Evaluation of post operative pain in single and multi visit endodontic therapy with rotary instruments

The objective of this study is to evaluate post operative pain in single and multi visit endodontics therapy with rotary instrument. This study may help the clinicians to decide to complete the RCT in one visit. Experimental Study. This study was conducted in Department of Operative Dentistry LUH Hyderabad, from July 2010 to Jan 2011. This study was performed to compare post obturation pain following single and multiple visit root canal treatment [RCT] with rotary instruments. Sample size was sixty six permanent anterior teeth which were divided into Group A [Single visit] and Group B [Multiple visit] with 33 teeth in each group. After taking informed written consent routine RCT steps were carried out like access opening, canal path finding, and radiographic working length determination. Canal preparation was done by Pro Taper rotary files up to F2 size file with 2.5% sodium hypochlorite irrigation. In Group A obturation was done at same visit lateral condensation and in Group B, after canal preparation calcium hydroxide as intra canal medication was given for 7 days. Then the canal was obturated by lateral condensation technique and temporized with cavit. The patients were recalled at three specific post obturation periods, after 24 hours, 7 days and one month and were evaluated to determine pain severity on verbal rating scale. Chi Square test and Fridman test were used to interpret the results. The results of present study indicated almost same degree of post obturation pain in both groups

Determination of number of apical foramina in mesial root of mandibular first molar-Ex Vivo

This study was design to investigate the number of apical foramen in mesial root canal of mandibular first molar in local population. Cross Sectional Descriptive Study. The study was conducted to evaluate number of apical foramen in mesial root canal of mandibular first molar at Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, from March 2007 to August 2007. One hundred specimens of extracted permanent mandibular first molar teeth were decoronated at cemento-enamel junction. Root canal orifices of mesial root were located and radiograph was taken with 15 # K files inside root canals with visible tip at root apex. The specimens were classified as: 1C/1AF [Icanal 1 apical foramen]; 2C/2AF; 2C/1AF and 3C/ 3AF. The existence of apical foramina/foramen was additionally confirmed under dental operating microscope and classified in the same manner. Out of 100 specimens, 1C/1AF was not observed in specimen, 2C/1AF was observed in 43%, 52% had 2C/2AF and only 5% had 3C/3AF. A total of 100 specimens of permanent mandibular first molar teeth were included in this study. Periapical radiographs were analyzed to investigate the number of canals of the mandibular 1[st] molars and compare the number of apical foramina observed on the radiographs to that revealed by dental operating microscope. Significant difference was not observed in Radiographic and dental operating microscope findings [Wilcoxon rank sum test; p =0.99]

Type 2 diabetes mellitus; dental caries in patients

To determine the frequency and pattern of dental carries in patients with type 2 diabetes mellitus. Cross sectional descriptive study. Patients with history of type 2 diabetes mellitus for >/=02 years duration with >/=35 years of age and of either gender with dental pain visit at medical and dental outpatient department [OPD] of Liaquat University Hospital Hyderabad. The detail history was taken and the blood samples were taken for haemoglobin A1c [HbA1c] to assess the glycemic status. The existence of dental carries and its pattern was diagnosed through dental examination by consultant dentist had clinical experience >/=05 years. The data was collected on pre-designed proforma, entered and analyzed in SPSS version 11.00. A total of 137 type 2 diabetic patients were selected for this study, out of these 82 were males and 55 females. The dental carries was found in 98 [71.5%] patients. Out of these ninety eight, 53 [54.08%] were males and 45 [45.92%] were female. Upper molar teeth involvement was present in 46 patients and lower molar teeth were involved in 52 patients. Dentine carries was seen in 35 patients, enamel carries in 19, white spot carries in 20 patients, pulpitis in 16 patients, and pulp capping in 8 patients. Involvement of individual teeth was also assessed, the upper molar involvement was present in 32 patients, premolar involvement was present in 11, incisor involvement in 03 patients. The lower molars were involved in 28 patients, lower pre molar in 21 and lower incisors in 03 patients. Dental carries was present in 43 [43.9%] patients in patients whose duration of diabetes was between 5-10 years, whereas those patients having duration >10 years had 31.6% frequency of dental carries, while regarding duration of <5 years only 24 [24.5%] patients had dental carries. The diabetic patients are more prone to acquire dental caries

Comparison of analgesic effects of oral carbamezapine with pregablin in idiopathic trigeminal neuralgia

