ABSTRACT
OBJECTIVES: Inferior alveolar nerve block (IANB) does not always provide adequate pulpal anesthesia, and supplemental techniques have been investigated in adults. This study aimed to pre- and intraoperatively evaluate the success of pulpal anesthesia following supplemental mandibular buccal infiltration (SMBI) after failure of IANB in permanent mandibular molars with deep caries of pediatric patients. MATERIALS AND METHODS: Following IANB, preoperative pulpal anesthesia was assessed using the cold test, and success was defined when there was a negative response. In cases with failed IANB, SMBI was administered, and pulpal anesthesia was re-evaluated. A maximum of three SMBIs was allowed. After achieving successful preoperative pulpal anesthesia, treatment was then initiated. Intraoperatively, success of pulpal anesthesia was determined when the Wong-Baker FACES Pain Rating Scale reported by the patients was ≤ four. RESULTS: Sixty molars of patients aged 9.6 ± 2.3 years were included in the study. The success of preoperative pulpal anesthesia following IANB was 33.3%. The overall cumulative preoperative pulpal anesthesia after three SMBIs was 95%. However, the success of intraoperative pulpal anesthesia was only 66.7%. CONCLUSIONS: SMBI greatly improved the success of preoperative pulpal anesthesia after failure of IANB. However, the success of preoperative pulpal anesthesia, confirmed by the cold test, does not always guarantee intraoperative pulpal anesthesia, especially in teeth with irreversible pulpitis. CLINICAL RELEVANCE: IANB produced low pulpal anesthesia in vital permanent mandibular molars with deep caries of pediatric patients. Clinicians should always prepare for supplemental injection both pre- and intra-operatively.
Subject(s)
Molar , Nerve Block , Anesthesia, Dental , Anesthetics, Local , Carticaine , Child , Double-Blind Method , Humans , Mandibular Nerve , PulpitisABSTRACT
INTRODUCTION: This study aimed to compare the success rates of direct pulp capping (DPC) by using either ProRoot Mineral Trioxide Aggregate (MTA) or Biodentine in the cariously exposed permanent teeth of 6- to 18-year-old patients. Gray discoloration was also evaluated. METHODS: Fifty-nine cariously exposed permanent teeth, including teeth with diagnosis of normal pulp, reversible pulpitis, or irreversible pulpitis, early periapical involvement, and exposure size of up to 2.5 mm, were included. Each patient with only 1 cariously exposed tooth was randomly allocated to DPC with either ProRoot MTA (n = 30) or Biodentine (n = 29). Patients were recalled every 6 months. Clinical and radiographic examinations were used to determine success. RESULTS: Fifty-five patients (mean age, 10 ± 2 years), 27 treated with ProRoot MTA and 28 with Biodentine, were included in the analysis. At mean follow-up of 18.9 ± 12.9 months, the success rate was 92.6% with ProRoot MTA and 96.4% with Biodentine (P > .05; difference, 4%; 95% confidence interval [CI], -8% to 16%). Biodentine was non-inferior to ProRoot MTA. Failures were distributed equally in all categories of pulpal diagnosis and occurred in teeth with no periapical involvement and small exposures (0.5 mm). The survival probabilities of DPC with ProRoot MTA and Biodentine were 0.92 (95% CI, 0.73-0.98) and 0.96 (95% CI, 0.80-0.99). No significant difference was observed between them (P > .05). Gray discoloration was observed only with ProRoot MTA (55%). CONCLUSIONS: Biodentine was non-inferior to ProRoot MTA when used as a DPC material for cariously exposed permanent teeth of 6- to 18-year-old patients. However, Biodentine did not cause any gray discoloration in this study.
