Pulp Tester Research Articles

Pulp sensitivity changes during orthodontic treatment at different time periods: a prospective study

ObjectiveThe purpose of this investigation was to recognize pulp sensitivity changes in teeth receiving orthodontic treatment by means of an electric pulp tester (Vitality Scanner Model 2006; Kerr Corporation, Brea CA, USA).Materials and methodsAn electric stimulus response threshold of eight teeth in 22 patients was measured prior to positioning orthodontic attachments, immediately before ligation of a nickel titanium archwire, immediately after ligation of a stainless steel archwire and 9 to 15 months after having achieved the clinical purposes established with the nickel titanium archwires. The first measurement served as baseline.ResultsAll teeth responded to an electrical stimulus at all times. No statistical differences were observed between the response thresholds obtained at different treatment times. The mean response threshold of the second measurement showed a decreasing response threshold tendency when compared with those of the baseline measurement. The mean response threshold of the third measurement showed an increasing tendency when compared with those of the baseline measurement. The first maxillary incisor and canine showed the lowest decreasing response threshold after the second measurement and the highest increasing response threshold after the third measurement. Less noticeable, but similar decreasing and increasing response threshold tendencies were observed in all other teeth after the second and third measurements, respectively.ConclusionsThe results obtained in this investigation suggest that pulp sensitivity can be monitored during orthodontic treatment by means of an electric pulp tester.Clinical relevanceThe importance of monitoring the pulp status during orthodontic treatment.

Preoperative Intraligamentary Injection of Dexamethasone Can Improve the Anesthetic Success Rate of 2% Lidocaine during the Endodontic Management of Mandibular Molars with Symptomatic Irreversible Pulpitis

IntroductionThe aim of this randomized, double-blind clinical trial was to evaluate the effect of preoperative administration of intraligamentary injections of diclofenac sodium and dexamethasone on the anesthetic efficacy of 2% lidocaine given as an inferior alveolar nerve block in the endodontic management of symptomatic irreversible pulpitis. MethodsOne hundred seventeen patients randomly received 1 of the 3 intraligamentary injections before the endodontic treatment: 0.9% normal saline, 25 mg/mL diclofenac sodium, or 4 mg/mL dexamethasone. After 30 minutes, patients received an inferior alveolar nerve block with 2% lidocaine and 1:80,000 epinephrine. The teeth were tested with electric pulp testing after 10 minutes. In case of a positive response, the anesthesia was considered as “failed.” If the electric test response was negative, a rubber dam was applied, and endodontic treatment was started. Any pain during the treatment was recorded. The anesthesia was considered successful if the patients experienced no pain or faint/weak/mild pain during root canal access preparation and instrumentation (Heft-Parker visual analog scale score <55 mm). The effect of intraligamentary injections on maximum heart rates was also recorded. The anesthetic success rates were analyzed with the Pearson chi-square test at 5% significance. ResultsThe control, diclofenac sodium, and dexamethasone groups had anesthetic success rates of 32%, 37%, and 73%, respectively. Dexamethasone was significantly more successful than the control and diclofenac sodium groups (P < .001, χ22 = 14.7). There were no differences between the control and diclofenac groups (P > .05). All the solutions did not significantly affect heart rates. ConclusionsThe administration of an intraligamentary injection of dexamethasone before endodontic intervention of mandibular molars with symptomatic irreversible pulpitis increases the success rates of an inferior alveolar nerve block with 2% lidocaine.

Buffered 2% articaine versus non-buffered 4% articaine in maxillary infiltration: randomized clinical trial.

This randomized, triple-blind, crossover clinical trial aimed to evaluate the efficacy, onset, length of pulp and soft tissue anesthesia, and pain during injection of 2% buffered articaine and 4% non-buffered articaine solutions. Each volunteer received two maxillary supraperiosteal anesthesia infiltrations in canine area. The infiltrations were performed at two different sessions using a different local anesthetic solution for each session, and the anesthetic injection speed was always 1 mL/min. The assessment of the onset and length of pulpal and soft tissue anesthesia was performed with the pulp electrical test "pulp tester" and the esthesiometer kit, respectively. Volunteers marked pain during injection on a visual analog scale (VAS). The anesthetics solutions pH was evaluated through the pH meter equipment. There was no difference between the two anesthetic solutions (onset of soft tissue anesthesia, p = 0.5386; length of soft tissue anesthesia, p = 0.718; onset of pulpal anesthesia, p = 0.747; length of pulpal anesthesia, p = 0.375), except for pain during the injection which was lower when buffered 2% articaine was used (p = 0.001) and the pH. The pH analysis revealed that the solutions differed from one another (p < 0.01). The 2% buffered articaine solution provided the same anesthetic properties then 4% unbuffered articaine with a great reduction in pain during injection. The possibility of use 2% buffered articaine solution instead of 4% articaine maintaining the same anesthetic properties with a great reduction in pain during injection and half of the anesthetic salt concentration.