Idiopathic trigeminal neuralgia, a form of neuropathic pain, caused by not well defined etiology, is a formidable therapeutic challenge to clinicians because it does not respond well to traditional drug therapies. Anticonvulsant drugs are regarded as useful treatment for neuropathic pain. Carbamazepine, the first anticonvulsant studied in clinical trials, probably alleviates pain by decreasing conductance in Na[+] channels and inhibiting ectopic discharges. Pregabalin has the most clearly demonstrated analgesic effect for the treatment of neuropathic pain. The role of anticonvulsant drugs in the treatment of Idiopathic trigeminal neuralgia is evolving and has been clearly demonstrated with Pregabalin and carbamazepine. The aim of this study was to investigate comparison of analgesic effects of oral carbamezapine with pregablin in idiopathic trigeminal neuralgia. Interventional study. Oral and Maxillofacial surgery department, LUMHS. Jan 2012 to DEC 2012 . 30 patients with well defined history and diagnostic clinical symptoms of idiopathic trigeminal neuralgia were selected, divided into two groups of 15 individuals with similar gender and age difference. Clinical trial were conducted with group 1 with carbamazepine and group 2 with Pregabalin for 4 weeks. Subjective pain level of both groups was recorded before intervention [pre treatment recording] and after intervention [1[st], 2[nd], 3[rd] and 4[th]] on weekly basis by using 0-10 visual analogue scale [zero represent no pain 10 represent pain that could not be worse]. Following intervention, both groups were evaluated for pain score in 1[st] and 2[nd] week, there was no significant difference observed between the two groups. [P value 0.44 and 0.456], but after 3[rd] and 4[th] weeks it was observed that, there is significant difference, [p value 0.000 and 0.009] on visual analogue scale. It was observed that there was a significant difference between pretreatment and fourth week mean pain score in group 2, [8.9 and 1.07]. Similarly marginally significant difference with [r = .640] was seen in 1[st] week of group 2 receiving Pregablin, the mean value was [2.53, 1.60] respectively. Based on these results that are in line with the recommendations made by other studies, the 1[st] line medical therapy is Carbamazepine but this should be changed to other drug therapy if there is no pain relief or adverse effect

Freeway space measurement by Willis gauge and sprung divider

To compare the accuracy of Willis gauge and Sprung divider in determination of freeway space in dentate subjects. Cross-sectional comparative study. This study was carried out at Department of Prosthodontics, Lahore Medical and Dental College, Lahore from March 2010 to August 2010. Three hundred dentate subjects were included in this study. Both Willis gauge and Sprung divider methods were performed on same subject to measure the freeway space. Subjects were seated in comfortable upright position with unsupported head. Freeway space was measured by both Willis gauge and Sprung divider. The difference between the two measurements of rest position and maximum intercuspation was taken as freeway space. The collected data was entered in proforma. SPSS version 17 was used to analyze the data. Mean and SD was taken for age and gender. The measurement of both methods were compared through chi square test p value < 0.05 was considered significant. Out of 300 subjects, freeway space was achieved 217 [72.33%] with Willis Gauge and in 247 [82.33%] subjects freeway space was achieved with Sprung Divider. Although the achievement rate was slightly high with Sprig Divider as compare to Willis gauge method but it was non-significant [p-value = 0.078]. Sprung Divider measurement of freeway space is somewhat superior to Willis gauge

Removable partial dentures: patient satisfaction with associated demographic and biomechanical factors

Liaquat University of Medical and Health Sciences

Influence of instrument size in debriding apical third of the root canal system

Objective: the purpose of this study was to compare the efficacy of root canal debridement in apical 3mm when instrumenting with traditional stainless-steel number 20 K file and traditional stainless-steel number 40 K file at working length with commonly used irrigation solutions

Materials and methods: this in vitro comparative study was conducted at Operative Department, Lahore Medical and Dental College, Lahore. Data was collected from 2005 to 2006. Fifty human mandibular incisor teeth were selected. Preoperative radiographs of each tooth were taken and teeth were extracted. Teeth were divided in to two groups and, decoronated at cementoenamel junction. Group A was instrumented with stainless steel # 20 K file and group B was instrumented with stainless steel # 40 K file to the working lengths. Sodium hypo-chlorite and EDTA compounds were used as chemical means to debride the canals. All these selected teeth were, decalcified and sliced at 0.5 millimeters, 1.5 millimeters, and 2.5 millimeters levels from the root apex and set for histological inspection

Results: no dissimilarities were recognized between each level within each root apex size group except at1.5 millimeters level from the apex, open dentinal tubules were seen in Group B which was instrumented with the # 40 K type file

