Diagnosis Of Irreversible Pulpitis Research Articles

Cannabidiol - an effective analgesic for toothache?

This study is a randomised, placebo-controlled, triple-arm, phase IIA clinical trial with double masking which investigates the effectiveness and safety of Cannabidiol (CBD) as an analgesic for acute dental pain. The intervention drug, Epidiolex is an FDA-approved CBD oral solution (100 mg/ml) derived from the cannabis plant. The psychoactive ingredient tetrahydrocannabinol (THC) is not included. The maximum recommended daily dose of Epidiolex is 20 mg/kg. 64 patients with moderate-severe odontogenic pain participated in the study and REDCap software was utilised to randomly assign participants into groups: CBD10 (10 mg/kg), CBD20 (20 mg/kg) and placebo. A single dose of the respective oral solution was administered, and participants monitored for 3 h. Patients remained blinded to group assignment, as did the outcome assessor. The provider was not blinded. The primary outcome measure was VAS (visual analogue scale) pain difference, compared to baseline and recorded at 7 subsequent marked times following administration (15, 30, 45, 60, 90, 120, 180 min). Additional outcome measures were also recorded: changes in bite force, pain intensity differences, the onset of significant pain relief, the maximum pain relief, psychoactive effects, mood changes and adverse events. 40 female and 21 male patients with moderate-severe odontogenic pain (defined as ≥30 on a 100 mm VAS) with a diagnosis of irreversible pulpitis or pulp necrosis and symptomatic apical periodontitis were included. Participation required a negative test for recent drug and alcohol use, a negative pregnancy test and no use of analgesics within 6 h of the trial. Pregnancy, breastfeeding, hepatic impairment, recreational cannabis users and patients taking CBD metabolising drugs were excluded along with those with an ASA classification above III. Patient characteristics recorded included: age, gender, race, tooth type affected, weight and BMI. Mixed model analysis was used to compare numerical variables among the cohorts at the marked time intervals. VAS, bite force, Bowdle and Bond/Lader questionnaires were recorded. Inter-group analysis was completed using parametric and non-parametric post-hoc tests, including Holm-Bonferroni adjustment and the Shapiro-Wilk test, to evaluate data normality. NNTs were calculated for both CBD doses- the number of patients needing treatment before one patient experiences a minimum of 50% pain relief. X² tests were used to analyse categorical variables: pain intensity and adverse events. JMP software was used for the statistical analysis. 64 participants had originally enroled in the study, but three were excluded from data analysis due to 'unrealistic results', reporting complete pain relief within the first 15 min. 20 participants were given CBD10, 20 were given CBD20 and 21 placebo. 68% of the participants were Hispanic/Latino whilst 11% were white. The average age was 44 +/- 13.7. There was equal distribution of age, sex, race, tooth type, weight and body mass index (p > 0.05). No subject required rescue pain relief during the 3-h observation period. Compared to baseline VAS, significant pain relief was seen 30 min after drug administration for CBD10, versus after 15 min for CBD20 (p < 0.05). Pain reduction reached 50% at 60 min for CBD10 and at 120 min for CBD20. Both reported maximum pain reduction of 73% of baseline at 180 min. 33% pain reduction from baseline was seen in the placebo group, with a median VAS pain of 67% at 180 min. 45.4% of CBD10 and 46.6% of CBD20 required pain relief after 1-6 h, versus 37.5% of placebo (p > 0.05). Bite force increase was seen in both CBD10 and CBD20 groups at 90 and 180 min, versus no significant differences between time points in the placebo group. On assessing pain intensity, pain reduction was significantly associated with increasing time in the CBD groups (p < 0.001), versus no significant association with the placebo group (p = 0.0521). No statistically significant differences were seen between and within the groups for Bowdle or Bond/Lader questions (p > 0.05). In the 3 h observation period, CBD10 experienced 14 times more sedation symptoms versus placebo (p < 0.05), whilst CBD20 experienced this 8 times more (p < 0.05). Within the 3 h, CBD20 were 10-fold more likely to have diarrhoea and abdominal pain (p < 0.05), with some experiencing pain beyond the 3 h but resolving within the day. Based on this randomised clinical trial, pure CBD drug Epidiolex demonstrates effective analgesia against acute toothache.

