Symptomatic Irreversible Pulpitis Research Articles

Comparative evaluation of various biomaterials as pulpotomy agents in molars with symptomatic irreversible pulpitis: A randomized single-blinded single-center control trial

Abstract Introduction: Untreated tooth decay in mature permanent dentition is a prevalent global issue, affecting 34.1% of people with 2.5 billion cases annually. Extensive decay often leads to irreversible pulpitis, characterized by pulp inflammation and pain. Pulpectomy, the standard treatment, involves complex procedures with potential complications. Modern endodontics favors minimally invasive treatment such as pulpotomy, which preserves pulp vitality. This study aims to compare the clinical as well as radiographic outcomes of different pulpotomy agents: Biodentine, mineral trioxide aggregate (MTA), Bio-C repair, and Endosequence Bio-ceramic root repair material (BCRRM) in mature permanent molars. Methodology: This single-blind, single-center study involved 80 participants randomly assigned to four groups, each receiving one of the biomaterials. Ethical approval was obtained. Participants aged 14–60 years with symptomatic irreversible pulpitis were selected. Pulpotomy procedures were performed, and follow-up evaluations occurred at 24 h, 1 week, 4 weeks, 3, 6, and 12 months. Clinical success was measured by the absence of pain, sensitivity, and tenderness. Radiographic evaluation used the periapical index (PAI) scoring system. Results: Pulpotomy significantly reduced postoperative pain in all groups. Endosequence BCRRM showed the maximum pain reduction at 24 h with a statistically significant difference from all the groups (at 1% probability level), followed by Bio-C repair, Biodentine, and MTA. At 1 week, Bio-C repair led in pain reduction with statistically nonsignificant results. All groups reported no pain at 3, 6, and 12 months. Endosequence BCRRM had the highest improvement in periapical findings at 1 year. Sensitivity to hot and cold improved significantly in all groups, with Endosequence BCRRM performing best. Conclusion: Endosequence BCRRM provided the best overall outcomes, emphasizing the importance of material choice in pulpotomy treatments. Further research on biomaterials’ long-term clinical and radiographic outcomes is needed to enhance treatment efficacy.

Effect of lateral extent of pulp tissue removal on the outcome of partial pulpotomy for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis: A randomized clinical trial.

The aim of this study is to compare the outcomes of restricted partial pulpotomy (R-PP) versus extended partial pulpotomy (E-PP) for managing cariously exposed mature permanent molars with symptomatic irreversible pulpitis (SIP). This double-arm, parallel designed randomized clinical trial was registered at clinicaltrials.gov (registration number: NCT05406557). Following random allocation, 43 participants of each group received the designated intervention. In the R-PP group, 2-3 mm of superficial pulp tissue was removed only from the exposure site, while chamber was completely de-roofed and 2-3 mm of superficial pulp tissue from entire chamber was removed in the E-PP group. Haemostasis was achieved using 3% sodium hypochlorite-soaked cotton pellets. Upon haemostasis, ProRoot mineral trioxide aggregate (ProRoot MTA) was placed over the pulpal wound, overlaid with a resin-modified glass ionomer liner, and restored with composite resin in the same visit. Outcome measures included clinical and radiographic success evaluation at 6 and 12 months, and pain assessment using the visual analogue scale pre-operatively and daily for 7 post-operative days. Nonparametric tests were used for variables including patient's age, pain intensities, mean analgesic consumption, and haemostasis time. Categorical variables including gender, caries type, analgesic intake, hard tissue barrier formation, clinical and radiographic success, and pulp sensibility responses were assessed using Chi-square or Fisher's exact test. Tooth survival was analysed using Kaplan-Meier analysis. A total of 81 cases were analysed at 12 months follow-up. Comparable success was observed in both groups (97.6% in E-PP & 97.5% in R-PP; p > .05). The R-PP group reported significantly lower pain scores on the 1st and 2nd post-operative days than E-PP (p < .05) and required significantly less analgesic intake (p < .05). Hard tissue barrier formation was significantly lower in the R-PP group (p < .05). No significant differences were observed between groups regarding haemostasis time, pulp sensibility responses, and tooth survival (p > .05). Both the PP approaches exhibited comparable success for managing cariously exposed mature permanent molars with SIP. Given the conservative nature of R-PP, it may be used as preferred PP approach for managing such cases. Being the first study of this kind, further work is necessary to draw definitive conclusions.

