Mandibular Posterior Teeth Research Articles

Evaluating the osteogenic potential of insulin-like growth factor-1 microspheres on osteoblastic activity around dental implants in patients with type 2 diabetes mellitus using bone scintigraphy: A split-mouth randomized controlled trial

Statement of problemDental implants are susceptible to early failure when placed in patients diagnosed with type 2 diabetes mellitus. The osteoinductive potential of insulin-like growth factor-1 (IGF-1) has been widely investigated in animals with type 2 diabetes mellitus, but studies investigating the osteoinductive potential of IGF-1 around dental implants in patients diagnosed with type 2 diabetes mellitus are lacking. PurposeThis randomized controlled trial was conducted to assess the osteogenic efficacy of poly(lactide-co-glycolide)– (PLGA) encapsulated IGF-1 microspheres around dental implants placed in patients diagnosed with type 2 diabetes mellitus. Material and methodsA split-mouth, randomized controlled trial was conducted in 10 participants diagnosed with type 2 diabetes mellitus and with bilaterally missing mandibular posterior teeth. The 20 sites were randomly allotted to receive the PLGA encapsulated IGF-1 or placebo microspheres followed by the placement of Ø3.8×11-mm implants. Osteoblastic activity was quantitatively assessed with bone scintigraphy scanning on the thirtieth, sixtieth, and 90th day after implant placement. The Shapiro-Wilks test was used to analyze the normality of data, followed by the independent t test to compare the experimental and placebo groups. Intragroup comparison was performed by using repeated-measures ANOVA and the post hoc Bonferroni test (α=.05). ResultsStatistical analysis revealed that the mean osteoblastic activity was higher in the experimental group which received the PLGA–encapsulated IGF-1 than in the placebo group at the 30th, 60th, and 90th day after implant placement (P≤.001). ConclusionsThis randomized controlled trial indicated that the PLGA–encapsulated sustained release of IGF-1 microspheres enhanced the process of osseointegration in patients diagnosed with type 2 diabetes mellitus until the 90th day after implant placement.

Evaluation of Mineralized Plasmatic Matrix as a grafting material around immediate dental implant in mandibular posterior teeth

Abstract Objective: the present study was performed to evaluate Mineralized Plasmatic Matrix (MPM) as a grafting material around immediate dental implant in mandibular posterior teeth Material and Methods: eight patients were selected for immediate dental implant in mandibular posterior teeth and use MPM as a grafting material around the implant. After surgery each patient were evaluated clinically at the following interval immediate, one week, two weeks, and three months postoperatively for:: Presence of infection, Edema, Graft exposure and/or loss, Soft tissue dehiscence, Pain, Nerve injury and Implant stability, and radiographically immediate and three months postoperatively interval by CBCT for: Bone density around the dental implant and Horizontal bone loss around the dental implant. Results: All patients hadn’t any infection, nerve injury, Graft exposure and /or loss, soft tissue dehiscence and facial edema throughout the study till three months. Osstel at 3 months (81.0 ± 7.68) was higher than immediately (63.40±4.16). Bone density at 3 months (447.0± 28.64) was higher than immediately (243.0±17.18). Patients experienced mild to moderate pain after surgery, at the surgical sites which decrease gradually during four days postoperatively then disappeared completely at the 7th day. Conclusion: The use of MPM with immediate implant reduces postoperative infection, edema, pain, graft exposure and/or loss and soft tissue dehiscence. Use of MPM with immediate implant enhances the implant stability, improves bone density around it and decrease marginal bone loss around the immediate implant.

Flapless Guided Implant Surgeries Compared with Conventional Surgeries Performed by Nonexperienced Individuals: Randomized and Controlled Split-Mouth Clinical Trial.

The study aimed to evaluate the outcomes of flapless guided surgery related to surgery, patient, operator, assistant, and advisor, comparing it with conventional surgery performed by undergraduate students who had never placed implants in patients. A randomized controlled split-mouth clinical trial was carried out. Ten patients with bilateral mandibular posterior tooth loss received an implant on each side with conventional flap surgery or flapless guided surgery that was performed by undergraduate students. Surgery time, pain, patient satisfaction, quantity of consumed medications, time of procedure, ease of procedure, anxiety, and stress were assessed. Conventional surgery showed statistically significantly inferior results compared with flapless guided surgery in terms of procedure time (56 minutes, 36 seconds ± 8 minutes, 38 seconds vs 30 minutes, 1 second ± 6 minutes, 2 seconds), consumption of analgesic medications (49 tablets vs 15 tablets), intraoperative (1.75 ± 1.56 vs 0.65 ± 0.64) and postoperative pain (4.62 ± 2.17 vs 1.17 ± 0.72), and operator anxiety (4.76 ± 1.66 vs 3.47 ± 1.50), respectively. Flapless guided implant surgeries performed by individuals with no previous clinical experience showed reduced surgery time and delivered better patient-reported outcomes both in the intraoperative and postoperative periods; reduced medication consumption; and showed better results in the operator and assistant perspectives.

