Symptomatic Irreversible Pulpitis Research Articles

Post Operative Pain and Expression of Substance P, Il8 After the Use of Ketorolac Irrigant in Teeth with Symptomatic Irreversible Pulpitis with Apical Periodontitis (Clinical Trial)

Post Operative Pain and Expression of Substance P, Il8 After the Use of Ketorolac Irrigant in Teeth with Symptomatic Irreversible Pulpitis with Apical Periodontitis (Clinical Trial)

Assessment of The pretreatment Efficiency with Dexamethasone VS Placebo on Post-operative Pain in teeth with Symptomatic Irreversible Pulpitis

Assessment of The pretreatment Efficiency with Dexamethasone VS Placebo on Post-operative Pain in teeth with Symptomatic Irreversible Pulpitis

Local Tramadol Improves the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis.

Symptomatic irreversible pulpitis is a painful clinical condition with a broad inflammatory component. Dental anesthesia in these patients is affected by the inflammatory process, reporting a high incidence of anesthesia failure. The aim of this systematic review and meta-analytical evaluation was to determine the effect of pre-treatment with tramadol in patients with symptomatic irreversible pulpitis, as well as for pain control and adverse effects. This study was registered in PROSPERO (ID: CRD42021279262). PubMed was consulted to identify clinical investigations comparing tramadol and placebo/local anesthetics in patients with symptomatic irreversible pulpitis. Data about the anesthesia, pain control, and adverse effects were extracted. Both the anesthetic success index and the adverse effects of local tramadol and placebo were compared with the Mantel–Haenszel test and odds ratio. Data analysis showed that the local administration of tramadol increased the anesthetic success rate when compared to placebo in patients with symptomatic irreversible pulpitis (n = 228; I2 = 0; OR = 2.2; 95% CIs: 1.30 to 3.79; p < 0.004). However, local administration of tramadol increased the risk of adverse effects when compared to placebo/local anesthetics (n = 288; I2 = 0; OR = 7.72; 95% CIs: 1.37 to 43.46; p < 0.02). In conclusion, this study shows that the local administration of tramadol increases the anesthetic success index when compared to placebo in patients with symptomatic irreversible pulpitis.

Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double-blind single-centre clinical trial.

The aim of this study was to assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation. Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6ml 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4ml 4% articaine hydrochloride with 1:100 000 adrenalin (n=165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point Numerical Rating Scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need for supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analysed using Mann-Whitney U- and Chi-squared (χ2 ) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure were calculated. The effect of pre-disposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects. Baseline variables were balanced between groups (p > .05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p > .05). IOP intensity was associated with preoperative pain intensity and tooth type (p < .05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p > .05) with a relative risk of failure [95% CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p > .05; RR [95% CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia. 2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

Effectiveness of pulpotomy vs root canal treatment on postoperative pain and the treatment outcome in the management of permanent mature posterior teeth with symptomatic irreversible pulpitis: A systematic review and meta- analysis

Aim and objective: The objective of the present systematic review is to evaluate the success of pulpotomy in mature permanent teeth presented with irreversible pulpitis. Methodology: The following databases were searched: MEDLINE, EMBASE, Cochrane Library, CINAHL Complete, Scopus, and ClinicalTrials.gov. We included studies published in the English language only. However, narrative reviews and case reports/series were excluded. The first electronic and hand search yielded a total of 210 articles. After going through extensive screening and eligibility process, only thirteen articles were finally selected for the review. The follow-up period ranged from 1 to 10years. A Meta- analysis of two randomized clinical trials was performed using RevMan 5.4 (RevMan 5.4, The Nordic Cochrane Centre, Copenhagen). Results: Randomized controlled trials which compared pulpotomy with the root canal treatment reported comparable success of pulpotomy. All the other studies have also shown comparable clinical and radiographic success of pulpotomy. Conclusion: Pulpotomy can be considered an alternative option for mature permanent teeth with irreversible pulpitis.

A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis.