Postoperative pain evaluation in patients undergoing endodontic treatment subsequent to working length determination with and without integrated apex locator endomotor: Randomized control trial

Abstract Introduction: Precise working length control during chemomechanical preparation is one of the primary factors for successful endodontic therapy. Aim: The study aims to evaluate the postoperative pain after determining working length with an integrated apex locator-endomotor and a separate apex locator-endomotor. Subjects and Methods: One hundred and twenty subjects with a diagnosis of symptomatic irreversible pulpitis and preoperative pain score Visual Analog Scale (VAS) &gt;50 were allocated into Group I with nonintegrated apex locator and endomotor and Group II with integrated apex locator endomotor, further treated by single endodontist. Postoperative pain was assessed with a VAS chart on days 1, 3, and 7. The necessity of analgesic intake if required was considered as the highest VAS score. Statistical Analysis Used: Pre- and post-operative VAS scores between the groups were compared using the Mann–Whitney and one-way ANCOVA tests. Results: On days 1 and 3, Group II showed significantly lower values of postoperative pain and lesser frequency of rescue medication when compared with Group I (P &lt; 0.05). On day 7, none of the patients reported postoperative pain. Conclusion: Simultaneous working length determination during instrumentation leads to significantly lesser postoperative pain.

The short-term postoperative pain and impact upon quality of life of pulpotomy and root canal treatment, in teeth with symptoms of irreversible pulpitis: A randomized controlled clinical trial.

Few studies focus upon patient-reported outcomes in endodontics. To determine whether full pulpotomy offers a less painful, improved health-related quality of life (HRQoL) compared with root canal treatment (RCT) in cases of irreversible pulpitis (IP) in the 7 days after the treatment. One hundred sixty-eight participants presenting with symptoms of IP were randomized to either pulpotomy (n = 86) or RCT (n = 82). Two participants were excluded, 61 participants underwent full pulpotomy with Biodentine (35.7%), 80 had RCT (46.8%), and 25 were randomized to have pulpotomy which progressed to RCT (PRCT) due to uncontrollable bleeding (14.6%). Clinical and radiographic assessments, using CBCT and periapical radiographs, were carried out preoperatively, for the evaluation of the results only CBCT images were used. Pain (VAS) and HRQoL (EQ 5D) assessments were carried out at baseline and Days 1, 3, 5 and 7 post-baseline. Analysis included descriptive and continuous variables, chi-squared, Fisher's exact, and two-sample t-tests. In pulpotomy and RCT groups, VAS pain decreased significantly over the first week (p < .001). The magnitude of reduction was similar in RCT and pulpotomy (p = .804), RCT and PRCT (p = .179), pulpotomy vs. PRCT (p = .144) and in the comparison of combined RCT /PRCT groups (ORCT) with Pulpotomy (0.729). However, the overall level of VAS pain was significantly higher in the PRCT group than in the Pulpotomy (p = .045) and RCT group (p = .049). Using CBCT, significantly more radiolucencies were found in the PRCT group than in the pulpotomy group and overall teeth presenting with CBCT radiolucencies had significantly higher pain scores (p = .015), particularly at Days 1, 3 and 5. There were significant differences in many OHRQoL domains (Questions 1, 6, 11 and 12) between RCT and PRCT groups with higher frequencies of the impact of oral health problems at Day 0 and Day 7 in the PRCT group. In the treatment of IP, pulpotomy is as effective as RCT in reducing post-operative pain, and improving QoL and HRQoL, teeth displaying uncontrollable bleeding and periapical radiolucencies detected using CBCT are associated with more intense postoperative pain and lower QoL.

Outcomes of vital pulp treatment in permanent teeth with carious pulp exposure with signs and symptoms of irreversible pulpitis.

