Irreversible Pulpitis Research Articles

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.

On the question of choosing the most valid methods for diagnostics of pulpal hyperemia

The choice of the most optimal methods for the diagnosis and treatment of reversible forms of pulpitis is an urgent issue of modern practical endodontics. The dental pulp is unique in its histological structure, innervation and microcirculation. Reversible forms of pulpitis (including pulp hyperemia) are associated with a number of morphological and functional changes in the neurovascular bundle, which, at their early stages, are not fully detected during clinical examination, and require the inclusion of additional functional diagnostic methods, which include not only in the assessment of the nerve elements of the pulp (EOD), but also the study of the state of microcirculation (LDF), a change in which can become a predictor of the inflammatory response. In order to determine the most valid method for assessing the condition of the pulp in reversible forms of pulpitis, 43 young people with a diagnosis of K04.00 (pulp hyperemia) deep caries were examined and treated. Each patient was assessed carious and intact (symmetrical) teeth. At the same time, in addition to clinical diagnostic methods, EOD and LDF were used (M and σ were evaluated). Within two weeks, after the treatment, in 2 patients with the highest values of EOD (19 and 21 μA at the time of the initial examination) and LDF (M: 21.14 and 23.56 arb. units and σ: 0.82 and 0.85 conventional units) was diagnosed with irreversible pulpitis, which required a different treatment strategy. Therefore, when diagnosing reversible forms of pulpitis, it is necessary to be guided not only by the data of a clinical examination (which is undoubtedly the main and determining one), but also to assess the state of the vascular and nervous elements of the pulp, changes in which often anticipate the clinical manifestations of the pathology of the pulp of the tooth.

Comparison the effect of different irrigation on post-operative pain in cases with irreversible pulpitis

the aim of this study was to evaluate the effect of different types of irrigants solution on postoperative pain after root canal treatment.
 Materials and method: 75 patients with irreversible pulpitis on the lower mandibular premolars teeth, after diagnosis all cases were treated in a single visit in a private clinic over a period of 18 months. selected for this investigation endodontic treatment for the teeth using a wave one technique and then we divided the patients into 3 groups each group consist of 25 patients : in G.I irrigated with sodium hypochlorite (NaOCl).G.II irrigated with chlorhixdine and GIII irrigated with NaOCl, followed by EDTA 17% then CHX ( using conventional needle irrigation was performed with a 27-G (Appli-Vac) needle and syringe). The needle was placed short of the binding point or 2mm from the working length and irrigant was expressed over 30 seconds.)after irrigation the canals Will dried with paper point then obuterated it with guttapercha , a temporary filling covered the teeth after that we asked the patient to record the postoperative pain after 6_12h , 24_48 h & one week , by using annual scale(AVS)the results show that the pain in G.III is the lowest pain than the other two groups.
 Conclusion the uses of the combination of irrigants solution resulting in less postoperative pain after endodontic treatment.
 The aim is to compare the effect of different irrigants solution on postoperative pain after root canal treatment.

Outcomes and predictive factors of vital pulp therapy in a large-scale retrospective cohort study over 10 years

This cohort study evaluated the long-term success/survival of vital pulp therapies (VPTs) after carious pulp exposure in adult teeth. Additionally, factors influencing long-term success were identified. Teeth treated during 2011–2022 in a private clinic were studied with clinical/radiographic follow-ups. Data included patient demographics, tooth specifics, and treatment details. Outcomes were classified as success/failure based on clinical/radiographic findings, with tooth functionality determining the survival rate. Encompassing 1149 patients and 1257 VPT-treated teeth, the average monitoring period was 42.2 months. Overall VPTs’ survival and success rates were 99.1% and 91.6%, respectively. Success rates for 768 direct pulp cappings, 217 miniature pulpotomies, and 272 full pulpotomies were 91.9%, 92.6%, and 90.1%, respectively (P > 0.05). Influencing factors included symptomatic irreversible pulpitis (SIP; HR 1.974, 95% CI 1.242–3.137; P = 0.004), radiographic signs of apical periodontitis (AP; HR 2.983, 95% CI 1.961–4.540; P < 0.001), restoration type (HR 2.263, 95%CI 1.423–3.600; P = 0.001), and restoration surfaces (HR 1.401, 95%CI 1.034–1.899; P = 0.030). This study concludes that VPT techniques consistently exhibit high long-term success/survival rates in treating carious pulp exposures. Critical predictors include initial clinical signs of SIP/AP, caries extent, and use of composite restorations.