Perawatan saluran akar satu kali kunjungan dilanjutkan dengan restorasi endocrown

Introduction: Root canal treatment is a common procedure in dentistry. The main indications for root canal treatment are irreversible pulpitis and pulpal necrosis resulting from a carious process, fracture, or trauma to the tooth. The success of root canal treatment depends on various factors, one of which is post-endodontic restoration. Objective: This case report aims to demonstrate a one-visit root canal treatment followed by endocrown restoration. Case report: A 22-year-old male patient came with complaints of throbbing tooth pain in the lower right side since 1 week ago. Intra oral examination of tooth 46 showed a temporary filling on the occlusal surface. Radiographic findings showed that the crown had a radiopaque appearance reaching the pulp chamber, without periapical abnormalities. Root canal treatment was performed based on the diagnosis of irreversible pulpitis followed by endocrown restoration. Root canal treatment begins with mandibular block anesthesia and then inserts a rubber dam, opens the cavity, explores the root canal, and prepares the root canal. Biomechanical preparation was carried out using a single length technique, combined with 5.25% NaOCl irrigation, 17% EDTA, and 2% chlorhexidine. Root canal closure was performed in single visit, with the warm vertical condensation technique. The next restoration was carried out one week after root canal treatment, with an endocrown. A week later the patient came for control with no complaints. Conclusion: Root canal treatment in single visit followed by endocrown restoration was successfully carried out.

A Randomized Controlled Clinical Trial of Pulpotomy versus Root Canal Therapy in Mature Teeth with Irreversible Pulpitis: Outcome, Quality of Life, and Patients’ Satisfaction

IntroductionVital pulp therapy is increasingly practiced as an alternative treatment to root canal therapy (RCT) in teeth with carious pulp exposure. The aim of this study was to compare the outcome, quality of life (QOL), and patients’ satisfaction after full pulpotomy and RCT in mature teeth with irreversible pulpitis. MethodsSixty mature permanent molar teeth with carious pulp exposure and a diagnosis of irreversible pulpitis were randomly divided into 2 groups (n = 30). The first group was treated with full pulpotomy using Biodentine (Septodont, Saint Maur des Fosses, France), and the second group was treated with RCT. The pain level was recorded preoperatively and at 1, 2, 3, 5, and 7 days. Clinical and radiographic assessments were performed at the 6- and 12-month follow-ups; 1 case in each group did not attend. Based on the Oral Health Impact Profile questionnaire and 7 semantic differential scales, QOL, and patients’ satisfaction were evaluated and compared statistically. ResultsPulpotomy and RCT had comparable success rates (27/29, 93%). Pain levels at day 1 after pulpotomy were significantly lower than after RCT (P = .037), less patients required analgesics (P = .028), and pulpotomy provided pain relief in a shorter time compared with RCT. Both treatments improved the Oral Health Impact Profile QOL of patients without significant differences (60.29, 64.1% at 1 year). Patients’ satisfaction with pulpotomy was higher than RCT in terms of the time involved, intraoperative pain, pleasantness, and cost (P < .05). ConclusionsFull pulpotomy could be an alternative treatment to RCT in mature teeth with carious pulp exposure and symptomatic irreversible pulpitis based on the clinical and radiographic success rates and patients’ satisfaction.

Evaluation of the expression of nerve fiber markers in healthy and inflamed dental pulp.

The diagnosis of irreversible pulpitis (IP) depends on clinical data, especially the chief complaint of the patient, visual inspection, response to the application of stimuli, and radiographic examination. The characterization of nerve fibers (NF) in IP may contribute to better interpret painful symptoms, but has been barely explored. This study sought to characterize the density and integrity of NF in 16 samples of IP and in five healthy pulps (HP) using S-100 and PGP 9.5 markers. Immunohistochemistry was performed to determine the density/mm2 of S-100+ and PGP 9.5+ in NF. The amount of degenerated NF was obtained by subtracting the total NF density from the amount of intact NF. Associations between NF density and integrity and symptomatology were calculated. All samples were positive for S-100 and PGP 9.5. Compared to HP samples (38.20/mm2), IP samples had a lower density of intact NF (6.24/mm2). A significantly higher density of degenerated NF was found in IP samples with spontaneous pain (39.59/mm2) compared to those with provoked pain (23.96/mm2) (p = 0.02). No association was observed between intensity of the inflammatory infiltrate and NF density and integrity (p > 0.05). The findings of this study suggest that pulpitis may involve different stages of degeneration and may be more advanced in cases with spontaneous pain. The symptoms reported by affected individuals do not appear to depend on the intensity of the inflammatory infiltrate, but rather on the integrity of NF.

