Evaluation of anesthetic efficacy of 4% articaine as buccal infiltration vs 2% lidocaine as IANB in the mandibular 1st molar with irreversible pulpitis

The purpose of this prospective, randomized, study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:200,000 epinephrine for buccal infiltration and inferior alveolar nerve block respectively in patients experiencing irreversible pulpitis in permanent mandibular first molars. Sixty emergency patients diagnosed with irreversible pulpitis of a mandibular first molar ran-domly divided into two groups. Thirty patients received buccal infiltration of 1.7 ml of 4% articaine with 1:100,000 epinephrine and thirty patients received standard inferior alveolar nerve block with 1.8 ml of 2% lidocaine with 1:200,000 epinephrine. Endodontic access was begun 10 minutes after solution deposition, success [anesthetic efficacy] was defined as none or mild pain [Visual Analogue Scale recordings] on endodontic access preparation or pulp extirpation. Twenty-two patients out of 30 did not experience pain with 4% articaine [success = 52.4%] and 20 out of 30 patients did not experience pain in 2% lignocaine group [success = 47.6%]. There was no statistically significant difference between the articaine formulation as buccal infiltration and lidocaine formulation as IANB with regard to anesthetic success [p value =0.220]. Even though buccal infiltration of 4% articaine and IANB of 2% lidocaine were equally effective, buccal infiltration can be considered a viable substitute in IANB for anesthetizing mandibular first molar with irreversible pulpitis

Impacted mandibular third molar surgery; the role of dexamethasone in postoperative swelling and trismus

The objective of this study was to evaluate the therapeutic effect of dexamethasone in post-operative edema and trismus after impacted third molar surgery. It was a prospective randomized control study carried in Department of Oral and Maxillofacial surgery, BADC, Larkana from March 2012 to Feb 2013. Patients age between 20-45 years of either gender; unilateral mandibular impacted third molars [right or left] were included. Patients divided in two groups by using random allocation number. Patients in Group-A were given intramuscular 8 mg dexamethasone 1 hour before surgery and four tablets [2mg] dexamethasone orally immediate postoperatively and 24 hours after surgery. The facial swelling was checked before surgery, after 24 hours [1st day], after 48 hours [2nd day], after 72 hours [3rd day] and on 7th postoperative day Inter-incisor distance was checked on every follow up. Data was analyzed by SPSS version 17. Mean and standard deviation was calculated for age and gender. Mean and SD of facial swelling and mouth opening was calculated before extraction, on 1st, 2nd, 3rd and on 7th post-operative day in both groups. The dexamethasone group showed significant reduction in swellingcompared with control group at all intervals. Dexamethasone resulted in significantly less trismus than controls on day 2 postoperatively, but there was no significant difference among the groups at 7thday. Dexamethasone is effective in minimizing swelling and trismus after removal of impacted lower third molar and improves the social life of individual

Forehead flap for reconstruction of maxillofacial region defects

OBJECTIVES: To assess the efficacy and efficiency of forehead flap in reconstruction of maxillofacial region defects

STUDY DESIGN: Descriptive study

PLACE AND DURATION: Department of Oral and Maxillofacial Surgery King Edward Medical University/Mayo hospital Lahore, from November 2009 to June2012

METHODOLOGY: This study was carried out on 30 [Thirty] consecutive patients, of either sex, who required soft tissue reconstruction of maxillofacial region including oral cavity defects due to trauma, infection or after tumor ablative surgery. Follow up was done for four months and on every follow up visit, patients were questioned about the degree of satisfaction, with mouth opening and donor site aesthetics. Cosmetic deformity judged subjectively

RESULTS: The axial pattern fascio-cutaneous flap, for the reconstruction of maxillofacial region with oral cavity defect, performed in 30 patients. Success rate of the flap was 100%, with only partial necrosis of the flap in 1 case. Subjective assessment of the donor site however showed suboptimal results with 30% [n-9] patients moderately satisfied and 20% patients [n-6] were unsatisfied

CONCLUSION: Forehead flap is a reliable technique for reconstruction of maxillofacial region defects

Frequency of C-shaped canals in mandibular permanent second molar among Hyderabad population

