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Kumar U, Garg N, Vashisht R, Kumari A, Kaur CK, Rajput A. Buccal versus buccal palatal infiltration for pulpal anesthesia using 2% lidocaine and 4% articaine: A randomized controlled trial. J Oral Biol Craniofac Res 2024; 14:205-210. [PMID: 38445050 PMCID: PMC10912647 DOI: 10.1016/j.jobcr.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/01/2024] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Background The inability in achieving complete pulpal anesthesia with standard buccal infiltration especially in cases with SIP used for maxillary teeth. The study aimed to compare the anesthetic efficacy of buccal and buccal plus palatal infiltration technique using 2% lidocaine and 4% articaine in permanent maxillary first molars with the diagnosis of symptomatic irreversible pulpitis (SIP). Material and method One hundred and twenty-three patients with clinical diagnosis of SIP, aged 18-50 years were randomly allocated to three treatment groups (N = 41). Group 1(BIL): Buccal infiltration technique using 2% lidocaine with 1:80,000 adrenaline. Group 2(BPIL): combination of buccal plus palatal infiltration using 2% Lidocaine with 1:80,000 adrenaline. Group 3(BIA): Buccal infiltration using 4% articaine with 1:100,000 adrenaline. Pain intensity of patients were recorded before and after the administration of local anesthesia during endodontic procedure that is during caries removal, access preparation and pulp removal using Heft-Parker Visual Analog Scale (HP-VAS). Success was defined by "no pain (0 mm)" or "mild pain (0-54 mm)" during endodontic procedure. The anesthetic efficacy rates were analyzed using chi-square tests, age differences using one-way ANOVA. Results The final analysis included total of 117 patients. Higher success was observed in group II (85%) in comparison to group I (69%) and group III (74%), but the difference was statistically nonsignificant (p > 0.05). Our results demonstrated a nonsignificant difference between genders in all three groups (p > 0.05). Conclusion The use of buccal plus palatal infiltration and 4% articaine can provide effective anesthesia as standard buccal infiltration and 2% lidocaine for patients with SIP in maxillary first molars.
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Affiliation(s)
- Umesh Kumar
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Nikita Garg
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Ruchi Vashisht
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Amrita Kumari
- Oral Health Sciences Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | | | - Akhil Rajput
- Dr. BSA Medical college and hospital, Rohini, New delhi, India
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Das S, Govind S, Jena D, Dash S, Jena SP, Yadav D, Karan S, Kancherla J, Jena A, Mishra L, Bal SCB, Pattanaik S. Local Anesthesia Onset and Pain Perception in Hemophilic and Thalassemic Conditions. J Clin Med 2023; 12:jcm12113646. [PMID: 37297841 DOI: 10.3390/jcm12113646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The study aims to evaluate and compare the onset of local anesthesia (LA) and pain perception during endodontic treatment in hemophilic and thalassemic patients. Methods: The study included 90 patients with symptomatic irreversible pulpitis of the mandibular molars. Three groups (n = 30 in each group) were included. Group 1: hemophilic patients; group 2: thalassemic patients; and group 3: individuals without any systemic diseases. Onset of LA and visual analogue scale (VAS) scores was recorded immediately after the administration of local anesthesia, during the pulp exposure procedure, and during canal instrumentation, and were compared between the three groups. Frequency distribution, ANOVA, and linear regression analysis (p < 0.05) were applied. Results: The mean onset time was 46 ± 34 s in the hemophilic group, 42 ± 23 s in the thalassemic group, and 38 ± 12 s in controls, but the differences were statistically insignificant. After LA administration (LA-VAS), all three groups experienced a statistically significant reduction in pain (p = 0.048). On pulp exposure (PE-VAS) (p = 0.82) and during canal instrumentation (CI-VAS) (p = 0.55), there was no statistically significant difference in pain perception between the groups. The coefficients indicate a positive correlation between the VAS and onset time, indicating a positive reduction in the VAS following the administration of LA. Conclusions: Hemophilic patients exhibited a clinically longer average onset time for LA. However, the difference among the three groups with regard to the overall pain perception after LA administration, during and after pulp exposure, and during canal instrumentation was statistically insignificant.