Endodontic Flare-up Incidense in Irreversible Pulpitis in Universitas Airlangga Dental Hospital (RSKGMP Universitas Airlangga)

Background: Carious lesions that do not be treated, becomes infected and inflamed, leading to irreversible pulpitis. One of the treatments for irreversible pulpitis is root canal treatment. In root canal treatment can cause flare-ups. Purpose: Obtaining a data base on flare-ups with a diagnosis of irreversible pulpitis at RSKGMP and obtaining a picture of flare-ups in irreversible pulpitis based on root canal preparation techniques, root canal irrigation materials, root canal dressing materials, and root canal obturation techniques. Methods: The study used was a descriptive observational study with a study design cross sectional in patients with a diagnosis of irreversible pulpitis who had received root canal treatment at the UPF Dental Conservation RSKGMP University of Airlangga in 2018, 2019, and 2020. Results: A total of 14 patients (28%) of 50 patients experienced (flare-up). Conclusion: The incidence flare-ups of root canal treatment in irreversible pulpitis at RSKGMP University of Airlangga is 28%.

Observation of Inflammation, Oxidative Stress, Mitochondrial Dynamics, and Apoptosis in Dental Pulp following a Diagnosis of Irreversible Pulpitis.

Mitochondrial dynamics play a pivotal role in maintaining the homeostasis of the dental pulp. Inflammation and oxidative stress can trigger changes in mitochondrial dynamics, leading to cell death in the dental pulp. This study aimed to investigate inflammation, oxidative stress, mitochondrial dynamic alterations, and cell death in inflamed pulpal tissues compared to healthy pulp tissues. Pulpal tissues were collected (n=15 per group) from: 1) healthy people as the control and 2) people with clinically diagnosed irreversible pulpitis. Proteins indicating inflammation, oxidative stress, mitochondrial dynamics, and cell death markers were investigated by western blot analysis. A Student's t-test was used to analyse differences between the healthy and irreversible pulpitis groups. A probability of 0.05 was used to indicate statistical significance (p<0.05). The expression of the proteins, tumour necrosis factor-alpha (TNF-α) and nuclear factor kappa-lightchain-enhancer, by activated B cells (NF-κB) from inflamed pulp tissues were significantly higher than those of control. Compared to controls, 4 hydroxynonenal (4HNE) and dynamin-related protein 1 (Drp1) were significantly higher, while mitofusin 2 (MFN2) and optic atrophy type 1 (OPA1) were significantly lower in inflamed pulp tissues. Bcl-2-associated X protein (Bax), cleaved caspase-3, and cytochrome c were significantly higher in inflamed pulpal tissues compared to controls. In inflamed pulpal tissues, we found a significant increase in the expression of receptor-interacting serine or threonine-protein kinase 1 (RIPK1) but not receptor-interacting serine or threonine-protein kinase 3 (RIPK3). Irreversible pulpitis is associated with inflammation, oxidative stress, alterations in mitochondrial dynamics, and apoptosis in pulpal tissues. (EEJ-2022-01-014).

Evaluation of Postoperative Pain Following Single-Visit Root Canal Treatment with Rotary and Reciprocal Ni-Ti File Systems in Children.

