Incidence and factors associated with flare-ups in a post graduate programme in the indian population

Effect of Ultrasonic and Diode Laser Irrigation Activation on Post-operative Pain and Microbial Reduction in Single Visit Endodontic Treatment of Necrotic Mandibular Molars

Aim: To clinically evaluate the effect of continuous ultrasonic and diode laser 810 wave length irrigation activation techniques on postoperative pain and bacterial reduction in single visit endodontic treatment of mandibular molars. Material and methods: Forty patients requiring root canal treatment therapy for necrotic mandibular molars teeth were included in this study with age ranges between 20 and 45 years. In all cases, single visit endodontic treatment was carried out using Revo-S rotary file system in crown down sequence. NaOCl 2.5% irrigation solution was used during treatment. Patients were randomly and equally assigned into two groups according to irrigation technique. Group (1): conventional syringe irrigation and group (2): continuous ultrasonic irrigation. Each group was subdivided into two sub groups (n = 10); subgroup 1A (conventional syringe irrigation with no laser), subgroup 1B (conventional syringe irrigation with diode laser), subgroup 2A (continuous ultrasonic irrigation with no laser) and subgroup 2B (continuous ultrasonic irrigation with diode laser). Postoperative pain evaluation was done using Visual Analogue Scale (VAS) at 6, 12, 24, 36, 48 hours and 7 days postoperatively. Microbiological detection of bacterial reduction was done by taking Samples (S1 and S2) for bacterial cultures. S1 after finishing access cavity and before mechanical preparation and S2 after finishing mechanical preparation and irrigation activation and before obturation. Samples were cultured on blood agar and determined as colony forming units (CFU/mL). Microbiological bacterial reduction was calculated accordingly.  Statistical analyses were analyzed using the Mann-Whitney U test.  The significance level was set at p < 0.05. Results: In all sub groups, postoperative pain decreased by time in all time intervals but pain was significantly lower in subgroup (2B) (continuous ultrasonic irrigation with diode laser) than subgroup (1A) (conventional syringe irrigation with no laser) in all time interval. Microbiological results showed the highest bacterial reduction was in subgroup (2B) (continuous ultrasonic irrigation with diode laser) and least bacterial reduction was in subgroup (1A) (conventional syringe irrigation with no laser). Conclusion: Using diode laser and continuous ultrasonic irrigation activation techniques as adjunctive methods showed improvement in postoperative pain records and enhanced bacterial reduction in root canal therapy. Keywords: Continuous ultrasonic irrigation, diode laser 810, post-operative pain, bacterial reduction, single visit endodontic treatment.

Postoperative Pain after Endodontic Treatment under Irrigation with 8.25% Sodium Hypochlorite and Other Solutions: A Randomized Clinical Trial

INTRODUCTION

The aim of this study was to evaluate the postoperative pain in patients after endodontic treatment using 8.25% sodium hypochlorite (NaOCl) compared with other concentrations and 2% chlorhexidine (CHX).

METHODS

In this double-blind randomized trial, 180 patients were evaluated who underwent a single session of endodontic treatment under irrigation with 2.5%, 5.25%, or 8.25% NaOCl or 2% CHX solutions. The presence of postoperative pain was assessed 24, 48, and 72 hours after treatment and recorded using the visual analog scale (VAS). A descriptive analysis, logistic regression, and Wald test were performed.

RESULTS

Altogether 169 patients participated, of whom 107 were women, and the mean age was 38.1 ± 14.4 years. No significant differences occurred between the irrigants and the pain outcomes, not even for the use of postoperative pain medication and responses to VAS (P > .05). In the multivariate model including irrigants, after 24 hours or at any time, a significant difference (P < .05) remained in preparation time ≥10 minutes and the presence of overfilling. Also, in relation to the VAS, the overfilling presented significantly different results (P < .05).

CONCLUSIONS

There was no significant difference in the presence of postoperative pain between the 8.25% NaOCl and the other irrigation solutions. However, the extended preparation time and the overfilling material were responsible for the increase of postoperative pain.

