Sanjay Miglani

Dentin hypersensitivity: Recent trends in management

Dentinal hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. It can affect patients of any age group and most commonly affects the canines and premolars of both the arches. This article concisely reviews the patho-physiology, mechanism and clinical management of the DH. Treatment of DH should start with an accurate diagnosis. Differential diagnosis should be made and all other probable causes should be excluded. An often neglected phase of clinical management of DH is the identification and treatment of the causative factors of DH. By removing the etiological factors, the condition can be even prevented from occurring or recurring. There are various treatment modalities available which can be used at home or may be professionally applied. The “at home” desensitizing agents include toothpastes, mouthwashes or chewing gums and they act by either occluding the dentinal tubules or blocking the neural transmission. This article also discusses the recent treatment options like bioglass, Portland cement, lasers and casein phosphopeptide.

Comparative Evaluation of Local Infiltration of Articaine, Articaine Plus Ketorolac, and Dexamethasone on Anesthetic Efficacy of Inferior Alveolar Nerve Block with Lidocaine in Patients with Irreversible Pulpitis

INTRODUCTION The inferior alveolar nerve block (IANB) has a poor success rate in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of ketorolac and dexamethasone infiltration along with standard IANB on the success rate. METHODS Ninety-four adult volunteers who were actively experiencing pain participated in this prospective, randomized, double-blind study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive any supplemental infiltrations (control). Twenty-four patients received supplemental buccal infiltration of 4% articaine with 1:100,000 ephinephrine, and 24 patients received supplemental buccal infiltration of 1 mL/4 mg of dexamethasone. It was planned to give supplemental buccal infiltration of 1 mL/30 mg of ketorolac tromethamine in 26 patients, but the first 2 patients experienced severe injection pain after ketorlac infiltration and were excluded from the study. In the subsequent patients, 0.9 mL of 4% articaine was infiltrated before injecting ketorolac. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft-Parker visual analog scale. Success was recorded as none or mild pain. RESULTS Statistical analysis was done by using nonparametric χ(2) tests. Control IANB gave 39% success rate. Buccal infiltration of articaine and articaine plus ketorolac significantly increased the success rate to 54% and 62%, respectively (P < .05). Supplementary dexamethasone infiltration gave 45% success rate, which was insignificant with control IANB. CONCLUSIONS Articaine and ketorolac infiltration can increase the success rate of IANB in patients with irreversible pulpitis. None of the tested techniques gave 100% success rate.

Comparative evaluation of push-out bond strength of ProRoot MTA, Biodentine, and MTA Plus in furcation perforation repair

Purpose: Few studies have comparatively evaluated the push-out bond strength of different calcium silicate–based materials (CSMs) used in furcal perforation repair. The objective of this in vitro study was to comparatively evaluate the push-out bond strength of commercially available CSMs used as furcation repair materials, in the presence of blood contamination. Materials and Methods: Furcal perforations were made in 120 molars and were divided on the basis of the repair material used (ProRoot MTA, Biodentine, and MTA Plus), blood contamination, and duration of setting time (24 h vs. 7 days). Push-out bond strength was measured and analyzed by three-way analysis of variance (ANOVA) test. Results: Push-out bond strength increased with time. The 24-h push-out strength of MTA was less than that of Biodentine. Blood contamination affected the push-out bond strength of MTA Plus irrespective of the setting time. Conclusion: Caution should be taken while condensing restorative materials over furcation repair materials.

Conventional apexification and revascularization induced maturogenesis of two non-vital, immature teeth in same patient: 24 months follow up of a case

Various authors have demonstrated the regenerative process in immature, non vital teeth by revascularization induced maturogenesis. The aim of this case report is to compare calcium hydroxide apexification and pulp revascularization induced maturation procedures in the same patient, in two different teeth. The right maxillary central incisor in this individual was treated with conventional calcium hydroxide induced apexification procedure followed by guttaperchaobturation, and the left maxillary central incisor was treated by pulp revascularization induced maturation procedures. 24 months follow-up shows root elongation and apical closure in the tooth treated with revascularization induced maturation procedures. Revascularization induced maturogenesis, where indicated, can provide several advantages over conventional apexification procedures.

A Prospective, Randomized Single-blind Evaluation of Effect of Injection Speed on Anesthetic Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

INTRODUCTION Speed of injection may affect the solution spread in the pterygomandibular space. It was hypothesized that speed of injection will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. METHODS Fifty-nine adult volunteers who were actively experiencing pain participated in this prospective, randomized, single-blind study. The patients were divided into 2 groups on a random basis and received either slow or rapid IANB with 3.6 mL of 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated after 15 minutes of the initial IANB. Pain during treatment was recorded by using the Heft-Parker visual analogue scale. The primary outcome measure, and the definition of success, was the ability to undertake pulp access and canal instrumentation with no or mild pain (Heft-Parker visual analog scale score < 55 mm). Secondary outcome measure was the solution deposition pain. Statistical analysis was performed by using Mann-Whitney U test and χ(2) test. RESULTS Slow and rapid injections gave 43% and 51% success rates, respectively. The difference was statistically insignificant. Slow injections produced less solution deposition pain than rapid injections. CONCLUSIONS Rate of injection has no effect on anesthetic success of IANB, but slow injections were more comfortable than rapid injections.

