Pulp Vitality Testing Research Articles

Jet or conventional local anaesthesia? A randomized controlled split mouth study.

To compare the efficacy, acceptance and preference of conventional infiltration technique with a needleless jet anaesthetic device (Comfort-In). Non-fearful healthy adult volunteers, aged 19-40 years, were recruited in the Dental School of Aristotle University of Thessaloniki, Greece. Intact maxillary premolars were selected for local anaesthesia. Both techniques were applied sequentially with 35 min time gap on either buccal side on the same day by the same operator. The quadrant and the order of administration were randomly assigned using an online randomization generator. Immediately after administration, at 1, 3, 5, 10, 15, 20, 25 and 30 min, pulp vitality and soft tissue pain reaction tests were performed. Each participant was asked 6 questions in order to assess acceptance. At the end of the session, at 24 h and 7 days, all participants were asked to report any adverse events and their preference. In 63 volunteers who were successfully followed, 63 teeth received conventional local infiltration and 63 the Comfort-In. Both techniques presented with similar anaesthetic efficacy at 1, 3, 5, 10 and 15 min, whereas the conventional technique was more efficacious at 20 min (p < 0.005). Both presented similar acceptance apart from higher pain/discomfort during administration of Comfort-In (p = 0.002). Significantly higher preference was reported for the conventional technique immediately after the session, at 24 h and at 7 days (p < 0.0005); 19 (30.2%) reported the presence of ecchymosis or lacerations at the Comfort-In site as opposed to 5 (7.9%) with the conventional method (p < 0.0001). Both techniques showed similar effectiveness. Conventional infiltration was preferred to needleless anaesthesia by non-fearful adult volunteers and was associated with less adverse events. This study enhances the advantages of conventional local anaesthesia. ISRCTN17400733.

Response to the Letter.

Response to the Letter.

Response to Pulp Vitality Tests in Teeth Submitted to Orthodontic Movement, Adjacent to the Cleft Area.

To evaluate the pulp vitality in teeth adjacent to the cleft area submitted to orthodontic movement into the alveolar graft area in individuals with complete unilateral cleft lip and palate (CUCLP). Cold sensitivity, vertical, and horizontal percussion tests were conducted on the teeth adjacent to the cleft and the contralateral teeth. Endodontics Sector in the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRAC/USP). One hundred patients with CUCLP and hypodontia of the upper lateral incisor in orthodontic movement and after successful alveolar bone graft in the cleft area. The cleft study group (SG) was composed of 200 teeth, adjacent to the cleft area. The control group (CG) consisted of 200 contralateral teeth. Statistical analysis was performed using the chi-square test for comparisons between groups (P < .05). In the SG, 82.0% of teeth presented positive response to the cold sensitivity testing, 13.5% had negative response, and 4.5% had marked response, with statistically significant difference in relation to the CG. The vertical and horizontal percussion tests on teeth in the SG revealed the same results, in which 95.0% presented negative response and 5.0% responded positively, without significant difference compared to teeth in the CG, for both tests. Teeth adjacent to the cleft area presented changes in the physiological conditions of the pulp, which were observed by reduction of positive response to the cold sensitivity testing or presence of pulp hypersensitivity in cases of marked response.

Pulp Vitality Testing with a Developed Universal Pulse Oximeter Probe Holder.

Background and Objectives An accurate determination of the pulp status is relevant for a proper endodontic diagnosis. Objectives: The aim was to develop a universal pulse oximeter probe holder for measuring the oxygen saturation and to evaluate the use of pulse oximetry as a test for pulp vitality, by comparing the levels of oxygen saturation in the index finger and in the healthy dental pulp. Materials and Methods The universal holder was designed with software and printed with a 3D printer. The study was carried out on 128 healthy teeth. They were divided into eight groups according to tooth type. Ten root canal treated teeth served as a negative control group. For each patient, a pulse oximeter was first applied on the tooth followed by the index finger. The significance level (α) was set at 0.05. Results: The developed and manufactured universal pulse oximeter probe holder was suitable to measure the pulp vitality of all types of teeth. The handle allowed for holding the pulse oximeter on the tooth in parallel, firmly and securely. Significantly higher oxygen saturation was observed in the index finger (97.22%) compared to the dental pulp (93.17%) (p < 0.001). No correlation was observed between the maxillary teeth and index finger oxygen saturation values (r = 0.05, p = 0.72), whereas, between the mandibular teeth and index finger, a positive correlation was detected (r = 0.29, p = 0.02). There were no significant differences in the pulp oxygen saturation values between different teeth groups. Conclusion: The newly developed universal pulse oximeter probe holder is an effective device for pulp vitality testing.