To investigate the outcomes and factors influencing the success of vital pulp treatment (VPT) in permanent teeth with carious pulp exposure and signs and symptoms of irreversible pulpitis (IP). Dental records from 2016 to 2023 of patients who received VPT for carious pulp-exposed permanent teeth with IP symptoms were reviewed. Outcomes were assessed using clinical and radiographic criteria. Univariate and multivariate analyses were performed to identify factors affecting treatment success. The Kaplan-Meier estimator was used to compare survival probabilities. The overall success and survival rates were 88.24% and 97.06%, respectively. Success rates for direct pulp capping, partial pulpotomy, and full pulpotomy were 87.7%, 92.0%, and 87.7%, respectively. Key factors influencing outcomes included the presence of periapical radiographic lesions, type of pulp dressing material, and quality of the final restoration. Full pulpotomy demonstrated the highest survival time, followed by partial pulpotomy and direct pulp capping. VPT in permanent teeth with carious pulp exposure and IP symptoms shows high success rates. Crucial factors include periapical radiographic findings, type of pulp dressing material, and quality of the final restoration. Full pulpotomy exhibited the longest survival time. VPT in teeth with IP symptoms shows promising outcomes, highlighting the importance of certain clinical factors in treatment success.

PREPARO DO CANAL RADICULAR COM SISTEMA PRODESIGN LOGIC - RELATO DE CASO CLÍNICO

The objective of this study was to describe the preparation of root canals with a rotary system in a maxillary premolar. A 26-year-old patient, classified as ASA I, attended the Faculty of Dentistry of Pernambuco – FOP due to the presence of spontaneous pain in the region of the upper left first premolar. After clinical, radiographic examinations and sensitivity tests with an intense response, it was concluded that the probable diagnosis was symptomatic irreversible pulpitis. The preparation of the root canal was carried out with the ProDesign Logic rotary system and for this purpose, the Glide Path 25.01 file was used in order to explore the buccal and palatal canals. Odontometry was performed with the Root ZX apical locator (J.Morita) and confirmed by the radiographic method. The filling of the root canal system was performed using the single cone technique, 30.05 (HB). The final x-ray of the case was performed. It was concluded that the ProDesign Logic system determined a good shape of the canals, thus facilitating the filling of the root canal system.

Efficacy of QuickSleeper Intraosseous Injection of 4% Articaine in Mandibular First Molars With Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial

Objective To evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine via primary intraosseous (IO) injection with the QuickSleeper device vs inferior alveolar nerve block (IANB) for mandibular first molars diagnosed with symptomatic irreversible pulpitis (SIP). Methods Sixty-four patients with a first mandibular molar with SIP were randomly divided into 2 groups: IO (n = 32) and IANB (n = 32). Each received either an IO injection with the 5th generation QuickSleeper device or a conventional IANB with 1.7 mL 4% articaine with 1:100,000 epinephrine. Success was defined as no/mild pain upon the access cavity preparation and initial filing. Injection pain, anesthetic onset, heart rate (HR) change, HR recovery time, and duration of anesthesia were also recorded and analyzed. Results The success rates were 40.6% for IANB and 81.2% for IO (P &lt; .001). IO exhibited a significantly lower injection pain (P = .027), a shorter onset of action (P &lt; .001), a greater heart rate increase (P &lt; .001), a faster heart rate recovery time (P &lt; .001), and a shorter duration of action (P &lt; .001) vs IANB. Conclusion Primary IO anesthesia using the fifth generation of the QuickSleeper device was more successful than IANB when using 4% articaine with 1:100,000 epinephrine to anesthetize mandibular first molars with SIP. The QuickSleeper device appeared to be a viable alternative to IANB for mandibular anesthesia.