The objectives of this study were to assess the frequency and configuration of C-shapedcanal in mandibular second molar teeth. Descriptive type of study. This study was performed at the Dental OPD, Department of Operative Dentistry, Liaquat University Hospital, Hyderabad / Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro from June 2010 to December 2010. A total of 100 extracted mandibular second molars were collected. The teeth were stored in 0.9% physiological solution [Otsuka Pakistan Ltd:] after extraction. Calculus and the remainder of periodontal tissue were thoroughly removed by a curette. All the samples were then rinsed with tap water and dried with air. Each tooth was opened to gain access of the pulp chamber by a small round bur [Mani, Japan]. The pulp chamber was injected with the 0.5% methylene blue [BDH Gurrcertistan chemical Ltd: Poole England]. The contrast color penetrated through pulp-down to the pulp orifice of the root canal. All the teeth were resected transversally at the cemento-enamel junction by a thin diamond disc [Mani, Japan] and the crowns were discarded. The canal orifices were located by DG-16 endodontic explorer. The same diamond disc were used for cutting roots transversally into two more sections at middle 3[rd] and 2mm above the root apex. All these three section were studied under operating microscope [66 vision tech: Co. Ltd: Sozhou, China] for anatomical properties mentioned in objectives. Thirteen C-shaped canals were found out of 100 mandibular second molars. 03 were of category I and II respectively and 07 were of category III. The present study demonstrated that mandibular second molar teeth have variations in terms of number of roots, number of canal orifices and canal morphology. Therefore it cannot be assumed that these teeth always have two-roots and three canals. The overall prevalence of C-shaped canal was found 13% in the local population. The difference to other studies may be attributable to racial differences and study model

Etiology and incidence of maxillofacial skeletal injuries at tertiary care hospital, Larkana, Pakistan

The objective of this study was to determine the causes, incidence and distribution of maxillofacial injuries. This was a descriptive study performed at the tertiary care hospital of Larkana [Accident and Emergency Department of Chandka Medical College, Hospital and Outpatient's Department of Bibi Aseefa Dental College Hospital, Larkana] from 1st February 2011 to 30th August 2013. Two hundred and eighty eight patients of maxillofacial injuries were included in this study patients less than 11 years of age, suffering from neurological disorders and patients with isolated cases of dental and nasal injuries or only with facial lacerations were excluded. Information and data were collected from history, clinical examination and surgical preoperative records of each patient. Results showed that the most common etiology was road traffic accident [170] 59%, interpersonal violence [31] 10.76%, gunshot injuries [28] 9.7%, falls [19] 6.5% and others [40] 13.88%. The mandible was the most frequent bone fractured, which accounted for [148] 50.38% followed by zygomatic complex [52] 18% and [24] 8.3% maxillary bone. Fracture in combination form involved [64] 22%. It was concluded that road traffic accident was the most common etiological factor of maxillofacial skeletal trauma, while second most common cause was the interpersonal violence. Mandible was the most commonly fractured bone

Frequency of second canal in maxillary second premolars [ex-vivo study]

The objective was to determine the frequency of second canal in extracted maxillary second premolars. This was an in vitro study conducted at the Department of Operative Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro from October 2011 to March 2012. This study included two hundred extracted human maxillary second premolars. The pulp chambers were accessed with round bur in a high speed air turbine, and they were irrigated with 2.5% sodium hypochlorite solution for 12 hours to dissolve the pulp tissues, then rinsed under running tap water for 2 hours and dried overnight. The dye was introduced coronally and flooded throughout the pulp space by vacuum suction apically. Teeth were then decalcified in 5% nitric acid solution for five days. Eventually teeth were made clear by dipping in methyl salicylate and examined under operating microscope under 7.5 x magnification for the frequency of second canal. Results showed that the frequency of second canal of the maxillary second premolars is 37% [74/200]. Chi-square test was used to evaluate the results. It was concluded that dentists must always look for the second canal during endodontic treatment of the maxillary second premolars

Prevalence of dental caries in Bibi Aseefa Dental College, Larkana areas

The study was conducted for the first time in Bibi Aseefa Dental College [BADC], Larkana from April 2012 to March 2013 to evaluate the prevalence of dental caries in Larkana city and its adjoining areas, and to know the effect of age, gender, socioeconomic status, oral hygiene status and attitude towards dental awareness to caries prevalence. It was a Cross-sectional study. Six hundred patients between 13-20 and 21-30 years of age were selected from dental OPD, BADC, Larkana. The dentition was examined using WHO 1997 guidelines. The results were tabulated and statistically analyzed. Chi-square test was used to evaluate results. The overall caries prevalence in 13-20 years and 21-30 years old groups in Larkana city and adjoining areas determined was 100%.The mean DMFT value was higher i.e. 3.42 in age group 13-20 years. Besides age, the gender, socioeconomic status, oral hygiene status and attitude towards dental awareness were significantly related to dental caries prevalence. It was concluded that prevalence of dental caries in Larkana city and its adjoining areas was found considerably higher, and it was significantly related to bad oral hygiene and socioeconomically deprived patients which indicates lack of awareness and motivation. Prevalence of dental caries decreased with increasing age

