endodontic triad (cleaning and shaping, sterilizationand root canal obturation) which are completed in OV; the advantage is lower risk of bacterial contamination, shorter time without compromising the quality oftreatment results. This case report discusses OV-RCT of man-dibular right second molar. A 23-year-old woman with a diagnosis of asymptomatic irreversible pulpitis in the mandibular mo-lar, radiographically showed slight widening of the periodontal ligament. One-visit RCT was performed using Protaper Next ro-tary files on the mesiobuccal and mesiolingual roots up to X2 files (#25/06) and X3 files (#30/07) on the distal roots. The root canals were irrigated using 5.25%NaOCl and 17% EDTA. The root canal filling technique was carried out using a single cone technique using an epoxy resin sealer and gutta percha material. The treatment was successfully carried out. It was concluded that OV-RCT of the right lower second molar showed success both clinically and radiographically.

Outcome of pulpotomy in permanent teeth with irreversible pulpitis: a systematic review and meta-analysis

Treatment planning is key to clinical success. Permanent teeth diagnosed with “irreversible pulpitis” have long been implied to have an irreversibly damaged dental pulp that is beyond repair and warranting root canal treatment. However, newer clinical approaches such as pulpotomy, a minimally invasive and biologically based procedure have re-emerged to manage teeth with pulpitis. The primary aim of the study was to conduct a meta-analysis to comprehensively estimate the overall success rate of pulpotomy in permanent teeth with irreversible pulpitis as a result of carious pulp exposure. The secondary aim of the study was to investigate the effect of predictors such as symptoms, root apex development (closed versus open), and type of pulp capping material on the success rate of pulpotomy. Articles were searched using PubMed, Scopus, CENTRAL, and Web of Science databases, until January 2021. Outcomes were calculated by pooling the success rates with a random effect model. Comparison between the different subgroups was conducted using the z statistic test for proportion with significance set at alpha = 0.05. A total of 1,116 records were retrieved and 11 studies were included in the quantitative analysis. The pooled success rate for pulpotomy in teeth with irreversible pulpitis was 86% [95% CI: 0.76–0.92; I2 = 81.9%]. Additionally, prognostic indicators of success were evaluated. Stratification of teeth based on (1) symptoms demonstrated that teeth with symptomatic and asymptomatic irreversible pulpitis demonstrated success rate of 84% and 91% respectively, with no significant difference (p = 0.18) using z-score analysis; (2) open apex teeth demonstrated a significantly greater success rate (96%) compared to teeth with closed apex (83%) (p = 0.02), and (3) pulp capping materials demonstrated that Biodentine yielded significantly better success rates compared to Mineral Trioxide Aggregate (MTA), calcium hydroxide, and Calcium Enriched Mixture (CEM.) Collectively, this is the first meta-analytical study to determine the clinical outcome of pulpotomy for carious teeth with irreversible pulpitis and it’s predictors for success. Moreover, we identify the stage of root development and type of biomaterial as predictors for success of pulpotomy.

Anesthetic Efficacy of Intraligamentary Injection Techniques on Mandibular Posterior Teeth Diagnosed with Asymptomatic Irreversible Pulpitis

Objective: To compare the effectiveness of Intraligamentary Injection with the IANB injection technique for root canal treatment of mandibular molars and premolars in patients with asymptomatic irreversible pulpitis undergoing access opening.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Operative Dentistry Department, Fatima Jinnah Dental College Karachi Pakistan, from Nov 2018 to Apr 2019.
 Methodology: The study was conducted on 80 patients. Visual analogue scale was used to determine the level of pain. Three groups were made depending on the effectiveness of anaesthesia at 2-sites (Group-A), 4-site (Group-B) and failure of Intraligamentary injection (Group-C). Anaesthesia was successful when the patient revealed no pain symptoms during access opening.
 Results: A total of 80 cases were evaluated, out of which 47 were males (58.70%), and 33 were females (41.30%). The most common age groups recorded in our study were 18 – 25 years (33.75%) and 36- 45 years (33.75%). According to our results, the Intra-ligamentary technique was successful in 23(28.75%) cases. The remaining 57(71.25%) cases which received anaesthesia via IANB showed a 100.00% success rate with profound anaesthesia.
 Conclusion: Inferior alveolar nerve block was more successful compared to Intraligamentary injections for providing profound anaesthesia to mandibular posterior teeth previously diagnosed with asymptomatic irreversible pulpitis and under-going the procedure of access opening.

Postoperative Pain Following Root Canal Instrumentation Using ProTaper Next or Reciproc in Asymptomatic Molars: A Randomized Controlled Single-Blind Clinical Trial.