Ill-defined extensive radiolucent lesion of the left posterior mandible

A 60-year-old female patient was referred by an outside oral and maxillofacial surgeon for evaluation of a left posterior mandibular “lesion.” The patient estimated that she had first experienced pain associated with the left mandibular posterior teeth approximately 6 months before presentation. She also experienced progressive difficulty with mastication on the left side. She was seen by her general dentist and was referred to an oral surgeon for extraction of the left mandibular posterior teeth due to periodontally compromised dentition.

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%.

Comparison of efficacy of lignocaine, ropivacaine, and bupivacaine in pain control during extraction of mandibular posterior teeth.

Background:The management of pain during extraction of mandibular third molars is an important requisite to achieve patient comfort and to obtain desired result in an effective manner. There are various anesthetics that can be used to achieve regional or local anesthetic effect in this regard.Aim:The aim of this study was to compare the efficacy of 2% lignocaine with 1:80,000 adrenaline, 0.75% ropivacaine and bupivacaine in pain control during extraction of mandibular posterior teeth.Materials and Methods:This prospective, cross-sectional study included 300 study participants indicated for mandibular third molar surgical extractions. The study subjects were categorized into three broad groups - (a) Group I (n = 100): Third molar extractions performed using 2% Lignocaine with 1: 80,000 epinephrine; (b) Group II (n = 100): This group included subjects who underwent extractions of mandibular third molars using 0.75% ropivacaine and (c) Group III (n = 100): This group included patients who underwent extractions of mandibular third molars with bupivacaine. Inclusion criteria were: (a) partially impacted mandibular third molars which were symptomatic; (b) written informed consent. Exclusion criteria were – (a) any systemic diseases and/or undergoing any medication for same; (b) subjects not willing for extraction after clinical and radiographic examination and opinion and (c) subjects undergoing orthodontic therapy. Subject response for pain was recorded using – (a) visual analog scale (VAS) and (b) Verbal Rating scale (VRS). Postoperative pain was assessed using requirement of analgesics after extraction. SPSS version 21.0 was employed as statistical software. Statistical tool used was the Analysis of Variance test which was used for determining statistical significance which was set at a P value of lesser than 0.05 (significant).Results:On analysis of visual analog scale (VAS), it was observed that in Group I (2% Lignocaine with 1:80,000), no pain during the extraction procedure was demonstrated in 30 study participants while minimal or less pain was present in 70 patients, while in Group II (0.75% ropivacaine), 90 patients presented with no pain while ten patients had presented with minimal amount of pain during tooth extraction. While on the other hand, Group III patients whose mandibular third molars were extracted using local anesthesia by injecting bupivacaine, lack of any pain was observed in 69 patients while minimal pain was noted in 31 individuals. While making statistical comparison between three groups, a significant P = 0.03 was observed. Also, postoperative pain was noted in 60% of cases who underwent extraction using 2% lignocaine (Group I), 10% patients who had third molar extractions under Bupivacaine anesthesia presented with pain whereas none of the patients (0%), demonstrated the presence of pain following third molar extraction.Conclusion:0.75% Ropivacaine is the most effective local anesthetic agent that can be used for extracting mandibular third molars due to its effective pain control both during and following the procedure when compared to 2% lignocaine and bupivacaine.

Glandular odontogenic cyst: Report of a pediatric case in an uncommon location

Glandular odontogenic cyst (GOC), first described by Padayachee and Van Wyk in 1987, is a rare odontogenic cyst of the jaw which is commonly prevalent in the fourth decade. Clinically, it commonly presents as an asymptomatic swelling in the mandibular anterior region. A conclusive diagnosis can be given through histopathological examination. GOC is found to have a high recurrence potential which requires regular follow-up. Here, a rare case of a 14-year-old boy is described who presented with a swelling in left mandibular posterior teeth.