Učestalost različitih indikacija za endodontsko lečenje zuba u delu populacije stanovnika grada Pančeva

Introduction: Different types of irreversible pulp diseases are the most commonly stated reasons for conducting root canal treatment. Data obtained from epidemiological studies are of great importance for a better understanding of endodontic pathology and for evaluating the need for this kind of treatment. Aim: The aim of this epidemiological study was to evaluate the structure of endodontic pathology among selected adult population of municipality of Pancevo, Serbia, indicated for endodontic treatment. Material and methods: Investigations were conducted on a sample of patients who referred for dental examination and treatment, at the Department of Restorative Dentistry and Endodontics, Faculty of Dentistry in Pancevo, during 2018. The study included 229 male and female subjects, aged over 18, who had at least one tooth indicated for endodontic treatment. Subjects were clinically examined by a standardized procedure, using visual and tactile inspection, percussion and palpation tests, periodontal evaluation and pulp vitality tests. Panoramic and retroalveolar radiographs were also analyzed. Data were statistically analyzed using Chi-Square test. Results: Endodontic treatment was indicated on 322 teeth from total number of 4911 (6.6%). Largest frequency of teeth indicated for treatment was recorded among subjects aged over 60 years (7.5%) and on frontal teeth (36.6%). The most commonly registered indications were asymptomatic irreversible pulpitis (32.3%) and symptomatic irreversible pulpitis (19.9%). Irreversible pulpitis was the most common indication for endodontic treatment between all age groups of subjects, between both genders and between all three teeth functional groups (p &lt; 0.001). Conclusion: Percentage of teeth indicated for endodontic treatment was higher than presented in other studies. Irreversible pulpitis was the most common indication for endodontic treatment. After conducting the study, it is clear that dental care and caries preventive programs should be strengthened and expanded, especially among people with less education and awareness regarding dental health.

RESINA BULK FILL COMO ALTERNATIVA PARA PACIENTES GESTANTES: UM RELATO DE CASO

Aim: to describe, through a clinical case report an operational sequence of a single increment technique resin in a patient with special needs. Case report: a 30 year-old female patient, at 23 weeks of gestation, sought the dental care service of a dental care university reporting aesthetic dissatisfaction in the lower left second premolar. In the cold pulp vitality test, there was a positive response with rapid decline when removing the stimulus and the percussion and palpation test showed negative responses. The radiographic examination was not performed due to the clinical aspects described above, protecting the patient from exposure to X-rays. After comprehensive planning, it was decided to perform a dental restoration with a regular consistency Bulk Fill composite resin due to unique increment technique allows a shorter clinical time. Conclusions: Bulk Fill composites have become more popular in the dental clinic. In pregnant patients, this material can be considered the first choice due to its ease of insertion and time savings in direct restorations.

