Dental Pulp Testing: A Review

Dental pulp testing is a useful and essential diagnostic aid in endodontics. Pulp sensibility tests include thermal and electric tests, which extrapolate pulp health from sensory response. Whilst pulp sensibility tests are the most commonly used in clinical practice, they are not without limitations and shortcomings. Pulp vitality tests attempt to examine the presence of pulp blood flow, as this is viewed as a better measure of true health than sensibility. Laser Doppler flowmetry and pulse oximetry are examples of vitality tests. Whilst the prospect is promising, there are still many practical issues that need to be addressed before vitality tests can replace sensibility tests as the standard clinical pulp diagnostic test. With all pulp tests, the results need to be carefully interpreted and closely scrutinised as false results can lead to misdiagnosis which can then lead to incorrect, inappropriate, or unnecessary treatment

Various Strategies for Pain-Free Root Canal Treatment

Introduction: Achieving successful anesthesia and performing pain-free root canal treatment are important aims in dentistry. This is not always achievable and therefore, practitioners are constantly seeking newer techniques, equipments, and anesthetic solutions for this very purpose. The aim of this review is to introduce strategies to achieve profound anesthesia particularly in difficult cases. Materials and Methods: A review of the literature was performed by electronic and hand searching methods for anesthetic agents, techniques, and equipment. The highest level of evidence based investigations with rigorous methods and materials were selected for discussion. Results: Numerous studies investigated to pain management during root canal treatment; however, there is still no single technique that will predictably provide profound pulp anesthesia. One of the most challenging issues in endodontic practice is achieving a profound anesthesia for teeth with irreversible pulpitis especially in mandibular posterior region. Conclusion: According to Most investigations, achieving a successful anesthesia is not always possible with a single technique and practitioners should be aware of all possible alternatives for profound anesthesia

`In vitro` studies of the pharmacodynamics of the active components of ledermix paste, a corticosteroid-antibiotic root canal dressing material

Thesis (M.D.S.) -- University of Adelaide, Dept. of Dentistry, 1986

A Clinical Update on the Different Methods to Decrease the Occurrence of Missed Root Canals

One of the main causes of endodontic treatment failure is the clinician’s inability to localize all the root canals. Due to the complex anatomy of the root canal system, missed canals are not uncommon. There are several strategies to decrease the possibility of missed root canals starting with good pre-operative radiographies. In order to overcome the limitations of conventional radiographies, cone-beam computed tomography (CBCT) can be considered. A correct access cavity preparation is of pivotal importance in localizing the orifices of the root canals. Furthermore, ultrasonics are very important devices to find missed canals. Increasing magnification and illumination enhance the possibility of finding all root canals during root canal treatment. The purpose of the present paper was to review all of the above techniques and devices.Keywords: Access Cavity; Cone-Beam Computed Tomography; Microscope; Missed Canals; Radiography; Root Canal Morphology; Transillumination; Ultrasonic

Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review

Introduction: Post-operative pain and flare-up may occur in up to 58% of patients following root canal treatment. The aim was to conduct a systematic review and a possible meta-analysis to determine the effect of glucocorticosteroid (GCS) on pain following root canal treatment. Methods and Materials: Scopus, MEDLINE and CENTRAL databases were searched up to 30th January 2017 with broad key words. In addition, the reference lists in eligible papers and text books were hand-searched. Assessment of the eligibility of papers and data extraction were performed by two independent reviewers. Results: Of 9891 articles, 18 were recruited as eligible papers. Most of these papers showed pain reducing effect of GCS on post-endodontic pain. Because of wide heterogeneity among the recruited papers, it was not possible to perform meta-analysis. Conclusion: Based on the results of this systematic review, there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment. Further investigations with similar methods and materials are needed before meta-analysis on the effect of GCS on post-operative pain following root canal treatment can be performedKeywords: Corticosteroid; Endodontics; Flare-Up; Meta-Analysis; Post-Operative Pain; Systematic Review

Presence of Two Distal and One Mesial Root Canals in Mandibular Second Molars: Report of Four Cases

Most mandibular second molars have one and two canals in distal and mesial roots, respectively. This report represents four cases of mandibular second molars with a single mesial and two distal root canals with two different canal configurations. After access cavity preparation, two teeth had one distal and two mesial orifices, whereas in the two other teeth one mesial and two distal orifices were found. In the teeth with two mesial canal orifices, the distal root canal and one of root canals with a mesial orifice joined together in the apical part of the root, whereas in the two other teeth with one mesial and two distal canal orifices, three separate canals each with a different apical foramen were detected. Dental practitioners should be aware that despite higher prevalence of one distal and two mesial root canals, the mandibular second molar teeth may also have one mesial and two distal root canals

Effect of Various Electronic Devices on the Performance of Electronic Apex Locator