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Affiliation(s)
- Supriya Das
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Shashirekha Govind
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Debkant Jena
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Sumit Dash
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Siba Prasad Jena
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Deepika Yadav
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Smita Karan
- Department of Dentistry, Shadan Institute of Medical Sciences Research Centre and Teaching Hospital, Himayat Sagar, Hyderabad 500086, Telangana, India
| | - Jyothsna Kancherla
- Department of Dentistry, Dr.V.R.K. Women's Medical College Teaching Hospital and Research Centre, Aziz nagar, Hyderabad 500075, Telangana, India
| | - Amit Jena
- Department of Conservative Dentistry and Endodontics, Sriram Chandra Bhanja Dental College & Hospital, Cuttack 753007, Odisha, India
| | - Lora Mishra
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Sourav Chandra Bidyasagar Bal
- Department of Public Health Dentistry, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
| | - Satabdi Pattanaik
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan (Deemed to Be) University, Bhubaneswar 751003, Odisha, India
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Hameed MS, Kumar S, Charanya C, Muthalagu M, Anitha M. Comparison of Jet Injection Technique with Conventional Injection Technique in Patients Undergoing Endodontic Therapy. Contemp Clin Dent 2021; 12:28-31. [PMID: 33967534 PMCID: PMC8092093 DOI: 10.4103/ccd.ccd_466_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background: In order to reduce the fear and anxiety of injection during root canal procedures, Madajet injection technique was substituted for the first time among the adult patients to obtain its efficacy and to overcome the painful procedure during the conventional syringe technique. Aim: The aim of this study is to compare the clinical efficacy and level of patient acceptance of jet injections with conventional syringe technique in patients with symptomatic pulpitis. Methodology: Seventy patients were randomly divided into needleless pressure injection technique using Madajet XL and conventional syringe technique. The onset of anesthesia was evaluated using the electric pulp tester, and the pain was assessed using the Visual Analog Scale scoring criteria. Statistical Analysis: The obtained data were tabulated and subjected to the statistical analysis using the Chi-square test. Results: Needleless pressure injection technique (Madajet XL) proves to be effective in patients with symptomatic irreversible pulpitis during endodontic procedure. Conclusion: It can be concluded that the needle-less pressure injection technique (Madajet XL) promises to be a viable mode of pain control during endodontic procedures as it converts the solution to a tiny droplet which is then carried by the myelin sheath.
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Affiliation(s)
- Mahaboob Shahul Hameed
- Department of Conservative Dentistry and Endodontics, Saveetha Dental College, Chennai, Tamil Nadu, India
| | - Senthil Kumar
- Department of Conservative Dentistry and Endodontics, SRM Dental College and Hospital, Chennai, Tamil Nadu, India
| | - C Charanya
- Department of Conservative Dentistry and Endodontics, Tagore Dental College and Hospital, Chennai, Tamil Nadu, India
| | - M Muthalagu
- Department of Conservative Dentistry and Endodontics, Ultra's Best Dental Science College, Madurai, Tamil Nadu, India
| | - M Anitha
- Department of Oral Medicine and Radiology, Ultra's Best Dental Science College, Madurai, Tamil Nadu, India
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Influence of Lignocaine Hydrochloride with Adrenaline on Free Active Chlorine Content of Sodium Hypochlorite Solution Admixed in Various Proportions. Eur Endod J 2021; 6:117-121. [PMID: 33531450 PMCID: PMC8056803 DOI: 10.14744/eej.2020.52523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Local anaesthetic solution that is commonly employed for supplemental intrapulpal injection (IPI) may routinely come in contact with subsequently used sodium hypochlorite (NaOCl) during endodontic treatment of symptomatic irreversible pulpitis cases. This in vitro study investigated the available free active chlorine (FAC) content of 3% NaOCl after mixing with 2% lignocaine hydrochloride with adrenaline (LA) solution in three different proportions using iodometric titration analysis. Methods: Aliquots of 3% NaOCl (control) in different measures (30 mL, 27 mL, 21 mL and 15 mL) served as the effective concentrate of various proportions of NaOCl admixed with the test solutions, i.e., demineralised water (DM) and LA. The mixed aliquots containing NaOCl-DM and NaOCl-LA combination solutions admixed in various proportions (9:1, 7:3 and 1:1 w/v) respectively served as the experimental groups. Iodometric titration was performed to determine the FAC of each independent solution.The results were then evaluated using one-way ANOVA and Tukey’s post hoc analysis to determine the differences between various groups and amongst the individual admixtures. The level of significance was set at P<0.05. Results: Inter-group comparisons revealed statistically significant differences (P<0.05) between all the test groups. An intra-group analysis revealed significant differences (P<0.05) in group 2, whereas no differences (P>0.05) were observed in group 3. Further, there was a dose dependent reduction in FAC content in both the experimental groups with lowest FAC values were observed in 1:1 solution admixtures followed by 7:3 and 9:1 proportions. Conclusion: There was a significant reduction in NaOCl FAC content when admixed with lignocaine HCl even in small proportions. Hence, adequate measures should be taken to remove the residual LA from the pulpal space, before the use of NaOCl after IPI administration.