Accomplishing painless endodontic treatment, especially in the mandibular molar region, is challenging. Hence, the aim of the study was to compare the efficacy of 2% lidocaine and 4% articaine when used as supplemental intra-ligamentary (IL) anesthesia in mandibular molars having symptomatic irreversible pulpitis with symptomatic apical periodontitis after failed Inferior Alveolar Nerve Block (IANB) injection. In this prospective study, one-hundred and forty-seven adult patients diagnosed with irreversible pulpitis in a mandibular tooth were included who received IANB with 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Patients who experienced pain were recorded using the Heft–Parker visual analog scale (HP-VAS score ≥ 55 mm) and received supplement intra-ligament injection with either4% articaine or 2% lidocaine with 1:100,000 epinephrine. Supplementary intra-ligament injections resulted in 82.6% and 91.3% of profound anesthesia in the first molar region for 2% lidocaine and 4% articaine, respectively. Similarly, an additional IL injection of articaine success percent (78.9%) in the second molar region was higher than lidocaine (63.1%). The overall success ratio revealed no significant difference in achieving profound anesthesia of either solution. In this study population, there was no difference in the success ratio of anesthesia between 2% lidocaine and 4% articaine when used as supplemental IL injection.

Determination and Comparison of Frequency of Endodontic Emergency, Non-endodontic Emergency, and Non-Emergency Conditions in Patients Attending Qamar Dental Hospital, Karachi During Early COVID-19 Pandemic

OBJECTIVE: To determine and compare the frequency of endodontic emergencies (EE) with other dental conditions in patients attending Qamar Dental Hospital (QDH), Karachi during first wave of COVID-19 pandemic. METHODOLOGY:The dental records of all the dental patients (n= 1824) who attended the QDH during first wave of COVID-19 Pandemic peak were retrieved and divided into 3 groups based on diagnostic conditions:1) - non-emergency (NE), 2)- Emergency endodontic (EE), and 3) - Emergency non-endodontic (ENE). The age groups were also divided into 3 group of 0 to 25, 26 to 50, and &gt;50. Categorical variables were reported as %. Chi-square test was used to find inter-group difference. p &lt;0.05 was regarded as significant. RESULTS: Dental records of 1823/1824 patients were analysed. Results suggested that 54.6% of the patients were females and 50.1% of patients belonged to age range 0 to 25. Moreover, 1040 (57%) patients suffered with EE conditions, and 805 (77.4%) with symptomatic irreversible pulpitis. Analysis showed that significantly higher number of females and patients with age &lt; 50 suffered with EE as compared to males and age &gt;50 (p &lt;0.05). Significantly higher number of patients aged &gt;50 years had ENE conditions as compared to 0 to 25 age group (p= 0.007) CONCLUSIONS: Emergency endodontic conditions, especially symptomatic irreversible pulpitis was most prevalent during COVID-19 pandemic. This condition was experienced more by females and patients of age group &lt;50 years. Efficient allocation of resources and cross-training is recommended to facilitate treatment of such patients during the pandemics. KEYWORDS: COVID-19; Dental care; Dental emergency; Demographics; Endodontic emergency; Frequency

Dexamethasone Increases the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis.

Inferior alveolar nerve block (IANB) has a high failure rate in subjects with symptomatic irreversible pulpitis (SIP). It has been suggested that drugs with anti-inflammatory activity could improve the efficacy of the anesthetic used for IANB. The aim of this study was to assess the effect of dexamethasone on the success of dental anesthesia in patients with SIP. An information search was performed using PubMed and Google Scholar. The risk of bias of the included studies was evaluated with the Cochrane Collaboration’s risk-of-bias tool. The anesthetic success rate, pain intensity (VAS), and adverse effects were extracted. Data were analyzed using the Mantel–Haenszel test and odds ratio or the inverse variance and standardized mean difference. Dexamethasone increased the anesthetic success in comparison with placebo (n = 502; p < 0.001; OR = 2.59; 95% CIs: 1.46 to 4.59). Moreover, patients who were given dexamethasone had lower pain scores at 6 h (n = 302; p < 0.001; MD= −1.43; 95% CIs: −2.28 to −0.58), 12 h (n = 302; p < 0.0001; MD = −1.65; 95% CIs: −2.39 to −0.92), and 24 h (n = 302; p < 0.0008; MD = −1.27; 95% CIs: −2.01 to −0.53) when compared with placebo. In conclusion, the systemic administration of dexamethasone increases the anesthetic success rate and improves pain management in patients with SIP.

