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Objectives: The present study investigated the prevalence of mechanical allodynia (MA) in healthy teeth adjacent and contralateral to endodontically diseased teeth. Materials and Methods: This cross-sectional study included 114 patients with symptomatic irreversible pulpitis and apical periodontitis in permanent mandibular first molars who possessed healthy teeth adjacent and contralateral to the endodontically diseased tooth. The mechanical sensitivity of the teeth was determined by percussion testing. The presence or absence of pain on percussion in the teeth adjacent and contralateral to the endodontically diseased tooth and the tooth distal to the contralateral symmetrical tooth was recorded according to coding criteria. The prevalence of MA was computed as a percentage, and binary logistic regression analysis was done. The Fisher exact test and Mann-Whitney U test were used for binary and ordinal data. Results: Age and sex did not influence the prevalence of MA. An increased prevalence of MA was found in patients with higher levels of spontaneous pain (p < 0.001). The prevalence of allodynia was 57% in teeth adjacent to endodontically diseased teeth and 10.5% in teeth contralateral to endodontically diseased teeth. In addition, on the ipsilateral side, there were more painful sensations distal to the diseased tooth than mesially. Conclusions: Despite being disease-free, teeth adjacent and contralateral to endodontically diseased teeth exhibited pain on percussion. There was a direct association between the severity of the patient's pain and the presence of MA.
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Context: Adjuvant use of platelet-rich fibrin (PRF) in many areas of dentistry is well documented. However, its role in periapical surgery remains contested which requires further clarification by a higher level of evidence. Aim: The objective of this systematic review was to evaluate the effect of PRF on periapical surgery using meta-analysis. Materials and Methods: A comprehensive literature search was conducted in PUBMED, Cochrane Central Register of Controlled Trials, SCIENCE DIRECT, and GOOGLE SCHOLAR for randomized controlled trials (RCT) published until May 2021. Meta-analysis was performed for comparisons of baseline (pretreatment) versus posttreatment values for different measurement parameters (postoperative pain, peri apical healing both qualitatively and quantitatively). The risk of bias in all the included trials was assessed after the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Results: Among the 356 eligible articles found in the initial search, 10 RCTs from 2011 through 2021 were included. Qualitative analysis of all the included studies showed that PRF may play a positive role in bone healing, reduction in periapical lesions, and enhancing quality of life using different imaging modalities. The results of the meta-analysis indicated a significant reduction in postoperative pain when PRF was used (standard mean difference [SMD] = 0.515; 95% confidence interval [CI] = 0.061- 0.969;P = 0.026; I 2 = 0%). However, there was no statistically significant association observed while evaluating peri apical bone healing both qualitatively (odds ratio [OR] = 1.427; 95% CI = 0.309-6.584; P = 0.648) and quantitatively measured by Cone beam computed tomography (SMD = -0.264; 95% CI = -0.974-0.447;P = 0.454) between PRF and control group. Conclusions: Considering the notable benefits demonstrated by use of PRF, it may be considered as a valuable adjunct in periapical surgery. However, more high-quality trials are necessary to assess the exact role of PRF.
