Postobturation Pain Associated with Tricalcium Silicate and Resin-based Sealer Techniques: A Randomized Clinical Trial.

INTRODUCTION: The incidence of immediate postobturation pain associated with 2 sealer techniques was compared and potential prognostic factors identified. METHODS: Patients referred for endodontic treatment were recruited with informed consent. Root canals were debrided and teeth rendered asymptomatic before random allocation to receive TotalFill BC (FKG Dentaire SA, La Chaux-de-Fonds, Switzerland) or AH Plus sealer (Dentsply Maillefer, Ballaigues, Switzerland). Patients blinded to the sealer reported their postobturation pain experience 1, 3, and 7 days after treatment. Blinded and calibrated assessors independently reviewed treatment quality, sealer extrusion, and radiographic data under standardized conditions. RESULTS: One hundred sixty eligible patients (163 teeth, 95.3%) returned their pain diary. No postobturation pain difference was found between the 2 sealers (P > .05), although the AH Plus sealer technique was significantly associated with extrusion beyond the apex (P < .05; odds ratio [OR] = 3.02; 95% confidence interval [CI], 1.39-6.57). Thirty-three (20.6%) patients reported pain on day 1 (median 1 = very mild pain), 16 (10.0%) on day 3 (median 1 = very mild pain), and 9 (5.6%) on day 7 (median 2 = mild pain). The prognostic factors were as follows: (1) moderate/severe preoperative pain (OR = 4.41; 95% CI, 1.42-13.76 on day 3 and OR = 5.16; 95% CI, 1.17-22.78 on day 7), (2) provoked preoperative pain (OR = 4.24; 95% CI, 1.40-12.78 on day 3 and OR = 5.35; 95% CI, 1.27-22.51 on day 7), (3) pulpless tooth (OR = 0.11; 95% CI, 0.02-0.57 on day 3), and (4) sonic activation during treatment (OR = 3.02; 95% CI, 1.39-6.57 on day 1 and OR = 3.01; 95% CI, 1.05-8.59 on day 3). CONCLUSIONS: There was no significant difference in pain experience between teeth filled using AH Plus or TotalFill BC Sealer 1, 3, and 7 days after obturation. Patient- and treatment-related factors could influence postobturation pain.

Long-term Pulpal and Restorative Outcomes of Pulpotomy in Mature Permanent Teeth.

INTRODUCTION: Pulpotomy in mature permanent cariously exposed teeth preserves the remaining pulp tissues, but long-term outcomes of the pulp and the restoration are unknown. This prospective study examined the immediate and long-term status of the pulp and the restored tooth and identified potential predictors of early and late failures in teeth that were asymptomatic or experiencing only mild symptoms at the time of treatment. METHODS: Pulpotomy was performed using the aseptic technique and a tricalcium silicate cement under local anesthesia. Teeth were assessed for up to 5 years for pulpal and apical signs and symptoms, restorative marginal integrity, and periodontal health. RESULTS: Fifty-two patients (61 teeth) with a median age of 40 years (range, 21-75 years) were included in this study; 17 (32.7%) men and 35 (67.3%) women were treated and reviewed. Overall pulp survival was 90.2% (95% confidence interval, 79.8%-96.3%); 6 teeth developed irreversible pulpitis or pulp necrosis when the restoration was intact. Preoperative pain was a potential predictor (P < .05) for early failure. Eleven late failures occurred between 2 and 4 years: 1 tooth with intact coronal restoration had pulp necrosis and asymptomatic apical periodontitis, 4 had recurrent caries resulting in asymptomatic apical periodontitis, 4 remained vital and only needed new restorations, 1 was unrestorable, and 1 was extracted for periodontal reasons. The type of definitive restoration was a potential predictor for late failure (P < .05). CONCLUSIONS: Carious pulp exposures in asymptomatic mature permanent teeth can be predictably managed by pulpotomy using a tricalcium silicate cement. Short-term failures were few and managed by pulpectomy. Appropriate coronal restoration is critical to long-term success.

Cysteamine Enhances Biofilm Eradication Efficacy of Calcium Hydroxide.

INTRODUCTION: Calcium hydroxide (Ca[OH]2) is a widely used interappointment dressing, but its antibacterial property is compromised by dentin. Hence, the addition of chlorhexidine (CHX) with Ca(OH)2 has been proposed. However, the antimicrobial efficacy of this mixture compared with Ca(OH)2 alone is currently still debatable. Cysteamine is a mucolytic agent used to reduce the viscosity of mucus through the disruption of proteins, which are also important components of the extracellular matrix of biofilms. The aims of this study were to determine the efficacy of cysteamine alone and in combination with Ca(OH)2 to eradicate Enterococcus faecalis biofilm compared with CHX with Ca(OH)2, and to determine if this effect is affected by dentin. METHODS: The biofilm eradication efficacies of Ca(OH)2 alone and with cysteamine were determined using 7-day E. faecalis biofilm cultured on dentin discs and compared with Ca(OH)2 with 2% CHX. The effects of dentin on the efficacies of Ca(OH)2 alone and with either cysteamine or CHX were examined. RESULTS: Cysteamine alone completely abolished E. faecalis biofilm at 200 mg/mL. The combination of Ca(OH)2 with either cysteamine at 10 mg/mL or 2% CHX completely obliterated E. faecalis biofilm. Cysteamine with Ca(OH)2 completely eradicated E. faecalis biofilm despite preincubation with dentin, whereas CHX with Ca(OH)2 was less effective. CONCLUSIONS: Cysteamine effectively eliminated E. faecalis biofilm and showed synergistic effects in combination with Ca(OH)2, which were unaffected by dentin. Hence, our findings support the use of cysteamine as a potential adjunct to Ca(OH)2 as an interappointment dressing.