Systemic Antibiotic Use in Acute Irreversible Pulpitis: Evaluating Clinical Practices and Molecular Insights.

This scoping review systematically evaluates the use of systemic antibiotics in treating acute irreversible pulpitis, integrating clinical practice patterns with recent molecular insights. We analyzed clinical evidence on antibiotic prescription trends among dental professionals and examined molecular research advancements in relation to pulpitis. This review is intended to bridge the gap between clinical practice and molecular research, guiding more evidence-based approaches to treating acute irreversible pulpitis. Electronic databases were searched for relevant articles published in English based on the objective of the review. A second search using all identified keywords and index terms was undertaken across all the included databases. In addition, a reference list of identified articles was searched. Studies including original research, systematic reviews, meta-analyses, clinical trials, and observational and retrospective studies, all written in English and published from 2010 onwards, were included, and an analysis of the text words contained in the titles and abstracts of the retrieved papers and of the index terms used to describe the articles was performed. A total of N = 53 articles were selected. Altogether, N = 43 (76.79%) articles were cross-sectional studies, N = 4 (11.11%) were systematic reviews, and N = 3 (5.36%) were guidelines. The most frequent level of evidence was level VI (N = 43 (76.79%). The mean percentage of dentists who prescribed antibiotics to treat acute irreversible pulpitis was 23.89 ± 23.74% (range: 0.05-75.7). Similarly, for specialists, it was 22.41 ± 15.64 (range 2.2-50.4), and the percentage for undergraduates was 17.52 ± 20.59 (range 0-62.6). The significant developments in research models for pulpitis research and the characterisation of biomarkers have led to better management strategies. Concurrently, significant advancements in molecular research provide new understandings of pulpitis, suggesting alternative therapeutic approaches. Although there are guidelines available, increased rates of antibiotic prescription are still prevalent around the globe.

Can instrumentation kinematics affect postoperative pain and substance P levels? A randomized controlled trial

BackgroundThis study aimed to assess the influence of continuous rotation and reciprocation kinematics on postoperative pain (POP) levels and substance P (SP) levels in patients diagnosed with irreversible pulpitis and symptomatic apical periodontitis (SAP).Materials and subjectsA total of twenty patients were randomly assigned into two groups: Continuous Rotation Group (CRG) (n = 10), subjected to mechanical preparation with the EdgeEndox7 rotary system (Albuquerque, NM, USA), and Reciprocation Group (RG) (n = 10), treated with the EdgeOne Fire reciprocating system (Albuquerque, NM, USA). Apical fluid (AF) samples were collected, and SP levels were quantified through radioimmunoassay. POP was assessed using the Numerical Rating Scale (NRS) at various time intervals (preoperatively, 6 h, 12 h, 24 h, 48 h, and 72 h). Data were statistically analyzed utilizing the independent t-test, Mann-Whitney U test, Friedman’s test, and Nemenyi post hoc test.ResultsThere was a significant increase in SP levels in the reciprocating group compared to the continuous rotation group (P ≤ 0.05). Additionally, patients in the reciprocating group reported significantly higher POP levels (P ≤ 0.05) at all measured intervals (6 h, 12 h, 24 h, and 48 h), with both groups exhibiting similar pain level reductions at the 72-hour mark.ConclusionOur findings suggest that continuous rotation kinematics in root canal preparation leads to a considerable reduction in SP expression and POP.Trial registrationThe study protocol was retrospectively registered on the www.clinicaltrials.gov database (NCT06081335) at (13/10/2023) after the approval of the Ethics Committee, Faculty of Dentistry, Ain Shams University (FDASU-RecIM012135).

The use of medicaments in the management of symptomatic irreversible pulpitis: A community-based cohort study.