Changes in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders.

Menstrual cycle may contribute to experimental pain measures in healthy women and women with chronic pain. The present study aimed to investigate variation in pulp sensitivity across the menstrual cycle in healthy women and women with temporomandibular disorders (TMD) and to explore the effect of TMD pain and psychosocial variables on the pulp response. This longitudinal study involved 47 regularly menstruating women aged 20-45, 24 healthy and 23 with diagnosed painful TMD. The electric and cold stimuli were performed by electric pulp tester and refrigerant spray, respectively, on mandibular lateral incisors, in five menstrual phases (menstrual, follicular, periovulatory, luteal and premenstrual). Research Diagnostic Criteria for TMD were used to assess TMD, chronic pain, depression and somatisation. Regression analysis was performed to investigate the effect of the predictor variables on the pulp sensitivity. Significant phase-related differences were observed for pain intensity to cold stimuli. Higher pain sensitivity was reported in menstrual in comparison with luteal phase (P=.019) among healthy women, and in menstrual in comparison with follicular (P=.033), periovulatory (P=.003) and luteal (P=.007) phases in TMD women. No significant differences were recorded for electric stimuli. Regression analysis identified depression as the determinant of cold and electric response in menstrual phase, regardless of age and presence of TMD. Menstrual phase in healthy and TMD women with regular menstrual cycle is characterised with higher pulp sensitivity to cold stimuli. Depressive symptoms independently influence pulp response in this phase.

Evaluation of variability of electric pulp response threshold in molars: an in vivo study

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Electric pulp testers are widely used diagnostic tools in endodontics. Several factors can affect the result of electric pulp test like thickness of enamel and dentin, concentration of sensory fibres (A delta fibres), direction of dentinal tubules, pulp chamber size, neural elements etc. There are very few studies available in the literature which evaluated the variability of electric pulp response in molar teeth, which are more susceptible to caries. Hence aim of current study was proposed to evaluate response threshold in molars with respect to age and sex using electric pulp tester.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Fifty volunteers aged between 20 to 69 years were recruited. The human subjects were divided into 5 groups of 10 each (5 males and 5 females) based on age. EPT was used with appropriate electrolyte as a conducting media. Seven sites on each molar crown were tested which includes mesiobuccal cusp tip, mesiobuccal cuspal surface, mesiobuccal gingival surface, centre of the supporting cusps (palatal of maxillary molar and buccal of mandibular molar), distobuccal cuspal surface, distobuccal gingival surface and centre of the guiding cusps (buccal of maxillary molar and lingual of mandibular molars). Statistical analysed using descriptive statistics and independent sample t test.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Mesiobuccal cusp tip showed lower response threshold values compared to other sites in all the groups. group 1 responded at lower threshold and group 5 at higher.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The optimum electrode placement site for electric pulp test in molars is the mesiobuccal cusp tip irrespective of age and sex.&lt;/p&gt;

Management of Deep Carious Lesion with Single Visit Indirect Pulp Capping: A Case Report

Background: Preservation of pulp vitality is of utmost importance during management of deep caries cases.There remains a possibility of pulp tissue to repair upon excavation of caries with no pulpal exposure.However, in case of exposure of pulp, such type of minimally invasive management becomes doubtful&amp; impulsive. Indirect pulp capping(IPC) treatment plays an essential role in these cases to prevent pulpalexposure.Case Presentation: This case report describes the single visit indirect pulp therapy in mandibular molar.Patient reported with a chief complaint of food lodgement and mild intermittent pain. There was no historyof night pain and/or spontaneous pain. The clinical and radiological evaluation revealed no peri-radicularpathosis and no pulpal involvement. The tooth was examined for vitality using electric pulp test and revealedvital pulp. The treatment was done with the protocol of Single Visit Indirect Pulp therapy using light curecalcium hydroxide and cavity was disinfected with 2% chlorhexidine. Cavity was lined with Glass IonomerCement and final restoration was done using Composite resin restoration. The patient was followed up till6 months and showed satisfactory outcome eliminating the need for more invasive approach as root canaltherapy.Conclusion: Indirect pulp therapy is a safe, economical and proven treatment option in the teeth that havenot involved pulp and with sound peri-radicular tissues. The success of Indirect Pulp Capping relies onproper case selection and diagnosis, complete isolation, caries removal and disinfection with selection ofsuitable pulp capping material

Effectiveness of Autologous Platelet Concentrates in Management of Young Immature Necrotic Permanent Teeth-A Systematic Review and Meta-Analysis.