Anaesthetic Efficacy of Adjunct Therapy with Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomised Controlled Study

Abstract Objective: The aim of this prospective, randomised controlled study was to evaluate the efficacy of pulpal anaesthesia in the management of pain in mandibular first molars with symptomatic irreversible pulpitis (SIP) in relation to alternative adjunct therapies with a conventional inferior alveolar nerve block (IANB) versus the conventional IANB technique. Methods: In accordance with the CONSORT statement, a prospective, randomised controlled parallel-design clinical trial was created. Group 1: Conventional IANB (Control group); Group 2: IANB plus local infiltration; Group 3: IANB plus long buccal nerve block; Group 4: IANB plus premedication with paracetamol; and Group 5: IANB plus cryotherapy was the five groups comprised 50 participants who met the inclusion and exclusion criteria. People were asked to use the Heft-Parker Visual Analogue Scale (HP-VAS) to score their level of discomfort at three separate intervals during the treatment process: before treatment, during access opening, and during pulp extirpation. Results: During access opening, Tukey’s post hoc multiple comparison tests showed statistically highly significant differences (P &lt; 0.001) between Group 1 and Group 4 and a statistically significant difference (P &lt; 0.05) between Group 1 and Group 3. During pulp extirpation statistically significant difference (P &lt; 0.05) between Group 1 and Group 4 were reported. While the other group shows a statistically insignificant difference. Conclusion: IANB alone does not provide painless endodontic treatment in SIP patients. Hence, adjunct therapy of premedication with paracetamol or a supplementarily anaesthetising long buccal nerve block can significantly increase anaesthetic efficacy of IANB.

Vital Pulp Therapy in Primary Teeth Having Signs and Symptoms of Irreversible Pulpitis

Abstract Dental caries being the most prevalent disease worldwide usually ends in pulpitis due to negligence of the patient and the caretaker. The major diagnostic factor followed in deciding the status of pulpitis as, reversible or irreversible, is the severity and intensity of the pain. Traditionally, a tooth diagnosed as irreversible pulpitis results in the removal of coronal and radicular pulp resulting in the non-vitality of the tooth. This case report describes the use of vital pulp therapy (VPT) in three paediatric patients with primary teeth showing signs and symptoms suggestive of irreversible pulpitis. Calcium silicate cement (Biodentine) was used to preserve the radicular pulp, demonstrating favourable clinical and radiographic outcomes over a 1-year follow-up. The findings support the potential of VPT as an alternative to traditional pulpectomy in cases where radicular pulp tissue remains healthy, despite a history of severe pain.

Teeth with vital pulps and stage III periodontitis unresponsive to therapy exhibit a pulpal inflammatory profile similar to symptomatic irreversible pulpitis.

The aim of this study is to investigate the expression of inflammatory biomarkers (TNF-α, IL-10, IL-1β) and the pulpitis-associated miRNA (miR-30a-5p and miR-128-3p) in pulp tissue samples from unrestored teeth with a vital normal pulp (NP), teeth with symptomatic irreversible pulpitis (IP) and in unrestored teeth with periodontal disease, unresponsive to periodontal therapy, and a vital pulp (EP). Thirty patients were included in this observational study (10 teeth with NP, 10 teeth with IP, 10 teeth with EP). Dental pulp tissues samples were collected from patients during root canal treatment (RCT). RNA was extracted and qRT-PCR of target genes (tumour necrosis factor [TNF]-α, interleukin [IL]-1β, IL-10) and miRNAs (has-miR-30a-5p, has-miR-128-3p) performed to assess the expression profile. Fold-change in expression was calculated using the formula 2-(ΔCt(Exp)-ΔCt(Ctrl)). One-way anova with post-hoc Tukey's was used to determine significant differences between groups. The significance level was set at 5% (p < .05). All teeth were also followed up clinically for 1 year and evaluated for a range of endodontic and periodontal-related outcomes. All investigated genes significantly increased in expression and miRNAs significantly decreased in expression in the IP and EP groups compared with the NP group (p < .05). With regards to TNF-α and IL-1β there were no significant differences in expression between the IP and EP groups (p > .05), whereas IL-10 expression levels were significantly reduced in the EP compared with the IP group (p < .05). Both miR-30a-5p and miR-128-3p showed significantly reduced expression in both IP and EP lesions, compared with NP (p < .05); however, no significant differences in miRNA expression were observed between IP and EP groups (p > .05). One year after root canal treatment and periodontal maintenance, tooth mobility and probing depth were significantly reduced in the EP group (p < .05). Pulp tissues from teeth with IP and EP presented similar levels of altered inflammatory markers compared with NP. TNF-α, IL-10, IL-1β cytokines and miRNAs (miR-30a-5p and miR-128-3p) are potential objective biomarkers to indicate pulpal inflammatory status, aiding diagnosis and directing clinical decision-making. RCT may be beneficial to improve stage III periodontitis unresponsive to non-surgical periodontal treatment, but further research is required.

