Efficacy of pre-anesthetic medication in the inferior alveolar nerve block technique in patients with irreversible pulpitis on mandibular molars : an umbrella review

O objetivo desta revisão sistemática umbrella foi responder à seguinte questão: “O uso de medicação pré-anestésica aumenta a eficácia anestésica do nervo alveolar inferior em dentes com pulpite irreversível sintomática?”. Esta revisão sistemática seguiu as recomendações dos padrões PRISMA e foi registrada no banco de dados PROSPERO (ID 304361). A busca foi realizada por dois pesquisadores em seis bases de dados eletrônicas. Foram selecionados artigos publicados até agosto de 2021, sem restrição de idioma e sem restrição de ano de publicação. Para tanto, foi realizada uma busca utilizando a combinação de termos MeSH nas seguintes bases de dados eletrônicas: PubMed, Cochrane Library, Web of Science, Scopus, EMBASE e Open Grey. Os critérios de elegibilidade, baseados na estratégia PICOS, foram: (P) humanos adultos com pulpite irreversível em molares inferiores; (I) uso de pré-medicação antes do procedimento anestésico; (C) Técnica anestésica sem o uso de medicação pré-anestésica (O) Avaliar a eficácia anestésica (S) Revisões sistemáticas com e sem meta-análise. Foi realizada a seleção dos estudos, a extração dos dados, a análise de vieses e, a partir disso, descritos os resultados. Doze estudos foram incluídos na análise qualitativa. Apenas em um estudo, a meta-análise não foi realizada. A qualidade metodológica foi avaliada através da ferramenta AMSTAR 2. Os principais achados das revisões sistemáticas foram que anti-inflamatórios não-esteróides tais como: ibuprofeno, oxicam diclofenaco, associação de ibuprofeno com paracetamol e cetorolaco foram eficazes para aumentar o sucesso da técnica de bloqueio do nervo alveolar inferior. Três revisões sistemáticas apresentaram uma qualidade ‘alta’; seis apresentaram uma qualidade ‘moderada’, duas, uma qualidade ‘baixa’; e uma revisão sistemática apresentou uma qualidade "muito baixa". Por meio desta revisão abrangente que reuniu dados de doze revisões sistemáticas, pode-se concluir que a medicação pré-anestésica em casos de pulpite irreversível em molares inferiores aumenta a eficácia da técnica de bloqueio do nervo alveolar inferior.The aim of this systematic review was answer the following question: “Does the use of pre-anesthetic medication increase the anesthetic efficacy of the inferior alveolar nerve in teeth with symptomatic irreversible pulpitis?”. This umbrella review followed the PRISMA standard (Preferred Reporting Items for Systematic Review and Metaanalysis) and was record in the PROSPERO database (ID 304361). The search was conducted on the databases by two researchers. Only papers published until August 2021 were selected, with no language restrictions and no restrictions on the year of publication. The search used the combination of MeSH and subject-to-subject terms, and it was performed in the following electronic databases: PubMed, Cochrane Library, Web of Science, Scopus, EMBASE and Open Grey. Eligibility criteria, based on the PICOS strategy, were: (P) human adults with irreversible pulpitis in lower molars; (I) use of premedication before the anesthetic procedure; (C) Anesthetic technique without using pre-anesthetic medication (O) Evaluate anesthetic efficacy (S) Systematic reviews with and without meta-analysis. The selection of studies, the extraction of data and their bias analysis were carried out and, based on that, the results were described. Twelve studies were included in qualitative synthesis. Only in one study, meta-analysis was not performed. The methodological quality was assessed using the AMSTAR 2 tool. The main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs such as ibuprofen, oxicam, diclofenac, association of ibuprofen with paracetamol and ketorolac were effective in increasing the success of the inferior alveolar nerve block anesthetic technique. The AMSTAR 2 overall confidence for the included systematic reviews ranged from very low to high quality. Three systematic reviews presented a ‘high’ quality, six presented a ‘moderate’ quality, two a ‘low’ quality; and one systematic review presented a ‘very low’ quality. This current umbrella review gathered data from twelve systematic reviews and can conclude that premedication in cases of irreversible pulpitis in mandibular molars increases the effectiveness of the inferior alveolar nerve block anesthetic technique

