Dens invaginatus is a rare malformation with a widely varied morphology. It typically affects permanent maxillary lateral incisors, central incisors, and premolars. This article demonstrates rapid management of type II dens invagination with open apex and large periradicular lesion using calcium hydroxide as intracanal medicament for 1-week followed by apical plug formation with mineral trioxide aggregate Plus and lateral condensation of Gutta-percha. At 24-month follow-up, the patient was asymptomatic and lesion was entirely resolved.
Background
The efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp.
Methods
One hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment.
Results
The rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups.
Conclusion
Preoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.
Aims:Presence of bacteria within the environment of infrabony pockets affects healing during their treatment. Present investigation utilized a diode laser for pocket sanitization before the placement of bone biomaterial with the aim of enhancing the healing.Materials and Methods:Twelve patients with bilateral intrabony defects participated in a split-mouth study design. Control group received biomaterial application only after surgical debridement. Infrabony pockets in the test group were irradiated with 810-nm diode laser at 0.8 W, continuous wave for 20 s before surgical debridement and biomaterial application. Healing was assessed using clinical and radiologic parameters.Results:Control group showed mean probing depth (PD) reduction of 3.25 ± 0.62 at 3, 4.08 ± 0.90 mm at 6 months. 3.00 ± 0.73 at 3, 3.91 ± 0.66 mm at 6 months reduction in mean PD was seen in the test group (P < 0.001). No statistically significant differences between the groups were observed. A gain of 2.50 ± 0.67 at 3, 3.25 ± 0.62 mm at 6 months in relative clinical attachment level was seen in the control and of 2.33 ± 0.77 at 3, 3.16 ± 0.57 mm at 6 months in the test group (P < 0.001) without significant differences between groups. 1.33 ± 0.57 and 0.95 ± 0.68 mm hard-tissue fill (difference in the radiographic distance between cementoenamel junction and base of the intrabony defect pre- and post-operative) at 6 months was observed in the control and test groups, respectively (P < 0.001). Between groups differences (0.22 ± 0.24 mm) were not significant.Conclusions:Similar reduction in soft- and hard-tissue parameters in both groups indicates that adjunctive pocket sanitization with diode laser did not improve the healing of intrabony defects treated with bioactive glass.
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