Electric Pulp Tester Research Articles

Evaluation of the response to electric pulp testing in multiple sclerosis patients without a history of trigeminal neuralgia: a case-control study

BackgroundThe importance of evaluating the pulpal threshold to electrical stimulation, as a side effect of probable neuropathy in Multiple Sclerosis (MS) patients is a novel issue. This study aimed to investigate electrical pulp test thresholds in MS patients without a history of trigeminal neuralgia compared to healthy individuals.MethodsSixty-nine maxillary central incisors, belonging to 34 relapsing-remitting MS patients, and 35 healthy individuals were included in this survey. The MS patients matched for intended variables, were 22–50 years old, had a more than 1-year history of MS, no history of trigeminal neuralgia and/or other neuropathy. The electric pulp sensibility test was performed on all samples. Electric pulp testing (EPT) results were recorded based on the pulp tester’s grade that evoked a response. Data were analyzed with paired T-test, Mann-Whitney test, and Spearman correlation (P < 0.05).ResultsAccording to the results of this study, the mean values of response to EPT were 1.2 ± 0.5 and 1.8 ± 0.5 in MS patients and healthy individuals, respectively. The pulpal response to EPT between the two groups was significantly different (P < 0.0001).ConclusionsMS patients showed a significantly reduced response to the electric pulp test in their maxillary central incisors in comparison to matched healthy persons.

Pulpal and periapical disease in crowned vital teeth: A prospective matched cohort study.

This study aimed to determine the incidence and contributing factors to pulpal and periapical disease in crowned vital teeth. Seventy-three pairs of healthy teeth were included and divided into two groups; 'crowned' and 'untreated' groups. The crowned group was prepared for full coverage crown and no treatment was carried out on the untreated group. Both groups were subjected to clinical and radiographic examination to detect endodontic signs and symptoms pre-operatively and one-week after crown cementation. Electric pulp test was also subjected to both groups, pre-operatively, after tooth preparation and before crown cementation. The incidence of pulpal and periapical disease was 6.8% and 1.4%, respectively, after tooth preparation. Factors associated with pulpal and periapical disease were exposed pulp during tooth preparation and pre-operative bone level <35%. Despite the low incidence, the occurrence of pulpal and periapical disease within a short period is noteworthy.

Biomimetic Mineralization Approach of Dentin Hypersensitivity in Patients with Early Non-Carious Cervical Lesions.

Objective: to evaluate the efficacy of non-invasive procedures through biomimetic mineralization of a fluoride gel, bioactive glass materials with and without fluoride and self-organizing biomimetic peptides in the treatment of dentinal hypersensitivity due to early non-carious cervical lesions. Materials and methods: Twenty-eight patients with self-reported history of dentin hypersensitivity were evaluated sequentially for evidence of erosion, abrasion or gingival recession at facial cervical region. Patients were randomly distributed into four treatment groups of seven patients each according to the type of the treatment (group I: Elmex Gele'e, group II: BioMin™ F, group III: BioMin™ C group IV: CurodontTM D’senz). The teeth were subjected to five follow up periods (baseline, after 3,6,9 and 12 weeks) and assessed in response to evaporative air-blast stimulus utilizing Schiff Sensitivity and Visual Analogue Scales. Electrical test was performed utilizing electrical pulp tester. The extent of tubule occlusion was examined under scanning electron microscope using negative replica of randomly selected patients. Results: All the tested groups showed different degrees of relieving dentinal hypersensitivity symptoms. The difference between the studied groups was statistically significant. Under SEM, group II, III and IV showed complete tubule occlusion. However, group I showed partial tubule occlusion. Conclusions: Elmex® gelee, BioMin™ F, BioMin™ C and Curodont™ D’senz were effective to manage dentin hypersensitivity related to early non-carious cervical lesions based on the biomimetic mineralization concept that has focused on permanent management of dentin hypersensitivity. Keywords: Fluoride, Bioactive glass, self-organizing biomimetic peptides, non-carious cervical lesions, dentin hypersensitivity.

