The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

OBJECTIVES: Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. MATERIALS AND METHODS: Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. RESULTS: At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. CONCLUSIONS: There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

OBJECTIVES: Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis. MATERIALS AND METHODS: Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests. RESULTS: At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure. CONCLUSIONS: There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Artifacts in cone-beam computed tomography of a post and core restoration: a case report

Cone-beam computed tomography [CBCT] has been accepted as a useful tool for diagnosis and treatment in endodontics. Despite a growing trend toward using CBCT in endodontic practice the CBCT images should be interpreted carefully. This case report presents a case that showed radiolucency inside and around a tooth which was free of pathologic changes under a dental operative microscope and conventional radiographs. A male patient was referred to an endodontic office for evaluation of radiolucency inside and around tooth #21 in his CBCT images. The post and crown over the tooth was removed and the tooth was observed under a dental operative microscope. Clinical examination as well as direct observation under a dental operative microscope showed no pathological lesions inside and around the tooth. The misdiagnosis was based on an artifact on CBCT. Despite the advantages of CBCT images as a great radiographic aid in endodontic practice, in the presence of metallic structures such as post and core the images should be interpreted with caution

comparative in vivo study of tissue reactions to four suturing materials

The purpose of this study was to compare the histopathologic reaction of four suturing materials: silk, polyvinylidene fluoride [PVDF], polyglycolic acid, and catgut in the oral mucosa of albino rabbits. The twenty-one male mature albino rabbits which were used in this study were randomly divided into three groups of seven each. Silk, PVDF, polyglycolic acid and catgut suture materials were tested in the oral mucosa of these animals. The animals were sacrificed 2, 4, and 7 days after suturing. Two pathologists evaluated the samples by determining the presence and level of inflammation, granulation tissue, and fibrosis formation. Data were statistically analyzed by Kruskal Wallis and Mann-Whitney U tests. Histological features of the samples showed that PVDF and plain catgut suture materials produced more fibrous tissue [favorable response] on the fourth day in comparison with silk suture [P=0.02]. Also, in the 7-day samples PVDF sutures produced the mildest inflammation when compared with the silk sutures [P=0.015]. According to the results of this study, it can be convey that PVDF suture materials created mild tissue reactions and can be a reasonable candidate for suturing oral tissues

Comparing subcutaneous tissue responses to freshly mixed and set root canal sealers

The purpose of this study was to compare the subcutaneous tissue responses of freshly mixed or set endodontic root canal sealers [i.e. RoekoSeal, AH26, AH Plus] in Wistar Albino rats. Seventy-two male albino rats weighing 200-250g were used. The animals were randomly divided into six groups of 12 rats each. Root canal sealers were implanted in subcutaneous tissue in both freshly mixed and set conditions. The animals were sacrificed after 7, 14, and, 60 days. After histological preparation and Hematoxylin and Eosin [H and E] staining, the specimens were evaluated for capsule thickness, severity and extent of inflammation, and necrosis. Results were statistically analyzed using Multivariate ANOVA test. Differences between set and freshly mixed root canal sealers were significant [P=0.014], but not significant between test materials and controls, except for capsule thickness and extent of inflammation between control and AH26 [P=0.019 and P=0.006 respectively]. The interaction between the type of material and setting condition was significant for capsule thickness and severity of inflammation in AH26 specimens at 14 and 60 day [P=0.001]. Based on the results of this study assessing the biocompatibility, both set and freshly mixed states can be used

importance of long time follow-up after vital pulp therapy: a case report

This report describes a case of an eight years old girl who was treated for complicated crown fracture of right maxillary central incisor because of a sport accident. For the tooth total pulpotomy was performed in order to achieve apexogenesis and the tooth was restored with a composite resin. The patient was reviewed over 10 years. At first the tooth showed continued root development and complete apex formation following vital pulp therapy, however, after 10 years the tooth developed pulp necrosis and periapical radiolucency. Following root canal therapy, periapical radiolucency has been healed