To investigate patient outcomes from either pulpotomy or pulpectomy for the management of symptomatic irreversible pulpitis, with and without application of antibiotic/corticosteroid pastes in urgent primary dental care settings in the United Kingdom. All patients receiving intervention for symptomatic irreversible pulpitis in three different primary care settings were invited to participate. Pre-operatively, data regarding patients' numerical ratings scale (NRS), pain score (0-10), analgesic use, oral-health impact profile-14 (OHIP-14) and need for time away from work were collected. For 7 days post-operatively, participants recorded their NRS pain score, global rating of change score, medication use and their ability to work. Analysis used a mixed-effects model with post hoc Tukey's multiple comparisons test for continuous data and chi-squared or Fisher's exact test for categorical data. To test the effect of the corticosteroid/antibiotic paste, pulpectomy and pulpotomy groups were combined following Mantel-Haenszel stratified analysis or a weighted average of the difference between pulpotomy and pulpectomy with and without the use of corticosteroid/antibiotic paste. A binary composite score was constructed using pre- and post-operative data, whereby overall treatment success was defined as: (i) patients did not return for treatment due to pain by day seven; (ii) at day three, there was a 33% (or 2-points) reduction in NRS pain score; (iii) there was a change score of +3 in global rating; (iv) the patient was no longer using analgesia and able to return to work. Eighty-five participants were recruited, with 83 completing follow up. Overall treatment success was 57%, with 25% of participants returning for more treatment due to inadequate pain relief. Overall treatment success did not differ between the two groups (p = .645), although patients self-reported greater improvement with an antibiotic/corticosteroid dressing for global rating of change (p = .015). This study identified limited evidence of improved outcomes using antibiotic/corticosteroid dressings in the management of symptomatic irreversible pulpitis in the emergency setting. Further clinical research is needed to understand if these medications are beneficial in affording pain relief, above that of simple excision of irreversibly inflamed pulp tissue.

Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial.

Single-visit pulpectomy (SVP) protocol with rotary files is highly recommended for the treatment of teeth with irreversible pulpitis. Various rotary endodontic files specially designed for use in the pediatric population are available. The aim is to clinically assess the parameters related to the time required for biomechanical preparation (TBMP) and quality of filling using a single file system vs a sequential multi-file system in infected primary mandibular molars. A total of 45 infected primary molars were allocated to three groups (two experimental groups (n = 15) and a control group. The first experimental group was instrumented using NiTi K-Flex files, the second group with a single file rotary system with variably variable (VV) taper, and the third with a sequential multi-file system with constant taper. Biomechanical preparation time was recorded and standardized digital radiograph (RVG) were taken pre- and postinstrumentation. The data recorded was sent for statistical analysis. There is a substantial reduction of TBMP in primary molars using single file VV taper and multi-sequential file constant taper. Obturation time for all three file systems was comparable and there were no differences between the three file systems used (p > 0.05). Multi-sequential file constant taper files showed a higher probability of optimal obturations and minimal voids followed by NiTi "K-Flex" files and single file system but the difference was nonsignificant (p > 0.05). However, using a rotary in primary teeth results in better canal shape, and less TBMP leading to a better quality of treatment in less time. Shetty B, Singh R, Patil V, et al. Comparative Evaluation of Single Rotary File System and Sequential Multi-file Rotary Systems on Time for Biomechanical Preparation and Obturation Quality in Single-visit Pulpectomy Protocol: A Double-blind Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(S-3):S247-S252.

Possible Involvement of X-Box Binding Protein-1 in the Onset of Pulpitis.

Endoplasmic reticulum (ER) stress plays important roles not only in stress avoidance, but also in cell differentiation and maturation, cell proliferation, and promotion of bone formation. This study aimed to investigate the involvement of ER stress in the onset of pulpitis. Immunohistochemical analysis was conducted on human teeth extracted for orthodontic reasons. The effects of tunicamycin (TM), an inducer of ER stress, lipopolysaccharide (LPS), and 4μ8c, an inhibitor of inositol-requiring enzyme 1 (IRE1) on cultured human dental pulp cells (hDPCs) were also examined. The expressions of two ER stress markers, X-box binding protein (XBP)-1 and binding immunoglobulin protein (BiP)/78 kDa glucose-regulated protein (GRP78), were found in the human pulp tissues of a decayed tooth that had not developed irreversible acute pulpitis, but not in an impacted tooth without inflammation in pulp tissue. Both TM and LPS increased the mRNA levels of XBP-1, interleukin (IL)-6, and IL-8, whereas TM, but not LPS, enhanced the mRNA expression of BiP/GRP78 in hDPCs. 4μ8c significantly suppressed the increased level of XBP-1 by LPS. This study is the first to demonstrate that XBP-1, in addition to inflammatory cytokines, may participate in the onset of pulpitis through IRE1. These findings provide a more comprehensive understanding of pulpitis pathogenesis through the cooperation of ER stress and inflammatory cytokines.