Outcomes of pulpotomy using calcium silicates in permanent teeth with symptomatic irreversible pulpitis: A systematic review and meta-analysis

Abstract The decision making process for managing irreversible pulpitis in permanent teeth often involves choosing between pulpotomy and root canal treatment, with clinicians exercising discretion. This systematic review and meta-analysis aim to evaluate the efficacy of calcium silicate based pulpotomy in treating symptomatic permanent teeth with irreversible pulpitis. A comprehensive search across PubMed, Google Scholar, and SCOPUS databases yielded 482 articles. From this pool, 169 articles underwent further scrutiny. Following data filtration, presentation, and analysis, a meta-analysis was conducted using RevMan 5 software. Eleven articles were ultimately selected based on predefined inclusion and exclusion criteria. This meta-analysis revealed that calcium silicate based pulpotomy, employed in treating irreversible pulpitis cases, exhibited notable success rates ranging from 75% to 90% over a period of 15 years across most of the included studies. The majority of studies integrated into this systematic review reported successful outcomes for teeth with symptomatic irreversible pulpitis undergoing pulpotomy with the utilization of calcium silicate. Nonetheless, further research is necessary to delineate the precise roles of calcium silicate based pulpotomy in managing this condition.

The effect of two different contemporary chelating agents on vital pulp therapy in mature permanent teeth with irreversible pulpitis using bioceramic material: randomized clinical trial.

Vital pulp therapy maintained functionality, vitality, and asymptomatic teeth. Compared to normal root canal treatment, pulpotomy was more helpful for irreversible pulpitis in adult permanent teeth. The research was aimed to assess effectiveness of vital pulp therapy using mineral trioxide aggregate with Apple Vinegar and Ethylene diamine tetra acetic acid (17%) for five minutes in adult carious exposed pulp of permanent teeth. Forty patients between 18 and 50 years old with a clinical diagnosis of symptomatic irreversible pulpitis but no periapical radiolucency were then divided randomly into two groups based on the irrigation method; ethylene diamine tetraacetic acid or apple vinegar. If pulpal bleeding could not be managed in less than six minutes, the assigned procedure was abandoned. After mineral trioxide aggregate application as a pulpotomy agent, glass ionomer and composite restoration were placed. Using a visual analogue scale, the pre and post-operative pain were recorded after 2,6,24,48, and 72h. Success was assessed using radiographic and clinical examination data at three, six, and twelve months. The success rate was discovered to be non-statistically significant in both groups after a year follow-up. Apple vinegar had a lower mean value than ethylene diamine tetra acetic acid at the preoperative baseline pain level, which was significant.Postoperatively, the ethylene diamine tetraacetic acid group reported the greatest mean value after two hours while Apple vinegar group reported the lowest mean values after 48h (P < 0.05). After 72h, pain level recorded insignificant difference. Apple vinegar yielded a marginally successful outcome but substantially improved pain alleviation. The trial was registered in Clinical trials.gov with this identifier NCT05970536 on 23/7/2023.

Comparision of interleukin-1β concentrations in posttreatment endodontic disease and other pulpal and periapical conditions - A clinical study.