Hemimandibular hyperplasia treatment with condylectomy and orthodontic camouflage treatment using miniplate

A 13-year-old growing female patient presented with hemimandibular hyperplasia of the right side, Class III hypodivergent skeletal pattern, and severe facial asymmetry. Corrective surgery was deferred until her growth had been completed. When the patient was 16years old, a low condylectomy was performed on the hyperplastic side of her mandible to prevent its progressive condylar hyperplasia, while simultaneous orthodontic camouflage treatment was performed with the intrusion of the maxillary right posterior teeth using temporary skeletal anchorage devices without additional orthognathic surgery. A low condylectomy caused anterior and lateral open bite after the downward and backward movement of the chin, which improved Class III appearance. The intrusion of the maxillary right posterior teeth followed by compensating extrusion of the mandibular posterior teeth contributed to improve the patient's facial asymmetry with correction of the transverse occlusal plane and lip canting. After 30months of treatment, an acceptable esthetic outcome and functional occlusion were achieved. The treatment results were well maintained for 1-year retention.

A COMPARATIVE EVALUATION OF ANESTHETIC EFFICACY OF 4% ARTICAINE WITH 1:100000 EPINEPHRINE AND 2% LIDOCAINE WITH 1:100000 EPINEPHRINE FOR INFERIOR ALVEOLAR NERVE BLOCK AND LONG BUCCAL NERVE BLOCK DURING ROOT CANAL TREATMENT: AN IN VIVO STUDY

Background: It is important to control the pain associated with root canal treatment (RCT) in endodontic. Pain accompanying fear and anxiety due to endodontic treatment can be reduced by anesthetic techniques. The present study aims to compare the effect of articaine versus lidocaine local anesthesia for inferior alveolar nerve block (IANB) and long buccal nerve block on pain during RCT. METHODS: Twenty patients diagnosed with symptomatic irreversible pulpitis of mandibular posterior tooth were selected. The patients randomly received either cartridge of lidocaine or articaine using IANB and long buccal nerve block. The patients were randomly divided into two groups of ten. Group 1: patients received IANB and long buccal nerve block 2% lidocaine with 1:100000 epinephrine. Group 2: patients received IANB and long buccal nerve block with 4% articaine with 1:100000 epinephrine. Before the Injection, the patient received all information about the visual analysis scale (VAS). Pain was evaluated using VAS scale in numberic value 1 to 10 number. The pain was evaluated at three different stages: before administration of LA, after immediate access opening, and after immediate obturation procedure. Data were analyzed using various suitable statistical tests. RESULT: The mean value of efcacy of pain before administration of local anesthesia (LA) was 8.50 ± 0.97 for lidocaine and 8.30 ± 0.48 for articaine had no signicant difference. A signicant difference was observed at two different duration after immediate access opening and after immediate obturation where articaine has a lower mean value 3.60 ± 1.08 and 1.60 ± 0.17 respectively (P&gt;0.05) as compared to the mean value of lidocaine 4.10 ± 1.10 and 1.60 ± 0.17 respectively Conclusion: Within the limitations of the study, in cases of symptomatic irreversible pulpitis articaine 4% did not alleviate pain much and showed better anesthetic efcacy than 2% lidocaine with IANB and long buccal nerve block.

Rehabilitation single tooth loss with screw retained implant crown: Case report

Tooth loss is a common problem in adults. the negative effects of tooth loss are decreased chewing and speech function, reduced aesthetics, and migration of adjacent teeth. Many types of dental prosthetics can be used to prevent these negative effects, such as removable partial dentures, adhesive resin dentures, fixed partial dentures, and dental implants each prosthesis had its advantages and disadvantages. In this case report the clinician will discuss about single tooth implants. The aim of this case report is to provide information about the procedure for placement single tooth implants to the posterior mandibular teeth using the screw retained implant technique.