An in vivo, randomized, controlled comparative evaluation of efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years.

To compare and evaluate the efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years. 100 participants were randomly distributed to receive either 4% articaine using infiltration anesthesia or 2% lidocaine using inferior alveolar nerve block on each side of the mandibular arch, in two different appointments, after a 1-week interval. The pain perception was evaluated using visual analog scale (VAS) and Wong-Baker Faces pain rating scale (WBFPRS). In both the appointments, the efficacy and onset of anesthesia were evaluated using an electric pulp tester. Hemodynamic parameters, which included pulse rate and oxygen saturation levels, were evaluated using a pulse oximeter. Postoperative complications were evaluated at 24-hour follow-up. Pain score recorded with block was more painful compared to infiltration (P < .05). Anesthetic success was observed with both the local anesthetic agents, with no significant differences (P > .05). Shorter onset of action was observed with articaine (P < .05). Statistically significant differences between groups were noted with regard to heart rate (P < .05). Oxygen saturation levels did not show significant differences (P > .05). When postoperative complications were evaluated with either 4% articaine or 2% lidocaine, very few adverse effects were recorded (P > .05). Buccal infiltration using 4% articaine has the potential to replace 2% lidocaine using inferior alveolar nerve block in children.(Quintessence Int 2021;52:780-786; doi: 10.3290/j.qi.b1492247).

Effect of precooling injection site and cold anesthetic administration on injection pain, onset, and anesthetic efficacy in maxillary molars with symptomatic irreversible pulpitis: a randomized controlled trial.

This randomized controlled clinical trial assessed the analgesic and anesthetic effects of precooling the injection site and administration of refrigerated 2% lignocaine HCl with 1:100,000 epinephrine (LE) in maxillary molars with symptomatic irreversible pulpitis (SIP). Sixty patients diagnosed with SIP (preoperative pain score ≥ 85mm) in maxillary first molars were randomly allocated to two groups. In group I (control), topical gel was applied for a minute followed by conventional LE infiltration, whereas in group II (experimental), topical ice application for 15s and refrigerated (4-6°C) LE administration was done prior to endodontic treatment. The primary outcome measure was anesthetic efficacy that was defined as none to weak pain (≤ 36mm) as measured on Heft Parker visual analog scale (HP-VAS) following access cavity preparation. Pain on injection and onset constituted the secondary outcome measures. The pain on injection was measured using HP-VAS, whereas the onset of anesthesia was assessed using an electric pulp tester (EPT) which was applied on the experimental tooth every minute until no response was elicited. Mann-Whitney U test was performed to analyze the data (p < 0.01). Experimental group reported a success rate of 86.6% when compared to control group (26.6%) and a statistically significant reduction on injection pain (20.0mm vs 54.5mm) (p < 0.01). The onset of anesthesia for experimental group was 2.4min which was also significantly lower than control group (4.5min) (p < 0.01). Cryotherapy can serve as an effective alternative to conventional anesthesia for achieving success, reduced pain, and faster onset during endodontic treatment of maxillary molars with SIP. Precooling the injection site and cold LE administration can result in effective pulpal anesthesia during endodontic management of maxillary molars in SIP patients.

An evaluation of the repeatability of electric pulp sensibility tests.

The accuracy, reliability and reproducibility of electric pulp tests (EPT) have been investigated but there is conflicting information about their repeatability. The aim of this study was to investigate whether EPT are repeatable over time. EPT results from 180 healthy teeth in 39 patients with 2-10 readings per tooth (total 692 readings) were analysed. Single measures intraclass correlation coefficients (ICC) ranged from 0.776 to 0.845 in teeth with 2-7 repeated measures (P < 0.001), indicating good repeatability. With eight or more measures per tooth, the ICC was low, indicating poor repeatability over longer follow-up times, but only seven teeth in two subjects were included in this analysis. The Pearson correlation showed no statistically significant correlation for 2-7 readings but when all readings were included, there was a statistically significant negative correlation. Hence, EPT has good repeatability.

