Comparison of efficacy of lignocaine, ropivacaine, and bupivacaine in pain control during extraction of mandibular posterior teeth.

BACKGROUND: The management of pain during extraction of mandibular third molars is an important requisite to achieve patient comfort and to obtain desired result in an effective manner. There are various anesthetics that can be used to achieve regional or local anesthetic effect in this regard. AIM: The aim of this study was to compare the efficacy of 2% lignocaine with 1:80,000 adrenaline, 0.75% ropivacaine and bupivacaine in pain control during extraction of mandibular posterior teeth. MATERIALS AND METHODS: This prospective, cross-sectional study included 300 study participants indicated for mandibular third molar surgical extractions. The study subjects were categorized into three broad groups - (a) Group I (n = 100): Third molar extractions performed using 2% Lignocaine with 1: 80,000 epinephrine; (b) Group II (n = 100): This group included subjects who underwent extractions of mandibular third molars using 0.75% ropivacaine and (c) Group III (n = 100): This group included patients who underwent extractions of mandibular third molars with bupivacaine. Inclusion criteria were: (a) partially impacted mandibular third molars which were symptomatic; (b) written informed consent. Exclusion criteria were - (a) any systemic diseases and/or undergoing any medication for same; (b) subjects not willing for extraction after clinical and radiographic examination and opinion and (c) subjects undergoing orthodontic therapy. Subject response for pain was recorded using - (a) visual analog scale (VAS) and (b) Verbal Rating scale (VRS). Postoperative pain was assessed using requirement of analgesics after extraction. SPSS version 21.0 was employed as statistical software. Statistical tool used was the Analysis of Variance test which was used for determining statistical significance which was set at a P value of lesser than 0.05 (significant). RESULTS: On analysis of visual analog scale (VAS), it was observed that in Group I (2% Lignocaine with 1:80,000), no pain during the extraction procedure was demonstrated in 30 study participants while minimal or less pain was present in 70 patients, while in Group II (0.75% ropivacaine), 90 patients presented with no pain while ten patients had presented with minimal amount of pain during tooth extraction. While on the other hand, Group III patients whose mandibular third molars were extracted using local anesthesia by injecting bupivacaine, lack of any pain was observed in 69 patients while minimal pain was noted in 31 individuals. While making statistical comparison between three groups, a significant P = 0.03 was observed. Also, postoperative pain was noted in 60% of cases who underwent extraction using 2% lignocaine (Group I), 10% patients who had third molar extractions under Bupivacaine anesthesia presented with pain whereas none of the patients (0%), demonstrated the presence of pain following third molar extraction. CONCLUSION: 0.75% Ropivacaine is the most effective local anesthetic agent that can be used for extracting mandibular third molars due to its effective pain control both during and following the procedure when compared to 2% lignocaine and bupivacaine.

Evaluation of mandibular third molar position as a risk factor for pericoronitis: A CBCT study.

AIMS: The present study was conducted to evaluate mandibular third molar position as a risk factor for pericoronitis. MATERIALS AND METHODS: The present study was conducted on 145 subjects of both genders. The clinical symptoms and signs such as redness, pus discharge, pain, and tenderness over pericoronal flap were assessed. All candidates were subjected to CBCT scan evaluation for a third molar position such as vertical, mesioangular, distoangular, and horizontal type. RESULTS: Maximum number of cases of pericoronitis was observed in the age group 18-28 years (80) followed by 28-38 years seen in 47 cases, and 38-48 years seen in 28 cases. The most common type of impaction was mesioangular seen in 48 females and 42 males, followed by vertical in 22 females and 18 males, distoangular in 8 females and 10 males and horizontal in 2 females and 5 males. Maximum clinical features of swelling, trismus, dysphagia, and enlarged lymph nodes were seen in patients with mesioangular impaction followed by vertical impaction. CONCLUSION: Maximum number of pericoronitis cases was seen in the age group 18-28 years and most commonly mesioangular impactions were observed with pericoronitis.

An in vitro Evaluation of Shear Bond Strength of Orthodontic Brackets after Mouth Rinse.

AIMS: The aim of the study was to evaluate the shear bond strength (SBS) of orthodontic brackets after mouth rinsing. MATERIALS AND METHODS: Sixty orthodontically extracted maxillary premolar teeth were used in the present study. Buccal surfaces of all the teeth were bonded with orthodontic bracket. Later, each tooth was embedded into acrylic resin and stored in distilled water. All the teeth were randomly divided into four groups (group I: Artificial saliva, group II: Alcohol mouth rinse- Listerine, group III: Chlorhexidine (CHX) mouth rinse-Hexidine, and group IV: Herbal mouth rinse-Befresh) and stored in each solution for 12 hours. Later, each tooth was subjected to SBS testing using universal testing machine. Brackets and enamel surfaces were examined under a stereomicroscope at 10* magnification for modified adhesive remnant index (ARI). The data were statistically evaluated using IBM Statistical Package for the Social Sciences (SPSS) Statistics for Windows, version 20.0 (IBM Corp., Armonk, New York, USA) and using one-way analysis of variance (ANOVA) and Chi-square test with significance of p < 0.05. RESULTS: Highest mean SBS was observed in artificial saliva control group (14.27 ± 0.52 MPa), followed by herbal Befresh group (11.14 ± 0.72 MPa) and CHX, and least was found in alcohol-Listerine group of 8.48 ± 0.52 MPa (p < 0.001). The ARI score showed highest bond failure for group I (ARI 14) compared to group II (ARI 11) (p < 0.001). CONCLUSION: Alcohol-containing mouth rinses should be avoided in patients during fixed orthodontic treatment because it affects the bond strength. CLINICAL SIGNIFICANCE: Shear bond strength is affected with the use of alcohol-based mouth rinse compared with herbal or CHX mouth rinses.

Evaluation of Antimicrobial Efficacy of Root Canal Sealers against Enterococcus faecalis: A Comparative Study.

AIM: The study aimed to evaluate the efficacy of root canal sealer's antimicrobial activity against Enterococcus faecalis. MATERIALS AND METHODS: Root canal sealers with the brands Endoflas FS, AH Plus, and Tubli-Seal EWT were selected. Enterococcus faecalis organisms' zone of inhibition was measured. Tukey post hoc tests and one-way analysis of variance (ANOVA) were used to compare the data among study groups and within its group. The data were said to be statistically significant with an established p-value less than 0.05. RESULTS: The maximum zone of inhibition (23.20 ± 1.202 mm) was shown by Endoflas FS sealer; AH Plus and Tubli-Seal showed the inhibition zone of (18.42 ± 1.023) and (16.88 ± 0.962) respectively, following Endoflas FS. The ANOVA test showed p < 0.0001, which is highly statistically significant. AH Plus and Endoflas FS showed a statistically significant difference of 0.04 and 0.001 in between groups, and there was no statistically significant difference in the Tubli-Seal group from Tukey post hoc test. CONCLUSION: The study showed that Endoflas FS sealer has a significant antimicrobial effect against E. faecalis. CLINICAL SIGNIFICANCE: In clinical situation, despite perfect che-momechanical root canal preparation, persistence of microorganisms may reinfect the root canal. Therefore, endodontic root canal sealers play a major role in the eradication of bacteria. The polymicrobial nature of endodontic infection plays a main role during the usage of endodontic sealer with antimicrobial agents, which in turn reduces the failure of endodontic treatment.