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Background: Advances in adhesive technologies and escalation in esthetic demands have increased indications for tooth-colored, partial coverage restorations. Recently, material knowledge has evolved, new materials have been developed, and no systematic review has answered the question posed by practitioners: Is the clinical efficacy of resin or ceramic better, for inlay, onlay, and overlay in the long run? Aim: The aim of this systematic review and meta-analysis was to evaluate the clinical performance of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes. Materials and Methods: Two reviewers (VN and AJ) searched PubMed, Embase, and Cochrane Central registry of controlled trials for published articles between 1983 and 2020 conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines for systematic reviews. Only clinical studies which met the following criteria were included (1) studies regarding ceramic and resin inlays, onlays, and overlays were included; (2) randomized controlled trials, retrospective or prospective studies conducted in humans; (3) studies with a dropout rate <50% 4) studies with a follow-up higher than 5 years. Results: Of 1718 articles, 21 articles were selected. At 5 years, the estimated survival rates for resin (n = 129) was 86%, feldspathic porcelain (n = 1048) was 90%, and glass ceramic (n = 2218) was 92%; at 10 years, the survival of resin was 75% (n = 115), feldspathic porcelain was 91% (n = 1829), and glass ceramic was 89% (n = 1075). Conclusion: The meta-regression indicated that ceramic partial coverage restorations (feldspathic porcelain and glass-ceramic) outperformed resin partial coverage restorations both at 5-year and 10-year follow-up. When compared between ceramic types, glass ceramics outperformed feldspathic porcelain at 5 years' follow-up and feldspathic porcelain outperformed glass ceramics at 10 years' follow-up. The failures were mostly due to fractures (6.2%), endodontic problems (3%), secondary caries (1.7%), and debonding which was 0.9%.
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Introduction One of the major health problems in many countries including India is type 2 diabetes. Yoga is being explored as an alternative therapy for the management of diabetes. Methods Among the total of 137 participants who successfully completed the 'Living Well' workshop by the Art of Living, 84 with type 2 diabetes were assessed for change in random blood sugar levels, systolic and diastolic blood pressure levels (SBP/DBP), and pulse rate over seven days. In the Living Well workshop, the participants performed a comprehensive Yogic Breathing Program that included yogic movements and postures (Asana), relaxation practice, three-stage Pranayama, Sudarshan Kriya Yoga (SKY), breathing techniques, and discussion of stress relieving principles over those seven days. The parameters were recorded at the time of enrollment and after the completion of seven days of the workshop. Results There was a greater (p<0.05) percent reduction in the mean blood sugar level in diabetics as compared to non-diabetic individuals. However, the reduction in SBP and DBP were similar (p>0.05) in diabetics and non-diabetics. The percent reduction in the pulse rate however was greater (p<0.05) in diabetics than non-diabetics. Conclusion Comprehensive yogic breathing practices comprising SKY may be beneficial in patients with type 2 diabetes mellitus.
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Background: The aim of this in vitro study was to determine the accuracy in measuring the working length (WL) using Dentaport ZX, Rootor, and a newly introduced budget friendly electronic apex locator (EAL), E-Pex Pro in two commonly simulated clinical conditions (in the presence of irrigant and blood). Materials and Methodology: Eighty-eight single-rooted premolars were randomly assigned to two groups according to simulated clinical conditions: Group 1: Presence of irrigant (5% NaOCl) and Group 2: Presence of blood. WL was determined with all three EAL and was then compared with actual length (AL) of the tooth, which was measured using Vision Inspection System. The difference between the length measured by EAL and AL was tabulated and statistically analyzed using one-way analysis of variance (ANOVA) with post hoc Dunnett's test. All testing was done using two-sided tests at alpha 0.05 (95% confidence level). Thus, the criteria for rejecting the null hypothesis were "P < 0.05." Results: Measurement using Dentaport ZX, Rootor, and E-Pex Pro had an accuracy of 99.79%, 99.69%, and 99.64%, respectively, in Group 1 and 99.95%, 99.7%, and 99.74%, respectively, in Group 2. ANOVA revealed that the mean error value is least for Dentaport ZX followed by Rootor and then E-Pex pro EAL. Conclusion: Dentaport ZX gave better results both in the presence of NaOCl and blood followed by Rootor and E-Pex Pro EALs.