Endodontics-orthodontics interrelationship: a review.

The endodontic-orthodontic interface is not well understood due to the limited scientific literature on the topic. This article aims to provide an overview of the orthodontic treatment and the risk of root resorption, the effects of orthodontic tooth movement on dental pulp and endodontically treated teeth, the role of orthodontics in endodontic-restorative treatment planning, and interdisciplinary patient management. Articles published in English from 1982 to 2021 were searched manually from google scholar using keywords ‘endodontic-orthodontic interface’ and ‘endodontic-orthodontic interrelationship’. Another search engine was MEDLINE/PubMed database using keywords ‘endodontics AND orthodontics’, ‘orthodontic tooth movement AND dental pulp’, 'orthodontic tooth movement AND endodontic treatment' and ‘orthodontics AND dental trauma’. Other relevant articles were obtained from the references of the selected papers. Alterations to the dental pulp following orthodontic tooth movement can be histologic and/or cell biological reactions as well as the increased response threshold to pulp sensibility tests. However, the occurrence of root resorption is complex and multifactorial, and can be linked to individual variation, genetic predisposition and orthodontic treatment-related factors. Endodontically treated teeth can move as readily and respond similarly to orthodontic forces as vital teeth, however with inadequate endodontic treatment, the risk of apical inflammation and bone destruction following orthodontic tooth movement is increased. Dental treatment that involves endodontic and orthodontic specialities should be carefully planned according to the individual case, taking into consideration the skills and experience of the clinicians while applying interdisciplinary patient management and available scientific data.

Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study

The dental pulp sensibility test is one of the main auxiliary resources for the diagnosis of pulp pathologies, and its accuracy is still debatable. This cross-sectional observational study evaluated the accuracy of the pulp sensibility test (PST) using cold spray (1,1,1,2-tetrafluoroethane) for the diagnosis of pulp diseases and determined the effect of individual and clinical variables on the reliability of this test. The paper was designed following the STROBE statement. Sixty patients with indications for primary endodontic treatment were selected and examined from August 2017 to July 2018. Data collection was performed through interviews, clinical/radiographic examinations and the PST. The results of the cold test, along with data on sex, age, the tooth type regarding the root number, and the presence of restorations and caries, as well as the recent consumption of analgesics, were recorded. The presence of bleeding within the pulp chamber was used as the gold standard to compare with the clinical diagnosis and to identify the true-positive, false-positive, true-negative, and false-negative responses. The accuracy of PST achieved in subgroups of individual and clinical variables was compared using the chi-square test with a significance level of 5% (p &lt; 0.05). The PST with the use of cold spray showed a sensitivity of 0.88, a specificity of 1.00, a positive predictive value of 1.00, a negative predictive value of 0.86, and an accuracy of 0.93. The accuracy of the cold spray was not affected by individual or clinical variables. The PST with the use of cold spray is an accurate and reliable method for determining the diagnosis of pulp diseases, especially in cases of pulp vitality or irreversible pulpitis.

Relationship between the difference in electric pulp test values and the diagnostic type of pulpitis