Vital Pulp Therapy of Permanent Teeth with Reversible or Irreversible Pulpitis: An Overview of the Literature.

Vital pulp therapy (VPT) has been recently proposed as an alternative approach even in symptomatic mature permanent teeth with deep caries’ lesions, aiming to maintain the pulp vitality over time and/or to avoid non-surgical root canal therapy (NSRCT). However, to date, the diagnosis of reversible or irreversible pulpitis is only based on clinical pain quantity and quality, without precisely reflecting the pulp inflammation status. Therefore, the aim of the present study was to provide an overview based on the current scientific literature to demonstrate the clinical effectiveness of VPT on mature permanent teeth, validating the use of hydraulic calcium silicate-based cements and their role in pain management. VPT may be successfully applied not only in mature permanent teeth diagnosed with reversible pulpitis, but also in permanent dental elements with signs and symptoms of irreversible pulpitis. Hydraulic cements showed favorable outcomes in terms of decrease of pro-inflammatory mediators and of post-operative pain. Pain plays a central role in the chance to perform VPT in mature permanent teeth, since it may be considered as a pre-operative diagnostic criterion as well as a treatment success parameter. In addition, proper assessment of pulp inflammation and choice of appropriate materials are key factors in enhancing VPT success.

Effect of preoperative tramadol, ibuprofen, ibuprofen/acetaminophen on the anaesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis.

The purpose of this double-blind clinical trial was to compare the effect of preoperative tramadol 50 mg, tramadol 100 mg, ibuprofen 600 mg, ibuprofen 600 mg/acetaminophen 1000 mg or placebo 60 min before the administration of inferior alveolar nerve blocks (IANB) of mandibular teeth in patients experiencing symptomatic irreversible pulpitis (SIP). Two hundred and fifty emergency patients diagnosed with SIP were randomly divided into five groups and received medications. Endodontic access was begun 15 min after completion of the IANB, and all patients had profound lip numbness. The Heft-Parker visual analogue scale was used to evaluate pain. Premedication with tramadol 100 mg significantly increased the success rate to 62% than the other groups (p < 0.05). The success rates of ibuprofen, ibuprofen/acetaminophen and tramadol 50 mg groups were not significantly different (p > 0.05). Premedication with tramadol 100 mg enhanced the anaesthetic success of IANB in mandibular molars with SIP.

EFFICACY OF 4% ARTICAINE BUCCAL INFILTRATION VERSUS INFERIOR ALVEOLAR NERVE BLOCK FOR MANDIBULAR MOLARS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

To compare the anesthetic efficacy of buccal infiltration (BI) using 4% articaine vs 4% articaine or 2% lidocaine inferior alveolar nerve block (IANB) for mandibular molars with symptomatic irreversible pulpitis. PubMed, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov were searched using MESH terms and specific keywords. Included articles were Randomized Clinical Trials (RCTs), which compared 4% articaine BI vs conventional IANB in terms of the efficacy of pulpal anesthesia and success rate. The quality assessment of included studies was done according to the Cochrane risk of bias assessment tool. Studies were quantitatively assessed using fixed or random effect models. Out of 756 articles, 5 RCT studies were included with a total number of 500 patients: 231 in 4% articaine BI group, 150 in 2% lidocaine IANB group, and 119 in 4% articaine IANB group. Our meta-analysis results showed that patients anesthetized with 4% articaine BI had a similar success rate compared to 2% lidocaine IANB [pooled RD: 0.14 (95% CI, -0.01 to 0.29); P = .08]. Similarly, there was non-significant difference when compared to 4% articaine IANB [RD:-0.01 (95% CI, -0.13 to 0.11; P = .86)]. Patients anesthetized with 4% articaine BI presented comparable pain scores compared to IANB (4% articaine or 2% lidocaine) [pooled MD: -0.14 (95% CI, -0.38 to 0.11); P = .27]. Regarding quality assessment, 3 studies were considered to have a low risk of bias, one study has an unclear risk of bias, and one study has a high risk of bias. 4% articaine BI showed comparable results in terms of pain relief and success rate in comparison with 2% lidocaine IANB or 4% articaine IANB. However, due to the limited number and small sample size of included studies, these findings should be considered carefully, and further studies are required to confirm our findings.