The top risk factors for endodontic flare-up: a Monte Carlo simulation

OBJECTIVES

The aim of this study was to analyze the strength of risk factors related to endodontic flare-ups and rank them in order of their importance MATERIALS AND METHODS: A systematic literature search of PubMed, Cochrane Central Register of Controlled Trials, Scopus, and ISI Web of Knowledge, and grey literature was conducted up to November 2019. One hundred ninety-eight publications were identified. Twelve records fulfilled the eligibility criteria, and eight significant risk factors for flare-up, namely, "Periapical lesion," "multiple-visit treatment," "preoperative pain," "necrotic teeth," "female gender," "retreatment," "percussion pain," and "analgesics," were selected to construct the simulation model. The final data pool was established by the integration of data of common risk factors in the included articles. Monte Carlo method was used to analyze of combined numerical data, for simulation of the risk factor impacts. Ten thousand iterations were generated in the simulation model.

RESULTS

The results of the simulation revealed that the risk estimates of the factors had varying ranges of influence and probability on the flare-up risk. "Periapical lesion" was found to be the most sensitive risk factor, following by "preoperative pain" which was ranked the second place. The third-ranked risk factor was "multiple-visit treatment." The least sensitive risk factors for endodontic flare-up were "retreatment," "female gender," "necrotic teeth," and "analgesics."

CONCLUSIONS

The present study provides better comprehension on the importance of risk factors for flare-up based on their risk estimates.

CLINICAL RELEVANCE

A Monte Carlo simulation was adopted to identify the most influential risk factors for endodontic flare-up with a ranking, which can be used to provide meaningful predictions and further insights into clinicians' perception of flare-up risk.

TREATMENT OUTCOME OF MANUAL VERSUS ROTARY TECHNIQUES IN SINGLE-VISIT ENDODONTICS FOR PATIENTS IN A NIGERIAN TEACHING HOSPITAL: A RANDOMIZED CLINICAL TRIAL

BACKGROUND

Adequate canal preparation is essential in achieving successful outcome sequel to root canal treatment. Nickel-Titanium (NiTi) rotary instruments has steadily gained grounds in endodontics for root canals preparation, however, it is yet to be widely practiced among dental practitioners in Nigeria.

AIM AND OBJECTIVES

To compare the treatment outcomes of single visit root canal treatment when either rotary or manual step-back preparation technique is used in shaping the canal, employing clinical and radiographic criteria.

DESIGN OF THE STUDY

A randomized controlled trial.

SETTING

Conservation Unit of Restorative Dentistry Clinics, Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.

MATERIALS AND METHODS

120 consecutive consenting subjects were included in the study. The inclusion criteria were: medically fit individuals with restorable anterior, premolar or first molar tooth diagnosed with irreversible pulpitis, pulp necrosis or apical periodontitis; they had no to moderate pain, with periodontally sound and not excessively curved tooth. Randomization was performed by balloting using sealed envelopes and subjects were assigned in equal numbers to one of two groups, rotary and manual. Subjects were monitored following treatment for clinical and radiographic parameters at 1 day, 1 week, 1 month, 3 months and 6 months. Data analysis was done using SPSS-version 20.0, and differences were considered significant if p < 0.05.

RESULTS

Twenty-seven (45%) and 23(38.3%) teeth in manual and rotary group respectively had pain at 1-day review. Significant difference in occurrence of pain in relation to both gender (p=0.001) and tooth-type (p=0.026) was noted between the groups at 1-day review. By the final review, there was no reported post-operative pain. There was no significant difference between the two groups in relation to the other clinical parameters at the different review periods. Twenty-four (40%) and 16 (26.7%) teeth had pre-existing periapical radiolucency in manual and rotary groups respectively; by final review, periapical radiolucency had reduced to 16.9% and 3.4% respectively, with the rotary group having significantly less radiolucency. Favourable outcome at 6-month review was significantly higher in the rotary group (96.6%), compared to the manual group (83.1%) in (p=0.033); the difference in outcome was due to significantly better outcomes with the molar tooth category in the rotary group.

CONCLUSION

There was a significantly more favourable treatment outcome in the rotary compared to the step-back technique in canal preparation, employing clinical and radiographic criteria.