MODERN APPROACHES TO DIAGNOSTICS AND TREATMENT OF DENTAL TRAUMA

Relevance of the topic. Disruption of the anatomical integrity of the dentition, occurring as a result of dental trauma, not only impairs the patient’s appearance, but can also affect the functional properties of the entire maxillofacial area. Therefore, the choice of optimal methods for treatment of dental traumas remains an urgent problem of dentistry and requires further development.&#x0D; The aim of this study was to offer the most effective methods for treatment of dental traumas, with a view to preserve and restore the damaged structures of teeth and provide positive long-term outcomes.&#x0D; Materials and methods. The research relied on the study and generalization of modern scientific literature.&#x0D; Results and discussion. To diagnose dental traumas and, accordingly, to determine the ways to eliminate their consequences, its classification is of great importance. In this context, the classification by Andreason gained the strongest support in the world dental community. The approaches to the diagnostics and treatment of dental traumas, which have become established in the world of dentistry, largely rely on this classification.&#x0D; In modern conditions, computed tomography provides the opportunity to obtain maximum information about the condition of the injured tooth and bone damage. Cone-beam computer devices are used to study the maxillofacial area, providing high image quality at low radiation exposure. Essential diagnostic methods also include pulp vitality tests (cold test and electroodontodiagnostics). In this case, to exclude the diagnosis of pulp necrosis, it is recommended to check its vitality repeatedly.&#x0D; Currently, as an alternative to classical restoration in case of fracture of the tooth crown, specialists consider the fixation of the proper fragment of the tooth. Recently, this method of eliminating the effects of fractures of the dental crown is becoming increasingly popular due to the significant improvement in quality and enhanced technological properties of adhesive systems and materials.&#x0D; The search for ways to improve medical care in cases of tooth avulsion is mainly associated with the introduction of replantation and autotransplantation of teeth in the clinical practice. It is recommended to replant a tooth with an open apex without its depulpation due to the high ability of the germinal zone and periodontium to revascularize. Immediately after returning the tooth to the alveolus, a flexible splint is applied for a period of 3-4 weeks. Further endodontic treatment is performed only in cases when revascularization does not occur and signs of apical periodontitis appear. When the root apex is formed, the tooth is replanted in the alveolus, splinted for up to 2 weeks. Endodontic treatment should begin before the splint is removed, 7-10 days after replantation.&#x0D; Experts suggest replanting permanent teeth with both open and closed root apices, even in cases where the tooth has been in a dry environment for more than 60 minutes. However, not always after the injury the tooth can be found or it can be destroyed so that replantation becomes impossible. Nevertheless, in modern conditions, having received an in-depth biological justification of the process of engraftment of the transplanted tooth, it becomes possible to widely use the method of autotransplantation in the clinical practice.&#x0D; Conclusions. Thus, based on the study of a significant array of scientific publications, we can conclude that the problems of dental trauma are increasingly attracting the attention of researchers due to the prevalence of this pathology, the complexity of its diagnostics and treatment. The current approach to the treatment of dental trauma is focused on less invasive and more biologically oriented methods of treatment of hard dental tissues, pulp, periodontal ligament and alveolar bone.&#x0D; Research prospects. It is important to develop the best conditions for tooth storage before replantation in order to improve the periodontal regeneration, the quality of the revascularization process, offer better types of splinting, which will ensure the regeneration of periodontal and pulp tissues, prevent inflammatory complications.

Influence of Lateral Sinus Floor Elevation Procedures on the Pulpal and Periapical Status of Adjacent Vital Teeth

The aim of the present study was to evaluate the pulpal and periapical status of vital teeth within the area of a lateral sinus floor elevation (LSFE). The files of patients treated by LSFE between 2009 and 2015 were retrospectively evaluated. The radiographic bone measurements and the periapical status of the teeth adjacent to the LSFE area were evaluated preoperatively and 6 months following the surgery by CBCT. The pulpal status of the adjacent teeth was clinically evaluated using thermal pulp vitality testing. Vital teeth within the sinus floor elevation area were the main inclusion criteria for this study. A total of 158 LSFE procedures were evaluated; 18 cases fulfilled the inclusion criteria, and 20 adjacent teeth were vital. There were no cases of periapical pathology or loss of pulp vitality. There was a statistically significant difference in the ridge height between the baseline and 6 months postoperatively and in the distance from the apex to the sinus floor between pre- and 6 months postoperatively (p &lt; 0.01).The pulpal and periapical status of vital teeth was not affected following LSFE.

