Kovanaze Intranasal Spray vs Traditional Injected Anesthetics: a Study of Pulpal Blood Flow Utilizing Laser Doppler Flowmetry.

OBJECTIVE: An ideal local anesthetic would be effective, minimally reduce pulpal blood flow (PBF), and not require injection. This study compared the effects of 3% tetracaine plus 0.05% oxymetazoline nasal spray (Kovanaze; KNS) and injections using 2% lidocaine with 1:100,000 epinephrine (LE) or 3% mepivacaine plain (MP) on PBF, anesthetic efficacy, and participant preference. METHODS: In a double-blind cross-over design, 20 subjects randomly received a test anesthetic and placebo at each of 3 visits (KNS/mock infiltration; mock nasal spray/LE; or mock nasal spray/MP). Nasal sprays and infiltration apical to a maxillary central incisor were delivered ipsilaterally. PBF was evaluated by laser Doppler flowmetry, and local anesthetic success was assessed with electric pulp testing. Postoperative pain levels, participant preference, and adverse events were also assessed. RESULTS: LE injections demonstrated significant reductions in PBF at all time intervals compared with baseline (P < .05), whereas KNS and MP did not. Pulpal anesthesia success rates were higher for LE (85%) compared with MP (35%) and KNS (5%). Participants reported significantly higher postoperative pain levels for KNS compared with LE and MP. Additionally, KNS was the least preferred of the anesthetics administered and resulted in more reported adverse events. CONCLUSION: Although KNS showed no significant effect on PBF, it was not effective in achieving pulpal anesthesia as used in this study.

Effect of Endodontic Access Preparation on Fracture Load of Translucent versus Conventional Zirconia Crowns with Varying Occlusal Thicknesses.

PURPOSE: To evaluate the effect of endodontic access hole preparation on fracture resistance of translucent zirconia (5Y) and conventional zirconia crowns (3Y) with varying occlusal thicknesses. MATERIALS AND METHODS: Polymethylmethacrylate (PMMA) dies, representing a prepared tooth, were milled. Zirconia crowns with 1 mm thick axial walls and varying occlusal thicknesses were milled from 3Y (Cercon HT) or 5Y (Cercon XT) zirconia discs and sintered. 160 crowns were divided into 16 groups (n = 10 per group) based on the zirconia type (3Y, 5Y), occlusal thickness (0.5, 1.0, 1.5, 2.0 mm), and access hole preparation (with access hole, control). Crowns were cemented on the PMMA dies with resin-modified glass ionomer cement (Rely X Luting Plus) under constant weight (500 g) and thermocycled for 10,000 cycles. In half of the samples, following 5000 cycles of thermocycling, a uniform endodontic access hole was created using a diamond bur and restored immediately with resin composite (Filtek Supreme Ultra, 3M ESPE). The fracture resistance of the specimens was tested on an Instron 5566 universal testing machine with a stainless steel ball indenter (9.0 mm dia.) and the maximum load before failure was recorded as fracture load (N). Three-way ANOVA testing examined the effect of zirconia type, occlusal thickness, and access hole preparation on fracture loads of the crowns. Statistical tests were two-sided and significance level was set at 95% (α = 0.05). RESULTS: Fracture load was significantly affected by the type of zirconia, occlusal thickness, and access hole preparation (p < 0.001). Pairwise comparisons revealed that access hole preparation significantly reduced the fracture load of 3Y crowns with 0.5 or 1.0 mm of occlusal thickness and 5Y zirconia crowns with 0.5, 1.0, or 1.5 mm of occlusal thickness (p < 0.05). Increasing occlusal thickness reduced the effect of access hole preparation on fracture load. CONCLUSION: Type of zirconia, occlusal thickness, and access hole preparation had significant effects on the fracture load of zirconia crowns. The effect of endodontic access was significant on the 3Y and 5Y zirconia crowns with ≤1.0 and ≤1.5 mm occlusal thicknesses, respectively.