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Determination of Anesthetic Efficacy of Lidocaine Versus Bupivacaine in Single Visit Root Canal Treatment. Eur Endod J 2020; 5:68-72. [PMID: 32766514 PMCID: PMC7398995 DOI: 10.14744/eej.2020.88597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/14/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: To compare the anesthetic efficacy of 2% Lidocaine with 1:80,000 epinephrine and 0.5% Bupivacaine with 1:200,000 epinephrine in one-visit root canal treatment in patients with symptomatic irreversible pulpitis. Methods: A total of 60 patients presenting with symptomatic irreversible pulpitis with normal periapical tissues on periapical radiography of mandibular 1st and 2nd molars, reporting moderate to severe pain as assessed by visual analogue scale (VAS) for at least 24 hours were included in this study. All patients received local anesthesia via the inferior alveolar nerve block technique by the investigator. These patients were randomly allocated into two groups in which first group received 2% lidocaine with 1:80,000 epinephrine and the second group received 0.5% bupivacaine with 1:200,000 epinephrine. Patients were instructed to rate the intensity of pain during root canal treatment which was then noted on visual analogue scale (VAS). Results: The average age of the patients was 34.15±9.49 years, in which 32 (53.3%) were male and 28 (46.7%) were female. The anesthetic efficacy was significantly high in bupivacaine as compared to lidocaine local anesthesia group (76.7% versus 40%; P=0.004). Conclusion: The administration of bupivacaine anesthetic agent for inferior alveolar nerve block (IANB) injections can be a better and appropriate pain management aid as compared to lidocaine during root canal treatment of patient with symptomatic irreversible pulpitis.
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Chandrasekaran C, Amirtharaj L V, Sekar M, Nancy S M. Post-operative analgesia of 2% lignocaine with or without magnesium sulfate for inferior alveolar nerve block in symptomatic mandibular molars - a randomized double blind controlled clinical trial. J Dent Anesth Pain Med 2020; 20:147-154. [PMID: 32617409 PMCID: PMC7321741 DOI: 10.17245/jdapm.2020.20.3.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/21/2020] [Accepted: 06/06/2020] [Indexed: 11/15/2022] Open
Abstract
Background Single inferior alveolar nerve block is ineffective in achieving adequate pulpal anesthesia in 30-80% of patients due to anatomical variations, local tissue pH, central sensitization, and several factors. Various supplementary techniques and combination of adjuvants with lignocaine are used to overcome these failures. Magnesium sulfate (MgSO4), one such adjuvant, acts at the N-methyl-D-aspartate glutamate receptor resulting in effective anesthesia. The aim of this prospective, randomized, double-blind, clinical controlled trial was to evaluate the onset, anesthetic efficacy, duration and post-operative analgesia of 2% lignocaine with and without the addition of MgSO4 in patients with symptomatic irreversible pulpitis and apical periodontitis. Methods Fourty-two patients were randomly divided into three groups: 2% lignocaine (group 1) and 2% lignocaine with MgSO4 (75 mg) and (150 mg) in groups 2 and 3, respectively. Pre-operative vitals and Heft Parker-Visual Analogue Scale (HP-VAS) pain scores were recorded. The onset of anesthesia, anesthetic efficacy, and duration of anesthesia were evaluated post administration of the local anesthetic solution. The post-operative analgesia was examined at intervals of 2, 6, 12, 24, and 48 h. Results Administration of 150 mg MgSO4 hastens the onset of anesthesia (1.29 min) and produces better anesthetic efficacy (3.29 HP-VAS) compared to group 2 (2.07 min and 9.14 HP-VAS) and group 1 (3.29 min and 35.79 HP-VAS), respectively. The duration of anesthesia was significantly higher in group 3 (247.07 min) compared to that of groups 2 and 1 (190 min and 110.21 min) with P < 0.05. Conclusion Combining 75 mg or 150 mg of MgSO4 with lignocaine is more effective than 2% lignocaine and 75 mg of MgSO4 is adequate for endodontic procedures.
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Burić N, Stojanović S, Burić K. The clinical significance of intrapulpal anesthesia for painless dental procedure. ACTA STOMATOLOGICA NAISSI 2020. [DOI: 10.5937/asn2082117b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction:The elimination of odontalgia and all other forms of oral pain that occurs on dental tissues during dental interventions is still one of the main goals in the dental profession. Aim: The aim of this paper wasto perform an analysis of the literature data on the use of supplementary intrapulpal anesthesia in clinical dental practice. Material and methods: Literature data on the use of intrapulpal anesthesia, the characteristics of this technique of supplementary anesthesia as well as the results of its application were collected. Various databases were used for this purpose, digital data from Google Scholar, Medline, Science-Direct, as well as traditional libraries with manuscripts in printed form were most often taken. Conclusion: The use of supplementary intrapulpal anesthesia in dental/endodontic practice represents a practical and successful type of local anesthesia, when standard mandibular anesthesia for the lower alveolar nerve does not provide a deep enough periinterventional analgesia for dental procedures.