Analgesic intake after pulpotomy and root canal treatment of permanent molars with carious exposure

To compare the patients’ analgesic intake after pulpotomy and root canal treatment and to compare the time span of both endodontic procedures. A total of thirty-four permanent mandibular molars with signs and symptoms of irreversible pulpitis were randomly assigned to a pulpotomy group (n=17) and root canal treatment (RCT) group (n=17). Endodontic procedure duration was recorded for both groups. Analgesic intake for each patient was recorded up to the fourth day post treatment. In management of mature permanent teeth with carious exposure, pulpotomy may be preferred because it is a simple technique requiring less time and patients requires significantly less analgesics postoperatively.

Post-Endodontic Pain after Root Canal Treatment of Symptomatic Teeth with Mtwo and Safe Sider Multiple File Systems: A Randomized Clinical Trial

Background: Considering the increasing popularity of rotary files among dental clinicians and the emergence of several types of rotary systems, clinical trials are necessary to compare these systems from various aspects. Objectives: This study compared post-endodontic pain following the use of Mtwo and Safe Sider multiple file system. Methods: A total of 150 maxillary and mandibular molars with symptomatic irreversible pulpitis were selected. Their root canals were randomly instrumented with hand files, Mtwo and Safe Sider instruments. The severity of postoperative pain was assessed using a Visual Analog Scale (VAS) at 6, 12, 24, 48 and 72 hours. The data were analyzed using repeated measures ANOVA. P&lt;0.05 was considered statistically significant. Results: The mean postoperative pain score significantly decreased in all three groups over time. The mean pain score at 12 and 24 hours post-treatment was significantly higher in the Safe Sider group compared to the other two groups. At 6, 48 and 72 hours, no significant difference was noted in the severity of pain among the three groups. Conclusions: Postoperative pain is significantly higher at 12 and 24 hours following endodontic treatment with Safe Sider compared to the conventional hand instruments and Mtwo system.

Anaesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta-analysis and trial sequential analysis.

Incorporating an additive into lidocaine is a method to enhance the efficacy of the inferior alveolar nerve block (IANB) in mandibular posterior teeth. To assess the efficacy of incorporating additives into lidocaine in the success rate of IANB for teeth with the diagnosis of normal pulp (NP) or symptomatic irreversible pulpitis (SIP). Randomized controlled trials (RCTs) assessing the incorporation of additives into lidocaine on the pulpal anaesthesia success rate of mandibular posterior teeth were searched in PubMed, Scopus, Web of Science, Ovid, EBSCO, Embase, and Cochrane databases up to 1 December 2021. The risk of bias (RoB) was assessed by the Cochrane Risk of Bias Tool. A random-effects model was employed to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI), using STATA 16. The trial sequential analysis (TSA) was applied to calculate the required information size (RIS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of the evidence. Of 6966 records retrieved initially, 14 trials (8 for NP and 6 for SIP groups) were included in qualitative and quantitative syntheses. All trials were categorized as low and unclear RoB for NP and SIP groups, respectively. In the NP group, with 307 participants, no significant effect was observed for additives incorporated into lidocaine (RR: 0.84; 95% CI: 0.53-1.32; I2 =98%). Subgroup analysis revealed that adding mannitol led to a higher success rate (RR=1.24; 95% CI: 1.15-1.34; I2 =7.16%). In the SIP group, with 434 participants, no significant effect was shown when the additives were incorporated (RR=1.22; 95% CI: 0.98-1.52; I2 =0%). Likewise, in subgroup analysis, incorporating mannitol or sodium bicarbonate demonstrated no significant effect (RR=1.76; 95% CI: 0.93-3.32; I2 =18.41% and RR=1.06; 95% CI: 0.65-1.72; I2 =53.5%, respectively). TSA revealed that the outcome was "inconclusive" for each group. The certainty of the evidence was graded as "very low" and "low" for NP and SIP groups, respectively. The very low to low certainty of evidence indicated that incorporating additives into lidocaine did not increase the efficacy of IANB and supplemental injections are still necessary to help practitioners achieve painless dentistry. PROSPERO database (CRD42020132585).

