Anaesthetic efficacy of lidocaine/clonidine for inferior alveolar nerve block in patients with irreversible pulpitis.

AIMS: This prospective, randomized, double-blind study aimed to compare the efficacy of lidocaine with epinephrine versus lidocaine with clonidine for inferior alveolar nerve block (IANB) and hemodynamic stability (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) in patients with irreversible pulpitis. METHODOLOGY: One hundred patients with irreversible pulpitis in mandibular molar teeth randomly received 1.8 mL of 2% lidocaine with clonidine (15 µg mL-1 ) or 1.8 mL of 2% lidocaine with epinephrine (12.5 µg mL-1 ), using a conventional IANB technique. Endodontic access cavities were prepared 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recording) upon endodontic access cavity preparation or initial canal instrumentation. The hemodynamic parameters were measured before, during and 5, 10 and 30 min after administration. Finally, the collected data were subjected to independent t-test, chi-square and Fisher's exact test using spss software ver.20 at a significant level of 0.05. RESULTS: The success rates for IANB using lidocaine with epinephrine and lidocaine with clonidine solutions were 29% and 59%, respectively. The clonidine group exhibited a significantly higher success rate (P < 0.05). Five minutes after drug administration, systolic blood pressure and heart rate significantly increased in the lidocaine with epinephrine group and insignificantly decreased in lidocaine with clonidine group. CONCLUSION: For mandibular molars with irreversible pulpitis, addition of clonidine to lidocaine improved the success rate of IANB compared to a standard lidocaine/epinephrine solution.

Effect of simvastatin on kinetics of osteoprotegrin/receptor activator nuclear kappa B Ligand mRNA expression in periapical lesions.

AIM: To evaluate the therapeutic effect of Simvastatin on apical periodontitis in rats by assessing the osteoblast production of receptor activator of nuclear factor-Kappa B Ligand (RANKL) and Osteoprotegerin (OPG) cytokines that are essential for bone resorption. METHODOLOGY: Twenty-five healthy 8- to 10-week-old male rats were selected. Periapical lesions were induced by exposure of pulps through the occlusal surfaces of mandibular first molars. The pulps were extirpated and canals contaminated with saliva. The teeth were filled temporarily to make animal feeding feasible. The experimental group (n = 12) was placed on 20 mg(-1)  kg(-1)  day(-1) of Simvastatin for 10 days (3 days before and 7 days after pulp exposure) and the control group (n = 12) received a placebo. After 1, 2 and 4 weeks, the animals were sacrificed and mRNA expression of OPG/RANKL was evaluated by real-time PCR. One rat was sacrificed without any interventions (negative control) to determine the baseline expression of the mediators involved. Data were analysed by one-way anova. RESULTS: Simvastatin significantly (P < 0.05) enhanced the expression of OPG and reduced the mRNA expression of RANKL in the experimental group compared with the control group. CONCLUSIONS: Oral administration of Simvastatin attenuated RANKL expression and accelerated OPG expression in induced rat periapical lesions.