El comportamiento epidemiológico de los tratamientos pulporradiculares en la Clínica Estomatológica de Gibara, 2016-2017 / Root canal therapy epidemiological behavior at the Stomatological Clinic of Gibara, 2016-2017

RESUMEN Introducción: la mayoría de las urgencias estomatológicas se deben a patologías pulpares y periapicales; la enfermedad más diseminada en los seres humanos. Objetivo: caracterizar el comportamiento epidemiológico del tratamiento pulporradicular en una clínica estomatológica. Métodos: se realizó un estudio transversal en 110 pacientes, en la Clínica Estomatológica Docente de Gibara, Holguín; desde septiembre de 2016 a marzo del 2017, en cuanto a: grupos de edades, sexo, grupo dentario afectado, sustancias irrigadoras del conducto utilizadas, condición pulpar y número de sesiones. Resultados: el tratamiento pulporradicular se presentó con mayor frecuencia en el grupo etario de 48 a 53 años, un 23,63%; con predominio del sexo femenino del 61,82%. El grupo dentario más afectado fue el de los incisivos con el 53,64%. La sustancia irrigadora más utilizada fue el metronidazol hasta un 47,27%; seguida por hipoclorito de sodio con el 39,09%; y la clorhexidina en un 13,64%. Predominó la pulpitis irreversible en un 75,46% sobre la necrosis pulpar con el 24,54%. La mayoría de los tratamientos se realizaron en varias sesiones con 104 casos, para el 94,55%. Conclusiones: el tratamiento pulporradicular se presentó con mayor frecuencia en los incisivos, en el sexo femenino, en el grupo de 48 a 53 años. La sustancia irrigadora más utilizada fue el metronidazol. Predominó la pulpitis irreversible y la mayoría de los tratamientos se realizaron en varias sesiones. Se sugiere fomentar las acciones de promoción y prevención de salud en la adolescencia, que les permita conservar la salud bucal.

ABSTRACT Introduction: most of stomatological emergencies are due to pulpal and periapical pathologies. They are the most widespread disease in humans. Objective: to characterize the epidemiological behavior of root octopus treatment in a stomatological clinic. Methods: a cross-sectional study was carried out in 110 patients in the Teaching Stomatological Clinic of Gibara, Holguín, Cuba from September 2016 to March 2017, regarding: age groups, sex, affected tooth group, irrigating substances of the duct used, pulpar condition and number of sessions. Results: root octopus treatment was frequent in the 48 to 53 age groups with a 23.63%, with a predominance of females up to 61.82%. The most affected dental group was that of the incisors, with 53.64%. The most used irrigating substance was metronidazole with 47.27%, followed by sodium hypochlorite 39.09% and chlorhexidine 13.64%. Predominantly irreversible pulpitis with 75.46% on pulpal necrosis, represented by 24.54% and most of the treatments were performed in several sessions with 104 cases for 94.55%. Conclusions: root octopus treatment was frequent in the groups of incisors, females, and ages from 48 to 53. The most used irrigating substance was metronidazole. Irreversible pulpitis predominated and the majority of treatments were performed in several sessions. Promotion and prevention are suggested as actions for adolescence groups, to preserve oral health.

Effect of premedication with aceclofenac and ibuprofen on the success rate of two different local anesthetic agents in irreversible pulpitis cases of maxillary posterior teeth (a prospective randomized double-blind clinical trial)

A double blind, randomized controlled clinical trial was done to investigate the effect of analgesics aceclofenac and ibuprofen in reducing pre-operative pain following local anesthesia with lidocaine and articaine. One hundred and twenty patients with irreversible pulpitis of the maxillary premolars and first molar region were randomly divided into 2 groups with group 1, 2% lidocaine with 1:200000 epinephrine and group 2, 4% articaine with 1:100000 epinephrine. The two groups were again subdivided into 3 subgroups in which patients were given identical capsules containing ibuprofen 600 mg, aceclofenac 100 mg, placebo (vitamin tablets), half an hour before the administration of buccal infiltration anesthesia. Patients indicated their pain scores on a Heft Parker Visual analog scale (VAS). Infiltration anaesthesia was given under sterile condition.1 min after the injection, electric Imrana Tasneem, B.R. Bharat, Murari Uday Kumar, Srirekha A. Effect of premedication with aceclofenac and ibuprofen on the success rate of two different local anesthetic agents in irreversible pulpitis cases of maxillary posterior teeth (a prospective randomized double-blind clinical trial). IAIM, 2019; 6(5): 40-45. Page 41 pulp test and cold test were done and testing was repeated after every 2 minutes for a total of 10 minutes. Premedication with ibuprofen (600 mg) and aceclofenac (100 mg) resulted in statistically significant increase in onset of action for both the anesthetic agents. There was no significant difference in the time of onset of anesthesia between the two local anesthetic solution (chi-square test/ One way ANOVA).