Orofacial Infections in Kenya: A Retrospective Study

Background: Orofacial infections are either odontogenic or non-odontogenic in nature. The clinical spectrum of these infections is diverse. This study aimed to describe the presentation and management of patients presenting with orofacial infections at Kenyatta National Hospital (KNH).&#x0D; Materials and Methods: This was a retrospective study based on clinical records of patients treated for orofacial bacterial infections at KNH fromJanuary 2016 to December 2018. Data on the following study variables were obtained and analyzed: demographic data, clinical presentation, diagnosis, management, and treatment outcome.&#x0D; Results: 214 clinical records were studied. Male to female ratio was 1.4:1 with age range of 3 months to 78 years (mean=27.0 years). Swelling (96.30%, n=206) was the most common symptom, next was pain (58.90%, n=123). The most common source of infection was odontogenic (60.30%,n=129) in nature. Permanent teeth (57.00%, n=122) were more commonly involved than deciduous teeth (2.80%, n=6). In both dentitions, the mandibular posterior teeth were the most commonly involved, Ludwig’s angina (30.84%, n=66) and submandibular abscess (25.23%, n=54) were the most common clinical diagnoses of orofacial bacterial infection. The commonly used treatment modality was a triad of extraction of the associated tooth, incision and drainage, and antibiotic therapy. These management modalities resulted in favorable treatment outcomes (92.50%, n=198) in most cases.&#x0D; Conclusion: Orofacial infections can occur among all sociodemographic groups. These infections are potentially life-threatening if not diagnosed early and managed promptly. Multidisciplinary teams are required to manage the severe morbidity and mortality of advanced orofacial infections.&#x0D; Keywords: Orofacial infections, Odontogenic, Abscess, Ludwig’s angina

Evaluation of the Influence of Bone Resorption on Dental Implant Systems Using Taguchi Method and Finite Element Analysis

Dental implants are currently the mainstay of dental restoration procedures. They are used to reestablish normal chewing functions for patients. Several studies have reported their high success rate, but post-op bone resorption at the implant site increases the risk of implant fracture, which is especially significant in the posterior mandibular tooth (PMT) area. This study focused on bone resorption at the PMT area to assess and understand the mechanism of implant failure. This study used three implant systems on the posterior mandibular area. Computer tomography (CT) scans and reverse engineering were used to construct mandible and implant systems. The Taguchi method and finite element analysis (FEA) were used to explore the role of biting force on the components of various implant systems in the development of bone resorption. The results of this study found that when the implant site with bone resorption takes a biting force, the stress on the implant is inversely proportional to implant diameter and proportional to its length. For the stress loading, cortical bone thickness does not play a significant role. Instead, the most significant factor is implant diameter, followed by implant length. For better operation outcomes, it is recommended to use implants of larger diameter and less length. Also, it is recommended to avoid the use of implants less than 4.5 mm in diameter, regardless of the implant system, in order to prevent early implant damage or fracture due to bone resorption.

RCT on the effectiveness of the intraligamentary anesthesia and inferior alveolar nerve block on pain during dental treatment

ObjectiveTo compare the effectiveness and complications of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) during injection and dental treatment of mandibular posterior teeth.Materials and methodsIn this randomized, prospective clinical trial, 72 patients (39 males, 33 females), scheduled for dental treatment of mandibular posterior teeth, were randomly allocated to ILA group (n = 35) received ILA injection or IANB group (n = 37) received the conventional IANB. Our primary outcome was to assess pain and stress (discomfort) during the injection and dental treatment, using the numeric rating scale (NRS) from 0 to 10 (0 = no pain, 10= the worst pain imaginable), whereas recording 24-h postoperative complications was our secondary outcomes.ResultsPatients in ILA group reported significantly less pain during injection when compared with IANB group (p = 0.03), while pain during dental treatment was similar in both groups (p = 0.2). Patients in both groups also reported similar law values of discomfort during treatment (p = 0.7). Although no signs of nerve contact or any other postoperative complications were observed, five patients in IANB group (none in ILA group) reported temporary irritations.ConclusionThis study showed equivalent effectiveness of both intraligamentary anesthesia and conventional inferior alveolar nerve block, for pain control during routine dental treatment of mandibular posterior teeth. Nevertheless, ILA showed significantly less pain during injection. No major postoperative complications in both groups were observed.Clinical relevanceILA could be considered as an effective alternative for routine dental treatment.Trial registrationNCT04563351

A Novel Approach to Restore a Decayed Mandibular Posterior Tooth by Immediate Implant Placement Using Autogenous Tooth Graft Material Mixed with Platelet-Rich Fibrin: A Case Report

A dental implant is the most accepted treatment option to replace the badly decayed tooth or missing tooth. The jumping gap left after the placement of the implant in the socket will require augmentation of bone graft material. In this case report, the extracted root stumps are used as an autogenous tooth graft material after its preparation. And PRF is mixed with graft material for additive advantage. So, the present case report discusses the feasibility of the use of autogenous tooth graft material along with PRF for the better osseointegration of the implant.