Aim: The development of postoperative pain following root canal instrumentation may impair patient’s comfort and undermine their trust in the dentist. This study assessed the effect of root canal instrumentation techniques (rotary (PTN; ProTaper Next®) and reciprocating (R; Reciproc®)) on the postoperative pain intensity (primary outcome) and tenderness on biting (secondary outcome) of patients’ asymptomatic molars. Methodology: This study protocol was registered with ReBec-WHO (U1111-1182-2800). From a pool of 112 patients evaluated for eligibility (healthy adults (≤18 years old)), with a single asymptomatic molar (maxillary or mandibular) indicated for root canal treatment, diagnosed with asymptomatic irreversible pulpitis (including chronic hyperplastic pulpitis), 75 were randomly allocated in similar proportions to receive the intervention (two-appointment root canal therapy) in either the PTN or R group. The allocated procedures were performed using standardized protocols. Participants (blinded to the instrumentation technique) rated their pain intensity at 6, 12 and 24 h and from day 2 to day 7 following the root canal instrumentation appointment using a VAS and an NRS; the ibuprofen tablets taken and the presence of tenderness on biting were recorded. The instrumentation time was registered. Univariate and multivariate statistics measured the effect of independent variables on the outcomes. Results: From the 75 patients allocated, 8 patients (4 from each group) were lost; in total, 33 patients were analyzed in the PTN group and 34 in the R group. The frequencies of postoperative pain (p > 0.05) and tenderness on biting (p > 0.05) were similar between groups. The medication intake (mean of 1.31 tablets) and the time of instrumentation (approximately 11 min) were similar between groups. Conclusion: ProTaper Next and Reciproc® caused a slight risk of tenderness on biting and contributed to similar self-reported postoperative pain (low intensity) up to 7 days following root canal shaping.

Endodontic Challenges in the Management of Multiple Pulp Stones and Root Canal Calcification - A Case Report

Root canal calcification is currently a challenging and interesting case for endodontists. Removing microorganisms and their by-products from the root canal system is the goal of root canal treatment. Worse outcomes from root canal procedures can occur due to root canal calcification, as it can block access to the root canal and hinder cleaning and shaping. Iatrogenic errors may occur in the treatment of such cases which will lead to failure of endodontic treatment. This case report describes a 20-year-old woman with multiple pulp stones in the pulp chamber of the mandibular left first molar. In addition, there were also calcified root canals in the mesiolingual and mesiobuccal canals. The patient had asymptomatic irreversible pulpitis and had to undergo endodontic treatment. Several challenges were faced in this case. The initial challenge was to determine the location of the pulp stone in the pulp chamber. Radiographs taken from multiple angles, as well as a direct assessment of the cavity during access preparation, addressed this initial challenge. Retrieval of the pulp stone which in this case is the embedded type that was carried out by grinding it with the help of an ultrasonic tip. Other difficult challenges were avoiding perforation of the pulp chamber floor during treatment, especially when removing the pulp stone, and identifying the location of the orifice. With clinical knowledge, magnification aids and ultrasonic tips, successful treatment in this challenging case was achieved.
 Calcific metamorphosis, sometimes known as pulp canal obliteration (PCO), is the extensive formation of tertiary dentin in the pulp chamber leading to circumferential narrowing of the pulp chamber and root canal.[1] According to the AAE (American Academy of Endodontics), PCO is radiographic evidence of increased dentin production mainly in response to trauma. The result is a calcified canal and does not necessarily indicate pulp disease.[2] Pulp calcification is a common occurrence. The incidence varies, but overall it can be estimated that 50 % of teeth have one or more calcifications.[3]
 There is no evidence to explain whether pulp calcification is a pathological process associated with various forms of injury or natural phenomena.[3] In general, the pulp chamber becomes progressively smaller and often very small, a phenomenon known as calcified metamorphosis or obliteration of the pulp canal. Dentin can be accelerated by caries, trauma, abrasion, restoration, and periodontal disease and is not uniform.[1]
 Calcifications are divided into denticle (pulp stones) and diffuse (linear) calcifications. Pulp stones are divided into free, attached, and embedded types. Pulp stones tend to be found in the coronal pulp, and diffuse calcifications are found in the radicular pulp. It has been speculated that the nidi of calcification arise from degenerating nerves or blood vessels, but this has not been proven.[1

Clinical practice guideline for pharmacological management of pain and swelling in endodontic emergencies

