A prospective clinical trial on the influence of a triamcinolone/demeclocycline and a calcium hydroxide based temporary cement on pain perception

Biological interaction, esthetics, handling, and loss rate of temporary luting cements - a clinical single-blind randomized controlled trial

OBJECTIVES

To evaluate three temporary luting cements in terms of their restoration loss rates, biological interactions, esthetic properties, and handling characteristics.

MATERIALS AND METHODS

75 adults requiring fixed prosthodontics voluntarily participated in a single-blind, randomized controlled trial. After preparation, temporary restorations were luted with a randomly selected temporary luting cement (either Provicol QM Plus (PQP), Bifix Temp (BT), or Provicol QM Aesthetic (PQA)). Clinical examinations were performed one to two weeks after cementation. The following criteria were evaluated: tooth vitality, percussion, hypersensitivity, gingival bleeding, odor formation, esthetics, cement handling, removability, cleanability, and retention loss. Antagonistic teeth served as controls. Statistical analysis was performed using the paired t-test, one-way ANOVA, Pearson's chi-square and Fisher's exact test, where appropriate.

RESULTS

The overall loss rate of temporary restorations was 16.0%, showing no cement-specific differences. Postoperative hypersensitivity occurred in 8% of cases regardless of cement type. Esthetic impairment was reported by 31% of the PQP-fixed restorations, compared with 4.0% and 4.2% of the BT and PQA-bonded restorations. Cement application was reported to be easy in 100% of cases, excess removal in 88-96%, depending on the cement used.

CONCLUSIONS

The choice of luting material affects the esthetic appearance of a temporary restoration and should be considered, particularly in restorations in esthetically demanding areas. No significant differences between the cements were identified regarding biocompatibility, handling, and loss rate.

CLINICAL RELEVANCE

Translucent cements can help to reduce color interferences, resulting in a more appealing appearance of the temporary restoration.

Retention force, translucency, and microstructural properties of translucent temporary luting cements: An in vitro study

The aim of the study was to investigate the retention behaviour (pull-off force include adhesive remnant index = ARI) as well as translucency of various temporary luting cements and use microstructure elucidation methods to formulate explanatory approaches to their mode of action. The retention force of the temporary luting cements Provicol QM Plus (P+), Provicol QM Aesthetic (Pae), Bifix Temp (BiT), and as a reference a glass ionomer cement Meron (M) with a direct (Structur 3/S3) or an indirect (Structure CAD/SCAD) resin-based composite restauration was investigated after accelerated aging (thermocycling). Additional investigation of the physical properties was performed regarding to translucency and surface free energy. The microstructure was evaluated by X-ray diffraction, thermogravimetric analysis, differential scanning calorimetry and micro X-ray computed tomography. All tested temporary luting cements showed different pull-off forces in the range between 3.0 and 16.8 N in combination with S3 or SCAD after thermocycling. Only BiT with S3 showed pull-off forces of 129.2 N and complete retention on the restoration (ARI = 0), which was significant (p < .001) to all other samples. High translucency (BiT > Pae > M > P+) was observed for materials with lower crystalline content and low residual mass (usally resulting from higher organic content). M showed the highest surface free energy with a predominantly polar fraction, while BiT had a predominantly dispersive fraction. The highest porosity was observed in the coronal region of the restoration. The results suggest that translucency of temporary luting cements can be increased with higher organic and lower cryristall content. All combinations of cements and temporary restorations (direct/indirect; with the exception of BiT/S3) showed pull-off forces below 17 N (equivalent to a weight force of ∼1.7 kg), which allows manual detachment of the restoration by the dentist.

Effectiveness of Intracanal Cryotherapy in Root Canal Therapy: A Systematic Review and Meta-analysis of Randomized Clinical Trials

INTRODUCTION

The effectiveness of intracanal cryotherapy for reducing postoperative pain is unclear. The objective of this systematic review was to evaluate the effect of intracanal cryotherapy on postoperative pain after root canal therapy in patients with pulpal or periradicular pathosis.

METHODS

We searched PubMed, Embase, Scopus, and the Cochrane Library as well as the top 3 endodontic journals for relevant articles. We included randomized controlled trials that included adults. Our main outcome was postoperative pain intensity measured with a validated scale. We assessed the risk of bias using the Cochrane criteria and the quality of the included studies using Grading of Recommendation Assessment, Development, and Evaluation. We used a random-effects model for meta-analysis.

RESULTS

Eight studies involving 810 patients were included. The overall risk of bias was moderate. Seven of 8 studies used a visual analog scale to measure pain intensity. Compared with controls, intracanal cryotherapy significantly reduced postoperative pain at 6 (mean difference = -1.37; 95% confidence interval [CI], -0.61 to -2.14; P < .05; I2 = 76%; moderate-quality evidence) and 24 hours after the procedure (mean difference = -1.43; 95% confidence interval, -0.70 to -2.15; P < .05; I2 = 89%; moderate-quality evidence). There was no significant effect on pain at 48 and 72 hours and 7 days after the procedure.

CONCLUSIONS

Moderate-quality evidence suggests that intracanal cryotherapy (ie, using cold saline irrigation as a final irrigant) significantly reduces the intensity of pain at 6 and 24 hours after root canal therapy. Future clinical trials assessing the effectiveness of intracanal cryotherapy are advocated.

Predictors, prevention, and management of postoperative pain associated with nonsurgical root canal treatment: A systematic review

Postoperative pain after root canal treatment can be reduced by applying recent advances in endodontic techniques and equipment. This systematic review includes current knowledge about pain after nonsurgical root canal treatment, including predictors, related factors, effects of recent advances, and management. A literature search was performed using the PubMed, ScienceDirect, and Cochrane Library databases for articles published between 1990 and 2016. Search keywords included postoperative pain, nonsurgical treatment, single visit, recent advances in endodontics, and management of postoperative pain with endodontic treatment. Only original research studies were included; editorials, reviews, brief notes, conference proceedings, and letters to the editor were excluded. The initial search yielded 4941 articles, which were assessed and filtered using the selection criteria. Sixty-five studies met the inclusion criteria and were included in the review. The findings showed that pain after nonsurgical root canal treatment occurred in 3–69.3% of patients. Microorganisms were identified as the primary contributors to postoperative pain, and there was no significant difference in postoperative pain between single- and multiple-visit treatments. Postoperative pain after root canal treatment ranges from mild to moderate and occurs even after optimally performed procedures. Furthermore, adequate management of postoperative pain is often considered an indicator of clinical excellence. Application of recently developed endodontic techniques and devices will reduce postoperative pain. Furthermore, a flexible, severity-based drug administration plan can be used to control and manage pain after root canal treatment. Application of the current research findings will reduce pain following root canal treatment and improve patient outcomes.