Comparison of immediate and delayed loading of dental implants in mandibular posterior teeth: Clinical observations and review

Introduction: The study is aimed to compare the clinical outcome of immediate and delayed loaded single tooth implants in replacement of mandibular posterior tooth in consideration with implant stability quotient, bleeding on probing, probing depth, implant mobility, marginal bone loss and peri-implant radiolucency. Materials and Methods: The study consisted of 20 patients who were divided into two groups and compared: Group A is an immediately loaded group with ten patients who received implants in the mandibular posterior tooth region along with abutment on the same day and acrylic crown placed within 48 h and the second group is a conventionally loaded group of ten patients who received the implant in the mandibular posterior tooth region in which the cover screw was placed and conventionally loaded after 3 months. Implant stability quotient, implant mobility, bone loss and peri-implantitis were assessed at 1st and 6th months after loading. All patients were evaluated for the parameters at 1st, 3rd and 6th months after loading in both the groups. Results: Probing depths obtained for all twenty patients after 1 and 6 months of loading were within the normal range (1–3 mm). In Group A, the mean probing depth after 1-month loading was 1.8 mm with a standard deviation (SD) of 0.63 and after 6 months of loading 1.2 mm with SD 0.42. In Group B, the mean of the probing depth after 1 month of loading is 1.8 mm with SD 0.42 and remained the same post loading after 6 months. Marginal bone loss was measured mesially and distally after 1 month and 6 months in both the groups. The standard intraoral periapical radiograph was used to evaluate peri-implant radiolucency. No patient showed peri-implantitis for 6-month follow-up after loading of implants. Conclusion: Immediate loading of an implant in a single mandibular posterior tooth can be an effective treatment modality and a promising alternative to delayed loading.

Comparative prospective clinical evaluation of computer aided design/ computer aided manufacturing milled BioHPP PEEK inlays and Zirconia inlays.

Aim:The aim of the present study was to clinically assess the performance of BioHPP PEEK material when used for inlay restoration and to compare it with widely used zirconia inlays. This clinical study was undertaken to evaluate their performance in terms of retention, colour matching, marginal discoloration, marginal adaptation, secondary caries, surface texture, wear-anatomic form, postoperative sensitivity and fracture resistance using the modified Ryge's criteria.Settings and Design:In vivo - prospective clinical study.Material and Methods:A total of 40 patients were selected based on inclusion and exclusion criteria requiring inlays. The patients were further divided in two groups: Group A - Consisted of 20 permanent maxillary and mandibular carious posterior teeth restored with BioHPP PEEK inlays and Group B - Consisted of 20 permanent maxillary and mandibular carious posterior teeth restored with CAD/CAM zirconia inlays (sintered monolithic zirconia, Zolid, Amann Girrbach AG, Koblach, Austria). Two prosthodontists, who were blinded to the study groups, evaluated the restorations. In cases of widely different scores, the observers re-evaluated the restorations and reached a consensus. Restorations were evaluated at the end of 1 week (base line), 3 months, 6 months, and 12 months, using modified Ryge's criteria.Statistical Analysis Used:Chi- square' test, 'Fisher's exact' test and 'z' test.Results:90% of the BioHPP PEEK inlays were rated satisfactory in comparison to 95% of zirconia inlays. Sensitivity score was 10% in BioHPP PEEK inlays and 15% in zirconia inlays. No significant difference was encountered with other parameters in this study.Conclusion:The BioHPP PEEK when used as indirect aesthetic restorations was found to be satisfactory with relatively low rate of fracture over an observation period of one year in comparison to zirconia inlays in posterior teeth. The BioHPP PEEK can be a suitable alternative with high level of accuracy in terms of retention, marginal quality and aesthetics.

Comparison of Condylar Bone Density in Cone-Beam Computed Tomographic Images of Patients with and without Temporomandibular Joint Disorders

Introduction: Temporomandibular disorders (TMDs) are the main source of orofacial pain of nondental origin. Density changes in mandibular condyles of patients with TMD have not been well documented. The aim of this study was to compare condylar head bone density values in patient with and without TMD in cone-beam computed tomographic (CBCT) images. Materials and Methods: CBCT images of 70 patients with TMD and 70 age- and sex-controlled individuals were studied. Density of the cancellous bone in the left and right condylar heads was measured on a CBCT slice with the widest mediolateral dimension. Moreover, absence of at least one maxillary or mandibular posterior tooth (except for third molars) was recorded. Interclass correlation, t test, and Chi-squared test were used for statistical analysis. Results: Bone density in the condylar head significantly increased in patients with TMD compared with the non-TMD group (P &lt; 0.001). The difference between males and females in each group was not significant (P = 0.182). Condylar head bone density in patients with TMD with posterior missing teeth was significantly less than individuals without missing teeth (P = 0.002). Conclusion: Increased density of condylar head must be regarded as a potential diagnostic tool for TMD when interpreting CBCT images of the joints.