BackgroundAccording to the diagnosis criteria of the American Association of Endodontists (AAE), sensitive responses to cold and/or heat tests of suspected teeth compared with those of control teeth can be used for the diagnosis of pulpitis, but the role of electric pulp test (EPT) is not mentioned. It is believed that EPT has some limitations in determining the vitality of the pulp. The aim of this study was to explore the association between the difference in EPT values and the differential diagnoses of reversible pulpitis (RP) and symptomatic irreversible pulpitis (SIRP) caused by dental caries.MethodsA total of 203 cases with pulpitis caused by dental caries were included. A diagnosis of pulpitis was made on the basis of the diagnostic criteria of AAE. Patient demographic and clinical examination data were collected. The EPT values of the suspected teeth and control teeth were measured, and the differences between them were calculated. The correlation between the difference in the EPT values and diagnosis of pulpitis was analyzed using univariate and multivariate logistic regression.ResultsIn the 203 cases (78 males and 125 females; 115 cases of RP, 88 cases of SIRP; 9 anterior teeth, 59 premolars, and 135 molars), the mean patient age was 34.04 ± 13.02 (standard deviation) years. The unadjusted (crude) model, model 1 (adjusted for age), model 2 (adjusted for age and sex), and model 3 (adjusted for age, sex, and tooth type) were established for the statistical analyses. In model 3 [odds ratio (OR) = 1.025; 95% confidence interval (CI) 1.002–1.050; P = 0.035], the difference in EPT values between RP and SIRP was statistically significant. However, the areas under the curve of predictive probability of the crude model, model 1, model 2, and model 3 were 0.565, 0.570, 0.585, and 0.617, respectively, showing that the model accuracy was low. The P-value for the trend in differences between the EPT values as a categorical variable showed that the differences in the EPT values, comparing RP and SIRP, were not statistically significant.ConclusionsBased on the present data, the difference in EPT values was not sufficient to differentiate RP from SIRP.

The management of deep caries in UK primary care: A nationwide questionnaire-based study.

To investigate current approaches and attitudes towards the management of deep caries in primary dental care within the United Kingdom (UK). Open distribution of an electronic questionnaire survey was undertaken to primary care dental professionals working in publicly funded National Health Service [NHS], privately funded, military and community dental services. Demographic variables investigated included the following: place of qualification, method of remuneration, level of restorative training, materials available, years qualified, appointment length and clinician type. Management variables focussed on case-based scenarios. Univariate analyses of responses to questions were undertaken using χ2 tests with sequential Bonferroni correction. Variables with a statistical relationship of p≤.2 were selected for binary logistic regression modelling. A total of 657 responses were received. Practitioners with formal postgraduate qualifications (PGQ) were more likely (OR, 95%CI) to undertake further tests to aid diagnosis including: gaining a patient history (1.80, 1.01-3.20), periapical radiography (1.43, 1.01-2.03), cold pulp testing (2.079, 1.46-2.97) and electric pulp testing (1.65, 1.02-2.65). Rubber dam was infrequently used for deep caries management (29.2%). Non-NHS practitioners were much more likely to use rubber dam (3.40, 2.15-5.37), as were those that had completed PGQ (2.24, 1.48-3.38). Non-selective caries removal was used in deep caries by 41.4% of practitioners. Indirect pulp caps were carried out by 56.7% of practitioners. NHS practitioners were more likely to place calcium hydroxide (3.74, 1.97-7.15), whilst non-NHS practitioners were more likely to place calcium silicate cements (CSCs) (3.303, 1.71-6.38) as were non-UK graduates (5.63, 2.47-12.86) and those with PGQ (2.12, 1.17-3.87). This UK survey highlights significant variation in the management of deep caries. There is lack of consensus regarding the use of a standard systematic approach to diagnosing disease, with a reliance on history and tests with poor specificity. Non-selective caries removal for managing deep carious lesions remains common, with low rubber dam compliance underlining a lack of asepsis. Notably, a significant number of practitioners placed indirect pulp caps, but CSCs and GIC were not commonly used. At present, although clear guidelines are available this is not translating into consistent management approaches in practice, suggesting that better dissemination of current treatments is essential to undergraduate and postgraduate groups.