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Saravanakarthikeyan B, Devarajan S, Sankeerthana K, Sujatha V, Mahalaxmi S. In vitro assessment of interaction between lidocaine hydrochloride and sodium hypochlorite on root canal dentin before and after chemomechanical instrumentation procedures. J Conserv Dent 2019; 22:255-259. [PMID: 31367109 PMCID: PMC6632634 DOI: 10.4103/jcd.jcd_565_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction To investigate the effect of resultant precipitate formed on interaction between 2% lidocaine hydrochloride with adrenaline (LA) and 2.5% sodium hypochlorite (NaOCl) on root canal dentin before and after chemomechanical preparation, using scanning electron microscopy (SEM). Methods Sixty mandibular premolars were decoronated, and the root length was standardized. All specimens were randomly distributed into the following three groups: Group I (control): 2% LA mixed with sterile water without root canal instrumentation, Group II: 2% LA with 2.5% NaOCl and no instrumentation, and Group III: 2% LA with 2.5% NaOCl, followed by mechanical instrumentation with rotary files. Teeth samples were sectioned into three parts, split and SEM analysis of the root canal wall was done at cervical, middle, and apical root thirds. Results SEM images revealed patent dentinal tubules with no precipitate occlusion in the control group, whereas there was occlusion of dentinal tubules with a precipitate in all the specimens in Group II and Group III at all the three root levels studied. Conclusions The precipitate formed on the interaction between 2% LA solution and 2.5% NaOCl tends to occlude the dentinal tubules at the coronal, middle, and apical root thirds. The chemomechanical rotary instrumentation procedure did not effectively remove the precipitate from all the three levels of the root specimens studied. LA/sterile water group did not result in any precipitate formation on root canal dentin.
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Affiliation(s)
| | - Shari Devarajan
- Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Kolli Sankeerthana
- Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Venkatappan Sujatha
- Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
| | - Sekar Mahalaxmi
- Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu, India
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Milani AS, Froughreyhani M, Rahimi S, Zand V, Jafarabadi MA. Volume of Anesthetic Agents and IANB Success: A Systematic Review. Anesth Prog 2018; 65:16-23. [PMID: 29509518 PMCID: PMC5841477 DOI: 10.2344/anpr-65-01-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/16/2017] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to provide an evidence-based answer to the question: "Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing anesthesia for mandibular molars?" Following formulation of research question and keyword selection, a comprehensive search of the following databases was conducted: Cochrane library, PubMed, Scopus, Google Scholar, ProQuest, and Clinicaltrials.gov. Three-phase eligibility appraisal and quality assessment of the studies were carried out by 2 independent reviewers. To reduce clinical heterogeneity, the included studies were divided into 2 groups: studies on healthy teeth and studies on teeth with pulpitis. The data of included studies were statistically combined through meta-analysis using a fixed-effects model. A total of 20,778 records were initially retrieved from the search. Following screening and eligibility assessment, 8 studies met the eligibility criteria and were included for qualitative synthesis. Of those, 5 studies were qualified for meta-analysis. In the irreversible pulpitis group, increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of inferior alveolar nerve block (risk ratio = 2.45, 95% CI: 1.67-3.59, p < .001). However, there was insufficient evidence to draw a conclusion regarding healthy teeth.
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Affiliation(s)
- Amin Salem Milani
- Assistant Professor, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Froughreyhani
- Associate Professor, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Rahimi
- Professor of Endodontics, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zand
- Associate Professor, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Associate Professor of Biostatistics, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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Balasubramanian SK, Natanasabapathy V, Vinayachandran D. Clinical Considerations of Intrapulpal Anesthesia in Pediatric Dentistry. Anesth Essays Res 2017; 11:1-2. [PMID: 28298746 PMCID: PMC5341638 DOI: 10.4103/aer.aer_11_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Saravana Karthikeyan Balasubramanian
- Department of Conservative Dentistry and Endodontics, SRM Dental College and Hospital, Ramapuram Campus, SRM University, Chennai, Tamil Nadu, India. E-mail:
| | - Velmurugan Natanasabapathy
- Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, MAHER University, Chennai, Tamil Nadu, India
| | - Divya Vinayachandran
- Department of Oral Medicine and Radiology, SRM Kattankulathur Dental College and Hospital, Chennai, Tamil Nadu, India
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Effective anaesthesia of the acutely inflamed pulp: part 1. The acutely inflamed pulp. Br Dent J 2015; 219:385-90. [DOI: 10.1038/sj.bdj.2015.812] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/08/2022]
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