Cryotherapy and pain intensity during endodontic treatment of mandibular first permanent molars with symptomatic irreversible pulpitis: A randomized controlled trial.

OBJECTIVES: The study aimed to assess the effectiveness of cryotherapy application after inferior alveolar nerve block (IANB) administration of the mandibular first permanent molars with symptomatic irreversible pulpitis (SIP) in adolescence. The secondary outcome was to compare the need for supplemental intraligamentary injection (ILI). MATERIALS AND METHODS: The study was designed as a randomized clinical trial including 152 participants aged from 10 to 17 years who were randomly assigned to two equal groups; cryotherapy plus IANB (intervention group) and the control group (conventional INAB). Both groups received 3.6 mL of 4% articaine. For the intervention group, ice packs were applied in the buccal vestibule of the mandibular first permanent molar for 5 min. Endodontic procedures started after 20 min for efficiently anesthetized teeth. The intraoperative pain intensity was measured using the visual analogue scale (VAS). The Mann-Whitney (U) and chi-square tests were applied to analyze data. The significance level was set to 0.05. RESULTS: There was a significant reduction in the overall intraoperative VAS mean in the cryotherapy group compared to that in the control group (p = 0.004). The success rate was significantly higher in the cryotherapy group (59.2%) compared to the control group (40.8%). The frequency of extra ILI was 50% and 67.1% in the cryotherapy and control groups, respectively (p = 0.032). CONCLUSIONS: The cryotherapy application boosted the efficacy of pulpal anesthesia of the mandibular first permanent molars with SIP in patients below the age of 18 years. Additional anesthesia was still necessary for optimal control over pain. CLINICAL RELEVANCE: Pain control during endodontic treatment of primary molars with irreversible pulpitis (IP) is a significant factor in a child's behavior in the dental office. Although the inferior alveolar nerve block (IANB) is the most commonly used technique to anaesthetize mandibular dentition, we found its success rate to be relatively low during endodontic treatment of primary molars with IP. Cryotherapy is a new approach that significantly improves the efficacy of IANB. CLINICAL TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov (reference no. NCT05267847).

Evaluation of Dentine Structure Loss after Separated File Retrieval by Three Different Techniques: An Ex-vivo Study.

OBJECTIVE: To evaluate the success rate of retrieving separated instrument, the root canal volume changes using cone-beam computed tomography and the retrieval time using Ruddle's technique, Terauchi file retrieval kit (TFRK) and Endo Rescue kit. METHODS: Sixty human mandibular first molars were selected, and a 4-mm portion of #25/.04 rotary files were separated in the middle third of moderately curved mesio-buccal canals. Teeth were randomly assigned into three groups (n=20): R group, in which separated files were retrieved according to Ruddle's technique; T group, in which separated files were retrieved using TFRK and E group, in which separated files were retrieved using Endo Rescue kit. Values were analyzed using IBM SPSS. Results presented as mean+-standard deviation and 95% confidence interval for the root canal volume and time and frequency (%) for success rate. Comparisons of differences in time, canal volume and success rate between groups were assessed. RESULTS: Retrieval was successful in R and T groups (70% and 80% respectively) without any significant difference between them (p=0.715), while E group hadn't any successful samples (0.0%) with significant difference compared to R and T groups (p<0.001, p<0.001). E group showed the highest increase in canal volume followed by R group, while T group exhibited the lowest increase in canal volume. There was no significant difference in the mean retrieval time between R and T groups (p=0.815). CONCLUSION: TFRK provides a more conservative way for retrieval of separated instrument from the middle third of moderately curved canals. (EEJ-2023-01-01).

Inferior Alveolar Nerve Block Plus Cryotherapy Anesthesia Success in Pulpectomy Of Primary Molars with Irreversible Pulpitis: a Randomized Clinical Trial.

PURPOSE: The primary purpose of this study was to assess the efficacy of cryotherapy applications on the success of an inferior alveolar nerve block (IANB) to reduce pain severity during a pulpectomy of primary molars with symptomatic irreversible pulpitis (SIP). The secondary purpose was to assess children's behavior before and during pulpectomy procedures and the need for supplementary local anesthesia injections. METHODS: A randomized parallel controlled trial included 170 healthy children aged five to nine years who complained of carious primary mandibular second molars with SIP. After an IANB administration, ice packs (cryotherapy group) were applied to half of the participants while the other half did not receive ice packs. During pulpectomy, pain severity was tested using the Wong-Baker FACES Pain Rating Scale (WBS). A failure of anesthesia was encountered in the case of moderate or severe pain reported. Children's behavior was assessed using Frankl's Behavior Rating Scale (FBRS) before and after clinical procedures. RESULTS: The overall success of IANB with cryotherapy (i. e., no or mild pain) was 79.2 percent, which was significantly superior to the control group (50.6 percent; P=0.007). The postoperative children's positive behavior proportions in the cryotherapy group were significantly higher compared to the control group (P=0.001). CONCLUSIONS: Cryotherapy application significantly improved inferior alveolar nerve block efficacy, diminished pain intensity, and improved children's behavior during pulpectomy of primary molars with symp- tomatic irreversible pulpitis. Based on these findings, cryotherapy application after IANB deposition is recommended.