Efficacy of i-PRF in regenerative endodontics therapy for mature permanent teeth with pulp necrosis: study protocol for a multicentre randomised controlled trial

BackgroundDental pulp necrosis, a common health problem, is traditionally treated with root canal therapy; however, it fails in restoring the vitality of damaged pulp. Most studies regarding regenerative endodontic therapy (RET) are limited to the treatment of immature necrotic teeth. Given that injectable platelet-rich fibrin (i-PRF) has shown great potential in regenerative medicine as a novel platelet concentration, this study is designed to explore whether i-PRF can serve as a biological scaffold, extending the indications for RET and improving the clinical feasibility of RET in mature permanent teeth with pulp necrosis.MethodsThis is a randomised, double-blind, controlled, multicentre clinical trial designed to evaluate the clinical feasibility of RET for mature permanent teeth with pulp necrosis and to compare the efficacy of i-PRF and blood clots as scaffolds in RET. A total of 346 patients will be recruited from three centres and randomised at an allocation ratio of 1:1 to receive RET with either a blood clot or i-PRF. The changes in subjective symptoms, clinical examinations, and imaging examinations will be tracked longitudinally for a period of 24 months. The primary outcome is the success rate of RET after 24 months. The secondary outcome is the change in pulp vitality measured via thermal and electric pulp tests. In addition, the incidence of adverse events such as discolouration, reinfection, and root resorption will be recorded for a safety evaluation.DiscussionThis study will evaluate the clinical feasibility of RET in mature permanent teeth with pulp necrosis, providing information regarding the efficacy, benefits, and safety of RET with i-PRF. These results may contribute to changes in the treatment of pulp necrosis in mature permanent teeth and reveal the potential of i-PRF as a novel biological scaffold for RET.Trial registrationClinicalTrials.govNCT04313010. Registered on 19 March 2020

The study and analysis of the prognosis criteria for a safe local anesthesia in patients with arterial hypertension

Relevance. To develop the algorithm for a safe and effective local anesthesia in dental outpatients with arterial hypertension.Materials and methods. The study was conducted in the laboratory of functional and clinical studies of Moscow State University of Medicine and Dentistry. Electric pulp testing (µA) was performed and pulp microcirculation (PU) was assessed in the intact teeth of patients with hypertension before and 5, 10, 15, 30 and 60 minutes after the administration of local anesthesia. We used 4% articaine solutions without a vasoconstrictor and with its minimal concentration 1:200 000 and 1:400 000, and 3% mepivacaine solution. The safety of the administered local anesthetic was assessed by the continuous hemodynamic monitoring.Results. 4% articaine solution without epinephrine had a shallow anesthetic effect in the maxilla and anterior mandible. 1:400 000 and 1:200 000 vasoconstrictor concentrations in 4% articaine solution increase the depth and duration of the anesthesia from 20 to 30 minutes respectively. Changes in the pulp sensibility but not in blood microcirculation were demonstrated by the functional parameters of the intact dental pulp in patients with hypertension after the administration of 3% mepivacaine solution at the mandibular foramen. The continuous hemodynamic monitoring data showed no changes in arterial blood pressure, heart rate, oxygen saturation on administration of either of the studied local anesthetic solutions or techniques.Conclusion. The analysis of the prognosis criteria for a safe local anesthesia allowed us to ground the choice of anesthetic in dental outpatients with arterial hypertension.

Partial Pulpotomy to Successfully Treat a Caries-Induced Pulpal Micro-Abscess: A Case Report