Combined prednisone and partial root canal therapy for acute irreversible pulpitis in third molars:a randomized controlled trial / 中华急诊医学杂志

Objective To study the effect of oral prednisone combined with partial root canal therapy on acute irreversible pulpitis pain in third molars. Methods A total of 131 patients with acute irreversible pulpitis of the third molar treated in the emergency department from September 2016 to December 2017 in Shaoxing People's Hospital were selected and been divided into experimental group and control group according to the principle of prospective, random, and contrast. 66 patients in the experimental group received combination prednisone and partial root canal therapy, and 65 patients in the control group received partial root canal therapy. The VAS scores at each time point during treatment, the doses of analgesics and anesthetics used during treatment, the number of return visits within 72 hours after treatment, and treatment comfort were analyzed and compared. And the SPSS 19.0 statistical software was used to compare two sets of biological quantitative data using t-test or rank sum test. Count data were compared using Chi-square test and exact Fisher test. Results After 24 hours of intervention, the VAS scores of both groups decreased, and the VAS scores of the experimental group decreased more signifi cantly. The VAS scores of the experimental group were lower than those of the control group, and the proportion of patients with a VAS score of <5 was higher than that of the control group. In the group,the difference was statistically signifi cant (P<0.05). In addition, the dose of acetaminophen, codeine and other analgesic drugs was lower in the experimental group than in the control group, with a signifi cant difference (P<0.05); The dose of anesthetic 2% lidocaine solution was slightly less in the experimental group than in the control group. There was no signifi cant difference between the two groups (P>0.05);The proportion of return visit patients in the experimental group was lower than that in the control group, and the difference was statistically signifi cant (P<0.05). In the end, the scores and total scores of each dimension of the GCQ scale in the experimental group were higher than those in the control group, and the difference was statistically signifi cant (P<0.05). Conclusion Corticosteroid prednisone can effectively relieve the pain symptoms of irreversible pulpitis in a short period of time and improve the patient's treatment comfort. It can be used as a simple and quick alternative to partial root canal treatment to help clinical planning of endodontic treatment under the best analgesic conditions.

Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial

Abstract Inferior alveolar nerve block has a high failure rate in the treatment of mandibular posterior teeth with irreversible pulpitis. The aim of this study was to compare the anesthetic efficacy of 4% articaine, 2% lidocaine and 2% mepivacaine, all in combination with 1:100,000 epinephrine, in patients with irreversible pulpitis of permanent mandibular molars during a pulpectomy procedure. Sixty-six volunteers from the Emergency Center of the School of Dentistry, University of São Paulo, randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and absence of pain during the pulpectomy procedure were evaluated respectively, by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. All patients reported the subjective signal of lip numbness. Regarding pulpal anesthesia success as measured with the pulp tester, the success rate was respectively 68.2% for mepivacaine, 63.6% for articaine and 63.6% for lidocaine. Regarding patients who reported no pain or mild pain during the pulpectomy, the success rate was, respectively 72.7% for mepivacaine, 63.6% for articaine and 54.5% for lidocaine. These differences were not statistically significant. Neither of the solutions resulted in 100% anesthetic success in patients with irreversible pulpitis of mandibular molars.

Resumo O bloqueio do nervo alveolar inferior apresenta uma alta taxa de falha para o tratamento de dentes posteriores mandibulares com pulpite irreversível. O objetivo deste estudo foi comparar a eficácia anestésica da articaína 4%, lidocaína 2% e mepivacaína 2%, todas em combinação com epinefrina 1:100.000, em pacientes com pulpite irreversível de molares mandibulares durante um procedimento de pulpectomia. Sessenta e seis voluntários do Centro de Emergência da Faculdade de Odontologia da Universidade de São Paulo receberam aleatoriamente 3.6 mL de anestésico local no bloqueio convencional do nervo alveolar inferior (BNAI). O sinal subjetivo de dormência do lábio, anestesia pulpar e ausência de dor durante o procedimento de pulpectomia foram, respectivamente, avaliados pelo interrogatório do paciente, usando um estimulador pulpar elétrico e uma escala analógica verbal. Todos os pacientes relataram o sinal subjetivo de dormência do lábio. Em relação ao sucesso da anestesia pulpar medido com o Pulp Tester, a taxa de sucesso foi, respectivamente, 68.2% para mepivacaína, 63,6% para articaína e 63,6% para lidocaína. Relativamente aos pacientes que relataram nenhuma dor ou dor leve, durante a pulpectomia, a taxa de sucesso foi, respectivamente, 72.7% para mepivacaína, 63.6% para articaína e 54,5% para a lidocaína. Estas diferenças não foram estatisticamente significantes. Nenhuma das soluções resultou em 100% de sucesso anestésico em pacientes com pulpite irreversível de molares mandibulares.