Anatomical Analysis of Mandibular Posterior Teeth using CBCT: An Endo-Surgical Perspective.

Objective:This study sought to analyse the relationship between mandibular posterior teeth and the surrounding anatomical structures.Methods:A total of 170 CBCT images were examined to obtain measurements regarding the following: buccolingual (BL) and mesiodistal (MD) root thickness at the standard level of resection (3 mm from the apex), the thickness of the overlying buccal and lingual bone at the same level, the proximity of the mandibular canal (MC) to the apices of the mandibular posterior teeth, as well as the horizontal location of the mental foramen (MF).Results:The BL root width at 3 mm from the apex was the broadest at the mesial roots of the first molars with males: 5.33±0.99 mm and females: 5.16±0.88 mm (mean±SD). The root width was narrowest at the second premolars (males: 3.80±0.83 mm; females: 3.61±0.60 mm). At the same level; the buccal bone was thickest over the distal roots of the second molars (males: 6.92±1.85 mm; females: 6.95±1.95 mm) and thinnest over the first premolars (males: 1.73±0.93 mm; females: 1.49±1.01 mm), while the lingual bone was thickest over the distal roots of the first molars (males: 5.58±1.36 mm; females: 4.52±1.24 mm) and thinnest over the distal roots of the second molars (males: 3.13±1.50 mm; females: 2.60±1.46 mm). The nearest root apices to the MC were the distal roots of the second molars (male: 1.21±1.45 mm; female: 1.75±1.97 mm), while the furthest were the mesial roots of the first molars (male: 4.00±2.39 mm; female: 4.77±2.58 mm). The most common horizontal location of the MF was between the first and second premolars (51.8%). The lingual bone was significantly thinner over both roots of first molars in females (P<0.05).Conclusion:As the position of the teeth became more posterior, the buccal bone thickness increased, the lingual bone thickness decreased, and the distance to the MC became closer. CBCT analysis provides distortion- and superimposition-free images of the relevant anatomic structures.

Most effective local anesthetic technique for mandibular posterior teeth with irreversible pulpitis: A systematic review and meta-analysis

Introduction: Achieving profound pulpal anesthesia is considered as a keystone in endodontic practice as it benefits both the patient and the dentist for smooth delivery of care. A tooth that has irreversible pulpitis causes severe pain and poses an additional challenge. The aim of the present systematic review is to compare the standard inferior alveolar nerve block with other local anesthesia techniques for effectively anesthetizing the mandibular posterior teeth that present with irreversible pulpitis. Materials and Methods: A systematic review protocol was registered at Prospero. The following databases were searched: PubMed, CINAHL, Cochrane, EBSCO Oral and Dentistry Database, and Trip Database using strict inclusion and exclusion criteria. All randomized control trials on the topic published in the English language only were included. Results: The first search yielded 1213 articles, and after going through extensive screening and eligibility process, only 8 articles were finally selected for the review. There were six articaine infiltration technique groups; two were based on intraosseous technique and one each on Gow-Gates and Vazirani–Akinosi methods. The standard inferior alveolar nerve block was compared with other mandibular anesthesia techniques pooled together. A meta-analysis was carried out to compare inferior alveolar nerve block with the articaine infiltration. The difference among two sets of techniques was found to be nonsignificant (P = 0.07). However, the overall results of the meta-analysis favor articaine infiltration. The study is first of its kind comparing multiple anesthetic techniques in mandibular posterior teeth with irreversible pulpitis. Studies with the highest level of evidence, i.e., randomized controlled trials, were included only. No conclusive inference regarding Gow-Gates block and Vazirani–Akinosi techniques could be drawn on account of limited data. Conclusions: Infiltration and intraosseous appeared to be viable alternative to standard inferior alveolar nerve block in the posterior teeth with irreversible pulpitis.

Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial.

BackgroundThe efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp.MethodsOne hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment.ResultsThe rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups.ConclusionPreoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.