Efficacy of four local anaesthesia protocols for mandibular first molars with symptomatic irreversible pulpitis: A randomized clinical trial

The influence of intraoral cryotherapy on postoperative pain and substance P in symptomatic apical periodontitis: randomized clinical study

Cryotherapy is widely utilized in medicine, particularly for pain management. This randomized clinical trial aimed to assess the effect of intraoral cold pack application (cryotherapy) on postoperative pain (POP) and the level of Substance P (SP) in patients with symptomatic apical periodontitis (SAP). Enrolled patients were randomly assigned to either cryotherapy or control group. After adequate anesthesia, access cavity, and biomechanical preparation of the root canal system were completed, the first apical fluid (AF) sample (S1) was obtained. A custom-made intraoral ice-gel pack was applied for 30 min in the cryotherapy group, while no intervention was performed in the control group. The second AF sample (S2) was collected 30 min later in both groups. Patients were asked to complete the Visual Analogue Scale (VAS) questionnaire to assess their POP. Quantification of SP in AF samples was performed using the enzyme-linked immunosorbent assay (ELISA) test. Data were analyzed statistically, revealing a significant reduction in POP and SP levels in the cryotherapy group compared to the control group (P ≤ 0.05). Furthermore, a moderate positive correlation was observed between SP levels and POP (P ≤ 0.05). In conclusion, intraoral cryotherapy represents a simple and cost-effective option for controlling POP and reducing inflammation levels in patients with SAP.

Primary and supplementary anesthetic efficacy of a modified two-step buccal infiltration of 4% articaine in mandibular molars with symptomatic irreversible pulpitis: a randomized clinical trial

OBJECTIVES

To evaluate a modified two-step buccal infiltration (MBI) of 1.7 mL 4% articaine as primary or supplemental anesthesia in mandibular first and second molars diagnosed with symptomatic irreversible pulpitis (SIP).

MATERIALS AND METHODS

One hundred and eight patients with SIP were randomly assigned to one of three groups (n = 36). They were given an inferior alveolar nerve block (IANB) of 2% lidocaine with 1:80.000 epinephrine or a primary MBI of 4% articaine with 1:100.000 epinephrine in the IANB and MBI groups, respectively. Patients in the IANB + MBI group received an IANB followed by an MBI. Pain levels during the injection, access cavity preparation, and initial filing were recorded on the Heft-Parker visual analog scale (HP-VAS). No or mild pain (HP-VAS ≤ 54) upon access cavity preparation and initial filing was considered a success. Chi-square and Kruskal-Wallis tests were used to analyze the data.

RESULTS

MBI (77.8%) and IANB + MBI (94.4%) had both significantly higher success rates than IANB (50.0%) (P < .001). However, when the Bonferroni adjustment was applied, there was no statistically significant difference between the MBI and IANB + MBI techniques (P = .041 > .017). MBI was associated with significantly less injection pain than IANB (P < .001).

CONCLUSIONS

Both primary and supplemental MBI with 4% articaine were superior to IANB with 2% lidocaine in mandibular first and second molars diagnosed with SIP. Further research may be needed to confirm the findings of this study.

CLINICAL RELEVANCE

The findings of this study suggest that supplemental or primary MBI can be a clinically viable alternative to IANB, which has a relatively low success rate when managing mandibular molars diagnosed with SIP.