Comparative Outcomes of Pulpotomy in Mature Molars with Irreversible Pulpitis: A Non-Randomized Trial Evaluating Calcified and Non-Calcified Pulp Chambers.

This non-randomized clinical trial investigated the outcomes of full pulpotomy in adult molars with irreversible pulpitis, comparing those with calcified and non-calcified pulp chambers over 6 and 12 months. A total of 101 adult permanent molars with irreversible pulpitis, in individuals over 12 years old, were categorized based on pulp chamber calcification observed in radiographic images by two endodontists. Subsequently, full pulpotomy procedures were performed, achieving hemostasis, and applying a 2 mm layer of calcium-enriched mixture (CEM) cement as a pulp covering agent. After 48 hours, the setting of the CEM cement was verified, followed by the application of a layer of resin-modified glass-ionomer. The tooth was then restored using amalgam. Clinical and radiographic evaluations were conducted at 6-month and 1-year follow-ups by blinded endodontists. Success rates were compared using Fisher's exact test and logistic regression tests with a significance level of 0.05. Among the 97 patients with 6-month and 1-year follow-ups, all achieved clinical success. Radiographic success rates were 99% at 6 months and 96.9% at 1 year, regardless of pulp calcification. In the 6-month follow-up, success rates were 98.07% for non-calcified pulp chambers and 100% for calcified pulp chambers. At the 1-year follow-up, success rates were 96.1% and 97.8%, respectively. Statistical analysis showed no significant difference in radiographic success rate between the two groups at both follow-ups (P>0.05). Full pulpotomy using CEM cement is a successful treatment for adult permanent teeth with calcified and non-calcified pulp chambers presenting signs and symptoms of irreversible pulpitis up to a 1-year follow-up. This study provides compelling evidence that vital pulp therapy can be effectively employed in the pulpotomy of calcified teeth, at least in the short term.

Effectiveness of Lignocaine with and without Pre-operative Oral Ibuprofen in Controlling Pain in Primary Mandibular Molars with Irreversible Pulpitis in 5 to 9-Year-Old Children: A Randomized Controlled Trial.

Childhood experiences of pain associated with dental treatment can induce dental anxiety. Infe-rior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children. One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1: 80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% ligno-caine (with 1: 80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated mea-sures analysis of variance (ANOVA). In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The differ-ence in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84. Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children.

Problems of diagnostic of the state of pulp and pulpal diagnoses in children.

Aim: To analyze diagnostic methods of the pulp status in children and align pulpal diagnoses with international and Ukrainian classifications. Materials and Methods: The authors searched for articles via Google using keywords such as «pulpitis classif i cation», «pulp diagnostic in children», «reversible pulpitis», «irreversible pulpitis», «pulp necrosis» combined with «primary teeth», «permanent immature teeth». Also evidence of primary data was evaluated by levels of evidence statements and grades of recommendations for questions relating to diagnosis. Results: Level of evidence of primary data about methods of pulpal state diagnosis varies from 2 to expert opinion, grade of recommendation is C-D. Sensibility tests can be used for pulp diagnosing in primary and immature permanent teeth, in conjunction with other clinical diagnostic aids. Such conditions of pulp as complete pulp necrosis, pulpless and infected root canal system, previously treated pulpitis, and previously initiated therapy could be included in the Ukrainian classif i cation. Pulp hyperplasia only partially corresponds pulpitis chronica hypertrophica and may be associated with any form of reversible and irreversible pulpitis. In international classif i cations, partial pulp necrosis includes pulpitis chronica gangraenosa and pulpitis acuta purulenta from the Ukrainian variant. Conclusions: Pulpal diagnosis in children relies on observation of clinical and periapical radiographic fi ndings. While the Ukrainian classif i cation covers various forms of pulpitis, it could be expanded to include pulp conditions, but only some of them completely correspond diagnoses of the Ukrainian classif i cation. Therefore, the development of new classif i cation of the status of the pulp in children is promising and challenging task.

Assessing the Impact of Mandibular Molar Root Length on Success in Supplemental Intraligamentary Injection for Irreversible Pulpitis.