Regeneration of Pulp-Dentin Complex in a Tooth with Symptomatic Irreversible Pulpitis and Open Apex Using Regenerative Endodontic Procedures

Regenerative endodontic procedures are undertaken on permanent teeth with necrotic pulps and open apices in an attempt to resolve symptoms, to allow the continued development of the root(s), and to reestablish vitality. The available histologic analysis of these teeth has, in the majority of studies, shown that true regeneration of the pulp-dentin complex is not achieved. A recent investigation using an animal model outlined a procedure wherein pulpal amputation a few millimeters short of the apex followed by evoked bleeding allowed the complete regeneration of the normal pulp-dentin complex in immature vital teeth of ferrets. By implementation of this procedure, we report successful pulp regeneration outcome evidenced by continued root development and a positive response to pulp vitality tests in a maxillary central incisor with an open apex diagnosed with symptomatic irreversible pulpitis.

Clinical outcome of metal- and all-ceramic resin-bonded fixed dental prostheses.

The aim of this retrospective cohort study was to investigate the long-term outcome of metal- and all-ceramic resin-bonded fixed dental prosthesis (RBFDP) up to 17 years, and to evaluate potential factors influencing the risk for complications. Patients who were treated with RBFDP to replace teeth in the anterior or first premolar region in an university setting were identified from electronic records. Data collection comprised dental and periodontal parameters, periapical radiographs, and assessment of the RBFDP. Patient-reported satisfaction was evaluated on visual analog scales (VAS), and 5-year cumulative survival and success rates were calculated. Cox regression models were used to compare metal- versus all-ceramic RBFDPs. Seventy-one patients with RBFDP replacing 65 anterior teeth and 6 premolars were included with a mean observation period of 56.1 (±42.7) months. RBFDP cumulative survival rate was 86.7% and cumulative success rate 71.7% after 5 years, with no significant difference between metal-and all-ceramic RBFDPs. The risk for RBFDP failure was significantly higher with more than one pontic (OR 6.1; p=0.033), or negative pulp vitality testing of abutments (OR 7.3; p=0.042), while complications tended to be increased with two-wings compared to one-wing RBFDP (OR 5.4; p=0.054). Metal- and all-ceramic RBFDPs facilitated good long-term results, particularly with one-wing, one-cantilever, and vital abutment teeth.

Biodentine Pulpotomies on Permanent Traumatized Teeth with Complicated Crown Fractures

IntroductionThe aim of this multicentric prospective study was to evaluate the clinical and radiographic outcomes of Biodentine (BD) pulpotomies on permanent teeth with complicated crown fractures. MethodsThis study was carried out in 2 hospital-based dental departments in Quebec, Canada. Children seeking emergency care after trauma to anterior permanent teeth were invited to participate in this study. The treatment outcome was assessed clinically and radiographically at 1 week and 1, 3, 6, 12, 18, and 24 months after treatment. ResultsForty-five patients between the ages of 8 and 16 years (mean, 10.8 ± 2.4) were included in this study. Fifty-one teeth were treated with a BD pulpotomy. The study showed a survival rate of 100% and a success rate of 91%. Four failures were noted at 1-, 6-, and 15-month follow-up, and the teeth were subsequently treated with either conventional root canal therapy or regenerative endodontic procedure. Dental sensitivity to cold reported by patients reduced over time, and more teeth responded normally to pulp vitality tests during the course of this study. Slight discoloration was noted on 8 teeth (17%). Radiographic outcomes showed dentinal bridge formation in 91% of cases, and all immature teeth showed continued root formation. ConclusionsBD is a suitable material for pulpotomies on anterior permanent teeth with complicated crown fractures. It may be a good alternative to mineral trioxide aggregate pulpotomies because it does not cause significant discoloration, and it allows root maturation.