Background and Objectives: Postoperative pain is a common symptom of a flare-up after root canal treatments (RCTs). Insufficient instrumentation, extrusion of irrigation solutions and debris, and the existence of a periapical lesion are the factors affecting postoperative pain after root canal treatments. The aim of this study was to evaluate the postoperative pain and instrumentation time of the single-file reciprocating system and multiple-file Ni–Ti rotary system in children ages 9–12 years old. Materials and Methods: Our study was conducted on 51 permanent mandibular molars with the diagnosis of irreversible pulpitis. Patients were randomly assigned into two groups, and RCTs were completed with either the Reciproc Blue or Protaper NEXT file systems. Instrumentation time for each system was noted, and patients were given a pain scale that included a visual analog scale for 6, 24, 48, and 72 h after treatment. Postoperative pain scores and instrumentation times were analyzed statistically with a chi-square test and Student’s t-test. Results: There was no statistically significant difference in postoperative pain between the Reciproc Blue and Protaper NEXT systems at all time intervals. Instrumentation time was significantly shorter in the Reciproc Blue group in comparison with the Protaper NEXT group. Conclusions: Postoperative pain findings following RCT using single-file reciprocating systems were similar to the rotary system group. However, chair time in the reciprocating system group was significantly lower. This provided a comfortable and patient-friendly treatment approach for children, and could enhance their cooperation.

Bilateral lesion centered access cavity preparation in mandibular first premolars: A case report

Lesion-centered access cavity preparation has gained attention due to the conservative and reliable approach to the main canal with preservation of tooth structure and aesthetics. Traditional access cavity preparation in tooth with cervical caries causes increased loss of tooth structure. In this case report, a cervical approach of access cavity preparation and root canal therapy was attempted by excavation of the cervical caries on right and left mandibular first premolar. A 38-year-old patient was referred with the chief complaint of pain in the left and right lower back tooth region for past 1 week. Based on the clinical and radiographic findings, a diagnosis of irreversible pulpitis was established. Minimally invasive access cavity preparation was completed through the Bucco-cervical surfaces, canals were located using DG-16 probe, straight line access was established, cleaning and shaping was carried out using flexible heat-treated rotary files and obturated. The cervical access cavity was restored with composite resin to re-establish aesthetics and function. Treatment was completed with reduced iatrogenic damage to tooth structure with conservation of occlusal surfaces and a follow -up was done after 1 year to evaluate the prognosis.

DENTAL CONSERVATIVE MANAGEMENT IN ONCOLOGY PATIENT WITH OBTURATOR PROSTHESIS REHABILITATION

A 51-year-old black female patient surgically treated for a low-grade mucoepidermoid carcinoma of palatal minor salivary gland attended the clinic complaining of pain in an abutment tooth (right third molar) of a removable obturator prosthesis. Intraoral examination and vitality tests were performed, with diagnosis of irreversible pulpitis. The removal of the amalgam filling revealed a mesiodistal crack line with imprecise limits. A conservative approach was adopted to maintain this tooth, and the endodontic and restorative treatment were performed. After 1 year, the patient returned complaining of pain and presenting a complete longitudinal fracture of the previously treated tooth, leading to tooth extraction. The prosthesis was adjusted until the installation of a new one. The individual assessment of oncology patients is important for dental treatment plan, and more conservative decisions avoids negative consequences such as oro-nasal communication due to the lack of prosthesis by an early extraction.

Mesenchymal Stem Cells Derived from Human Inflamed Dental Pulp Exhibit Impaired Immunomodulatory Capacity In Vitro

IntroductionDental pulp stem cells (DPSC) are very attractive in regenerative medicine. In this study, we focused on the characterization of the functional properties of mesenchymal stem cells derived from DPSCs. Currently, it is unknown whether inflammatory conditions present in an inflamed dental pulp tissue could alter the immunomodulatory properties of DPSCs. This study aimed to evaluate the immunomodulatory capacity in vitro of DPSCs derived from healthy and inflamed dental pulp. MethodsDPSCs from 10 healthy and inflamed dental pulps (irreversible pulpitis) were characterized according to the minimal criteria of the International Society for Cell Therapy, proliferation, differential potential, and colony-forming units. Furthermore, the immunomodulatory capacity of DPSCs was tested on the proliferation of T lymphocytes by flow cytometry and the in vitro enzyme activity of indoleamine 2, 3-dioxygenase. ResultsThere were no significant differences in the DPSC characteristics and properties such as immunophenotype, tridifferentiation, colony-forming units, and proliferation of the DPSCs derived from normal and inflamed pulp tissue. Furthermore, there were significant differences in the immunomodulatory capacity of DPSCs obtained from human healthy dental pulp and with the diagnosis of irreversible pulpitis. ConclusionsOur results showed that DPSCs isolated from inflamed dental pulp showed typical characteristics of MSCs and diminished immunosuppressive capacity in vitro in comparison with MSCs derived from healthy dental pulp. Further investigation in vivo is needed to clarify the mechanism of this diminished immunosuppressive capacity.