Eficácia da articaína, da bupivacaína e da lidocaína associadas à epinefrina em pacientes com pulpite irreversível em molares inferiores / Effectiveness of articaine, bupivacaine and lidocaine with epinephrine in patients with irreversible pulpitis in molars

O objetivo deste estudo foi comparar a eficácia anestésica da articaína 4%, da lidocaína 2%, ambas associadas à epinefrina 1:100.000, e da bupivacaína 0.5%, associada à epinefrina 1:200.000, durante pulpectomia em pacientes com pulpite irreversível em molares inferiores. Cento e cinco voluntários do Setor de Urgência da Faculdade de Odontologia da Universidade de São Paulo receberam, aleatoriamente, 3,6mL de um dos anestésicos locais para o convencional bloqueio do nervo alveolar inferior (BNAI). No caso de falha do BNAI, foram administrados 3,6mL da mesma solução como injeção complementar no ligamento periodontal. O sinal subjetivo de anestesia do lábio, a presença de anestesia pulpar e ausência de dor durante a pulpectomia foram avaliados, respectivamente, por indagação ao paciente, por meio do aparelho estimulador pulpar elétrico (pulp tester) e por uma escala analógica verbal. A análise estatística foi realizada por meio dos testes Qui-quadrado, Kruskal Wallis e Razão de Verossimilhanças. Foi adotado nível de significância de 0,05 (P <= 0,05). Todos os pacientes reportaram anestesia no lábio após o BNAI. A lidocaína apresentou valores superiores (42,9%) para a anestesia pulpar após o BNAI e após a injeção no ligamento periodontal (61,5%). A bupivacaína apresentou valores superiores para a analgesia (80%) após o BNAI e a lidocaína (92,3%) após a injeção no ligamento periodontal. Após a falha do BNAI, a dor na câmara pulpar foi a mais frequente para articaína e lidocaína e na dentina para a bupivacaína e após a falha da injeção no ligamento periodontal, a dor foi similar para articaína nas diferentes regiões; câmara, canal e dentina; para a bupivacaína foi mais frequente na dentina e para a lidocaína no canal. No entanto, essas diferenças não foram estatisticamente significantes. Portanto as três soluções anestésicas locais se comportam de forma semelhante e não apresentam efetivo controle da dor no tratamento da pulpite irreversível em molares inferiores.

The aim of this study was to compare the anesthetic efficacy of 4% articaine and 2% lidocaine both associated with 1:100,000 epinephrine and 0.5% bupivacaine associated with 1:200,000 epinephrine in patients with irreversible pulpitis of the mandibular molars during a pulpectomy procedure. One hundred and five volunteers from the Emergency Center of the School of Dentistry at University of São Paulo randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and the absence of pain during the pulpectomy procedure were, respectively, evaluated by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. Statistical analysis was performed using the chi-square test, Kruskal Wallis and likelihood rations. The level for significance of differences was P <= .05. All patients reported the subjective signal of lip numbness after the application of either IANB. Lidocaine showed higher values for pulpal anesthesia after the IANB (42.9%) and after injection in the periodontal ligament (61.5%). Bupivacaine presented higher values for analgesia after the IANB (80,0%) and lidocaine after injection in the periodontal ligament (92,3%). After the failure of the IANB, the pain in the pulp chamber was the most frequent to articaine and lidocaine and bupivacaine for dentin and after the failure of the periodontal ligament injection, the pain was equal to articaine in different regions, chamber, canal and dentin; for bupivacaine was greater in dentin and lidocaine was higher in the channel. However, these differences were not statistically significant. So the three local anesthetic solutions behave similarly and not present any effective pain control in the treatment of irreversible pulpitis in mandibular molars.

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.