Diagnostic accuracy of dental pulse oximeter with customized sensor holder, thermal test and electric pulp test for the evaluation of pulp vitality: an in vivo study

Background: the efficiency of the diagnostic aids plays an important role in the treatment plan. This study aims to assess the diagnostic accuracy of dental pulse oximeter with a customized sensor holder, thermal test and electric pulp tester in assessing the actual pulp status and to evaluate the oxygen saturation level in control healthy teeth, non-vital and teeth with irreversible pulpitis. Material and methods: thirty-seven single canal teeth requiring endodontic therapy were included in the study. The selected teeth were tested with dental pulse oximeter, electric pulp test, cold spray, and heated gutta percha stick. Between each test a time lag of 2 minutes was allowed for the central sensitization to occur. Three blinded operators were involved in the study. The actual status of the pulp was evaluated after the initiation of endodontic treatment. To assess the actual pulp status direct visual examination of access cavity as performed. The data was statistically analysed using (ANOVA) Analysis of Variance and Post-hoc Tukey test. Results: sensitivity of pulse oximeter, heat test, cold and electric pulp test, was 100, 25, 50, and 12, respectively. The specificity of these tests was 100, 72 81, and 77, respectively. The ANOVA showed that there was statistical difference between all the groups (p=0.0005). Post-Hoc Tukey revealed that there was statistical difference among all the groups, nonvital group (p=0.0005), control group (p=0.01) and for irreversible pulpitis (p=0.01). The overall diagnostic accuracy of pulse oximeter was 100% followed by cold test 66%, heat test to be 49% and electric pulp test to be 45%. Conclusion: the custom-made holder used in the present study aided in providing accurate response for pulp vitality testing. In this study the diagnostic accuracy was high with dental pulse oximeter followed by cold, heat and the least was electric pulp tester in different pulpal conditions.KEYWORDS Cold test; Heat test; Oxygen saturation; Pulse oximeter; Vitality tests.

Conservative management of peri-apical cementoblastoma: A case report

Conservative management of peri-apical cementoblastoma: A case report - JCHM- Print ISSN No: - 2394-272X Online ISSN No:- 2394-2738 Article DOI No:- 10.18231/j.jchm.2019.027, The Journal of Community Health Management-J Community Health Manag

Two calcium silicate-based materials used in direct pulp capping (in-vivo study)

Aim The aim was to clinically and radiographically evaluate mineral trioxide aggregate (MTA) and TheraCal LC as direct pulp capping (DPC) materials. Materials and methods Twenty male patients aged 17–35 years with immediate mechanical pulp exposure in lower molars were randomly divided into two equal groups (n = 10). Group 1: pulp exposures were capped using MTA. Group 2: pulp exposures were capped using TheraCal LC. Immediately after DPC, a base-line digital bitewing and periapical radiographs were taken. Clinical evaluation was performed at 1, 4, 12, and 24 weeks after DPC for presence/absence of spontaneous pain, tenderness to percussion, draining sinuses and pulp response to thermal pulp vitality test. At 24 weeks after DPC, digital periapical, and bitewing radiographs were taken. Digitalized bitewing radiographs were submitted to image analysis software to measure dentin bridge thickness in comparison to the base-line bitewing radiographic image. Digitalized preoperative and postoperative periapical radiographs were submitted to the same software to evaluate changes in the width of periodontal ligament space. Results Clinically, all cases showed criteria of successful treatment except 3, four cases in groups 1 and 2, respectively. Statistical analysis revealed no statistically significant difference between both groups (P > 0.05). All of the thirteen cases that were available for evaluation after 6 months showed dentin bridge formation. In MTA group, the mean value of dentin bridge formed was higher than in TheraCal LC group with no statistically significant difference (P = 0.710). Changes in the width of periodontal ligament space were not significantly different between both groups recording (P > 0.05). Conclusion Clinically and radiographically, MTA and TheraCal LC are favorable materials for DPC inducing adequate dentin bridge formation and minimal widening of periodontal ligament space.