To evaluate interleukin (IL)-1β concentrations in periapical tissue fluid (PTF) in persistent apical periodontitis requiring endodontic retreatment and to compare the levels of IL-1β with chronic apical periodontitis, symptomatic irreversible pulpitis (SIP), normal pulpal, and periapical tissues. The patients were selected based on inclusion and exclusion criteria and divided into 4 groups based on the pulpal and periapical status: Posttreatment endodontic diseases (PTED): Teeth with PTED due to failed primary root canal treatment having periapical radiolucency. PNAP: Teeth requiring root canal treatment due to pulpal necrosis having periapical radiolucency. SIP: Teeth with symptoms of SIP with healthy periapical tissues). Intentional root canal treatment (IRCT): Teeth requiring IRCT (healthy pulp and periapical tissues). The access cavity was redefined and the preexisting filling was removed using H-files. The root canals were minimally enlarged followed by collection of PTF using paper points, in the case of group PTED. For groups PNAP, SIP, and IRCT, conventional access cavity preparation was done followed by enlargement of canals till 20, 0.02. PTF was collected using 15, 0.02 size absorbent points 2 mm beyond the apex. Levels of IL-1β was assessed by enzyme-linked immunosorbent assay. A statistically significant difference was seen in levels of IL-1β in all the groups. The highest concentration was seen in group PTED (85.07 ± 11.57 pg/mL) followed by group PNAP (37.60 ± 10.94 pg/mL), group SIP (8.40 ± 1.99 pg/mL), and the least was seen in group IRCT (3.47 ± 1.36 pg/mL). The levels of IL-1β were highest in PETD cases followed by PNAP, SIP, and IRCT. This indicates the severity of inflammation in PETD cases as compared to other endodontic diseases.

Influence of needle gauge on pain perception and use of obturators in achieving profound pulpal anesthesia - A double-blinded in vivo study.

Achieving profound pupal anesthesia and pain management is key in endodontic practice. However, inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia, during symptomatic irreversible pulpitis and has a high failure rate between 35% and 45%. Intrapulpal (IP) injection has been found to have increased efficiency and pain. The study aims to find the pain perception of 26G and 31G and the use of obturators in improving the efficacy of IP anesthesia. Eighty patients with symptomatic irreversible pulpitis after the failure of IANB were recruited and divided into four groups to receive IP with Group I A: 26G with obturators, Group I B: 26G without obturators, Group IIA: 31G with obturators, and Group IIB: 31G without obturators. The pain was measured using the visual analog scale and the effectivity of anesthetic injection by the duration of action. A 31G needle produced the least pain perception compared to the 26G needle during IP injection. A 31G with an obturator was the most efficient, acting in less than a minute and 26G without an obturator showed the least. Within the limitation of this trial, it can be concluded that lesser gauge needles reduce pain perception during IP, and obturators achieve adequate back pressure.

Comparative evaluation of dual-cure resin (TheraCal PT) and Biodentine in coronal pulpotomy of patients with symptoms indicative of irreversible pulpitis: A randomized clinical trial.

New and innovative materials are being marketed for the treatment of coronal pulpotomy. It is crucial to compare their efficacy with already-established materials. TheraCal PT (TP) is such a new material that studies are scarce. This study aim to compare and evaluate the outcome of coronal pulpotomy using Biodentine and a newly introduced calcium silicate-based dual-cure resin cement, TP, in patients with symptoms of irreversible pulpitis. Sixty patients with exposed carious pulp and symptomatic irreversible pulpitis were included, aged 18-40, randomly allocated to two groups: TP (group I) and Biodentine (group II). Coronal pulpotomy was performed following a standardized protocol, with TP or Biodentine applied accordingly. The pain was recorded using Visual Analog Scale preoperatively for up to 1 week. Success was assessed clinically and radiographically for up to 12 months. The data were analyzed using the Friedman test and the Mann-Whitney U-test. Intragroup pain was analyzed using the Wilcoxon signed-rank test. Among 60 patients, intervention was done in 53. By removing dropout patients, 47 were analyzed, with 38 available for follow-up at 3, 6, and 12 months. The Biodentine group exhibited a 12-month success rate of 84%, while the TP group revealed 77.3%, with statistically insignificant difference (P = 0.563). TP can be effectively utilized as a pulpotomy material in cases of symptomatic irreversible pulpitis in mature permanent teeth, offering rapid setting and ease of use, although Biodentine yielded slightly better results in this study.