This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following an inferior alveolar nerve (IAN) block. Various factors, including anatomical location, tooth type, and anesthetic solution, may affect supplemental anesthesia success. A total of 251 patients diagnosed with irreversible pulpitis in mandibular first or second molars underwent buccal infiltration anesthesia (4% articaine with 1:100,000 epinephrine) after IAN block injection (3% prilocaine and 0.03 IU/mL of felypressin). Fifty patients experiencing pain during access cavity preparation received supplemental intraligamentary injection (0.3 mL of 2% lidocaine with 1:80,000 epinephrine) at each mesial and distal line angle. The root length of treated teeth was recorded using an apex locator. Data analysis involved independent t-tests, Chi-square tests, and logistic regression. Successful supplemental intraligamentary injection was observed in 21 (42%) out of 50 patients. No significant correlation was found between the mean length of mesiobuccal (P=0.61), mesiolingual (P=0.34), or distal (P=0.60) canals of mandibular molars and the injection's success. Logistic regression analysis, however, revealed a significant impact of mesiolingual canal length on the success rate [OR 0.09 (0.01-0.79), P=0.030]. The root length of mandibular first and second molars does not significantly affect the success of supplemental intraligamentary injection.

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.

A questionnaire-based study on the management of deep carious lesions and exposed pulp among members of the Indian conservative dentistry and endodontic societies

Aim: Lack of unanimity in decision-making regarding the management of deep caries and exposed pulp has been highlighted by several questionnaire-based studies from various geographic regions. There is no research available in the Indian setting. The aim of the present study was to evaluate the perspectives of the Indian Endodontic Society and Indian Association of Conservative Dentistry and Endodontics members using an online questionnaire. Methods: An online structured questionnaire of 17 questions was mailed to 200 members based on the periapical radiographs of two cases (18 and 55 years of age) highlighting deep carious lesions and normal periapex in a mandibular molar. Each case had three hypothetical scenarios based on pulpal symptoms, i.e., asymptomatic pulp, reversible, and irreversible pulpitis, respectively. Results: A response rate of 65.5% (n = 131) was achieved. Nonselective caries removal was chosen by 40% and 36% of the participants in young patients with asymptomatic pulp and reversible pulpitis. On pulpal exposure, direct pulp capping was chosen by a majority of the members (66% and 54%, respectively) in a young patient. For irreversible pulpitis, pulpectomy was favored by 70%. In an older patient, less vital pulp therapy and more pulpectomy were preferred. The symptoms and patient age significantly altered treatment decisions, as determined by Chi-square and Fisher’s exact tests (P &lt; 0.05). Conclusion: There was a lack of agreement in managing deep carious lesions. There was partial awareness of the management of exposed pulp.

The role of cryotherapy in the reduction of postoperative pain in patients with irreversible pulpitis and/or apical periodontitis: A randomized controlled clinical study

The role of cryotherapy in the reduction of postoperative pain in patients with irreversible pulpitis and/or apical periodontitis: A randomized controlled clinical study

Perception of Prophylactic Root Canal Therapy for Teeth used as Abutments in Fixed Partial Dentures among Dental Surgeons in Maharashtra and Kerala: A Questionnairebased Cross-sectional Survey

Introduction: The pulps of healthy teeth used as abutments for Fixed Partial Dentures (FPD) undergo mechanical and thermal stresses during tooth preparation. The remaining dentin thickness, the heat produced during tooth preparation, and the permeability of dentinal tubules influence the severity of pulpal injury. Prophylactic Root Canal Therapy (RCT) could be an option to provide better outcomes for FPD treatment. Aim: To assess dentists’ perception regarding the need for prophylactic RCT of abutment teeth in FPD through a questionnaire. Materials and Methods: A Questionnaire based Cross-sectional Surve was conducted among 200 dental professionals in the Indian states of Kerala and Maharashtra over a period of two months. The participants included dental professionals from private clinics, dental Institutions, and postgraduate students in these states. The Chi-square test of proportion was performed to assess significant differences between each response. Results: Total 67 out of 200 practitioners, accounting for 33.5%, recommended prophylactic RCT, while 60 (30%) practitioners disagreed with it. A total of 152 (76%) practitioners suggested clinical assessment of abutment teeth before starting the tooth preparation. Total 70 (35%) practitioners had never experienced pulpal damage in abutment teeth in their clinical practice. In contrast, 127 (63.5%) practitioners experienced pulpal damage in less than half of the total cases, and 3 (1.5%) practitioners experienced failures like pulp necrosis or irreversible pulpitis in more than half of the total cases. Conclusion: Total 33.5% of the surveyed dental practitioners recommended prophylactic endodontic treatment for abutment teeth in FPDs. Implementing precise elective RCT guidelines into dental curricula was suggested as a potential avenue to enhance decision-making and improve patient outcomes by reducing the incidence of pulpal damage beneath FPDs.