The use of autologous platelet concentrates (APCs) in regenerative endodontic procedures is inconsistent and unclear. The aim of this meta-analysis was to evaluate the effectiveness of autologous platelet concentrates compared to traditional blood-clot regeneration for the management of young, immature, necrotic, permanent teeth. The digital databases MEDLINE, SCOPUS, CENTRAL, Web of Science, and EMBASE were searched to identify ten randomized clinical trials. The outcomes at postoperative follow-up, such as dentinal wall thickness (DWT), increase in root length (RL), calcific barrier formation (CB), apical closure (AC), vitality response (VR), and success rate (SR), were subjected to both qualitative synthesis and quantitative meta-analysis. The meta-analysis showed that APCs significantly improved apical closure (risk ratio (RR) = 1.17; 95% CI: 1.01, 1.37; p = 0.04) and response to vitality pulp tests (RR = 1.61; 95% CI: 1.03, 2.52; p = 0.04), whereas no significant effect was observed on root lengthening, dentin wall thickness, or success rate of immature, necrotic teeth treated with regenerative endodontics. APCs could be beneficial when treating young, immature, necrotic, permanent teeth regarding better apical closure and improved response to vitality tests.

Recent Advancements in Pulp Testing Devices

Recent Advancements in Pulp Testing Devices

Electromagnetic interference effect of dental equipment on cardiac implantable electrical devices: A systematic review.

The electromagnet interference (EMI) effect resulting from using dental equipment near cardiovascular implantable electronic devices (CIEDs) is controversial based on in vitro and in vivo studies. We aimed to summarize the available evidence to investigate the safety of using dental equipment on patients with CIEDs. An electronic search was performed in PubMed, Embase, MEDLINE Ovid, and the Cochrane Library for relevant studies published between January 2000 and May 2020. The search strategy centered on terms related to dental devices and CIEDs. Two independent reviewers determined the final inclusion of the studies in the systematic review. The EMI effect was summarized based on different dental instruments detected in in vitro or in vivo studies. The primary search identified 84 articles, and 18 studies were finally included in this systematic review after exclusions. Most in vitro studies (n=12) reported background noise or severe EMI affecting CIED function at a close distance from the lead tip or at a high sensitivity setting of CIEDs. In in vivo studies (n=6), EMI that altered CIED function was not detected at clinical distance and sensitivity settings. The summary, based onelectronic apex locators, ultrasonic devices, and electric pulp testers, demonstrated the compatibility of these common dental devices with CIEDs. This systematic review indicates that most dental instruments can be used safely in routine dental practice. The EMI effect of dental equipment depends on the exposure distance and lead-related parameters of the CIEDs.

Electric Pulp Testing in Children During Permanent Teeth Apexes Formation

Pain sensation is evolutionarily the primary basis of sensitive human activity, and it is quite stable...

Development of chemometric model for characterization of non-wood by FT-NIR data

In this study, a model for prediction of lignocellulose components of agricultural residues has been developed with Fourier Transformed Near Infrared (FT-NIR) spectroscopy data. Two calibration techniques (Principal Component Regression (PCR) and Partial Least Square Regression (PLSR)) were assessed for prediction of lignin, holocellulose, α-cellulose, pentosan and ash, and found the PLSR better for lignin, holocellulose and α-cellulose. The PCR also produced better results for quantification of pentosan and ash. Spectral range (7000–5000 cm–1) showed more informative than other parts of the spectral data. The PLSR showed maximum value of R2 (R2 = 0.91%) for prediction of holocellulose. For the prediction of pentosan, the PCR was better (R2 = 0.68%). The PCR also showed better results (R2 = 86%) for quantification of ash. To determine amount of lignin, the PLSR was the best (R2 = 0.83%) when the spectral data were de-trained and smoothed with Savitzky-Golay (S-G) filtering simultaneously. For prediction of α-cellulose, the PLSR was the best model (R2 = 0.94%) when the data were pretreated with mean normalization. Considering the best alternatives inNear Infrared (NIR) data preprocessing and calibration techniques, methods for quantification of lignocellulose components of agricultural residues have been developed which is rapid, cost effective, and less chemical intensive and easily usable in pulp and paper industries and pulp testing laboratories.