Vital pulp treatment (VPT) is a therapeutic strategy aimed at conservatively managing deep carious lesions and the exposed pulp. VPT has recently expanded through the use of hydraulic-calcium-silicate cement (HCSC), cone-beam CT, and dental operating microscopy (DOM), as well as an improved understanding of pulpal repair mechanisms. Consensus documents have concluded that non-selective removal of caries is not necessary in the absence of clinical symptoms, as partial or non-selective caries removal techniques reduce the likelihood of pulp exposure. Alternatively, others suggest that leaving carious tissue may help sustain pulpal inflammation and lead to failure of VPT. The presence of a purulent discharge from the exposed pulp is considered indicative of an irreversible damage and a need for pulpectomy. This report documents the successful VPT in a symptomatic molar with deep caries that exhibited purulent discharge from the pulp after exposure. A female patient presented with spontaneous pain in the maxillary left second molar. One year before, she had received a cast-metal restoration over a resin-based-composite (RBC) restoration. The tooth had been largely asymptomatic since; however, after experiencing spontaneous pain, she consulted the hospital clinic. Radiographs indicated that the restoration was not deep with visible dentin between the restoration and the pulp. Pulp sensibility tests yielded a positive response. There was no pain on percussion and no periodontal problems. Removal of the restoration and carious dentin using a DOM resulted in a pulpal exposure with purulent discharge and bleeding. A partial pulpotomy using HCSC was performed. Six months later, the clinical symptoms had completely resolved; however, due to concerns of partial necrosis, the patient was re-assessed. DOM examination revealed an incomplete hard-tissue barrier; moreover, there were also signs of residual tissue with inflammation. As a result, the defected area was enlarged, the pulp tissue debrided, and the HCSC reapplied. After review at 1 year, the tooth remains symptomless, with no apical radiolucency. Notably, this report visually illustrates that exposed pulp tissue containing limited region pus can maintain vitality after VPT. This finding raises two questions: (1) whether leaving infected dentin in situ and avoiding visualization of the pulp exposure is appropriate; and (2) whether the presence of purulent tissue in the pulp warrants a pulpectomy.

Evaluation of Survival of Mature Second Premolar with Periapical Lesion Following Different Regenerative Treatment Protocols: A Randomized Controlled Trial

Introduction: The aim of the present study was to compare the survival, periapical healing and regaining sensibility of necrotic mature second premolars with periapical lesion following treatment with two different regenerative protocols, Platelet Rich Plasma(PRP) versus Platelet Rich Fibrin(PRF) pulp regeneration. Both regenerative endodontic procedures were used for regeneration of pulp tissue in the root canal. Methods: Twenty eight patients with mature, single canalled, necrotic, and asymptomatic second premolar with radiographic evidence of periapical lesion were included. At the first visit, the tooth was anesthetized, isolated and an access cavity was performed. Mechanical preparation of root canals was performed using the standardized technique reaching apical canal preparation to K-file size #40-60. Antibiotic paste was injected in canal, and the cavity was temporarily sealed. Two weeks later, regenerative procedures were performed by applying PRP (group 1) and PRF (group 2) in root canal and pulp chamber space. Collagen plug was placed directly over platelet concentrates followed by biodentin. Survival was defined as retention of the tooth in the arch at 12 months recall. Cone beam computed tomography assessments were done through recording of bone healing of periapical lesion and density of pulp chamber space at 12 months recall. The electric pulp test was used to record at 3,6,9 and 12 months follow-up. Results: There was no statistically significant difference in survival of teeth and healing of periapical lesions between the two groups at 12 months recall. Readings of sensibility revealed statistically significant difference (P &lt; .0001) between baseline and the 12-months follow-up,with no statistically significant difference between the two groups. Conclusions: PRP and PRF combined with revascularization protocol were successful treatment modalities for survival of mature necrotic teeth and healing of periapical lesion. Platelet concentrates protocol is successful in regaining sensibility of necrotic teeth.

Non-Surgical Management of an Anterior Tooth with Internal Inflammatory Resorption: A Case Report

Background: According to the Glossary of the American Association of Endodontists, resorption is definedas a condition associated with either a physiologic or a pathologic process resulting in the loss of dentin,cementum, or bone. It may present internally (pulpal origin) or externally (periodontal origin). Internalresorption is a rare, insidious, resorptive pathological process, starting from the pulp extending into thesurrounding dentin. Treatment is mainly focused on arresting the cellular activity accounting for theresorptive process.Methodology: A patient presented with an upper front tooth that was tender on percussion and a history oftrauma in her childhood which resulted in Ellis class II fracture of the tooth. Pulp sensibility testing showeda negative response suggestive of a non-vital tooth. A non-surgical endodontic therapy was carried out underthe microscope with calcium hydroxide dressings followed by the three-dimensional obturation techniqueusing thermoplasticized Gutta percha.Conclusion: The current case report discusses the etiology and symptoms of internal inflammatoryresorption, the contribution of cone beam computed tomography imaging in its diagnosis, and a step wiseprotocol for the three dimensional obturation of the resorptive lesion.