PREVENTION PROTOCOL OF OSTEORADIONECROSIS AFTER RADIOTHERAPY OF THE HEAD AND NECK: BIMODAL TREATMENT

Although osteoradionecrosis is considered a late sequela of radiotherapy in the head and neck region, it is the most severe. Dental examination should be performed in advance to eliminate all odontogenic foci, decreasing the chance of developing osteoradionecrosis. A white female patient, 50 years of age, was treated with adjuvant radiotherapy for undetected primary tumor with cervical metastasis. After 6 months, extensive caries in the lower left second molar were noticed, which were removed and a glass ionomer restoration and indirect pulp-capping with calcium hydroxide were performed. Dental pulp vitality test along with periapical radiography to follow the treatment's progress were also done. After 10 months, a periapical radiolucent lesion was observed. Pulp vitality testing turned out negative. As a sequela of radiotherapy, the patient presented with severe trismus, making endodontic treatment impossible. Exodontic procedure with antibiotic and laser therapy for the prevention of osteoradionecrosis was recommended, and the patient remains without any complications.

EXPANSIVE OSSEOUS DYSPLASIA: CASE REPORT AND LITERATURE REVIEW

Literature review was carried out and found 30 cases. According to the data found, the most affected sex is female at 35 ± 16.4 years, with location in the maxilla. A 33-year-old woman was diagnosed as having florid osseous dysplasia through radiographic examinations. Five years later, she was referred, exhibiting an expansive lesion of the mandibular anterior region. The intraoral examination revealed an expansion in the vestibular and lingual cortical bones, and the teeth showed displacement without alterations of pulp vitality testing and pain. The panoramic radiograph showed an expansive mixed lesion. Teeth resorptions were not visualized. The computed tomography showed a dense mixed lesion closely associated with the roots of the mandibular incisors. Intraoral incisional biopsy was performed, which proved difficult to detach from adjacent bone, and the specimen microscopically revealed a benign fibro-osseous lesion. The clinicopathologic features favored the diagnosis of expansive osseous dysplasia. The patient was referred for surgical evaluation. Literature review was carried out and found 30 cases. According to the data found, the most affected sex is female at 35 ± 16.4 years, with location in the maxilla. A 33-year-old woman was diagnosed as having florid osseous dysplasia through radiographic examinations. Five years later, she was referred, exhibiting an expansive lesion of the mandibular anterior region. The intraoral examination revealed an expansion in the vestibular and lingual cortical bones, and the teeth showed displacement without alterations of pulp vitality testing and pain. The panoramic radiograph showed an expansive mixed lesion. Teeth resorptions were not visualized. The computed tomography showed a dense mixed lesion closely associated with the roots of the mandibular incisors. Intraoral incisional biopsy was performed, which proved difficult to detach from adjacent bone, and the specimen microscopically revealed a benign fibro-osseous lesion. The clinicopathologic features favored the diagnosis of expansive osseous dysplasia. The patient was referred for surgical evaluation.

The clinical efficacy of deproteinized bovine bone mineral with 10% collagen in conjunction with localized piezosurgical decortication enhanced orthodontics: A prospective observational study.

Evidence exists on the clinical efficacy and safety of periodontally accelerated osteogenic orthodontics (PAOO) with "Piezocision"-a minimally invasive, flapless alternative to corticotomy for alveolar bone augmentation. Allograft has been extensively studied for alveolar bone augmentation in Piezocision; however, the use of deproteinized bovine bone mineral with 10% collagen (DBBM-C) in Piezocision for PAOO has not been investigated. This study is a prospective, observational, cohort study of 19 patients of Angle Class I malocclusion with a total of 692 teeth assessed for maintenance of health of the periodontal attachment apparatus. Patient-centered pain, sensitivity, and satisfaction outcomes, digital photographs and radiographs, and changes in probing depth, clinical attachment level, width of keratinized tissue, percussion sensitivity, pulp vitality tests, radiographic pathology, and root-crown-ratio were all recorded. Overall treatment was significantly faster (5 to 7days between clear aligner tray changes), periodontal parameters remained stable, and alveolar bone loss was not observed. Visual analog score for healing, sensitivity/duration, bleeding/duration, swelling/duration, appearance, and inflammation, demonstrated no significant differences between DBBM-C and control (no bone graft) groups. Patient-centered outcomes revealed high levels of satisfaction with Piezocision. Piezocision-treated teeth with DBBM-C tended to exhibit less root resorption, although it was not statistically significant (P=0.074). Within the limits of the study, our results show that the use of DBBM-C with piezosurgically enhanced orthodontics is effective and safe. This study was not designed to demonstrate equivalence with other materials that might be used in Piezocision. To understand whether there is an advantage to using DBBM-C, additional studies may be required.