Pulp blood flow and sensibility in patients with a history of dental trauma undergoing maxillary expansion.

To assess changes in pulp blood flow (PBF) and pulp sensibility (PS) in teeth of patients with a history of dental trauma undergoing maxillary expansion. Twenty-five patients requiring rapid maxillary expansion (RME) had the pulp status of their maxillary anterior teeth assessed using laser Doppler flowmetry, electric pulp testing, and thermal testing (CO2 snow). Each patient was tested at T1 (prior to expansion), T2 (2 weeks after rapid expansion), and T3 (3 months after expansion). Relationships between PBF, time interval, and history of trauma were evaluated using linear mixed modelling. Within the Trauma group, PBF was significantly lower (P ≤ .05) at T2 and T3 in comparison to T1 and significantly lower (P ≤ .05) at T2 in comparison to T3. In the Non-trauma group, PBF at T2 was significantly lower (P ≤ .05) than PBF at T1 and T3; however, no significant difference (P > .05) in PBF was observed when comparing PBF at T1 and T3. In both groups, PS was maintained in almost all teeth (>90%). RME in healthy teeth causes reduction of PBF before reestablishment of pretreatment values. RME in traumatized teeth causes reduction of PBF without PBF being reestablished to pretreatment levels. Teeth with a history of compromise may have reduced adaptive capacity under insults such as RME, which should be appreciated during the informed consent process.

Outcome of Root Canal Treatments Provided by Endodontic Postgraduate Students. A Retrospective Study.

The aim of this study was to assess the preoperative, intraoperative, and postoperative factors that influenced complete periapical healing in teeth that underwent primary root canal treatment (RCT), in patients treated by postgraduate students in endodontics. Factors were retrieved and compared with the periapical status during the follow-up visit. Healing was considered as the absence of clinical and radiological symptoms. Variables significantly associated by the chi-squared test were included in a logistic regression model (LRM). Preoperative factors associated with healing were: American Society of Anesthesiology (ASA) status (p = 0.01); the absence of preoperative pain (p = 0.04); positive response to pulp tests; when the RCT cause was caries, pain, abscess, or sinus tract; probing depth <4 mm; the absence of mobility; absence or <4 mm periapical lesion (p < 0.01). In the LRM, the factors included were: absence or <4 mm periapical lesion; probing depths <4 mm; RCT caused by caries, pain, abscess, or sinus tract; the tooth was not a bridge abutment. Postoperative factors were: teeth with direct restoration; teeth that did not act as a support for a fixed prosthetic restoration; the favorable condition of the coronal restoration (p < 0.01). In the LRM, only the status of the coronal restoration was included. Preoperative conditions and the adequate fit of the coronal restoration influenced the outcome of RCT.

Allogeneic Cellular Therapy in a Mature Tooth with Apical Periodontitis and Accidental Root Perforation: A Case Report

IntroductionCell therapy in regenerative endodontics introduces an alternative option to classic treatment strategies for complex endodontic cases. The aim of this case report was to describe cell-based therapy using allogeneic umbilical cord mesenchymal stem cells (UC-MSCs) encapsulated in a bioscaffold for a complex case of a mature permanent tooth with apical periodontitis and accidental root perforation. MethodsA healthy 19-year-old man undergoing orthodontic treatment was referred for endodontic treatment in tooth #7; he was diagnosed with apical periodontitis during a previously initiated treatment associated with accidental perforation of the radicular cervical third. The root perforation was sealed with glass ionomer and composite resin, and the root canal was instrumented, disinfected, and dressed with calcium hydroxide. After 3 weeks, allogeneic UC-MSCs were encapsulated in platelet-poor plasma and then implanted into the root canal, and Biodentine (Septodont, Saint-Maur-des-Fosses, France) was placed below the cementoenamel junction. Finally, the tooth was restored with composite resin. ResultsFollow-up examinations were performed 6 months and 1 year later. The examinations included periapical radiography, cone-beam computed tomographic imaging, and sensitivity and vitality tests. Radiographic and cone-beam computed tomographic images indicated remission of the apical lesion. Clinical evaluations revealed normal responses to percussion and palpation tests; the tooth was responsive to the electric pulp test, and the vitality test indicated low blood perfusion units. ConclusionsThis case report reveals the potential use of allogeneic cellular therapy using encapsulated UC-MSCS in a platelet-poor plasma scaffold for a complex case of a permanent tooth with apical periodontitis and root perforation.