Clinico-Histological Evaluation of Dentino-Pulpal Complex of Direct Pulp Capping Agents: A Clinical Study.

Introduction:Direct pulp capping treatment (DPC) maintains pulp vitality by promoting healing or repair in dentistry, which can be attributed to the advent of bioceramic materials.Aim:This examination looked to evaluate the clinical and histological effectuality of Biodentine with Dycal for DPC.Materials and Methodology:In this study, 30 intact human orthodontic teeth undergoing therapeutic extraction were chosen to perform DPC. They were arbitrarily divided into two groups (n = 15) and DPC with Biodentine and Dycal was performed. Composite resin was used as permanent restoration. After a period of 1 and 6 weeks, clinical as well as electric pulp tests were carried out. Asymptomatic patients were re-called after 6 weeks; follow-up radiograph was taken. Electric pulp testing and thermal testing was done to check the pulpal status of the teeth. This was followed by atraumatic extraction, and the teeth were sent for histological examination. SPSS Version 21.0. Armonk, NY: IBM Corp.was used for data analysis.Results:There was no pain and sensitivity in using Biodentine. Whereas, sensitivity and pain was noted when Dycal was used. The dentinal bridge was better with Biodentine when compared with Dycal.Conclusion:In accordance with the obtained results, it was concluded that on clinical and histological evaluation, Biodentine performed better as DPC agent. Subsequently, Biodentine is more dependable for the long-haul protection of dental pulp than Dycal.

Nitrous Oxide/Oxygen Effect on IANB Injection Pain and Mandibular Pulpal Anesthesia in Asymptomatic Subjects.

The inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia. Nitrous oxide may increase the success of the IANB. The purpose of this investigation was to study the effect of nitrous oxide/oxygen (N2O/O2) on IANB injection pain and mandibular pulpal anesthesia in asymptomatic subjects. One hundred five asymptomatic subjects received an IANB after the administration of N2O/O2 or room air/oxygen (air/O2) at 2 separate appointments. After the IANB, subjects rated their level of pain for each phase of the injection (needle insertion, needle placement, and solution deposition) using a Heft Parker visual analog scale. Pulpal anesthesia was evaluated with an electric pulp tester for 60 minutes. The mean pain rating for all 3 injection phases showed a statistically significant reduction in pain when N2O/O2 was used compared with Air/O2 (P < .05). Odds ratios demonstrated a statistically significant increase in IANB success for the N2O/O2 group compared with the air/O2 group. N2O/O2 administration statistically decreased pain for all 3 injection phases of the IANB. In addition, nitrous oxide statistically increased the likelihood of pulpal anesthesia for posterior mandibular teeth. However, the incidence of pulpal anesthesia was not 100%.

Ingrowth of Mineralized Tissue into the Root Canal of Immature Permanent Teeth after a Traumatic Injury: A Report of 3 Cases

The aim of this case series was to describe the endodontic management of 3 immature permanent teeth that sustained traumatic injuries and subsequently presented with complete ingrowth of mineralized tissue into the canal space. Ingrowth of bone/mineralized tissue into the canal has been considered a poor long-term outcome with an inherent risk of ankylosis. In cases 1 and 2, no endodontic treatment was undertaken, except for emergency management requiring splinting. The cases were followed for 36 and 23 months, respectively. No ankylosis was evident over the review period, and normal teeth eruption was apparent. In case 1, the tooth was treated orthodontically and was responsive to pulp sensibility testing. In both cases, there was an appearance of an internal periodontal ligament–like space on the inner root wall of the canal. In case 3, 2 years postinjury, pulp necrosis and apical periodontitis occurred, and the tooth was managed with regenerative endodontic treatment consistent with the European Society of Endodontology and the American Association of Endodontists guidelines/recommendations for a regenerative procedure. The case was followed for 8 years after regenerative endodontic treatment. No ankylosis was noted with normal eruption of the teeth. The tooth was responsive to pulp sensibility testing despite the ingrowth of mineralized tissue, which was confirmed clinically.