Revascularization-associated Intracanal Calcification: A Case Report with an 8-year Review

Revascularization-associated intracanal calcification (RAIC) is a common finding in immature teeth managed with regenerative endodontic treatment (RET). The aim of this report was to illustrate a case in which 2 mandibular premolar teeth developed complete canal obliteration and have been reviewed for 8 years. The 3 primary outcome goals as defined by the American Association of Endodontists after RET are resolution of signs and symptoms of pulp necrosis, further root maturation, and achievement of responses to pulp vitality testing. The teeth had been included in an earlier quantitative study in which an increase in root canal width of 72.1% and 39.6% and an increase in root length of 1.7% and 0% were reported for teeth #20 and #29, respectively. Qualitative assessments over the 8-year review period showed no pathosis and a response to electric pulp testing at the final review. A quantitative assessment at the 8-year review showed an increase of 100% for canal width because complete calcification had occurred and no substantive change in root length (−0.17% and 0.68% for teeth #20 and #29, respectively). In this report, complete RAIC occurred in both teeth over time. RAIC has the potential to complicate future endodontic or prosthodontic treatment if necessary. Therefore, it is recommended that the American Association of Endodontists clinical considerations for a regenerative endodontic procedure be updated to include the incidence of RAIC after RET.

Glandular Odontogenic Cyst with Hyaline Ring Granulomas

The glandular odontogenic cyst is a rare lesion, responsible for approximately 1% of all cases of cysts that affect the jaws. It usually exhibits clinical and radiographic characteristics similar to several pathologies of odontogenic origin. However, it possesses particular microscopic peculiarities, different from other lesions. A 46-year-old man reported a slight swelling in the region of the mandibular symphysis. Pulp vitality tests of the teeth associated with the lesion were negative. In the radiographic examination, a multilocular radiolucent area was observed, surrounding the roots of the inferior anterior teeth (from 3.5 to 45), and the computerized tomography showed an expansion of the cortical bone. The lesion was excised, and the microscopic diagnosis revealed a glandular odontogenic cyst with hyaline ring granulomas. The patient is under periodic follow-up, showing a satisfactory process of bone repair and no signs of recurrence after almost 2 years.

Efficacy of epinephrine-free articaine compared to articaine with epinephrine (1:100000) for maxillary infiltration, a randomised clinical trial.

The selection of local anaesthetic in dental practice is essential to the patient's comfort and the success of the treatment. Many patients prefer anaesthesia even for short treatments. Articaine is a local anaesthetic commonly used for dental practice. The duration of the effect of articaine on the nerve fibres is not yet precisely reported. This study was aimed to evaluate the clinical efficacy of 4% articaine with and without epinephrine in treatment of occlusal caries. Thirty healthy patients were included in this randomised double-blind study. Each subject received 4% articaine with and without epinephrine (1:100000). Maxillary infiltration was used for occlusal caries of the maxillary premolars on right and left sides. Quantitative sensory testing (QST) was performed in the innervation area of the infraorbital nerve, and pulp vitality test was performed on restoration-free canines. Duration of anaesthesia was longer when articaine with epinephrine was used. Articaine without epinephrine showed faster recovery of sensory blockade compared to articaine with epinephrine. The epinephrine-containing agent, when compared to the plain articaine solution, showed significantly stronger and longer anaesthetic efficacy on the soft tissue by all parameters of QST. Articaine with epinephrine caused a more reliable pulpal analgesia. A pain-free treatment of the soft tissue up to 15minutes can be performed under the vasoconstrictor-free anaesthetic without causing long-lasting numbness. Epinephrine-containing articaine delivers a longer, more effective anaesthesia and is preferable for caries treatments and longer invasive treatments of the soft tissue.