Conclusion: file size # 40 K is more effective in debris removal from the root canal system as compared to file size # 20 K while preparing the canals

Effect of cyanoacrylate as surface hardener on gypsum dies material

Objectives: to determine the effect of cynoacrylate on surface hardness of type IV dental Stone

Material and methods: this comparative observational study was conducted at Prosthodontics department; Lahore Medical and Dental College, Lahore, during August 2009 to February 2010. A total of 60 specimens were included in this study to compare the effects of surface hardener [cyanoacrylate coated group] with control group. The dimension of the specimen: 5 acrylic sheet [Perspex] dies were made having dimensions 5×5×1.25-cm3. The die comprises of three compartments upper, middle and lower compartments, which were secured with the help of screw and bolts. Type IV die stone was mixed with tap water and was left in the dies for 45minutes. The specimens were weighed first on a digital balance and then abrasion test was carried out on abrasion testing machine. The wear produced was again analyzed by weighing the specimen on the digital balance and the wear loss was calculated. The increase in abrasion resistance was measured by calculating weight reduction of specimen with relation to preabrasion weight

Results: pre and post abrasion of mean weight reduction was 4.47[0.94] grams in group A, average weight of specimen was 54.03 +/- 1.47 grams while in group B 54.07 +/- 1.66 grams before abrasion test significant difference was not observed between groups. After abrasion of test average weight of the specimen was 49.46 +/- 1.52 grams in group A and 54.02 +/- 1.66 grams in group B. Significant difference was observed between the groups after abrasion of test [p=0.0005]

Conclusion: surface hardness of type IV dental stone can be increased by surface coating its surface with cyanoacrylate resin

Comparison of inter-appointment pain between ledermix and no intracanal medicament in acute apical periodontitis

Objective: To compare the mean difference in inter-appointment pain by using ledermix and no intracanal medicament in patients with acute apical peridontitis

Material and Methods: This Randomized control trial was conducted at Operative dentistry department of Altamash Institute of Dental Medicine, Karachi during August 2009 to February 2010. Patients after selection were divided into two groups by even-odd method. Group 1: ledermix paste and Group 2: no intracanal medicament [control group]. The follow-up visit was scheduled and the Mean inter-appointment pain was recorded after 48 hours on visual analogue scale

Results: In 222 patients mean inter appointment pain was 9.0+/-0.71 in group 1 and 12.26 +/- 0.90 in group 2. The mean difference between groups 3.26 +/- 1.15 [95% CI of mean: 0.99 to 5.53]

Conclusion: Patients with ledermix paste experienced significantly less postoperative pain than with no intracanal medicament [p=0.005] at 48 hours

Postobturation pain after single visit endodontics in teeth with pulpal necrosis

Whether root canal treatment [RCT] is performed in single or in multiple sessions, infection control and elimination or reducing postobturation pain is a key factor for the success of RCT. Single visit RCT is now being considered as a good alternative to multiple visit RCT. The objective of this study was to assess the frequeney of post-obturation pain after single visit root canal treatment in teeth wilh pulpal necrosis along with the effect of age, gender and arch on pain severity after single visit endodontes. A total of 70 pulpally necrosed teeth of patients requiring RCT were treated at Operative Department of Altanmsh Institute of Dental Medicine, Karachi; from July 2008 to Feb 2009. 7 patients did not return for followup, therefore 63 patients were included in the study. The study design was Interventional Quasi experimental. Pre and Postobturation pain was recorded according to verbal rating scale before RCT, after 1[st] day, one week and after one month. Data was analyzed using the Chi-square test. Preoperative pain was observed in 57% of patients. While at first day follow up, postoperative pain was observed in 58% of patients, After seventh day pain existed in 14% [p=0.0001] of patients, after one month 8% [p=0.0001] patients remained painful. There was significant difference in severity of post-obturation pain in 16 to 35 year age group as compared to 36 to 40 year age group. Severity of pain significantly decreased in 16 to 25 and 26 to 35 age group at 1[st], 7[th] and 1 month recall [p=0.001]. Male gender in contrast to female gender had a significantly reduced severity of pain 1st month post operatively [p=0.001]. Severity of pain was significantly decreased in maxillary teeth as compared to madibular arch [pre vs. 1 days p=0.006] and [1st day vs. 1st month; p=0.0001]. The lack of post-obturation pain was found to be positivity co-related with single visit endodontics in age group of 16-35 years, male gender and maxillary teeth