Endodontic pain is one of the most predominantly associated symptoms. The pain may arise due to either because of an endodontic cause (or) a periradicular cause, importantly endodontic pain type variant is the most commonly encountered by the dentist in their clinical practice. The objective of endodontic treatment is to prevent or cure apical periodontitis (AP) caused by infection of the root canal systems of the affected teeth (or) due to persistence of primary infection (or) emergence of infection after treatment 1. An online search was conducted in MEDLINE, Embase, the Cochrane library and the cumulative Index to Nursing and Allied Health literature to retrieve evidence on benefits and harm associated with antibiotic use & review articles by utilizing the following keywords: Antibiotics, symptomatic Irreversible pulpitis, symptomatic apical periodontitis, pulp necrosis, localized acute apical abscess, clinical practice guidelines. The clinician must systematically gather all of the necessary information to make a “probable diagnosis” Endodontic diagnosis is similar to a Jigsaw puzzle diagnosis cannot be made from a single isolated piece of information. The indications are based on the clinical diagnosis of Normal pulp, reversible pulpitis, symptomatic (or) asymptomatic Irreversible pulpitis & necrotic pulp (or) localized acute apical abscess 2.

Efficacy of adding dexmedetomidine to lidocaine to enhance inferior alveolar nerve block in patients with asymptomatic irreversible pulpitis: double-blind randomized clinical trial.

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. Fifty adult volunteers with AIP in a first or second mandibular molar were randomly assigned to two groups to either receive 1.4ml 2% plain lidocaine or 1.4ml 2% lidocaine + 0.4ml (40μg) DEX, for standard IANB injection. Access cavity preparation initiated 10-15min 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. 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). DEX significantly increases the anesthetic effect of lidocaine in IANB injection in patients with AIP. 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.

Expression Profiling of S100 Proteins in Healthy and Irreversibly Inflamed Human Dental Pulps

IntroductionSeveral S100 proteins have been shown to play an important role in the innate immune response to infection and in regenerative processes. However, they have scarcely been investigated during inflammation of the dental pulp. Therefore, in this study, we performed gene expression profiling of S100 proteins in healthy and inflamed human dental pulps. MethodsTissue samples of human dental pulps were used, including 15 clinically diagnosed as symptomatic irreversible pulpitis (SIP), 7 as asymptomatic irreversible pulpitis (AIP), and 19 as healthy pulp (HP). S100 gene expression levels were quantitatively evaluated for S100A1, -A2, -A3, -A4, -A6, -A7, -A8, -A9, -A10, -A11, -A13, -A14, and -A16 by the quantitative polymerase chain reaction technique. In order to monitor the status of inflammation and degradation of pulp tissues, IL-8, COX-2, and HMGB-1 gene expression was also analyzed with GAPDH serving as the reference gene. Differential expression rates for each target gene between SIP, AIP, and HP were evaluated by analysis of variance followed by the Bonferroni post hoc test. ResultsSignificantly reduced gene expression levels could be detected in SIP compared with HP for S100A1, -A2, -A3, -A4, -A6, -A10, and -A13 and for HMGB-1, whereas the gene expression of S100A8 and -A14 and IL-8 were significantly increased. In AIP, significantly increased expression levels compared with HP were only detected for S100A14 and -A16 and IL-8, with other genes of interest not being altered. ConclusionsThe present study revealed significant differences in gene expression profiles of S100 proteins comparing samples from healthy and inflamed dental pulp. More pronounced differences were observed for symptomatic than for asymptomatic pulpitis.

Assessment of postoperative pain after single-visit root canal treatment using rotary and reciprocating file systems: an in vivo study.

BackgroundVarious instrument kinematics used in single-visit endodontics influence the occurrence of pain after endodontic therapy. This study aimed to evaluate the occurrence of pain after mechanical instrumentation with Hyflex EDM (HEDM) and WaveOne Gold (WOG) during single-visit endodontic therapy.MethodsSixty patients diagnosed with asymptomatic irreversible pulpitis and normal apical tissues in mandibular premolar teeth were included in the study for single-visit root canal therapy. The patients were divided into two groups (n = 30) according to the rotary instrument used during root canal preparation (group A [HEDM] and group B [WOG]). Pain was evaluated after endodontic therapy at 8, 24, and 48 h intervals using the visual analog scale (VAS). Data obtained were analyzed using the chi-square test, independent t-test, MannWhitney U test, and Wilcoxon matched-pairs test.ResultsStatistically significant differences were observed between the two groups (P < 0.001) at 8, 24, and 48 h, with WOG exhibiting less pain than HEDM files.ConclusionPostoperative pain was lower in the WOG file system than in the HEDM file system after single-visit root canal therapy at 8, 24, and 48 h.

