Anesthetic efficacy of articaine/epinephrine plus mannitol in comparison with articaine/epinephrine anesthesia for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial.

Background. It is difficult to achieve successful pulpal anesthesia in mandibular posterior teeth with symptomatic irreversible pulpitis. The present study aimed to compare the effect of articaine/epinephrine anesthesia with articaine/epinephrine at a combination of 0.5 mol/mL of mannitol for the inferior alveolar nerve block (IANB) in patients presenting with symptomatic irreversible pulpitis in the mandibular first molar tooth. Methods. One hundred patients with symptomatic irreversible pulpitis in the mandibular first molar tooth were selected and randomly divided into two groups based on the injection method. The first group underwent an IANB technique with 1.8 mL of articaine, whereas the second group received 2.9 mL of a formulation, consisting of 1.8 mL of articaine plus 1.1 mL of 0.5 mol/L of mannitol. Fifteen minutes after injections and anesthesia of the lip, the access cavity was prepared. According to the visual analog scale (VAS) criteria, no pain or mild pain for caries removal, pulp exposure and canal instrumentation were regarded as success. Chi-squared test was used for the analysis of data. The level of significance was set at 0.05. Results. The success rate in the group with articaine/epinephrine anesthesia plus mannitol was higher than that in the group with articaine/epinephrine anesthesia, with no significant difference between the two groups (P>0.05). Conclusion. It was concluded, under the limitations of this study, that adding mannitol to articaine/epinephrine anesthesia did not increase the success of IANB in mandibular posterior teeth with symptomatic irreversible pulpitis.

Comparison of the effect of Er, Cr-YSGG laser and ultrasonic retrograde root-end cavity preparation on the integrity of root apices.

The aim of this study was to compare the effect of Waterlase laser and ultrasonic root end cavity preparation on the integrity of root end in extracted human teeth. The canals of 60 extracted maxillary central incisors were cleaned, shaped, obturated and 3 mm of the root end was resected and examined for the presence of any cracks. Class I root-end cavities were then prepared using an ultrasonic unit or Waterlase laser. In the ultrasonic group, KIS 2D tip and medium intensity and in the laser group, 600 mum laser tips and an output power setting of 4 W with 55% water and 65% air were used to prepare the cavity which was studied for the presence of any cracks or chippings. One crack was found in the ultrasonic group, while no cracks were observed in the laser group. There was no significant difference between the two groups (P > 0.05). As for the chipping effect, seven cases (23%) had chipping after cavity preparation in the ultrasonic group but no chipping was found in the specimens of the laser group and the difference was statistically significant (P < 0.05). According to the results of this in vitro study, laser preserves the integrity of root-end cavities better than ultrasonic devices from the standpoint of producing chipping.