Photobiomodulation by soft laser irradiation with and without ibuprofen improves success rate of inferior alveolar nerve block using 2% lignocaine with adrenaline in symptomatic irreversible pulpitis of mandibular molar teeth: a double-blind, randomized placebo-controlled trial.

Achieving successful pain control and adequate anesthesia through an inferior alveolar nerve block for endodontic treatment in cases with symptomatic irreversible pulpitis (SIP) is difficult, especially in mandibular molars. This study was designed to compare the effect of oral medication with ibuprofen and soft laser therapy on inferior alveolar nerve block during endodontic treatment. The trial comprised 180 patients (45 each group) with SIP. Four groups of patients were created: group 1 received 400 mg of ibuprofen; group 2 received soft laser irradiation; group 3 received a combination of soft laser and ibuprofen 400 mg; and group 4 received a placebo 1 h prior to local anesthesia. Patients recorded their pain scores on the Heft-Parker visual analog scale (VAS) before the start of intervention, 15 min after anesthesia, during access cavity preparation, and ultimately during root canal instrumentation. Each patient also rated their level of discomfort on a VAS. Every stage with no or minimal discomfort was deemed successful. The chi-square, Kruskal-Wallis, and one-way analysis of variance tests were used to evaluate the data. The best success rate was achieved for soft laser ibuprofen combination, ibuprofen and soft laser groups reported similar success results, and control group recorded the least pain scores. The mean pain scores were lowest for group 3 and highest for group 4 (P < 0.001). Ibuprofen and soft laser combination was significantly better than control group (P < 0.001). There was no significant difference between ibuprofen and laser groups (P = 0.24). For teeth with irreversible pulpitis, preoperative ibuprofen treatment combined with soft laser irradiation greatly improved the success rates of inferior alveolar nerve block anesthesia.

Effectiveness of Lidocaine versus Lidocaine with Magnesium Sulphate During Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Randomised Double-Blinded Clinical Trial.

This study aimed to compare the effectiveness of lidocaine with magnesium sulphate in patients undergoing root canal treatment following irreversible pulpitis. A total of 86 patients were randomised to receive 1.8 ml of 2% lidocaine replaced with 0.2 ml of 10% magnesium sulphate with 1: 80,000 epinephrine (n=43) as MGS group and 1.8 ml of 2% lidocaine with 1: 80,000 epinephrine (n=43) as LDC group. Preoperative visual analogue scale (VAS) pain scores were record-ed. Patients were instructed to report any perioperative pain felt during the access cavity preparation and when introducing the first patency file (#10 k) in the root canal and perioperative VAS recorded. The success rate of the inferior alveolar nerve block (IANB) was higher in the MSG group. The mean+-SD of perioperative pain was 0.16+-0.37 in the MSG group and 3.13+-0.77 in the LDC group. The MGS group produced better anaesthetic efficacy with a p-value of 0.01. Based on the results, adding 10% magnesium sulphate to 2% lidocaine increased the effective-ness of IANB in patients with symptomatic irreversible pulpitis of mandibular molar teeth.

Negotiating and Treating Lateral Canals: Report of 7 Cases.

This is a series of 7 cases in which the operator penetrated lateral canals with instruments. Two teeth presented with irreversible pulpitis, 4 with necrotic pulps, and 1 with previous treatment. Except for the teeth with pulpitis, all the others were associated with apical periodontitis. The main root canal was always relatively straight, with the lateral canals at the middle third of the root. Suggestive images of lateral canal presence were seen on periapical radiographs in five cases. The clinician introduced intentionally small hand instruments in the lateral canal in 5 cases, while the penetration was fortuitous in the others. The lateral canals were obturated in all cases. Follow-up examination was possible in five cases, all of them showed evidence of successful clinical and radiographic outcomes. Introducing files into lateral canals may permit some preparation and penetration of irrigant solution, favoring disinfection and, consequently, enhancing the treatment outcome. (EEJ-2023-05-063).