Altered Prevalence of Pulp Diagnoses in Diabetes Mellitus Patients: A Retrospective Study

IntroductionDiabetes mellitus (DM) is a complex multisystemic disorder that affects an estimated 21 million Americans. No studies have evaluated the association of DM with the prevalence of each pulpal diagnosis. The objective of this study was to compare the prevalence of each pulp diagnosis including symptomatic irreversible pulpitis (SIP), asymptomatic irreversible pulpitis, reversible pulpitis, normal pulp, and pulp necrosis (PN) in DM patients against a nondiabetic control group. MethodsA retrospective chart review was approved by Rutgers University Institutional Review Board. The prevalence of the diagnoses SIP, asymptomatic irreversible pulpitis, reversible pulpitis, normal pulp, and PN was calculated from AxiUm (Exan software, Las Vegas, NV) electronic health records at Rutgers School of Dental Medicine. The chi-square test was used to see the relationship between the 2 categoric variables. Second, binary logistic regression analyses were performed for each group. ResultsA total of 2979 teeth were diagnosed with a pulp condition between April 2013 and November 2018. The total tooth number of DM patients was 682, whereas the tooth number of nondiabetic patients was 2297. In the subgroup of patients younger than 40 years old, SIP was notably more prevalent in DM patients. In addition, the prevalence of PN in elderly DM patients (60–69 years old) was significantly higher than in the control group. ConclusionsThe prevalence of SIP in DM patients was significantly higher compared with the control group (<40 years old), suggesting the possibility that DM could hypersensitize the subgroup of patients younger than 40 years old to pulpitis pain.

Comparison of Postobturation Pain Experience after Apical Extrusion of Calcium Silicate– and Resin–Based Root Canal Sealers

IntroductionThis study compared the intensity of postobturation pain after unintentional apical extrusion of calcium silicate–based root canal sealers (EndoSequence BC Sealer [Brasseler USA, Savannah, GA] and Bio-C Sealer [Angelus, Londrina, PR, Brazil]) with a resin-based sealer (AH Plus; Dentsply Sirona, York, PA). MethodsA total of 330 patients referred for root canal treatment on molar teeth with asymptomatic irreversible pulpitis were recruited. Root canals were prepared using WaveOne Gold instruments (Dentsply Sirona) in a crown-down technique and irrigated with 2% chlorhexidine gel and saline solution. Next, patients were randomly distributed into 3 groups according to the root canal sealer used (n = 110): AH Plus, BC Sealer, and Bio-C Sealer. Root canal filling was then accomplished with a vertical compaction technique. Patients presenting with an unintentional extrusion of sealers (n = 13/group) were assessed for postobturation pain experience using a visual descriptor scale ranging from 0–10 at 6-, 12-, 24-, and 48-hour and 1-week intervals after treatment. Mixed analysis of variance repeated measures were used to assess the results (α = 0.05). ResultsThe extrusion rate was similar for all sealers (~12%). There was no significant difference in the postobturation pain results between the root canal sealers evaluated (P > .05). However, after the time interval of 12 hours, AH Plus (P = .04073) and Bio-C Sealer (P = .04327) demonstrated a significant reduction in pain, whereas BC Sealer did not show differences in pain intensity, even in the maximum period evaluated of 1 week (P > .05). ConclusionsThe occurrence of unintentional apical extrusion of calcium silicate–based root canal sealers presents similar postoperative pain results compared with resin-based sealers with low-intensity pain.

Comparative Evaluation of the Effectiveness of Rotary Instrumentation over Manual Instrumentation with Ultrasonic Irrigation on Incidence, Duration, and Intensity of Postendodontic Pain: An In vivo Study.

Aim:The aim of this study was to compare the effectiveness of rotary instrumentation over manual instrumentation with ultrasonic irrigation on incidence, duration, and intensity of postendodontic pain (PEP).Subjects and Methods:Eighty patients, with asymptomatic irreversible pulpitis in maxillary anterior teeth, were selected and treated with single-visit endodontic treatment. Patients were randomly divided into 2 groups (40 each), Group A (K files using step-back technique) and Group B (ProTaper Next using crown-down technique) along with passive ultrasonic irrigation. Patients were recalled, examined, and asked to fill up questionnaire after 24 h, 48 h, and 7 days. On the basis of response given in the feedback forms, incidence, duration, and intensity of PEP were evaluated.Results:Statistical analysis of the data was carried out using Chi-square test, and level of significance (P < 0.05) was evaluated. More incidence of pain was noticed in Group A when compared with Group B. Significant difference found between two groups (χ2 = 22.759; P = 0.001). There was also statistically significant difference between two groups at different time intervals.Conclusion:Both instrumentation techniques under investigation cause PEP. The incidence of pain was more in manual technique than rotary technique. The duration of pain was higher in manual group than rotary group at different time intervals.