Assessment of mechanical allodynia in healthy teeth adjacent and contralateral to endodontically diseased teeth: a clinical study.

The present study investigated the prevalence of mechanical allodynia (MA) in healthy teeth adjacent and contralateral to endodontically diseased teeth. This cross-sectional study included 114 patients with symptomatic irreversible pulpitis and apical periodontitis in permanent mandibular first molars who possessed healthy teeth adjacent and contralateral to the endodontically diseased tooth. The mechanical sensitivity of the teeth was determined by percussion testing. The presence or absence of pain on percussion in the teeth adjacent and contralateral to the endodontically diseased tooth and the tooth distal to the contralateral symmetrical tooth was recorded according to coding criteria. The prevalence of MA was computed as a percentage, and binary logistic regression analysis was done. The Fisher exact test and Mann-Whitney U test were used for binary and ordinal data. Age and sex did not influence the prevalence of MA. An increased prevalence of MA was found in patients with higher levels of spontaneous pain (p < 0.001). The prevalence of allodynia was 57% in teeth adjacent to endodontically diseased teeth and 10.5% in teeth contralateral to endodontically diseased teeth. In addition, on the ipsilateral side, there were more painful sensations distal to the diseased tooth than mesially. Despite being disease-free, teeth adjacent and contralateral to endodontically diseased teeth exhibited pain on percussion. There was a direct association between the severity of the patient's pain and the presence of MA.

Can postanesthetic cold sensibility test be used as a tool for the efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis of mandibular molars? – In vivo study

Objectives: The goal of this investigation was to determine the efficiency of a postanesthetic cold test for the detection of pulpal anesthesia to improve diagnostic accuracy. Materials and Methods: Fifty-two participants who showed symptomatic irreversible pulpitis on the mandibular first molar, aged from 18 to 65 years, were given inferior alveolar nerve block (IANB), and subjective anesthetic symptoms were seen after 15 min and were finally assigned for studies. To determine the effectiveness of a postanesthetic cold test for the detection of pulpal anesthesia, the target tooth was separated and Endo-Frost was utilized to conduct a postanesthetic cold sensibility test and was compared to the gold standard test, painful or painless sensation during actual root canal therapy. Of 52 participants, 9 had a positive response to the postanesthetic cold test and 43 had a negative response; 10 responded positively to the gold standard test, whereas 42 gave negative results. Results: The postanesthetic cold sensibility test can diagnose the effectiveness of pulp anesthesia showing a sensitivity of 80%, specificity of 97.62%, positive likelihood ratio of 33.6, negative likelihood ratio of 0.2, positive predictive value of 88.89%, negative predictive value of 95.35%, accuracy of 94.23%, and Youden’s index of 0.78. Conclusions: The postanesthetic cold sensibility test can be used as a tool for the efficiency of IANB before starting root canal therapy to minimize pain and anxiety in patients.

Elective full pulpotomy in mature permanent teeth diagnosed with symptomatic irreversible pulpitis: a two years retrospective study

AimTo investigate the outcome of elective full pulpotomy, using calcium silicate-based cements (CSBC), after 2 years, in symptomatic mature permanent teeth with carious lesions, diagnosed as irreversible pulpitis, and analyse the capacity of Wolters et al. (2017) classification to predict the likelihood of treatment failure.MethodsThe treatment records of 56 patients with symptomatic mature teeth with carious lesions, diagnosed as irreversible pulpitis and treated by elective full pulpotomy, using CSBCs as pulp capping materials, were reviewed. Thirteen teeth were excluded. The remaining 43 teeth were evaluated retrospectively at 24 months. Fisher`s exact test with the Lancaster’s mid-P adjustment was used to assess different outcomes amongst the diagnostic categories.ResultsFour of the cases failed before 24 months and required root canal treatment (RCT). Overall success rate at 2 years was 90.7% (39 of 43). An inverse, but non-significant, correlation was observed between the severity of pulpitis according to the Wolters classification and the treatment success rate (p > 0.05). The type of CSBC used was associated to the success rate (OR = 10.5; 95% C.I. = 0.5 – 207.4; p = 0.027), being 82% with Endosequence and 100% with Biodentine. Postoperative pain associated significantly to lower success rate (66.7%) (Odds ratio = 8.0; 95% C.I. = 0.7 – 95.9; p = 0.047).ConclusionsElective full pulpotomy using a CSBC was a successful choice for the treatment of mature permanent teeth with symptoms indicative of irreversible pulpitis. There were no significant differences between the success rate of mild, moderate and severe pulpitis. Postoperative pain could be considered a risk marker for failure of full pulpotomy. The term “irreversible pulpitis” should be re-signified to indicate the need for access to the pulp chamber, rather than an indication for extraction or RCT.

EVALUATION OF INTRAOPERATIVE PAIN OCCURRENCE AND NEED FOR SUPPLEMENTAL ANESTHESIA DURING EMERGENCY DENTAL CARE

Aims: This study aimed to evaluate the intraoperative pain (IOP) occurrence in situations of symptomatic irreversible pulpitis (SIP) and symptomatic apical periodontitis (SAP).Materials and Methods: Patients who sought emergency care presenting a diagnosis of SIP or SAP were included. IOP was measured with a Visual Analogue Scale (VAS) after five minutes of local anesthesia, during access to the pulp chamber, root canal exploration and at the end of procedures. In cases where pain was reported during treatment, supplementary anesthesia was performed. Pain scores were recorded and analyzed using a generalized estimating equation model with posthoc comparisons. Results: 56 patients were included. 35 had a diagnosis of SIP; and 21 a diagnosis of SAP. Mean preoperative pain scores for SAP and SIP were 6.69 (±1.54) and 6.39 (±1.48), respectively (p&gt;0.05). In patients with SIP, significant differences were observed between: preoperative scores and other time points; scores after five minutes of local anesthesia and other time points; scores during pulp chamber access and at the end of procedures; and scores during root canal exploration and at the end of procedures (p&lt;0.05). In patients with SAP, significant differences were observed between preoperative pain scores with all other time points (p&lt;0.05). Chi-square test indicated an association between diagnosis and the need for supplementary anesthesia (p&lt;0.05). Conclusions: In conclusion, there is a strong relationship between reduction of moderate/severe pain after application of local anesthesia. The need for supplemental anesthesia is significantly associated to the diagnosis of symptomatic irreversible pulpitis.

Impact of Cryotreated and Warm Sodium Hypochlorite on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial

IntroductionThe purpose of this study was to evaluate effect of cryotreated and warm sodium hypochlorite (NaOCl) on postoperative pain in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis. MethodsSixty-six individuals with preoperative pain scores of ≥54 mm on the Heft Parker Visual Analogue Pain Scale (HP-VAS) diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis as per the American Association of Endodontists guidelines in mandibular molars were included. The preparation of the access and the root canals was instrumented and irrigated in accordance with a standard protocol. Based on the temperature of the final irrigant, the root canals were then randomly assigned to 3 groups and 3% NaOCl was irrigated: control (at 25°C), cold NaOCl (2°C), and warm NaOCl (60°C) (n = 22/group). Root canal treatment was completed at the same visit. Pre- and postoperative pain assessment at 6, 24, 48, and 72 hours was conducted using the HP-VAS, and analgesic consumption was noted. Suitable statistical tests were used to analyze the data. ResultsIn comparison with the other 2 groups, the cold NaOCl group had a lower HP-VAS score at all follow-up intervals. Between groups, there was a statistically significant difference in postoperative pain scores at 6 and 72 hours (P < .05). None of the subjects experienced any postoperative discomfort at 72 hours in the control and cold NaOCl groups. ConclusionPatients treated with cold NaOCl as the final irrigant experienced significantly less postoperative pain at 6 hours when compared with room temperature and warm NaOCl.