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Background: Postoperative pain can occur because of residual infection even after effective chemomechanical preparation. This study aimed to compare postoperative pain after chemomechanical preparation with placebo and laser irradiation in nonvital teeth having symptomatic apical periodontitis. Materials and Methods: Sixty (n = 30) participants after obtaining written consent were enrolled in the study. In Group 1, chemomechanical preparation followed by mock laser therapy was carried out in which laser tip was applied but not activated. In Group 2, chemomechanical preparation followed by a laser irradiation was applied and activated. Postoperative pain scores were evaluated at baseline, 24 h, 48 h, and 72 h using the Visual Analog Scale. Preoperative and postoperative percussion pain scores were also recorded. Subjects needing rescue medication were recorded as well. Mann-Whitney U test and Wilcoxon test were used for intergroup comparison and intragroup comparison. The Chi-square test was used for comparing rescue medication. Results: There was significant reduction in pain scores in the laser group as compared to placebo group at all time points. There was also significant difference in the preoperative and postoperative percussion pain scores. 9 and 3 subjects required rescue medication in Groups 1 and 2, respectively. Conclusion: Laser irradiation following chemomechanical preparation led to significant reduction in postoperative pain and can be considered as a valuable adjunct.
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BACKGROUND: The aim of the study is to assess the anxiolytic effects of yogic relaxation technique (YRT) in patients requiring root canal treatment (RCT). MATERIALS AND METHODS: In this prospective, randomized, placebo-controlled study, 30 patients undergoing RCT with baseline visual analog scale for anxiety (VAS-A) of score >4 were divided into Group 1: YRTs; Group 2: alprazolam (0.25 mg/0.5 mg), and Group 3: placebo. After 30 min of completion of YRT, endodontic treatment was performed. Reduction in anxiety was analyzed using state anxiety score (domain) of the state-trait anxiety inventory scale. RESULTS: There was no significant difference in anxiety score 1 h before RCT between groups (P = 0.401). Ten minutes before (P < 0.0001) and after RCT (P < 0.0001), there was significant difference between groups (yogic relaxation vs. alprazolam [P < 0.0001]; yogic relaxation vs. placebo [P < 0.0001]). Ten minutes before RCT, yoga relaxation showed significant difference in anxiety score for pain versus alprazolam and placebo (P < 0.0001 for both). Ten minutes after RCT, the change from baseline in mean anxiety score for pain was significantly different with yogic relaxation (versus alprazolam [P = 0.043]; versus placebo [P = 0.002]). As per the global assessment of efficacy, the response was excellent in 9 (90%), 2 (20%), and 1 (10%) patients in yoga relaxation group, alprazolam group, and placebo group, respectively. Difference in response between three groups was significant (P < 0.0001). There was no significant difference in the global assessment of tolerability between three groups (P = 0.535). No adverse events were reported. CONCLUSION: Before RCT, YRT is an effective alternative to anxiolytic agents, alprazolam.
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CONTEXT: Neoendo Flex and Mani Silk are recently launched nickel-titanium (NiTi) rotary files. Dentinal cracks and file separation remain a critical problem in the endodontic domain. AIM: The aim was to evaluate and compare the incidence of dentinal crack formation after root canal preparation with Neoendo flex and Mani silk files. MATERIALS AND METHODS: Thirty-six extracted single-rooted premolars with straight, single root canals were selected for the study. The specimens were randomly assigned to three groups, with 12 samples in each group. The root canal preparation for the three groups was done with hand K-file, Mani Silk, and Neoendo Flex files, respectively, following which the specimens were horizontally sectioned at 3, 6, and 9 mm from the apex. Sectioned samples were viewed under a stereomicroscope to determine the presence or absence of dentinal cracks. The data were analyzed using one-way ANOVA and Chi-square test. RESULTS: Hand K-files and Mani Silk files produced a lesser number of cracks than Neoendo Flex files; however, the difference was not statistically significant among the three file groups at 3 mm and 6 mm (P > 0.05). A statistically significant difference between the groups was seen at 9 mm, where Mani Silk files produced fewer cracks than K files and Neoendo Flex files (P = 0.007). Overall, Neoendo Flex significantly produced more cracks than Mani Silk and hand K-files (P = 0.0029). CONCLUSIONS: Both hand K files and NiTi rotary instruments may cause dentinal cracks. Neoendo Flex files tend to produce more dentinal cracks than Mani silk and K-file.