Clinical practice guideline for pharmacological management of pain and swelling in endodontic emergencies

Endodontic pain is one of the most predominantly associated symptoms. The pain may arise due to either because of an endodontic cause (or) a periradicular cause, importantly endodontic pain type variant is the most commonly encountered by the dentist in their clinical practice. The objective of endodontic treatment is to prevent or cure apical periodontitis (AP) caused by infection of the root canal systems of the affected teeth (or) due to persistence of primary infection (or) emergence of infection after treatment 1. An online search was conducted in MEDLINE, Embase, the Cochrane library and the cumulative Index to Nursing and Allied Health literature to retrieve evidence on benefits and harm associated with antibiotic use &amp; review articles by utilizing the following keywords: Antibiotics, symptomatic Irreversible pulpitis, symptomatic apical periodontitis, pulp necrosis, localized acute apical abscess, clinical practice guidelines. The clinician must systematically gather all of the necessary information to make a “probable diagnosis” Endodontic diagnosis is similar to a Jigsaw puzzle diagnosis cannot be made from a single isolated piece of information. The indications are based on the clinical diagnosis of Normal pulp, reversible pulpitis, symptomatic (or) asymptomatic Irreversible pulpitis &amp; necrotic pulp (or) localized acute apical abscess 2.

Regenerative endodontic procedures for two traumatized mature anterior teeth with transverse root fractures

BackgroundRegenerative endodontic procedures (REPs) are an alternative treatment in immature traumatized teeth with necrotic pulp/apical periodontitis. However, this procedure has been infrequently reported in multiple transverse root fractures of mature teeth. This case report describes management of a patient with multiple horizontal root fractures in 2 maxillary central incisors that were successfully treated with REPs.Case presentationA 17-year-old girl had a history of traumatic injury to mature teeth 11 and tooth 21 resulting in multiple transverse root fractures. Clinical examination showed that both teeth responded to electric and thermal pulp sensibility tests with prolonged severe pain and were tender to percussion and palpation. Periapical radiographic examination showed both teeth were fully developed and had multiple transverse fractures in the mid-root. The pulp diagnosis was consistent with symptomatic irreversible pulpitis. REPs were initiated with only the coronal fragments treated to preserve pulp vitality in the apical fragment for potential pulp tissue regeneration. After REPs, clinical signs/symptoms subsided, and the two teeth were followed for 48 months when cone beam computed tomography (CBCT) imaging was also undertaken. At the last review, the case demonstrated root fractures healing with calcified tissue and pulp calcification in the apical fragments. Both teeth were stable and in function.ConclusionsREPs have the potential to be used to treat traumatized and symptomatic mature permanent teeth that have sustained transverse root fractures.

Management of External Cervical Resorption in Mandibular Molar Furcation Area - A Case Series

&lt;p&gt;External cervical resorption (ECR) is an aggressive form of root resorption causing loss of tooth structure and sometimes leading to destruction of adjacent alveolar bone. In the advanced extent of ECR lesion, surgical intervention is inevitable. Several studies presented favorable treatment outcomes on advanced ECR lesions at single teeth. In the light of these studies, this article reports on surgical management of two ECR cases. Materials and Methods: Two cases had ECR combined with bony defect in left mandibular first molar. Case 1 had ECR lesion over buccal furcation area combined with buccal bone plate loss. Following root canal treatment, the resorptive defect was restored by mineral trioxide aggregate and the bony defect was treated with guided tissue regeneration (GTR). Case 2 had class II furcation defect with ECR over furcal surfaces of mesial and distal roots. The resorptive defect was restored with bioceramic putty and class II furcation bony defect was treated by GTR. Root canal treatment of tooth 36 was done later after case 2 suffered from symptomatic irreversible pulpitis of tooth 36. Result: At one-year follow-up of case 1, no inflammatory signs with probing pocket depth (PPD) less than 3mm clinically and regeneration of buccal bone plate radiographically were found of tooth 36. At half year follow-up of case 2, there was a healthy gingiva with PPD less than 3mm clinically and the furcation area has been partially filled with regenerated bone radiographically of tooth 36. Conclusion: These case series presented an interdisciplinary surgical management of two cases with external cervical resorption combined with bony defect over lower molar furcation area which were successfully treated with biocompatible restorative material in combination with GTR technique in short-term follow-up.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Cryotherapy as an adjunct to inferior alveolar nerve block in Symptomatic Irreversible Pulpitis: A randomised controlled clinical trial