DOES THE PRE-ANAESTHETIC MEDICATION IMPROVE THE ANALGESIA OF MANDIBULAR MOLARS WITH IRREVERSIBLE PULPITIS? AN UMBRELLA REVIEW

Determine whether the use of premedication increase the anaesthetic efficacy of the inferior alveolar nerve in teeth with symptomatic irreversible pulpitis, through the review question: Does the use of premedication increase the efficacy of the anaesthetic technique of inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?. Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anaesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were systematically searched in six electronic databases (MEDLINE/PubMed, Scoupus, Web of Science, Cochrane Library, EMBASE and Open Grey), without restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. Twelve systematic reviews were included. Only one did not performed meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high quality. The main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with paracetamol, and ketorolac) increased the success of the inferior alveolar nerve block. From the ‘very low’ to ‘high’ quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenases pathways and block the synthesis of specific prostaglandins that difficult the mechanism of action of the anaesthesia, increasing the success rate of the anaesthetic technique of inferior alveolar nerve block efficacy in cases of mandibular molars with symptomatic irreversible pulpitis

Do orthodontic tooth movements induce pulpnecrosis? : asystematic review

Background Orthodontic tooth movements are per-formed by applying forces on teeth, which may causealterations within the dental pulp. Previously pub-lished systematic reviews on the subject only includeda small number of studies that assessed pulp statusthrough reliable diagnostic methods. Since then, newevidence has been published, and a further systematicreview on the subject is necessary. Objectives To evaluate whether there is scientificevidence to support the possibility that orthodontictooth movements could induce pulp necrosis. Methods A systematic search of articles publisheduntil June 2020 was performed using MeSH and freeterms in the PubMed, Cochrane Library, LILACS,SciELO, Web of Science, EMBASE, Open Grey andGrey Literature databases. Randomized clinical trials(RCTs), nonrandomized clinical trials (nRCTs) andlongitudinal (prospective or retrospective) studies thatevaluated the pulp status of teeth subjected toorthodontic movements using laser Doppler flowmetryor pulse oximetry were included. The revisedCochrane risk of bias tools for randomized trials (RoB2) and nonrandomized interventions (ROBINS-I) wereused to assess the quality of the included studies. Rel-evant findings were summarized and evaluated. Theoverall quality of evidence was assessed through theGrading of Recommendations Assessment, Develop-ment, and Evaluation (GRADE) tool. Results Initial screening of databases resulted in 353studies. In total, 285 studies were excluded becausethey were duplicates. Of 68 eligible papers, fourteen metthe inclusion criteria and were selected for full-text read-ing. Two studies were excluded due to the methods usedto evaluate pulp status. Twelve studies (five RCTs, onenRCT and six prospective) were included. Four RCTswere classified as having an unclear risk of bias and oneas having a high risk of bias. The nRCT was classified ashaving a low risk of bias. Two prospective studies wereclassified as having a moderate risk of bias and four ashaving a serious risk of bias. The GRADE analysisdemonstrated a low to very low quality of evidence. Discussion Significant limitations regarding therandomization processes within the included RCTsand a lack of control of confounders on most nonran-domized and longitudinal studies were verified. Conclusions This systematic review indicates thatorthodontic movements do not induce loss of pulpvitality with low to very low certainty of evidence

DOES THE ULTRASONIC ACTIVATION OF CALCIUM SILICATE-BASED SEALERS AFFECT THEIR PHYSICOCHEMICAL PROPERTIES?