The effect of single buccal infiltration anesthesia of 4% articaine with either 1:100,000 or 1:200,000 epinephrine on pulpal blood flow and anesthesia of maxillary first molars and second premolars in humans.

The aim of this study was to determine the effect of single buccal infiltration of 4% articaine with either 1:100,000 (EP100) or 1:200,000 (EP200) epinephrine on pulpal blood flow (PBF), pulpal anesthesia and soft tissue anesthesia of maxillary first molars and second premolars in human subjects. Fifteen healthy volunteers with intact maxillary first molars and second premolars received an infiltration of 4% articaine with either EP100 or EP200 at buccal aspect of maxillary first molars. The PBF, pulpal anesthesia and soft tissue anesthesia were assessed with a laser Doppler flowmeter (LDF), an electric pulp tester (EPT) and Aesthesiometer II, respectively. Articaine (4%) with either EP100 or EP200 produced PBF reduction in maxillary first molars (injected teeth) by 68.09 and 69.83%, and produced PBF reduction in second premolars (adjacent teeth) by 76.81 and 75.02%, respectively at 15min post injection. Duration of PBF returned to baseline was 159.00 ± 21.06 (EP100) and 159.00 ± 31.97 (EP200) min in the molars, and 161.00 ± 20.02 (EP100) and 159.00 ± 25.86 (EP200) min in the premolars. The onset of pulpal anesthesia was 2.80 ± 1.26 (EP100) and 3.07 ± 1.28 (EP200) min in the molars, and 2.13 ± 0.52 (EP100) and 2.40 ± 0.83 (EP200) min in the premolars; the duration of pulpal anesthesia was 74.53 ± 24.16 (EP100) and 76.27 ± 34.03 (EP200) min in the molars, and 82.53 ± 31.03 (EP100) and 75.60 ± 37.17 (EP200) min in the premolars. Buccal tissue anesthesia was found in both teeth (100%), but palatal anesthesia was achieved by 13.33% in the premolars and 6.67% in the molars for each solution. Single buccal infiltration to maxillary first molar produced PBF reduction and successful pulpal anesthesia, evaluated by EPT, in both first molar and second premolar. This anesthetic technique also produced high success of buccal tissue anesthesia, but demonstrated very low success for palatal tissue anesthesia. Single buccal infiltration to maxillary first molar is potent enough for pulpal and buccal tissue anesthesia, except palatal tissue anesthesia, in both first molar and second premolar.

Pulp Testing -Implication and Advances

One of the greatest challenges to the clinicians is the accurate diagnosis an evaluation of the pulp status. Pulpsensibility tests [thermal and electric tests] interprets status of pulp health from sensory response. Thoughitis the most commonly used test in clinical practice, Recent studies have shown that blood circulation isthe most accurate determinant in assessing pulp vitality as it provides an objective differentiation betweenthe vital and non-vital pulp tissue. Examples of vitality tests includes Laser Doppler flowmetry and pulseoximetry. Although the results are promising with these tests,in order to replace sensibility tests as thestandard clinical pulp diagnostic test, practical issues of pulp vitality tests need to be addressed. The aimof this review is to provide the clinician a thorough knowledge and understanding of various pulp testingand its indications. The results of any pulpal test has to be interpreted carefully, as false results can lead tomisdiagnosis and ultimately inappropriate, or unnecessary treatment.