The effect of inferior alveolar nerve block anesthesia of 4% articaine and epinephrine 1:100,000 on blood flow and anesthesia of human mandibular teeth

Background/purposeLocal anesthetics and anesthetic techniques affect the patterns of pulpal blood flow (PBF) and pulpal anesthesia in human teeth. This study aimed to determine PBF changes and pulpal anesthesia of intact mandibular first molars and canines after administration of 4% articaine with epinephrine 1:100,000 using inferior alveolar nerve block (IANB). Materials and methodsTen healthy subjects received IANB of 4% articaine with epinephrine 1:100,000. Laser Doppler flowmetry and electrical pulp testing were combined to assess PBF changes and pulpal anesthesia of intact mandibular first molars and canines. The data were analyzed using one-way repeated-measures analysis of variance and Student–Newman–Keuls test. ResultsIANB with 4% articaine and epinephrine 1:100,000 did not have any significant change in PBF for the first 20 min post injection in mandibular first molars, and for 45 min post injection in the canines (P > 0.05). However, a hyperemic response occurred during 25–60 min post injection in the molars, and between 60 and 75 min post injection in the canines (P < 0.05). Thereafter, the PBF in both teeth returned to the baseline. Onset of pulpal anesthesia was 8.60 ± 2.12 min in the molars, and 9 ± 1.94 min in the canines. Duration of pulpal anesthesia was 82.40 ± 41.56 min in the molars, and 84 ± 47.40 min in the canines. ConclusionIn case of successful IANB, 4% articaine and epinephrine 1:100,000 caused insignificant changes in PBF up to 30 min but a hyperemic response at later time points. Thereafter, the PBF returned to the baseline.

Pulpal Disease Arising from Medication-related Osteonecrosis of the Jaw: A Case Report

Although bisphosphonates are widely used to treat conditions such as osteoporosis, they may cause osteonecrosis of the jaw. We treated a patient with no history of tooth extraction or other surgical treatment who developed medication-related osteonecrosis of the jaw (MRONJ) with secondary pulpal disease. A 79-year-old woman presented with purulent discharge from the gum at the incisor region. She had been using bisphosphonates for 9 years. Tooth #6 had undertaken root canal treatment at a general practice. All teeth other than tooth #6 reacted to electric pulp testing. Computed tomographic imaging revealed signs suggestive of necrotic bone, and MRONJ was diagnosed. Teeth #7 and #8, which had initially exhibited vital reactions, also subsequently ceased to react to thermal and electric pulp testing. Root canal treatment was performed on teeth #6–8, and their condition was monitored. Computed tomographic imaging at 9 months after the first presentation revealed that the bone defect had greatly enlarged with separation of the necrotic bone; therefore, excision of the necrotic bone and curettage were performed in the department of oral and maxillofacial surgery. The loss of pulp reaction in teeth that had exhibited a vital reaction at the first presentation was considered to indicate that teeth #6–8 had developed dental pulp pathosis as a result of MRONJ.

Relationship between Clinical Symptoms and the Microbiota in Advanced Caries

IntroductionThe composition and relative abundance of bacterial species change throughout the development of dental caries; however, how these changes relate to clinical symptoms remains elusive. In this study, we explored the relationship between clinical symptoms and specific microorganisms in advanced dentinal caries. MethodsA total of 111 permanent premolars and molars were used to simulate the progression from caries to pulpitis indirectly. Clinical symptoms were evaluated, and teeth were diagnosed according to the diagnostic criteria of the American Association of Endodontics. Samples were collected for 16S ribosomal DNA sequencing. Associations between the microbiota and clinical symptoms/diagnosis and the relationship between alpha diversity and clinical symptoms/diagnosis were evaluated independently by the linear discriminant analysis effect size and Spearman rank correlation analyses. ResultsThe 16S ribosomal DNA sequences were assigned to 13,852 operational taxonomic units. The linear discriminant analysis effect size and Spearman correlations unveiled negative associations between the relative abundance of Bacteroidia and Gammaproteobacteria and referred pain, Gammaproteobacteria and the electric pulp test response, and Actinomyces and Propionibacterium and diagnosis (r < 0.0, P < .05). Conversely, the relative abundance of Lactobacillus was positively correlated to referred pain, the cold test, the percussion response, and diagnosis (r > 0, P < .05). Lactobillus reuteri, a probiotic bacterium, was more abundant in teeth with referred pain and teeth diagnosed with symptomatic irreversible pulpitis. The Spearman correlation between alpha diversity and clinical symptoms/diagnosis was not significant (P > .05). ConclusionsClinical symptoms and diagnosis were significantly associated with specific microorganisms in the most advanced layers of dentinal caries.