A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with mechanical lumbar traction.

The objective of the study was to develop a clinical prediction rule for identifying patients with low back pain, who improved with mechanical lumbar traction. A prospective, cohort study was conducted in a physiotherapy clinic at a local hospital. Patients with low back pain, referred to physiotherapy were included in the study. The intervention was a standardized mechanical lumbar traction program, which comprised three sessions provided within 9 days. Patient demographic information, standard physical examination, numeric pain scale, fear-avoidance beliefs questionnaire and Oswestry low back pain disability index (pre- and post-intervention) were recorded. A total of 129 patients participated in the study and 25 had positive response to the mechanical lumbar traction. A clinical prediction rule with four variables (non-involvement of manual work, low level fear-avoidance beliefs, no neurological deficit and age above 30 years) was identified. The presence of all four variables (positive likelihood ratio = 9.36) increased the probability of response rate with mechanical lumbar traction from 19.4 to 69.2%. It appears that patients with low back pain who were likely to respond to mechanical lumbar traction may be identified.

Treadmill walking with body weight support is no more effective than cycling when added to an exercise program for lumbar spinal stenosis: a randomised controlled trial.

QUESTION: Is 6 weeks of treadmill walking with body weight support more effective than cycling in people with lumbar spinal stenosis when added to an exercise program? DESIGN: Randomised controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. PARTICIPANTS: Sixty-eight patients aged 58 (SD 8) with symptoms of lumbar spinal stenosis for 12 weeks (SD 49). INTERVENTION: Participants performed either treadmill with body weight support or cycling, twice weekly, for 6 weeks. Both groups also received an exercise program consisting of heat, lumbar traction, and flexion exercises. OUTCOME MEASURES: The primary outcome was disability measured using the modified Oswestry Disability Index. Secondary outcomes were disability, measured using the Roland-Morris Disability Questionnaire, pain severity, and patient perceived benefit. Measures were collected midway through intervention at 3 weeks and after intervention at 6 weeks. RESULTS: There was no difference between the groups in reduction in disability or pain over the 6-week intervention period. The between-group difference in the modified Oswestry Disability Index was 3.2 points (95% CI -3.1 to 7.7) at 6 weeks, and in pain severity was 2 mm on a 100 visual analogue scale (95% CI -5 to 10). Furthermore, the wide confidence intervals associated with estimates of patient benefit are consistent with no difference between the two groups. However, both groups did improve. CONCLUSION: Treadmill with body weight support and cycling may be equally effective in the conservative management of people with lumbar spinal stenosis. However, the improvement observed in both groups was probably a combination of the intervention and the natural course of recovery of lumbar spinal stenosis.

Correlates of self-reported disability in patients with low back pain: the role of fear-avoidance beliefs.

INTRODUCTION: The purpose of the study was to examine the determinants of self-reported disability - MODQ (Modified Oswestry Low Back Pain Disability Questionnaire) in patients with low back pain (LBP); and to examine the level of FABQ (Fear-Avoidance Belief Questionnaires) scores in an ambulatory clinical population referred to physiotherapy management. We believe that identifying potentially modifiable determinants of disability in patients with LBP provides an opportunity to broaden the strategies to reduce its socioeconomic burden. MATERIALS AND METHODS: A retrospective study was designed to be conducted in the physiotherapy department of a local hospital. The data were taken from standard examination of patients [n = 162, female 15.4%, male 84.6%, age mean = 30.6 years [standard deviation (SD), 11.4; range, 17 to 68)] presenting to the department with acute or chronic LBP. The data included physical examination of back, self-reported disability by MODQ, fear-avoidance beliefs by FABQ, pain intensity and demographic information. RESULTS: The final model generated by hierarchical regression analysis revealed that MODQ scores included self-reported symptom aggravation with all movements, pain medication usage, average straight leg raise (SLR), pain intensity, and Fear-Avoidance Belief Questionnaire-Work (FABQ-W). Overall, these variables account for approximately 40% of variance. The mediational analysis indicated that the relationship between the FABQ-W and MODQ scores may be partially mediated by pain intensity, average SLR values and pain medication usage. CONCLUSION: In this correlational study of physical impairments, psychosocial factors and self-reported disability, disability was driven primarily by measures of pain and fear-avoidance beliefs. Because the FABQ is a simple and useful clinical tool, we suggest that physicians and physiotherapists alike should make it a routine attempt to characterise the fear-avoidance beliefs of patients with LBP.

pH changes in root dentin after intracanal placement of improved calcium hydroxide containing gutta-percha points.

The in vitro pH changes in root dentin over a period of 2 weeks was investigated in 48 extracted bicuspids after intracanal placement of either Roeko Calcium Hydroxide Plus Points, aqueous calcium hydroxide paste, or gutta-percha points (control group) after root canal preparation. Microelectrodes were placed in outer and inner root dentin at cervical, middle, and apical thirds of the root to measure the pH at 1 h, 2 h, 3 h, 1 day, 3 days, 7 days, and 14 days. Roeko Calcium Hydroxide Plus Points reached a peak inner dentine pH of 11.67 and a peak outer dentine pH of 10.82 at 3 h. In addition, Roeko Calcium Hydroxide Plus Points maintained an outer dentine pH above 9.5 for approximately 2 days, whereas the aqueous calcium hydroxide paste did not reach this pH. However, the alkalinity in dentin with Roeko Calcium Hydroxide Plus Points was maintained for 7 days only, whereas aqueous calcium hydroxide paste maintained an alkaline environment throughout the 2-week period.