Introduction: Apex locators are important devices that can be used to determine working length during root canal treatment. However, it is not known whether electronic devices with various wave length frequencies influence the accuracy of apex locators. The aim of this study was to determine whether a cordless phone set, MP4 player, FM radio, asymmetric digital subscriber line (ADSL), or a mobile phone could influence the accuracy of working length determination by the Dentaport ZX apex locator. Methods and Materials: In this study, twenty-four sound intact single-rooted extracted human teeth were used. After determining the root canal length with a file and a microscope, the canals were measured with three separate Dentaport ZX apex locators while one of the test devices (ADSL, MP4, FM radio, mobile phone, and cordless phone) was used at a distance of 50 cm from the apex locator. Bland–Altman plots was used for reliability and consistency. Results: Except for the FM radio, all other devices showed significant difference with actual working length (P<0.05). ADSL and MP4 player showed the least consistency compared to the other devices. Conclusion: Based on this in vitro study, the use of ADSL, MP4 player, mobile phone, and cordless phone during root canal treatment may influence working length determination with the Dentaport ZX apex locator.Keywords: ADSL; Apex Locator; Cell Phone; Dentaport ZX Apex Locator; MP4 Player; Radio; Wave Lengt

Efficacy of Articaine and Lidocaine for Buccal Infiltration of First Maxillary Molars with Symptomatic Irreversible Pulpitis: A Randomized Double-blinded Clinical Trial

Introduction: The aim of the present study was to compare the efficacy of 2% lidocaine to 4% articaine in buccal infiltration of maxillary first molars with irreversible pulpitis. Moreover, the effect of root length on success of anesthesia irrespective of the type of anesthetic agent was assessed. Methods and Materials: Fifty patients suffering from painful maxillary first molars with irreversible pulpitis received an infiltration injection of either 4% articaine with 1:100000 epinephrine or 2% lidocaine with 1:80000 epinephrine. Each patient recorded their pain score in response to a cold test on a Heft-Parker visual analogue scale (VAS) before commencing the treatment, 5 min following injection, during access preparation, after pulp exposure and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analyzed using the multivariate logistic regression analysis, chi-square and t tests. Results: Finally, 47 out of 50 patients were eligible to be included in this study. The anesthetic success rates in the lidocaine and articaine groups were 56.52% and 66.67%, respectively and the difference was not significant (P=0.474). Irrespective of the anesthetic agent, the length of the palatal root (Odds Ratio=0.24, P=0.007) had an adverse effect on anesthetic success. There was an association between longer palatal root length and anesthetic failure. Conclusion: No significant difference was found between 2% lidocaine and 4% articaine in terms of anesthetic success in maxillary first molars with irreversible pulpitis. The length of the palatal root had a significant negative influence on anesthetic success.Keywords: Articaine; Buccal Injection; Infiltration; Irreversible Pulpitis; Lidocaine; Maxillary Molar; Palatal Root; Root Lengt

Efficacy of Pre-Medication with Ibuprofen on Post-Operative Pain after Pulpotomy in Primary Molars

Introduction: Pain management following dental procedures, particularly pulpotomies and extraction, is of great importance in pediatric dentistry. The aim of this study was to investigate the efficacy of pre-treatment with ibuprofen on post-operative pain following pulpotomy of primary molars. Methods and Materials: In a split mouth double-blinded randomized clinical trial, 49 children aging between 6-10 years old were given either ibuprofen or a placebo 45 min prior to the treatment. After pulpotomy and placement of a stainless steel crown (SSC), the pain level was evaluated using the Wong-Baker face visual analogue scale for up to 7 days post-treatment. McNemar and Wilcoxon tests were used for data analysis. Results: Forty-five patients were eligible to participate in this study. Pre-medication with ibuprofen significantly reduced pain during the first 24 h post-treatment (P=0.032). However, there was no significant difference in the pain levels between placebo and ibuprofen groups at 48 and 72 h post-treatment (P=0.154 and P=0.197, respectively). The number of times patients needed analgesics in ibuprofen group was significantly lower compared to that in the placebo group (P=0.008). Conclusion: Pre-medication with ibuprofen resulted in less pain following pulpotomy and SSC placement in primary teeth.Keywords:Ibuprofen; Pre-Medication; Primary Molar; Pulpotomy; Visual Analogue Scale; Wong Baker

Treatment of a Maxillary Second Molar with One Buccal and Two Palatal Roots Confirmed with Cone-Beam Computed Tomography

Root canal configuration is an important subject in endodontic practice and dentists should be familiar with all possible types of root canal configuration. A forty-three year old male was referred for root canal treatment of his maxillary left second molar tooth with symptomatic irreversible pulpitis. Pre-operative radiographs showed a three rooted molar. However, after access cavity preparation two palatal and one buccal orifices were detected. The patient was informed of the unusual root canal anatomy and cone-beam computed tomography (CBCT) was ordered for precise evaluation of the anatomy. CBCT image confirmed the presence of one buccal and two palatal root canals; an exceptionally rare condition.Keywords: Cone-Beam Computed Tomography; Maxillary Second Molar; Palatal Roots; Root Anatom