Agreement between Two Commonly Used Pulp Tests in Determining Pulp Vitality

Background: The pulp tissue is confined within hard tissue boundaries and cannot be examined directly for health evaluation. Hence, its assessment is usually based on sensibility tests. Accurate diagnosis of the pulpal status requires evaluation with combination of sensibility tests. The objective of this study was to assess the mutual agreement between the electric pulp test and cold test in determining pulp vitality. Methods: Total 106 patients, aged 18 to 30 years, attending the dental OPD of Operative Dentistry/Endodontics department; Dr. Ishrat-ul-Ibad Institute of Oral Health Sciences, Karachi were selected for the study. The cold and electric pulp tests were used to determine the presence or absence of tingling sensation. Teeth were marked as vital in presence and non-vital in absence of any tingling or painful response. Agreement between these two tests was calculated using SPSS-18. To calculate the mean and standard deviation, descriptive statistics were applied for quantitative variables. For qualitative variables, frequencies and percentages were calculated. Kappa statistics was applied for agreement between electric pulp and cold test. Results: The cold test showed that 70.8% of the teeth were vital and 29.2% were necrotic. The electrical pulp test showed that 74.5% were vital and 25.5% were necrotic. The outcome showed 83.0% agreement between the tests; with kappa value of 0.574 which provided sufficient agreement with p-value=0.000. Conclusion: There was a high agreement found between the cold test and electric pulp test. Assessment of pulp vitality would be more accurate when EPT and Endo frost are used in combination.

RECONSTRUCTION OF THE ORBITAL SKELETON USING COMPUTER- AIDED INDIVIDUALIZED TITANIUM MESH COMPARED TO CONVENTIONAL TITANIUM MESH

Introduction: Orbital reconstruction is one of the most challenging tasks for the surgeon who treats craniofacial trauma. Suboptimal outcomes may lead to debilitating morbidity with significant emotional, functional, and occupational deficits Objectives: This study was designed to compare the efficacy of the computer-aided fabricated individual titanium mesh and conventional titanium mesh in orbital skeleton reconstruction in cases of infraorbital dysesthesia. Materials and methods: The study population included 20 patients with orbital skeleton fractures. The sample was selected conveniently to fulfill a list of inclusion criteria. The selected participants were randomly allocated into two equal groups, each group included 10 patients. In the course of a surgical treatment, individually designed titanium mesh were manufactured by application of computer- aided design in combination with rapid prototyping technologies (CAD/RP). Preoperative analysis and postoperative monitoring were conducted to evaluate their success based on restoration of infraorbital nerve function that was evaluated by pin prick test and electrical pulp testing. Results:Regarding postoperative clinical evaluation, group 1(study group) was superior to that of group 2 (control group) in restoring the function of infraorbital nerve Conclusions: computer aided titanium mesh was an accurate option in reconstructions of traumatic orbital wall fractures.

Development of a method to clinically identify the position of the lingual nerve relative to the third molar region

ObjectivesTo develop a method to clinically identify the position of the lingual nerve within the lingual tissue in the third molar region by electro-stimulation. MethodsFollowing ethical committee approval a cross-sectional study was performed in 20 healthy participants. A proprietary Electric Pulp Tester (EPT) was used intra-orally to stimulate the lingual nerve and, to identify the vertical position of the lingual nerve, measurements were taken when subjects felt a projected tingling sensation in the tongue as the stimulation probe was placed directly over the nerve. The nerve location was investigated in three positions in relation to the third molar: Point A at the retromolar pad; Point C at the distolingual attached gingivae of the erupted lower second molar and; Point B at the midline of the erupted third molar (or when the third molar was unerupted, midway between Points A & C). ResultsOut of 20 participants 18 (90%) were able to identify the projected tingling sensation on the tongue upon stimulating the nerve, allowing the nerve position to be identified. The mean vertical height of the lingual nerve relative to the third molar was 10.5, 10.75 and 12.5 mm for positions A, B and C respectively. The sensation related to nerve stimulation was well accepted by participants with minimal adverse events. ConclusionWe have demonstrated that stimulation of the lingual nerve with an EPT can clinically identify the position of the lingual nerve in situ. This technique may be useful for the clinical determination of lingual nerve position prior to third molar surgery.