Frequency of fourth canal in permanent mandibular first molars

This study was carried out to investigate the frequency of fourth [distolingual] canal in the permanent mandibular first molars and to determine the effect of modified access cavity preparation for endodontic treatment. It was an observational study. The study was conducted at the Department of Operative Dentistry, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro/Hyderabad from September 2009 to February 2010. Two hundred permanent mandibular first molars were selected from male and female patients presenting for endodontic treatment. The method used for exploring the fourth canal was the modified access cavity preparation which involved changing the triangular access cavity shape to a quadrangular shape. The study involved careful selection criteria, pre-operative radiological examination and then triangular access cavity preparation. The number of canals found by triangular access cavity preparation was noted on the proforma before extending the shape to a quadrangular shape and then a thorough exploration of the floor of the pulp chamber was done. Finally, if fourth canal was present, the presence of the fourth canal was confirmed by taking two periapical radiographs at two different angles with 15 # K files in the root canals. The data collected were analyzed using the chi square test. The results showed that fourth canal was found in 36% of permanent mandibular first molars. The effect of modified access cavity preparation was significantly higher [P= 0.0001] in cases with a fourth canal than in teeth with three canals [P= 0.05]. Statistically there was insignificant difference [P= 0.7] between the genders for the occurrence of fourth canal. This study demonstrates that there is a greater frequency of fourth canal in the permanent mandibular first molar teeth than previously thought. Also changing the shape of access cavity from a triangular outline to a quadrangular outline facilitates in locating the fourth canal

Rate of apical extrusion of sodium hypochlorite: open ended versus closed ended needles

The objective was to compare the role of needles design [open ended versus closed ended] on the apical extrusion of sodium hypochlorite irrigant during root canal treatment. This was an in vitro study performed at the Department of Operative Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro from March 2011 to October 2011. Access cavities were prepared in one hundred extracted human maxillary first molars. The mesiobuccal canal was left open whereas the remaining canals were sealed. The acrylic receptacles were used to hold the teeth in a position as they are present in maxillary arch naturally. The starch/KI solution [A reagent that changes into blue color when comes in contact with sodium hypochlorite] was used to fill the receptacles. The teeth were divided into two groups [G1 and G2] each contained 50 specimens respectively. G1: Irrigation of the mesiobuccal canals with 5.25% sodium hypochlorite with open ended beveled needle. G2: Irrigation of the mesiobuccal canals with 5.25% sodium hypochlorite with closed ended side vented needle. Patency file was #10 K in both the groups. The change in any color of starch/KI solution was captured with digital photographs. Results showed overall frequency of apical extrusion of sodium hypochlorite is 43% [43/100]. There was higher extrusion incidence with open ended beveled needle which was 62% [31/50] than with closed ended side vented needle which showed 24% [12/50]. It was concluded that rate of extrusion was significantly high with open ended beveled needle than with closed ended side vented needle. A closed ended side vented needles appeared significantly safer than open ended beveled needles

Validity of different methods for MB-2 canal location in permanent maxillary molars

The purpose of this study was to evaluate the effectiveness of naked eye examination and Dental-operating microscope [DOM] examination for the location of second mesiobuccal canal [MB-2] in extracted maxillary first and second molars, considering the sectioning of the tooth as gold standard for the location of MB-2. This was a cross-sectional comparative study. One hundred extracted permanent maxillary first and second molars [50 of each] were stored in 10% neutral formalin. Using high speed headpiece standard endodontic access cavities were prepared. Initially, the mesiobuccal, distobuccal and palatal canals were located. Subsequently, the location of MB-2 canal was attempted by examining the pulp chamber floor with naked eye using only an endodontic explorer and canal confirmed with 10# K-file. MB-2 canal orifice was either located or not located with this method. Teeth in which MB-2 canal was not located were further explored under DOM. Yet again MB-2 canal orifice was either located or not located. Finally the mesiobuccal roots of each tooth were sectioned. The sections were explored with endodontic explorer and 10# K file with the adjunctive use of DOM at a magnification of 12x to decide the real presence of MB-2 canal. 42% and 60% of MB-2 canals in maxillary first molar, 20% and 38% of MB-2 canals in maxillary second molar were detected with naked eye and with DOM examination respectively. While 66% and 42% of MB-2 canals were actually present in maxillary first and second molar respectively as confirmed by gold standard [sectioning of teeth]. It is concluded that DOM examination may be more effective for location of the MB-2 canal than naked eye examination

Selecting the appropriate electrode placement-site for electrical pulp testing of molar teeth

The objective of the present experimental study was to report an appropriate electrode placement site on first molar teeth. Fifty volunteers with sound mandibular and maxillary first molar teeth [without any lesion or restoration] were selected from the Dental OPD of Dept of Operative Dentistry LUMHS Jamshoro from July 2008 to June 2009. Seven sites on each tooth were tested two times. The Elements Diagnostic Unit EPT was used to record the lowest threshold response of each site. Data was analyzed with one-way analysis of variance and the tukey test. The central fossa/pit of both maxillary and mandibular first molar teeth was found to be an appropriate site for EPT testing. Whereas, the tip of mesiobuccal cusp was the second site where lowest thresh hold was found to elicit pulpal response. No significant difference was observed between male and female subjects and between mandibular and maxillary molars. The experiment showed that the central pit might be an optimum site for placement of EPT probe tip