: To evaluate and compare the effect of two approaches of cryotherapy for improving the success rate of Inferior alveolar nerve block and reduction of pain during access opening in mandibular molars with symptomatic irreversible pulpitis.: Thirty patients diagnosed with symptomatic irreversible pulpitis were selected based on inclusion and exclusion criteria to participate in the study. 3 groups were designed; Group 1(Control group) - inferior alveolar nerve block(IANB) with lignocaine (2%) adrenaline (1:80000), Group 2(IANB+ small ice pack)-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + small ice packs (wrapped in sterile gauze); Group 3 (IANB+Endo Ice) -inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + Endo Ice application. Patients were randomly allocated to any one of the groups: The level of preoperative pain was recorded using the Numeric visual analogue scale (VAS). Endodontic therapy was done 15 minutes after the IANB injection. The level of intra operative pain during access opening was recorded again using the same scale. If the patients reported moderate or severe pain during the procedure, the IANB was defined as “unsuccessful,” and a supplementary injection was administered.: There was statistically significant difference found in pain reduction among 3 groups (p=0.01). Post hoc analysis revealed significant difference between Group 1(Control) and Group 2(IANB+ small ice pack) with (p=0.003). Overall success rate of IANB was found to be 66.66 %.: Both the techniques of intraoral cryotherapy exhibited improved pain reduction as well as increased the success rate of IANBs in mandibular molar teeth with SIP. Hence based on the results obtained, it is suggested that cryotherapy can serve as a useful adjunct to anaesthesia during endodontic procedures.

Comparative evaluation of complete and partial pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis: A randomized clinical trial.

The study aimed to compare the outcome of complete pulpotomy (CP) and partial pulpotomy (PP) techniques when utilised for the management of mature permanent teeth with carious pulpal exposure and symptomatic irreversible pulpitis (SIP). The study protocol was registered with ClinicalTrials.gov (NCT04397315). One hundred and six permanent mandibular molars with carious pulpal exposure and clinical diagnosis of SIP with periapical index ≤2, from patients aged between 18 and 40years were randomly allocated in equal proportion to either CP or PP group. Allocated procedures were performed using standardised protocols. The allocated procedure was abandoned in cases where pulpal bleeding could not be controlled within 6min using cotton pellets soaked in 3% sodium hypochlorite. MTA was used as a pulpotomy agent and teeth were restored using a base of glass ionomer followed by composite restoration. The pain was recorded by the patient preoperatively before administration of local anaesthesia and postoperatively every 24h for 1week using visual analogue scale. Success was analysed at 12months based on clinical and radiographic examination. Mann-Whitney U test was used to compare age, pain scores and mean analgesic consumption between the groups. Categorical data were analysed using chi-square test. Fisher's exact test was used to assess the clinical and radiographic success and incidence of pain. Kaplan-Meier analysis was used to assess the survival of teeth. A p-value <.05 was considered as statistically significant. One hundred and one patients were analysed at follow up. Higher success was observed in CP (89.8%) in comparison to PP group (80.8%), but the difference was non-significant statistically (p=.202). Although no significant difference was observed in pain incidence between the groups at 24h (p=.496), a significant difference in pain intensities was observed between groups at all the tested time intervals, with lower values reported in CP group (p<.05). Both CP and PP resulted in favourable outcomes in the management of cariously exposed permanent teeth with signs indicative of SIP. Given the more conservative nature of PP, it may be attempted first before proceeding to CP in such cases.

Preoperative oral medication of combination of Ibuprofen and Dexamethasone can improve the anesthetic success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis

Preoperative oral medication of combination of Ibuprofen and Dexamethasone can improve the anesthetic success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis