Electric pulp testing: a review

Electrochemical dissolution and retrieval of broken NiTi endodontic files from root canal using chloride based isotonic fluids as electrolytes - An in vitro study

Objective

The electrochemical dissolution method of instrument retrieval emphasizes on the dissolution of the instrument rather than sacrificing dentine. Most of the studies conducted for electrochemical dissolution used fluoride-containing electrolytes and were performed inside a beaker. In this study, we used chloride-based fluids as electrolytes.

Materials and Methods

Fifty extracted mandibular first premolars were divided into five groups based on the electrolytes used. Canals were enlarged to ProTaper Universal F2, and files were intentionally broken inside the canal. These specimens were subjected to electrochemical characterization by applying the potential of 9V for 20 min. Optical images were taken to assess the change in surface topography. The results were analyzed statistically by one-way analysis of variance (analysis of variance [ANOVA]).

Results

The rate of dissolution based on the electrolyte used decreased in the following order, viz. Tyrode's solution>artificial saliva>normal saline>Ringer's lactate/physiological serum.

Conclusion

Apart from fluoride, chloride-based electrolytes could be an efficient alternative.

Identification of the Ideal Reference Site and Pain Threshold Values for the Placement of Electric Pulp Testers in Permanent Upper and Lower Anterior Teeth: A Cross-Sectional Study

INTRODUCTION

Electric pulp testers (EPTs) are widely used diagnostic tools for diagnosing traumatized teeth. Several factors can affect the result of an electric pulp test. One such factor that will affect the diagnosis is the electrode tip placement. Hence, the current study aims to identify the most painful site and response time threshold in healthy anterior teeth.

METHODS

A total of 90 individuals, 48 male and 42 female, aged 19 to 25 years, were recruited. An EPT was placed on three different sites: the cervical, middle, and incisal third of the labial surface of both upper and lower anterior teeth (central incisor, lateral incisor, and canine) with an appropriate electrolyte as a conducting medium. Later, the threshold values were recorded, and pain assessment was done using the Memojis pain scale (MPS). Finally, the data was analyzed statistically using the Mann-Whitney U test.

RESULTS

Mean and standard deviation values of reaction time were collected from 540 EPT readings (three sites from 180 teeth). Among the three sites tested, the difference between the upper and lower central incisors was statistically insignificant (p > 0.05). Similarly, when upper and lower lateral incisors and canines were compared, a statistically significant difference was observed among the three sites (p<0.05). There was a significant difference (p<0.05) in the pain scores only on the incisal and cervical thirds of the upper and lower central incisors. Only the incisal third showed a statistically significant difference (p<0.05) between the pain scores in the upper and lateral incisors. At the same time, a statistically significant difference in the pain scores was observed among the three tested sites between the upper and lower canines (p<0.05).  Conclusion: Lower threshold values were appreciated at the incisal third of all the upper and lower anterior teeth for placing the EPT. Most individuals have experienced a score of 2 (hurts little bit) for the perceived pain using EPTs for both the upper and lower anterior teeth.

Comparison of the Efficacy and Safety of Pulp Sensitivity Testing Results Using a New Pulp Testing Device versus Some Commonly Used Methods: A Crossover Study

INTRODUCTION

The efficacy and safety of a single novel electronic pulp sensitivity tester with a transilluminator (PSTT) capable of providing 4 different tests was compared with gold standard (GS) pulp testing methods.

METHODS

Four hundred eighty teeth, including 3 from each quadrant and their contralateral and opposing teeth, were randomly assessed using the PSTT or GS methods. Seven days later, the same teeth were assessed using the method not used earlier so that all teeth were evaluated using both methods. Sixty previously root canal-treated teeth, serving as negative controls, were assessed identically to the experimental groups. Results were analyzed using IBM SPSS software (IBM Corp, Armonk, NY) (P < .05).

RESULTS

A higher percentage of teeth responded to cold and electricity using GS methods compared with the PSTT (99.4 vs 93.1 and 99.6 vs 97.3, respectively). A lower percentage of teeth responded to heat using the GS method compared with the PSTT (50.0 vs 68.1). Chi-square tests determined differences in the proportion of sensitivity to temperature, and electric testing methods were statistically significant (P < .001 and P = .004, respectively). No difference in the proportion of sensitivity was observed for transillumination. The Wilcoxon signed rank test determined significantly shorter cold testing times using the GS method (P = .024). Shorter testing times were observed using the PSTT for heat (P < .001), electric pulp testing (P = .048), and transillumination (P = .001). The overall PSTT testing time was significantly shorter than the GS testing time (P = .03). Tissue injury was not observed.

CONCLUSIONS

The PSTT efficiently and safely provided heat and transillumination for pulpal diagnosis. Improvements are needed to enhance the cold and electric stimulus efficacy.

A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study

Aim

The objective of this research was to conduct a comparison and evaluate the pain perception and time of onset of 2% lignocaine 1:80,000 epinephrine with 4% articaine 1:100,000 epinephrine in the pediatric population.

Materials and methods

A split-mouth randomized control trial was conducted on 50 children aged 9-14 years who required inferior alveolar nerve block (IANB) anesthesia for bilateral dental treatment in the mandibular arch. The time of onset was recorded when no sensation was reported even when maximum electrical stimulus was applied in an electric pulp testing (EPT). The pain perception was assessed using a visual analog scale (VAS) rated by the patient for subjective symptoms and face, legs, activity, cry, and consolability (FLACC) scale for objective pain rated by the operator.

Results

The mean onset of time, pain-VAS, and FLACC score decreased by 1.31, 12.07, and 18.39%, respectively in 4% articaine as compared to 2% lignocaine but the difference did not reach statistical significance (p > 0.05), that is, found to be statistically the same.In conclusion, it can be inferred that the utilization of 4% articaine is as potent as 2% lignocaine solution but showed slightly better onset of anesthesia and pain experience among the children although the findings were not statistically significant.

Clinical significance

Local anesthesia (LA) is one of the main methods of pain management in pediatric practice which makes it essential to choose an LA agent with a shorter time of onset and less pain on administration.

How to cite this article

Singh SS, Koul M. A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study. Int J Clin Pediatr Dent 2024;17(1):67-71.

Influence of the restoration after pulpotomy on the strength of electrical stimulus reaching the pulp space: An in vitro investigation

Introduction

The study evaluated the influence of coronal restoration after pulpotomy on the strength of electrical stimulus reaching the radicular pulp using an electric pulp test (EPT).

Materials and Methods

The pulp tissue from ten freshly extracted mandibular premolar teeth was removed and replaced with an electroconductive gel. The cathode probe of Powerlab was inserted into the pulp space and the anode probe was attached to the EPT handpiece. The EPT probe coated with electro-conducting material was positioned in the middle third of the buccal crown surface. The EPT stimulus reaching the pulp space of an intact tooth at 40 numerical readings was recorded. The tooth was removed from model and endodontic access was made. The 2-mm thick mineral trioxide aggregate was placed at the cementoenamel junction followed by composite resin restoration. The experimental setup was re-established and postpulpotomy EPT stimulus data were recorded. The data collected were compared using the Wilcoxon signed-rank test.

Results

There was a statistically significant difference (P = 0.038) between observed between the strength of EPT stimulus reaching the pulp space in prepulpotomy (mean 91.18 ± 101.02 V and median 25.79 V) and postpulpotomy (mean 58.49 ± 77.13 V and median 13.75 V) tooth samples.

Conclusion

The placement of the restoration and pulp capping agent after pulpotomy dampens the strength of EPT stimulus reaching the pulp canal space.

The effect of orthodontic tooth movement on the sensitivity of dental pulp: A systematic review and meta-analysis

Objectives

Orthodontic tooth movement (OTM) is a process that's initiated by orthodontic forces. As a consequence, the forces could restrict pulpal blood supply, possibly affecting dental pulp. The study aimed to review the available evidence on the short and long-term effects of orthodontic tooth movement on dental pulp sensitivity and to identify clinically relevant risk factors.

Sources

PubMed, Embase, Scopus, and Web of Science were searched for papers from 1990 to the end of December 2021.

Study selection

The studies that evaluated dental pulp sensitivity of teeth undergoing OTM were included in the systematic review. Randomized, nonrandomized and case-controlled studies were included in the analysis. Risk of bias in each study was assessed using the ROBINS-I tool.

Data

The systematic search yielded an initial sample of 1110 studies, 17 were included in qualitative analysis. Most studies were classified as moderate risk of bias, however only limited long-term evidence with a higher risk of bias exists. Electric pulp test (EPT) sensitivity threshold during active OTM was increased by 4.25 SD (P < 0.001) and the relative risk (RR) of pulpal non-sensitivity was 13.27 (P < 0.001) higher compared to pre-orthodontic baseline status. Significant differences were between subgroups associated with the type of OTM. A positive relationship between pulpal non-sensitivity and mean patient age was discovered (P = 0.041). After OTM the risk of pulpal non-sensitivity remained 5.76 times higher (P < 0.001) in the long term.

Conclusions

Evidence showed that OTM could affect dental pulp sensitivity. The type of OTM and patients' age were identified as clinically relevant risk factors.

Clinical significance

Orthodontic tooth movement negatively impacts the sensitivity of dental pulp during active treatment and to a lesser degree in the long term. Pulpal sensitivity tests during active OTM should therefore be interpreted with caution. Data indicates younger patients have a lower risk of negative pulpal sensitivity during orthodontic treatment.

The Effect of General Anesthesia on the Outcome of Root Canal Treatment in Pediatric Patients—A Retrospective Cohort Study

This study aimed to evaluate the effect of general anesthesia (GA) on the 1-year outcome of Root Canal Treatment (RCT) performed in pediatric patients and to compare it to the outcome of RCT in pediatric patients without GA. Patients admitted for RCT in permanent dentition in a public hospital, dated 2015 to 2020, age 8–15 with a minimum of one year follow-up period, were included in the study. The sample consisted of 326 teeth from 269 patients treated by a single operator, with a recall rate of 81%. Overall, 124 teeth were treated under GA and 142 teeth were without GA. The mean follow-up time was 31.5 months. Data underwent statistical analysis and the significance threshold was set for p < 0.05. Of the total cases, 90% showed favorable outcomes. A significantly higher favorable outcome was seen in the GA group than in the non-GA group (98% and 85%, respectively, p < 0.001). The outcome was significantly affected by the type and quality of the coronal restoration, degree of root development, and lesion size (p < 0.05). According to the current study, in uncooperative pediatric patients, a more favorable outcome of root canal treatment can be obtained under GA than LA if the procedure is carried out with immediate restoration.

The scientific management of deep carious lesions in vital teeth using contemporary materials—A narrative review

Aim

The aim of this article is to review the scientific evidence for deep caries removal in permanent vital teeth and the choice of dentine replacement material and restoration of the teeth to maintain long term tooth vitality and function.

Method

The two position statements namely the European Society of Endodontology and the American Association of Endodontists position statements on vital pulp therapy will be scrutinized and compared with regards to the deep caries removal strategy and assessed for evidence of best practice. The properties of materials used to manage vital pulps and the best way to restore the teeth will be reviewed and guidance on the full management of vital teeth will be suggested.

Conclusions

Promoting new treatment modalities for reversible and irreversible pulpitis allowing for pulp preservation should be considered. Although debatable, cases with deep caries should be managed by complete non-selective caries removal which will allow for pulpal management if needed and a more predictable outcome can be expected when using the new materials and treatment modalities of vital pulp therapy.

Introducing a new medical method and innovative suture technique to reduce scars in central lip lift medical surgery

"The central lip lift surgery with a new suture technique called; continuous locking suture in three cases is reported in this article. In this novel method, we used a 5.0 chromic suture by applying a 30-degree angle of the entrance to the skin semi-deeply. We start suturing at the middle of the wound,3-4 mm from the edges of the skin. The needle should be way out at the exact point of entrance, and this process is repeated to reach out to the two sides of the wound. More than 90% of patients (in more than 100 cases) were satisfied with the cosmetic results. Moreover, 90% of cases did not demonstrate any scar after three months without laser or reconstructive ointments. We evaluate many patients who undergo central lip lift surgery with this novel technique, and the scar problem was resolved in more than 90 % of cases with no supportive treatment."

Comparison of the Response to Pulpal Sensibility Tests in Well-Controlled and Uncontrolled Type II Diabetes Mellitus Patients: A Cross-Sectional Study

Introduction

Diabetes mellitus is a metabolic disorder in which impairment of sensory fibers would be anticipated. The present study would assess the dental pulp response to cold and EPT sensibility tests in patients with type 2 diabetes, both well-controlled and uncontrolled.

Materials and Methods

One hundred two maxillary central incisors, belonging to participants aged 35–67 years, were included in this survey. At last, 51 diabetic patients were allocated to each group of well-controlled (HbA1C < 7) and uncontrolled (HbA1C ≥ 7). Electric and cold pulpal vitality tests were conducted for all teeth. Statistical analysis was performed with Student's t-test, the chi-square test, and the multiple linear regression model. A P value less than 0.05 was considered significant.

Results

Based on the results of this study, the mean value of response to EPT was 4.51 ± 2.06 and 4.41 ± 1.85 in well-controlled and uncontrolled diabetic patients, respectively. Also, the pulpal responses to cold and EPT tests had no significant differences between the two groups (P > 0.05).

Conclusion

Tooth responses to the cold and EPT sensibility tests were not different in well-controlled and uncontrolled diabetic patients. Despite no statistically significant correlation, male diabetic patients in the uncontrolled group showed a lower sensory response threshold to EPT compared to a well-controlled group.

Quality of techniques used to assess clinical outcomes of regenerative endodontic treatment in necrotic mature teeth

Data sources A preliminary, randomised, prospective, controlled clinical trial of patients managed with two regenerative endodontic procedures, revitalisation and a platelet-rich fibrin (PRF)-based technique, in the treatment of mature permanent teeth with necrotic pulps.Study selection Twenty patients with mature necrotic anterior teeth with large periapical lesions treated with the blood clot and a PRF-based techniques for revitalisation. Periradicular healing and pulp sensibility was assessed at 6 and 12 months after treatment.Results Significant periradicular radiographic healing and sensibility was reported at 6 and 12 months.

Evaluation of the Response to Pulpal Sensibility Tests (Cold, EPT) in Anemic and Healthy Women

Introduction

The prevalence of anemia has been reported high in the female population in Iran. Anemia can be asymptomatic or can present in a variety of symptoms, especially when serum Hb values decrease. The present study would assess dental pulp response to cold and EPT sensibility tests in anemic and healthy women.

Materials and Methods

One hundred twenty maxillary central incisors belonging to participants aged 18–58 years were included in this survey. 60 patients had anemia (Hb ≤ 12.5) with/without medication (30 in each group) and 60 women as controls had no anemia (Hb > 12.5) with/without medication (30 in each group). Electric and cold pulpal sensibility tests were performed for all teeth. Statistical analysis was performed with t-student, Chi-square test, and two-way ANOVA. The significance level was set as p < 0.05.

Results

According to the results of this study, the mean value of hemoglobin in anemic and healthy women was 11.5 and 14.08 g/dl, respectively. The mean value of response to EPT in anemic women with and without medication was 3.21 and 3.14, respectively. The mean value of response to EPT in healthy women with and without medication was 3.81 and 3.58 g/dl, respectively. The mean value of time delay response to cold test was 3.03 and 2.82 s in anemic patients with/without medication. Also, the mean value of time delay response to cold test was 2.80 and 2.93 s in healthy women with/without medication. The pulpal responses to EPT tests had significant differences between anemic and healthy women (p=0.043). There were no significant differences between anemic and healthy women considering time delay response to the cold test (p=0.077).

Conclusion

Based on the results of the present study, tooth response to the EPT  sensibility test may alter in anemic patients despite medication. The evidence from this preliminary study suggests that peripheral neuropathy in anemic patients could affect pulpal sensibility tests.

A Diagnostic Insight of Dental Pulp Testing Methods in Pediatric Dentistry

The accurate diagnosis of pulpal pathology in pediatric dentistry is essential for the success of vital pulp therapy. Pulp testing is often a challenging task due to understanding and cooperation issues of pediatric patients, as well as the particularities of pulpal physiology encountered in primary and immature permanent teeth. Sensibility tests, although still widely used by dental practitioners, are no longer recommended by pediatric specialists mainly due to their subjective nature. Vitality pulp tests have gained popularity in the last decade in light of some encouraging results of clinical studies. However, their use is not a routine practice yet. This paper is a literature review aimed to guide dental practitioners towards selecting the appropriate pulp testing method for their pediatric cases. It provides an overview on a multitude of pulp testing methods and an update in recommendations for primary and immature permanent teeth.

Comparison of pulp sensibility test responses in normotensive and hypertensive individuals: A clinical study

Background

Pulp sensibility testing is an essential part of the diagnostic process in the assessment of pulpal health. Several lines of evidence suggest an interaction between control of blood pressure and pain regulatory mechanisms.

Aim

The aim of the study is to compare pulp sensibility test responses in normotensive and hypertensive individuals.

Materials and Methods

Ninety-eight patients participated in the study, with 49 individuals each in the hypertensive and normotensive groups. A minimum of 4 and maximum of 8 sound teeth were included in the study each from the anterior, premolar, and molar, i.e., 4 teeth from either arch. A total of 832 teeth were tested. The value and time when the responses evoked for electric pulp test (EPT) and cold test were recorded respectively.

Statistical Analysis

For intergroup and intragroup analyses, independent t-test and paired t-test were utilized.

Results

A statistically significant difference was noted in values for EPT as well as cold test responses when both the groups were compared (P < 0.01). Higher values were obtained with the hypertensive group.

Conclusion

Patients with established hypertension showed an increased threshold to electric pulp testing and cold stimulus as compared to normal healthy individuals.

Evaluation of the response to electric pulp testing in multiple sclerosis patients without a history of trigeminal neuralgia: a case-control study

Background

The importance of evaluating the pulpal threshold to electrical stimulation, as a side effect of probable neuropathy in Multiple Sclerosis (MS) patients is a novel issue. This study aimed to investigate electrical pulp test thresholds in MS patients without a history of trigeminal neuralgia compared to healthy individuals.

Methods

Sixty-nine maxillary central incisors, belonging to 34 relapsing-remitting MS patients, and 35 healthy individuals were included in this survey. The MS patients matched for intended variables, were 22–50 years old, had a more than 1-year history of MS, no history of trigeminal neuralgia and/or other neuropathy. The electric pulp sensibility test was performed on all samples. Electric pulp testing (EPT) results were recorded based on the pulp tester^’s grade that evoked a response. Data were analyzed with paired T-test, Mann-Whitney test, and Spearman correlation (P < 0.05).

Results

According to the results of this study, the mean values of response to EPT were 1.2 ± 0.5 and 1.8 ± 0.5 in MS patients and healthy individuals, respectively. The pulpal response to EPT between the two groups was significantly different (P < 0.0001).

Conclusions

MS patients showed a significantly reduced response to the electric pulp test in their maxillary central incisors in comparison to matched healthy persons.

Assessment of Electrosensitivity of the Pulp of the Mandibular Second Molar after Surgical Removal of an Impacted Mandibular Third Molar

Despite the frequent discussion of complications associated with surgical removal of wisdom teeth in the scientific literature, increased mobility of the second molar, which can affect the clinical status of the pulp, is often downplayed or overlooked. This study aimed to evaluate surgical removal of an impacted third molar on the change in the electrosensitivity of the pulp of the mandibular second molar. Sixty patients consecutively presenting to the Department of Oral Surgery to remove an impacted mandibular third molar were included in the study. Clinical examinations of pulp sensitivity of second molars in both the study and control groups were evaluated before the procedure, seven days after the procedure, and eight weeks after the procedure. The surgical removal of an impacted mandibular third molar significantly affected the pulp sensitivity of the second molar.

An evaluation of the repeatability of electric pulp sensibility tests

The accuracy, reliability and reproducibility of electric pulp tests (EPT) have been investigated but there is conflicting information about their repeatability. The aim of this study was to investigate whether EPT are repeatable over time. EPT results from 180 healthy teeth in 39 patients with 2-10 readings per tooth (total 692 readings) were analysed. Single measures intraclass correlation coefficients (ICC) ranged from 0.776 to 0.845 in teeth with 2-7 repeated measures (P < 0.001), indicating good repeatability. With eight or more measures per tooth, the ICC was low, indicating poor repeatability over longer follow-up times, but only seven teeth in two subjects were included in this analysis. The Pearson correlation showed no statistically significant correlation for 2-7 readings but when all readings were included, there was a statistically significant negative correlation. Hence, EPT has good repeatability.

Relationship between the difference in electric pulp test values and the diagnostic type of pulpitis

BACKGROUND

According to the diagnosis criteria of the American Association of Endodontists (AAE), sensitive responses to cold and/or heat tests of suspected teeth compared with those of control teeth can be used for the diagnosis of pulpitis, but the role of electric pulp test (EPT) is not mentioned. It is believed that EPT has some limitations in determining the vitality of the pulp. The aim of this study was to explore the association between the difference in EPT values and the differential diagnoses of reversible pulpitis (RP) and symptomatic irreversible pulpitis (SIRP) caused by dental caries.

METHODS

A total of 203 cases with pulpitis caused by dental caries were included. A diagnosis of pulpitis was made on the basis of the diagnostic criteria of AAE. Patient demographic and clinical examination data were collected. The EPT values of the suspected teeth and control teeth were measured, and the differences between them were calculated. The correlation between the difference in the EPT values and diagnosis of pulpitis was analyzed using univariate and multivariate logistic regression.

RESULTS

In the 203 cases (78 males and 125 females; 115 cases of RP, 88 cases of SIRP; 9 anterior teeth, 59 premolars, and 135 molars), the mean patient age was 34.04 ± 13.02 (standard deviation) years. The unadjusted (crude) model, model 1 (adjusted for age), model 2 (adjusted for age and sex), and model 3 (adjusted for age, sex, and tooth type) were established for the statistical analyses. In model 3 [odds ratio (OR) = 1.025; 95% confidence interval (CI) 1.002-1.050; P = 0.035], the difference in EPT values between RP and SIRP was statistically significant. However, the areas under the curve of predictive probability of the crude model, model 1, model 2, and model 3 were 0.565, 0.570, 0.585, and 0.617, respectively, showing that the model accuracy was low. The P-value for the trend in differences between the EPT values as a categorical variable showed that the differences in the EPT values, comparing RP and SIRP, were not statistically significant.

CONCLUSIONS

Based on the present data, the difference in EPT values was not sufficient to differentiate RP from SIRP.

The correlation between external apical root resorption and electric pulp test responses: a prospective clinical trial

OBJECTIVE

The current study investigated the correlation between pulpal sensitivity to the electric pulp tester (EPT) and external apical root resorption (EARR) in four types of maxillary anterior teeth of fixed orthodontic treatment patients.

METHODS

In this prospective cohort study, 232 anterior teeth of 58 patients (mean age 18.96 ± 6.13 years) treated with fixed orthodontic treatment were examined. The EPT readings were recorded at twelve time points immediately before archwire insertion. Root resorption of four maxillary incisors were measured by means of parallel periapical radiographs at three time intervals (six months interval from the start) through design-to-purpose software to optimize data collection. A multiple linear regression model and Pearson correlation coefficient were used to assess the association of EPT values and observed EARR (p< 0.05).

RESULTS

The highest level of EPT measurement was recorded at initial visit, and then there was a decreasing trend in EPT level during treatment for the next six and twelve months. There was another increasing trend after six months till the finishing time of the treatment. There was a significant correlation between changes in root length and time of recording the root length (p< 0.001). There was significant positive correlation between changes in EPT level and amount of observed root resorption (p< 0.001).

CONCLUSION

The relative decrease in electric pulp test level could be a diagnostic sign of root resorption during orthodontic treatment. Further studies with longer follow up are needed to confirm the current results.

A prospective cohort study evaluating subjective and objective neurosensory changes following LeFort I osteotomy

INTRODUCTION

This study aimed to investigate the incidence and recovery of neurosensory deficit (NSD) after LeFort I osteotomy over 12 months and identify any association between age, gender, and extent of surgical movement on recovery. Furthermore, the study explored the relationship between objective and subjective outcome measures.

METHODS

A prospective cohort study consisting of 31 patients. Subjects were assessed at baseline, 1 week (T1), 1 month, 3 months, 6 months, and 12 months (T5) after LeFort I osteotomy. Objective assessment measures included pinprick (PP), static light touch (SLT), static 2-point discrimination (STPD), and electric pulp testing (EPT). Subjective reporting was undertaken using a visual analog scale. Patients rated the impact of NSD on intraoral and extraoral sites at the same time points as for objective measures.

RESULTS

Twenty-eight patients (16 females and 12 males) with a mean age of 24.5 years (standard deviation, 7.4) completed the study. There was a notable reduction in NSD from T1 (85.7%) to T5 (17.9%). No significant differences were found with respect to the influence of gender; PP (P = 0.06), SLT (P = 0.10), STPD (P = 0.65) and EPT (P = 0.19) or extent of surgical movement; PP (P = 0.50), SLT (P = 0.72), STPD (P = 0.06) and EPT (P = 0.74) on NSD. Age is a significant factor for intraoral NSD in the immediate postoperative period; PP (P < 0.0001) and SLT (P < 0.0001). Subjectively, patients reported a high degree of concern associated with NSD immediately after surgery with a gradual reduction from T1 to T5. There is a significant difference in subjective reporting between those with intraoral NSD than those with no intraoral NSD at 12 months (P = 0.031).

CONCLUSIONS

NSD is high after LeFort I surgery, particularly intraorally in the palate. At 12 months, the incidence of NSD is 17.9%. Recovery of NSD to a nonsignificant value from baseline takes up to 3 months for extraoral sites and between 3 and 6 months for intraoral soft tissues. The maxillary dentition continues to recover from NSD up to 12 months postsurgery. Age, gender, and extent of the surgical movement do not influence the extent of NSD at 12 months. Increasing age is associated with increased NSD at intraoral sites immediately after surgery. Intraoral NSD is more of a concern to patients than extraoral NSD. Patients' concerns associated with NSD reduced over time, demonstrating a degree of adaptation in the longer term.

Risk factors for tooth loss with a mean follow-up period of 13.9 years in supportive periodontal therapy patients

Background

Clinical evidence indicates that there are various risk factors of tooth loss. However, the degree of this risk among other risk factors remains unclear. In this retrospective cohort study, the authors evaluated the hazard ratios of several risk factors for tooth loss.

Methods

Included patients had all been treated for dental disorders, were in the supportive phase of periodontal therapy by dental hygienists, and visited a Japanese dental office continually during a 10-year period. Periodontal parameters, tooth condition, and general status of all teeth (excluding third molars) at the initial visit and at least 10 years later were evaluated by using multiple classification analysis.

Results

The authors evaluated a total of 7584 teeth in 297 patients (average age: 45.3, mean follow-up time: 13.9 years) Non-vital pulp was the most significant predictor of tooth loss according to Cox hazards regression analysis (hazard ratio: 3.31). The 10-year survival rate was approximately 90% for teeth with non-vital pulp and 99% for teeth with vital pulp. Fracture was the most common reason for tooth loss.

Conclusions

Non-vital pulp had the most significant association with tooth loss among the parameters. Therefore, it is very important to minimize dental pulp extirpation.

Conservative pulp therapy in the management of reversible and irreversible pulpitis

Conservative pulp therapy is an alternative treatment option to tooth removal and root canal treatment in the management of deep caries, traumatic pulp exposures and developmental anomalies. Pulp tissue preservation can extend the long-term survival of teeth through relatively simple restorative procedures. This article aims to update clinicians on the current state of research in materials, techniques and outcomes of vital pulp therapies and provide practical guidelines for their implementation into daily practice.

Association between concentration of active MMP-9 in pulpal blood and pulpotomy outcome in permanent mature teeth with irreversible pulpitis - a preliminary study

AIM

To investigate the correlation between the concentration of active-matrix metalloproteinases-9 (aMMP-9) in pulpal blood and the outcome of pulpotomy in mature permanent teeth with symptomatic irreversible pulpitis (SIP).

METHODOLOGY

Forty permanent molar teeth with a clinical diagnosis of SIP and normal apical tissues with periapical index (PAI) score ≤ 2 and ten permanent teeth (8 molars and two premolars) with a diagnosis of normal pulp that required root canal treatment for prosthetic reasons from patients between the ages of 15-35 years were recruited. All clinical procedures were performed under local anaesthesia and rubber dam isolation. After access opening, the coronal pulp tissue was amputated up to the canal orifice. A 100 μL volume of the pulpal blood was collected using a micropipette and transported to the laboratory. Sodium hypochlorite (2.5 %) was used as a haemostatic agent, and mineral trioxide aggregate (MTA) was used as the pulp capping material. The tooth was restored with composite at the same visit. Teeth with normal pulps were treated with single-visit root canal treatment. Patients with pulpotomy were recalled at 6 and 12 months. Outcome assessment of teeth with pulpotomy was carried out at 12 months and was categorized as success (asymptomatic patients with PAI score ≤ 2) or failure (symptomatic patients or PAI score ≥ 3). Quantification of aMMP-9 in pulpal blood was achieved using a fluorometric assay. The following statistical analyses were performed to assess the data: t-test, Fisher's exact test, kappa coefficient, non-parametric test, Wilcoxon rank-sum test, Spearman rank correlation test and receiver operating characteristic curve (ROC).

RESULT

The success rate of pulpotomy was 88 % at 12-months. There was a significant difference between the median concentrations of aMMP-9 in pulpal blood of teeth with normal pulps (52 (12-96) ng mL^-1 :) and SIP (193.3 (25.8-607.7) ng mL^-1 :) (P = 0.0003) and successful (132.3 (25.8-548.3) ng mL^-1 :) and failed cases (512.4 (334.8-607.7 ng mL^-1 :) (P = 0.0015) of MTA pulpotomy. A significant association was established between aMMP-9 concentration and outcome of pulpotomy. The area under the receiver operating characteristics curve (0.9484, 95%CI) suggested excellent discriminatory power of aMMP-9 concentration in pulpal blood to predict the pulpotomy outcome.

CONCLUSION

The pulpal blood concentration of aMMP-9 was significantly associated with the outcome of pulpotomy in teeth with symptomatic irreversible pulpitis, where it may be used as a potential prognostic biomarker.

Electromagnetic interference effect of dental equipment on cardiac implantable electrical devices: A systematic review

BACKGROUND

The electromagnet interference (EMI) effect resulting from using dental equipment near cardiovascular implantable electronic devices (CIEDs) is controversial based on in vitro and in vivo studies. We aimed to summarize the available evidence to investigate the safety of using dental equipment on patients with CIEDs.

METHODS

An electronic search was performed in PubMed, Embase, MEDLINE Ovid, and the Cochrane Library for relevant studies published between January 2000 and May 2020. The search strategy centered on terms related to dental devices and CIEDs. Two independent reviewers determined the final inclusion of the studies in the systematic review. The EMI effect was summarized based on different dental instruments detected in in vitro or in vivo studies.

RESULTS

The primary search identified 84 articles, and 18 studies were finally included in this systematic review after exclusions. Most in vitro studies (n = 12) reported background noise or severe EMI affecting CIED function at a close distance from the lead tip or at a high sensitivity setting of CIEDs. In in vivo studies (n = 6), EMI that altered CIED function was not detected at clinical distance and sensitivity settings. The summary, based on electronic apex locators, ultrasonic devices, and electric pulp testers, demonstrated the compatibility of these common dental devices with CIEDs.

CONCLUSIONS

This systematic review indicates that most dental instruments can be used safely in routine dental practice. The EMI effect of dental equipment depends on the exposure distance and lead-related parameters of the CIEDs.

Dental anxiety and the effectiveness of local anesthesia

Aim: The successful anesthesia is an essential factor for dental treatment. This study aimed at determining the effectiveness of local anesthesia and it’s relationship with dental Anxiety. Methods: This cross-sectional study was carried out on 256 dental patients, in 2017. Dental Anesthesia was administered after completing the Modified Dental Anxiety Scale by the patients. The level of anesthesia was recorded in one of three states (successful, difficult, and failed). Collected data was analyzed using SPSS version 22 and tests of, Chi-square, independent t-test, analysis of variance, and logistic regression model.  Results: About 60.5% subjects had moderate-severe dental anxiety. The mean of dental anxiety significantly was lower in the successful anesthesia group (P<0.01). Patients with elementary education had a significantly higher level of dental anxiety (P<0.01). Dental anxiety was significantly higher in the age group of ≥59 years, compared to the other age groups, except for 49-58 years (P<0.05). Subjects with a significantly higher level of dental anxiety more delayed their visits to the dentist. The logistic regression model showed that the dental anxiety (high anxiety) and literacy level (elementary) were the most important predictors of failed or difficult anesthesia. Conclusion: Informing patients about dental treatment procedures, regular and periodic visits to the dentist, using psychotherapeutic techniques to reduce dental anxiety before anesthesia, could play an important role in the success of anesthesia.

Electrokinetic transport and distribution of antibacterial nanoparticles for endodontic disinfection

AIM

To assess a novel, noninvasive intervention capable of mobilizing charged antibacterial nanoparticles to the apical portions of the root canal system, utilizing the principles of electrokinetics.

METHODS

Experiments were conducted in three stages. Stage-1: A computer model was generated to predict and visualize the electric field and current density distribution generated by the proposed intervention. Stage-2: Transport of chitosan nanoparticles (CSnp) was evaluated qualitatively using a transparent microfluidic model with fluorescent-labelled CSnp. Stage-3: An ex vivo model was utilized to study the antimicrobial efficacy of the proposed treatment against 3-week-old monospecies E. faecalis biofilms. Scanning electron microscopy (SEM) was also utilized in this stage to confirm the deposition of CSnp.

RESULTS

The results of the computer simulations predicted an electric field and current density that reach their maxima at the apical constriction of the root canal. Correspondingly, the microfluidic experiments demonstrated rapid, controlled CSnp transport throughout the simulated root canal anatomy with subsequent distribution and deposition in the apical constriction as well as periapical regions. Infected root canals when subjected to the novel treatment method resulted in a mean bacterial reduction of 2.1 log CFU. SEM analysis revealed electrophoretic deposition of chitosan nanoparticles onto the root canal dentine walls in the apical region.

CONCLUSION

The findings from this study demonstrate that the combination of cationic antibacterial nanoparticles with a low-intensity electric field results in particle transportation (electrophoresis) and deposition within the root canal. This results in a synergistic antibiofilm efficacy and has the potential to enhance root canal disinfection.

A, Subbaiyan H. Different Treatment Modalities followed by Dental Practitioners for Ellis Class 2 Fracture – A Questionnaire-based Survey

Introduction:

Dental trauma is one of the most commonly seen injuries involving teeth and surrounding structures. The frequent causes of dental trauma are usually falls, traffic accidents, fights and sports injuries. Rapid treatment can prevent long-term damage to the orofacial structures and save the teeth. Ellis class 2 fracture is classified as the involvement of enamel and dentin excluding pulp. Dental practitioners are used to treating Ellis class 2 fracture very often in their dental practice and is usually considered as a dilemma among dental practitioners for the different treatment modalities followed for treatment of Ellis class 2 fracture. A survey is done among dental practitioners to assess the different treatment modalities followed by them in the case of Ellis class 2 fracture.

Materials and Methods:

A survey was done among 380 dental practitioners in the Chennai region in which 360 dental practitioners responded. The survey was distributed through electronic media and other means of communication. The survey data was collected, analysed and interpreted.

Results:

The results suggested that about 90% of dental practitioners had adequate knowledge and attitude towards the management of dental traumatic injuries. However, the practical application of the different treatment modalities was seen to be varied among dental practitioners. Based on this survey it was clear that majority of the dental practitioners in Chennai have good knowledge, attitude but there was a lack of clinical practice regarding the different treatment modalities followed by general practitioners for Ellis class 2 fracture.

Conclusion:

The survey shows that dental practitioners have a sound knowledge, attitude, but the practical application of the various treatment modalities available was seen to vary among various dental practitioners for Ellis class 2 fracture.

Endodontic microsurgery. Part one: diagnosis, patient selection and prognoses

Historically, surgical endodontics has been viewed as a treatment of last resort, mainly due to poor outcomes as a result of limitations in materials and techniques. Contemporary techniques, modern materials and better visualisation have all led to an improvement in success rates, making endodontic microsurgery a valuable treatment option to certain patients. Such advances, however, are no substitute for skill in endodontic diagnosis and treatment planning, which can often prove challenging. A variety of tools are available to test for fractures and assess both periodontal and pulpal health. More advanced techniques such as cone beam computed tomography are often invaluable in pre-surgical assessment and diagnosis. Once an accurate diagnosis has been established, a favourable prognosis is explicitly linked to careful patient selection. Orthograde treatment, or retreatment, remains the gold standard for the majority of endodontic problems. However, there are a number of indications for surgery where orthograde treatment is either impossible, or less likely to be successful. It is paramount for any clinician undertaking endodontic surgery to have a detailed understanding of the local and systemic factors associated with successful treatment. Whilst there are few absolute medical contraindications, there are a number of conditions which may influence patient management and make treatment more challenging.

Anesthetic efficacies of intrapapillary injection in comparison to inferior alveolar nerve block for mandibular premolar extraction: a randomized clinical trial

OBJECTIVE

Intrapapillary injection (IPI) has been suggested to improve pulpal anesthesia of mandibular teeth and to avoid complications from inferior alveolar nerve block (IANB). This study aimed to determine and compare clinical efficacies and prostaglandin E₂ (PGE₂) levels between IPI and IANB.

MATERIALS AND METHODS

IANB was randomly selected for mandibular premolar anesthesia on one side of 40 patients, whereas IPI was locally administered to the contralateral premolar. Pulpal anesthesia, pain during injection and extraction, patients' satisfaction, and complications were assessed from 30 patients. Gingival crevicular fluid from ten patients was collected for PGE₂ quantification by ELISA.

RESULTS

Of 30 patients, 18 preferred IPI after injection due to significantly faster mean onset of pulpal anesthesia (p < 0.001) and lower mean score of injection pain (p = 0.017) than IANB, but 21 preferred IANB instead after extraction due to less postoperative pain, consistent with the significantly lower median PGE₂ level on the IANB side than that on the IPI at 30 min (p = 0.047). However, there was no difference in the mean satisfaction score between the two techniques. Ulcerated epithelium and sloughing tissues were found at the IPI site in some patients with complete healing within 2 weeks.

CONCLUSIONS

The anesthetic efficacies of IPI for mandibular premolar extraction are comparable to those of IANB. However, postoperative pain and local complications at the IPI site should be considered.

CLINICAL RELEVANCE

IPI may be used for dental procedures that require only a short anesthetic duration to avoid failure of pulpal anesthesia, complications, and discomfort from IANB.

Pulp sensibility to electric stimuli in the Caucasian population

The aim of the study was to determine electric sensibility of the pulp in the Caucasian population depending on tooth morphotype, age and sex. Dental pulp sensibility was determined in 279 patients (2640 teeth). The study group consisted of 226 patients (1296 teeth), 110 men and 116 women aged 55-101. The control group consisted of 53 patients (1344 teeth), 23 men and 30 women aged 20-30. A statistically significant lower sensory threshold and increased pulp sensibility in the study group were noted. These affected the lower incisors, the second upper premolars and the first and second upper molar. The differences in the pulp sensibility were found in the region of maxillary central incisors, maxillary premolars, mandibular lateral incisors and mandibular premolars. The pulp sensibility threshold was lower for the aforementioned groups of teeth in the study group. The correlation between sensibility of the pulp and sex was not confirmed.

Dexmedetomidine Enhances the Pulpal Anesthetic Effect of Lidocaine: A Pilot Study

Dexmedetomidine hydrochloride (DEX) demonstrates analgesic, sedative, and hypotensive effects. DEX may also enhance the effect of local anesthetics used in the oral cavity, although this has not been well established in combination with lidocaine. We conducted a single-blind crossover study in 8 healthy volunteers to investigate whether DEX enhances the anesthetic effect of lidocaine in the oral cavity. DEX or DEX + lidocaine was injected into the labial gingiva corresponding to the root apex of the maxillary left central incisor and into the buccal gingiva corresponding to the root apex of the mandibular right first molar. Pain threshold, blood pressure, pulse rate, oxygen saturation, and bispectral index were measured 5 minutes after treatment and at 10-minute intervals for 60 minutes. DEX + lidocaine caused pulpal anesthesia in more subjects than lidocaine alone; this difference was significant for both central incisors and first molars up to 40 minutes after treatment. Following DEX + lidocaine treatment, blood pressure and bispectral index were significantly reduced at several time points, and pulse rate significantly reduced at all time points. Neither treatment caused changes in oxygen saturation. In conclusion, administering DEX with lidocaine for dental local anesthesia caused sedation and enhanced local anesthesia compared to lidocaine alone.

Clinical Performance and Epidemiologic Aspects of Fractured Anterior Teeth Restored with a Composite Resin: A Two-Year Clinical Study

PURPOSE

To investigate the etiologic factors, effect of age and gender on dental trauma, and to evaluate the performance of composite resin on the fractured crown of permanent anterior teeth.

MATERIALS AND METHODS

Over a 2-year period, 73 permanent teeth from 51 patients with dental trauma were treated with direct composite resin restoration. Informed consent and standardized trauma forms were completed by the patient; teeth were restored with a submicron hybrid composite resin (Spectrum TPH) and respective adhesive system (Prime&Bond NT). Sixty-nine teeth were directly restored without fiber posts, while four were treated with fiber posts. Two experienced clinicians, besides the operator, evaluated each restoration at 6-, 12-, and 24-month follow-ups according to US Public Health Service (USPHS) criteria for the following characteristics: anatomical form, marginal adaptation, color match, marginal discoloration, surface roughness, and caries. Data were analyzed using the Wilcoxon Signed Rank, Kruskal-Wallis, Mann-Whitney U, and Siegel and Castellan tests.

RESULTS

A total of 73 traumatized teeth in 51 patients aged from 14 to 64 years (mean age 25.47 ± 14.058 years) were assessed according to the Ellis classification and restored over a 2-year period. Crown fractures were more common in the maxilla (84.9%) and caused by falls (58.8%). At the end of 24 months, a total of ten restorations were lost. The survival rate after 24 months was 82.14%. There were statistically significant differences in marginal adaptation between the 6-, 12-, and 24-month follow-ups. Although changes in marginal discoloration over time were not significant (p = 0.194), changes in color match were significant (p = 0.029).

CONCLUSION

Within the limitations of this study, direct composite restorations were accepted as clinically satisfactory.

Buffered 1% Lidocaine With Epinephrine Can Be as Effective as Nonbuffered 2% Lidocaine With Epinephrine for Maxillary Field Block

PURPOSE

Buffering local anesthetics with epinephrine (Epi) offers clinicians options not often considered. This study assessed outcomes for pulpal anesthesia, pain on injection, and time to midface numbness for buffered 1% lidocaine with 1:100,000 Epi versus nonbuffered 2% lidocaine with 1:100,000 Epi.

MATERIALS AND METHODS

In this trial with a randomized, crossover design, buffered 1% lidocaine was compared with nonbuffered 2% lidocaine. Subjects were adult volunteers who served as their own controls. The predictor variables were alternate drug formulations. The outcome variables were subjects' responses to cold and electric pulp testing (EPT) stimulation of the maxillary first molar and canine, pain levels during the injection, and time to midface numbness. After maxillary field blocks with 40 mg of buffered lidocaine or 80 mg of nonbuffered lidocaine, subjects reported pain on injection and responses of the maxillary first molar and canine after cold and EPT stimulation. Teeth were tested before field block and at 30-minute intervals until a positive response was detected. Two weeks later, subjects were tested with the alternate drug combinations. For all outcome variables, assessment of treatment difference, calculated as 1% buffered minus 2% nonbuffered, was performed with the Wilcoxon rank sum test with significance at P < .05.

RESULTS

More of the 24 subjects were women and Caucasian. The median age was 23.5 years (interquartile range, 21, 25 years), and the median body weight was 155 lb (interquartile range, 128.5, 176.5 lb). Pain levels during the injection were significantly lower for 1% buffered lidocaine, with P = .04. Times to response after injection were not significantly different between the 2 drug formulations for the cold test on a molar, with P = .08, or the cold test on a canine, with P = .22. However, times to response were significantly longer for nonbuffered drugs for EPT on the molar and canine, both with P = .01.

CONCLUSIONS

Buffering 1% lidocaine with 1:100,000 Epi reduces the pain on injection with a maxillary field block and results in similar lengths of pulpal anesthesia tested with a cold stimulus as compared with nonbuffered 2% lidocaine with 1:100,000 Epi.

Buffered 1% Lidocaine With Epinephrine Is as Effective as Non-Buffered 2% Lidocaine With Epinephrine for Mandibular Nerve Block

PURPOSE

To assess outcomes for pulpal anesthesia and pain on injection for buffered 1% lidocaine with 1:100,000 epinephrine (EPI) versus non-buffered 2% lidocaine with 1:100,000 EPI.

PATIENTS AND METHODS

In a randomized cross-over trial approved by the institutional review board, buffered 1% lidocaine with 1:100,000 EPI was compared with non-buffered 2% lidocaine with 1:100,000 EPI. After mandibular nerve block with buffered lidocaine 40 mg or non-buffered lidocaine 80 mg, patients reported responses at the mandibular first molar and canine after cold and electrical pulp testing (EPT). Patients also reported pain on injection with a 10-point Likert-type scale. Teeth were tested before nerve block and at 30-minute intervals until a positive response returned. Two weeks later, patients were tested with the alternate drug combinations. The same outcomes were assessed. Predictor variables were alternate drug formulations. Outcome variables were patients' responses to cold and EPT stimulation of the mandibular first molar and canine and pain on injection. An assessment of treatment difference was performed using Wilcoxon rank-sum tests with Proc NPAR1WAY (SAS 9.3, SAS Institute, Cary, NC). Significance was set at a P value less than .05.

RESULTS

Fifty-seven percent of patients were women and 43% were men. Seventy percent were Caucasian, 17% were African American, and 13% had another ethnicity. Median age was 25 years (interquartile range [IQR], 21-26 yr) and median body weight was 140 lbs (IQR, 120-155 lbs). After the cold test and EPT, the time to sensation return for the molar or canine was not statistically different between the 2 drug formulations. Patients reported significantly lower pain scores with the buffered versus non-buffered drug (P < .01).

CONCLUSIONS

After mandibular nerve block, buffered 1% lidocaine with EPI can produce similar clinical outcomes for duration of pulpal anesthesia as non-buffered 2% lidocaine with EPI and lower pain on injections, which are a potential benefit to patients.

Risk of electromagnetic interference induced by dental equipment on cardiac implantable electrical devices

Patients with cardiac implantable electrical devices should take special precautions when exposed to electromagnetic fields. Proximity to equipment used in clinical dentistry may cause interference. This study evaluated in vitro the risks associated with different types/makes of cardiac devices and types of dental equipment. Six electronic dental tools were tested on three implantable cardioverter defibrillators and three pacemakers made by different manufacturers. Overall, the risk of interference with the pacemakers was 37% lower than with the implantable cardioverter defibrillators. Regarding the types/makes of cardiac devices analysed, that from Boston Scientific had a five-fold greater risk of interference than did that from Biotronik [prevalence ratio (PR) = 5.58]; there was no difference between that from Biotronik and that from Medtronic. Among the dental equipment, the electric pulp tester had the greatest risk of inducing interference and therefore this device was used as the benchmark. The electronic apex locator (PR = 0.29), Periotest M (PR = 0.47), and the ultrasonic dental scaler (PR = 0.59) were less likely to induce interference than the electric pulp tester. The risk was lowest with the electronic apex locator. Pacemakers presented a lower risk of light to moderate interference (PR = 0.63). However, the risk of severe electromagnetic interference was 3.5 times higher with pacemakers than with implantable cardioverter defibrillators (PR = 3.47).

Assessment of Pulp Regeneration Induced by Stem Cell Therapy by Magnetic Resonance Imaging

INTRODUCTION

This study was designed to evaluate the usefulness of magnetic resonance imaging (MRI) to assess the regeneration of pulp tissue.

METHODS

Mobilized dental pulp stem cells and granulocyte colony-stimulating factor with collagen were transplanted into mature pulpectomized teeth for pulp regeneration (n = 4). The controls consisted of pulpectomized teeth with or without collagen and normal teeth with intact pulp tissue (n = 4, each). The signal intensity (SI) of MRI using T2 sequences was compared after the extraction of teeth in dogs. MRI was correlated with the corresponding histologic findings.

RESULTS

Pulp tissue was fully regenerated 90 days after cell transplantation. On the other hand, the root canal was empty in the control collagen-transplanted teeth at 90 days. The SI of the normal teeth was significantly higher than that of nonvital pulpectomized teeth and the controls of collagen transplanted teeth at 90 days. The stem cell transplanted teeth showed a gradual decrease in the SI until 180 days at which time the SI was similar to that in the normal teeth and significantly higher than that in the teeth transplanted with collagen alone without the stem cells.

CONCLUSIONS

The changes in the SI of the pulplike tissue were consistent with the histologic findings, showing the potential usefulness of the noninvasive method to serially access the efficacy of pulp regenerative therapy.

Quantitative sensory testing of dentinal sensitivity in healthy humans

OBJECTIVE

The study was to provide information on quantitative sensory testing (QST) of normal teeth to establish a sensory profile and investigate the possible gender and regional differences.

MATERIALS AND METHODS

A modified QST protocol was applied on both left and right upper-jaw incisors and pre-molar sof 14 healthy men and 14 age-matched healthy women (18-25 years). Mechanical stimulus sensitivity (MSS), cold detection threshold (CDT), cold pain threshold (CPT), warm detection threshold (WDT), heat pain threshold (HPT), electrical detection threshold (EDT) and electrical pain threshold (EPT) were determined from the four teeth (labial side of incisor and buccal side of the first premolar). The QST parameters were analysed by ANOVA.

RESULTS

The applied mechanical or thermal stimuli did not evoke any pain sensation. A normal tooth did not seem to be able to distinguish between the warm or cold stimuli applied. No significant differences were found between genders (p > 0.099) or teeth (p > 0.053) regarding mechanical and thermal stimuli. The EDT and EPT were significantly higher in the pre-molar compared with incisor (p < 0.002) without gender differences (p > 0.573).

CONCLUSION

The established methods and results provided important information on diagnosis and treatment evaluation of dentinal hypersensitivity.

The Effect of Orthodontic Forces on Tooth Response to Electric Pulp Test

Introduction:

The current study investigated the pulp response to electric pulp testing (EPT), before, upon initiation and one month after the start of orthodontic tooth movement.

Methods and Materials:

A total of 402 anterior teeth from 39 patients (mean age of 16.8±2.7 years) were examined in this non-controlled prospective study. The aligning forces were administered using initial NiTi archwires ligated on fixed appliances by using the MBT straight wire technique. The electrical stimulation was provided by the EPT. The EPT readings were recorded at three time points: before bonding (EPT₀), immediately upon initiation (EPT₁) and 1 month post-treatment (EPT₂). The data were statistically analyzed by the ANOVA and Bonferroni tests (P<0.05).

Results:

Prior to bonding of the orthodontic brackets, the mean EPT value for all the experimental teeth was 3.42 EPT units. Upon initiation, the mean value of EPT₁ for each tooth increased to 7.62 units. One month later, the mean EPT₂ values dropped to 6.27 units. At this time point, 64 teeth (16%) of the experimental teeth failed to respond. The differences among EPT values at different time points were significant. There was no association between the EPT values and the location or the type of teeth.

Conclusion:

The physiological changes in the pulp affect the nerve fibers in the early stages of the orthodontic force application. As a result, thresholds to electrical stimulation would increase and the EPT may not initiate a response. Therefore results obtained by electrical pulp testing should be interpreted accordingly.

Capacity of dental equipment to interfere with cardiac implantable electrical devices

Patients with cardiac implantable electrical devices should take precautions when exposed to electromagnetic fields. Possible interference as a result of proximity to electromagnets or electricity flow from electronic tools employed in clinical odontology remains controversial. The objective of this study was to examine in vitro the capacity of dental equipment to provoke electromagnetic interference in pacemakers and implantable cardioverter defibrillators. Six electronic dental instruments were tested on three implantable cardioverter defibrillators and three pacemakers from different manufacturers. A simulator model, submerged in physiological saline, with elements that reproduced life-size anatomic structures was used. The instruments were analyzed at differing distances and for different time periods of application. The dental instruments studied displayed significant differences in their capacity to trigger electromagnetic interference. Significant differences in the quantity of registered interference were observed with respect to the variables manufacturer, type of cardiac implant, and application distance but not with the variable time of application. The electronic dental equipment tested at a clinical application distance (20 cm) provoked only slight interference in the pacemakers and implantable cardioverter defibrillators employed, irrespective of manufacturer.

Assessment of apical periodontitis in dogs and humans: a review

Veterinary dentists commonly encounter apical periodontitis in dogs. An overview of the disease is presented, concentrating on pathogenesis and mechanisms of healing. Assessment modalities are reviewed and interpretations of treatment success and failure are discussed. The limitations of readily available diagnostic equipment are illustrated. The benefits of identifying the causative agent and resultant pathosis should not be overlooked. Well-designed clinical studies evaluating various methods of long-term follow-up for apical periodontitis in dogs are needed.

Electrophysiological evidence on epileptiform activity enhanced by electrical stimulation of teeth in rats

The aim of this study was to evaluate the possible effects of electrical stimulation (ES) of tooth on penicillin-induced epileptiform activity in rats. Experiment was realized on 24 adult male Sprague Dawley rats. Rats were assigned three groups [stimulation group (SG), penicillin group (PG), and penicillin+stimulation group (PSG)]. In SG, ES was only applied. Ten pulses of electrical current were delivered to the teeth for a duration of 2 milliseconds at 1-second intervals from a stimulator. Currents were applied in the range of 40-240 μA with 40 μA steps. Electrocorticography (ECoG) recordings were taken before and after ES. In PG, ECoG recordings were taken before and during the injection of penicillin. In PSG, after epileptiform activity was induced, ES was applied and ECoG recordings were taken as in SG. All the data were analyzed with Student's t test. Applied currents did not cause any epileptiform activity in SG. When the PSG was compared with the PG it was seen that the spike frequency of epileptiform activity increased in a statistically significant way after application of 240 μA (P < 0·05). On the other hand current application caused an increase in the spike amplitude of the PSG compared with the amplitude of the PG, but it was not statistically significant. We concluded that ES of tooth with high current can trigger epileptiform activity in rats. For this reason, further research is required to evaluate the effects of ES of tooth for pulp testing on epileptic human subjects and antiepileptic drug users.

The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis

BACKGROUND

The authors evaluated published evidence from controlled clinical trials regarding the efficacy of two local anesthetic solutions in providing successful pulpal anesthesia.

METHODS

The authors searched MEDLINE and Embase databases to identify peer-reviewed randomized controlled trials in which researchers directly compared articaine and lidocaine local anesthetic solutions in adult participants. They extracted study characteristics and outcomes data as a basis for meta-analysis. They completed subgroup analyses for both infiltration and mandibular inferior alveolar block anesthetic techniques.

RESULTS

Articaine solutions had a probability of achieving anesthetic success superior to that of lidocaine, with an odds ratio of 2.44 (95 percent confidence interval [CI], 1.59-3.76; P < .0001). The greater odds ratio for articaine increased to 3.81 (95 percent CI, 2.71-5.36; P < .00001) when the authors analyzed only infiltration data. There was weaker, but still significant, evidence of articaine's being superior to lidocaine for mandibular block anesthesia, with an odds ratio of 1.57 (95 percent CI, 1.12-2.21; P = .009), and no difference when the authors considered only symptomatic teeth.

CLINICAL IMPLICATIONS

Research evidence supports using articaine versus lidocaine for achieving pulpal anesthesia when the infiltration mode of administration is used. It is premature to recommend articaine for mandibular block anesthesia in cases involving irreversible pulpitis.

Comparison of ropivacaine and articaine with epinephrine for infiltration anaesthesia in dentistry - a randomized study

AIM

To compare the efficacy, onset time and duration of maxillary infiltration anaesthesia with 0.5% plain ropivacaine or 4% articaine with epinephrine 1 : 100 000 and to determine their possible influence on cardiovascular parameters.

METHODOLOGY

Sixty volunteers received 1.8 mL of the anaesthetic for buccal infiltration anaesthesia of maxillary central and lateral incisors and canine teeth without caries, restorations or signs of pulpitis. The efficacy, onset time and duration of pulp anaesthesia were assessed with an electric pulp tester. The duration of numbness of the upper lip was also monitored. Blood pressure and heart rate were measured before and after administration of the solutions.

RESULTS

The efficacy of anaesthesia of lateral and central incisors was 100% for both anaesthetics. There were insignificant differences in effectiveness of canine pulp anaesthesia. The mean onset time was significantly (P < 0.05) shorter for ropivacaine (2.22 min) when compared with articaine (4.08 min). The duration of action and soft tissue anaesthesia were also significantly (P < 0.05) longer for ropivacaine (79.2 and 264 min) when compared with articaine (63.7 and 195.2 min, respectively). Ropivacaine caused significant (P < 0.05) increases in blood pressure and heart rate.

CONCLUSIONS

Ropivacaine (0.5%) achieved effective and long duration of uninflamed pulp and soft tissue anaesthesia. Ropivacaine could be useful for long-lasting operative procedures without the need for a vasoconstrictor.