This study aimed to evaluate the influence of ultrasonic activation (UA) on the physicochemical properties of calcium silicate sealers. Nine experimental conditions were created based on the calcium silicate sealers (Bio-C Sealer, Sealer Plus BC, and Bio Root RCS) and the ultrasonic activation (no activation, 10 seconds, and 20 seconds). Then the experimental groups were BC-NA, BC-10, BC-20, SPBC-NA, SPBC-10, SPBC-20, BR-NA, BR-10, and BR-20. The sealers were handled according to the manufacturer's instructions. A 3 mL syringe was adapted to receive 1 mL of sealer. Activation was performed with an ultrasonic insert 20/.01. The mold for the physicochemical analysis was filled and evaluated according to the ANSI/ADA specification nº. 57: initial and final setting time, flow, radiopacity and solubility. Tests were also performed to evaluate pH and calcium ion release with experimental periods of 1, 24, 72, and 168 hours with a pH meter and colorimetric spectrophotometer. Data were analyzed by one-way analysis of variance and post-hoc Tukey tests. The significance level was set at 5%. The time of UA progressively delayed the initial setting time for all calcium silicate sealers (P < .05). Twenty seconds of UA increased the mean flow values of Sealer Plus BC and Bio-C Sealer compared to NA (P < .05). UA did not influence the radiopacity and solubility of the tested sealers (P > .05). UA for 20 seconds enhanced the pH levels and the calcium ion release of Sealer Plus BC and Bio-C Sealer at 168h (P < .05). UA for twenty seconds interferes with some physicochemical properties of calcium silicate sealers

DOES PERIODONTAL INTERVENTION TIME INFLUENCE PERIAPICAL/PERIODONTAL REPAIR IN ENDODONTIC-PERIODONTAL LESIONS? A SYSTEMATIC REVIEW

The aim of this study was to investigate if the time of periodontal intervention influence the periapical/periodontal repair in endodontic-periodontal lesions. Six electronic databases were systematically searched for studies published up to April 2022, without restriction of language or year of publication, following the PIOS strategy: (P) adult patients with a diagnosis of endodontic-periodontal lesions; (I) endodontic and periodontal treatment; (O) periapical and periodontal healing; (S) clinical studies. Risk of bias assessment was performed with the revised Cochrane risk of bias tools for randomized trials (RoB 2) and nonrandomized interventions (ROBINS-I). The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Three studies (one prospective, one retrospective, and one randomized clinical trial) were included in the present review. Nonrandomized studies had a critical and serious risk of bias. The randomized clinical trial had some concerns risk of bias. Nonrandomized studies pointed that the endodontic intervention should be performed before the periodontal intervention. Randomized clinical trial reported improvements when endodontic and periodontal interventions were performed simultaneously. GRADE analysis showed a very low quality of evidence for both randomized and nonrandomized studies. Based on the evidence from the included studies, it was not possible to determine whether the time of periodontal intervention influence in periapical/periodontal repair of endodontic-periodontal lesions. Evidence suggests that although the endodontic intervention should be the first therapy of choice, it was not possible to specify the best time to perform the periodontal intervention

EVALUATION OF THE DENTINAL TUBULE PENETRATION OF AN ENDODONTIC BIOCERAMIC SEALER AFTER THREE FINAL IRRIGATION PROTOCOLS

Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol. Introduction: This study aimed to evaluate the dentinal tubule penetration of an endodontic bioceramic sealer, Sealer Plus BC, after three final irrigation protocols. Methods: Thirty distobuccal roots of maxillary molars were selected. Root canal preparation was performed up to an #40.06 instrument (X1 Blue) under 2.5% sodium hypochlorite irrigation. Specimens were randomly divided into three groups (n=10), according to the final irrigation protocol: G-NaOCl (2.5% sodium hypochlorite + PUI), G-SS (0.9% saline solution + PUI) and G-H20 (Deionized water + PUI). After final irrigation protocols, all specimens were irrigated with phosphate buffer solution. Root canal obturation was performed using the single cone technique and Sealer Plus BC, stained with a specific fluorophore. Specimens were transversely sectioned and each root third was evaluated in a confocal scanning laser microscopy. Images obtained were analyzed for sealer penetration in the dentinal tubules. Results: Dentinal tubule penetration of Sealer Plus BC was not observed in any root third, regardless of the final irrigation protocol investigated. Conclusions: Sealer Plus BC dentinal tubule penetration was not observed after none of the protocols tested. Dentinal tubule penetrability of Sealer Plus BC may be related to other factors rather than the final irrigation protocol