Demographic profile of patients and clinical characteristics of dental emergencies at the outpatient clinic of a Brazilian Dental School

ABSTRACT Objective: This retrospective study evaluated the demographic profile of patients and the clinical characteristics of dental emergencies in a brazilian university outpatient clinic. Methods: During the period from June 2013 to May 2014, data were collected from 1.345 clinical records. Chief complaint, gender, age, systemic alteration, clinical inspection of the affected tooth, pulp and periapical diagnosis, the type of procedure performed and whether there was the need for post-operative systemic medication. Data were analyzed using the SAS software and chi-square test was used to verify the presence or absence of statistical significance at a level of 5%. Results: Dental pain (53.3%) was the main reason why people attended the emergency service, that is, female patients (63.1%), aged 29-48 years old (42%), patients without systemic conditions (75%), and patients with decayed teeth (25%). In addition, involvement of lower molars (29.81%) and diagnosis of irreversible pulpitis (30.42%) were the most frequent findings. Emergency endodontic treatment (45.8%) was the most performed procedure. Irreversible pulpitis (30.4%) and pulp necrosis associated with acute apical periodontitis (21.9%) were the most frequent conditions requiring emergency endodontic treatment, and in most cases, there was no need for post-operative systemic medications (95.7%). Conclusion: The prevalence of endodontic emergencies during the period of one year emphasizes the need for more accurate diagnosis and the importance of providing this service to the population.

A Maxillary Third Molar With 2 Distobuccal Canals: A Case Report

Introduction: Knowledge about the anatomy and morphology of the root canal system plays an important role in the prognosis of endodontic treatment and its success. Maxillary third molars with two distobuccal canals have been rarely reported. Herein, we report a maxillary third molar with 2 canals in the distobuccal root and describe its successful endodontic treatment. Case Presentation: Our patient was a 67-year-old man referred to a private endodontic clinic complaining of pain in his maxillary right third molar tooth. With the diagnosis of irreversible pulpitis, the tooth underwent root canal therapy, during which, after thorough negotiation of orifices, a second distobuccal canal was found. Cleaning and shaping were carried out and root canals were filled. A follow-up was scheduled to ensure a successful endodontic treatment. Conclusions: In this case, we did not use any adjunct diagnostic modality. We only found an additional canal by extending the access cavity and paying attention to landmarks by probing the fissures and grooves between the main orifices. However, it seems that use of new methods can enhance a successful treatment especially in the elderly patients.

Antibiotics are not useful to reduce pain associated with irreversible pulpitis.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Clinical Trials.gov and the WHO International Clinical Trials Registry Platform. There were no language restrictions.Study selectionRandomised controlled trials which compared the relief of pain with systemic antibiotics and analgesics against placebo and analgesics in the preoperative phase of irreversible pulpitis. The primary interest was pain control with an antibiotic or without one in the presence of analgesics. The secondary outcomes were type, dose and frequency of medication for pain relief and any adverse effects related to hypersensitivity or other reactions to either the antibiotic or analgesics.Data extraction and synthesisTwo authors independently assessed the results of the searches. Data extraction and risk bias assessment were also carried out independently. A third reviewer settled any disagreement on inclusion. Since only one study was included a meta-analysis could not be performed.ResultsOnly one double blind randomised clinical trial involving 40 participants with a diagnosis of irreversible pulpitis in one of their teeth was included in this review. This was a low risk, well-constructed double blind study. Half of the participants were treated with penicillin 500 mg, the other with a placebo every six hours over a seven- day period. In addition, all the participants were instructed to initially take one tablet of ibuprofen every 4-6 hours as needed and to take acetaminophen with codeine (two tablets every 4-6 hours) only if the ibuprofen did not relieve the pain.There was no significant difference in the mean total number of ibuprofen tablets over the study period; 9.2(standard deviation (SD) 6.02) in the penicillin group versus, 9.6 (SD 6.34) in the placebo group; mean difference -0.40 (95% CI -4.23 to 3.43); P value = 0.84.The mean total number of Tylenol tablets, 6.9 (SD 6.87), used in the penicillin group versus 4.45 (SD4.42) in the placebo group; mean difference 2.45 (95%CI -1.23 to 6.13; P value = 0.19). The study did not address adverse events.ConclusionsThere is insufficient evidence to accept or refute the benefit of using penicillin to control pain intensity associated with irreversible pulpitis. This study primarily found that antibiotics given preoperatively (before definitive root canal therapy) do not appear to significantly reduce toothache caused by irreversible pulpitis. Between the two groups, those taking the antibiotics and those taking the placebo, there was no statistical difference in the amount of oral analgesics taken to relieve the pain.

Endodontic treatment of maxillary ‘radiculous’: A case report

The aim of this case report is to add to literature the occurrence of the ‘radiculous’ or three- rooted maxillary upper premolar and the guidelines to manage such a case. Recognition of unusual canal configurations and variations are paramount because it has been established that the root with a single tapering canal and the apical foramen is the exception rather than rule. A female patient presented with symptoms of pain in the left upper quadrant. A diagnosis of irreversible pulpitis was arrived at. Magnification and illumination aided in the visualization of a premolar with three roots. Root canal treatment was then successfully completed.

The efficacy comparison of ibuprofen, acetaminophen-codeine, and placebo premedication therapy on the depth of anesthesia during treatment of inflamed teeth

The purpose of this study was to elucidate whether premedication therapy with acetaminophen-codeine or ibuprofen is able to increase the depth of anesthesia in inflamed teeth. Sixty patients with the diagnosis of irreversible pulpitis in 1 mandibular tooth requiring root canal therapy (RCT) were selected. Two other teeth in the same quadrant were selected as controls. An electric pulp tester (EPT) was used to evaluate pulp sensitivity at the baseline and after drug administration and anesthesia injection. The subjects were divided into 3 groups randomly, and in each group 1 of the 3 drugs including acetaminophen-codeine, ibuprofen, and placebo were administered 1 hour before anesthesia delivery. After 1 hour, anesthesia was injected and after a waiting period, the EPT measurement was recorded. The reversed EPT scale was used to evaluate the depth of anesthesia achieved during RCT. Data were analyzed to statistically compare the results before and after intervention in cases and controls of each group and among different groups. Significanly lower tooth sensitivity levels (TSLs) were observed after intervention in acetaminophen-codeine and ibuprofen groups, which was more significant in the ibuprofen group. The comparison of inflamed teeth TSLs in the acetaminophen-codeine group and the placebo group after anesthesia and drug administration showed significant differences (P = .001). This comparison between ibuprofen and placebo groups also showed significant differences (P approximately 0). Also, significantly lower TSL of inflamed teeth was observed in the ibuprofen group in comparison with the acetaminophen-codeine group (P = .002). This study reflected preoperative administration of ibuprofen, if not contraindicated, as a drug of choice 1 hour before local anesthesia injection as an effective method for achieving a deep anesthesia during RCT of teeth with irreversible pulpitis.

Emergency Endodontic Therapy: Report of Case

In emergency situations relief of a patient’s discomfort, caused by a diseased pulp, may be obtained with use of a deep pulpotomy procedure. A 23-year-old woman was seen late at night because of pain in the region of the right mandibular first molar. A diagnosis of irreversible pulpitis was made. After anesthesia had been obtained, the roof of the pulpal chamber was removed completely. The chamber was debrided and the canals were instrumented to a depth of 16 mm. A medicated pellet was placed in the chamber and the access opening was closed with a temporary cement restoration. The patient was instructed to see her dentist for complete endodontic therapy. In emergency situations relief of a patient’s discomfort, caused by a diseased pulp, may be obtained with use of a deep pulpotomy procedure. A 23-year-old woman was seen late at night because of pain in the region of the right mandibular first molar. A diagnosis of irreversible pulpitis was made. After anesthesia had been obtained, the roof of the pulpal chamber was removed completely. The chamber was debrided and the canals were instrumented to a depth of 16 mm. A medicated pellet was placed in the chamber and the access opening was closed with a temporary cement restoration. The patient was instructed to see her dentist for complete endodontic therapy.