Comparative Evaluation of Fracture Resistance of Structurally Compromised Canals Restored with Different Dowel Methods

PURPOSE The objective of this in vitro study was to evaluate and compare the fracture resistance and fracture mode of endodontically treated teeth with wide root canals restored with various dowel methods. MATERIALS AND METHODS Fifty human uniradicular mandibular premolar teeth were decoronated and endodontically treated. The canals were widened with diamond points. The specimens were divided into five groups on the basis of type of dowel method used: conventional custom-made cast metal dowel; single glass fiber-reinforced resin dowel; glass fiber-reinforced resin dowel with accessory fiber dowels; relined glass fiber-reinforced resin dowel; and dowels formed with the help of polyethylene fiber ribbon-reinforced resin composite. Specimens were restored with indirect composite crowns, and 150,000 cycles of cyclic loading were applied. The specimens were loaded to test the fracture resistance and fracture mode (repairable and nonrepairable). RESULTS The cast metal dowel groups had the highest fracture resistance but showed nonrepairable fracture in 90% of specimens. CONCLUSIONS Cast metal dowels had the highest fracture resistance but led to nonrepairable fracture while restoring the wide root canals under cyclic loading. Specimens restored with fiber dowels, accessory dowels, relined dowels, and ribbon-reinforced resin provided adequate fracture resistance with increased incidence of repairable fractures.

Effect of Different Root Canal Obturating Materials on Push‐Out Bond Strength of a Fiber Dowel

PURPOSE During dowel space preparation, the instrumentation forms a thick smear layer along with sealer-occluded dentinal tubules. The purpose of this study was to evaluate the effect of different obturating materials on push-out bond strength of a fiber dowel. MATERIALS AND METHODS Fifty human uniradicular teeth were decoronated and prepared using the step-back technique. The specimens were divided into five groups on the basis of obturating materials: group I received no obturation; group II (ZOE) gutta-percha and zinc oxide eugenol sealer; group III (ZOAH) gutta-percha and AH plus sealer; group IV (GF) GuttaFlow; and group V (RE) with Resilon Epiphany system. Dowel spaces were made with manufacturers provided drills, and a fiber dowel was luted. Horizontal slices were obtained from the middle third, and push-out bond strength (S) was evaluated. Statistical analysis was carried out using one-way ANOVA and post hoc Tukeys test. RESULTS The push-out bond strength values in the control group, ZOE, ZOAH, GF, and RE were 9.303 ± 0.565 MPa, 8.859 ± 0.539 MPa, 8.356 ± 0.618 MPa, 9.635 ± 0.435 MPa, and 8.572 ± 0.256 MPa, respectively. There was no statistically significant difference between the S values of all the groups (p > 0.05). CONCLUSION There was no effect of different tested obturating materials on the push-out bond strength of fiber dowels; however, further studies should be conducted.

Comparative Evaluation of Anesthetic Efficacy of 2% Lidocaine, 4% Articaine, and 0.5% Bupivacaine on Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Clinical Trial

AIMS To compare the anesthetic efficacy of 1.8 mL of 2% lidocaine with 1:200,000 epinephrine, 4% articaine with 1:100,000 epinephrine, and 0.5% bupivacaine with 1:200,000 epinephrine on producing inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. METHODS A total of 91 adult patients who were actively experiencing mandibular molar pain were involved in this study. The patients were randomly divided into three groups on the basis of the anesthetic solution used. The first group received IANB with 1.8 mL of 2% lidocaine with 1:200,000 epinephrine, the second group received IANB with 4% articaine with 1:100,000 epinephrine, and the third group received IANB with 0.5% bupivacaine with 1:200,000 epinephrine. After 15 minutes of IANB, conventional endodontic access preparation was started. The pain during the treatment was noted on a Heft-Parker visual analog scale (HP VAS). The primary outcome measure was anesthetic success, and anesthesia was considered successful if the patient reported no pain or weak/mild pain (HP VAS score < 55 mm) during endodontic treatment (pulp access and canal preparation procedures). The data were analyzed with one-way analysis of variance and chi-square test. RESULTS The anesthetic success rates of 2% lidocaine, 4% articaine, and 0.5% bupivacaine were 23%, 33%, and 17%, respectively. The differences were statistically insignificant (P > .05). CONCLUSION The 2% lidocaine solution used for IANB had similar success rates when compared with 4% articaine and 0.5% bupivacaine.

Effect of thermal and mechanical loading on marginal adaptation and microtensile bond strength of a self-etching adhesive with caries-affected dentin

Aim: This study evaluated the effect of thermal and mechanical loading on marginal adaptation and microtensile bond strength in total-etch versus self-etch adhesive systems in caries-affected dentin. Materials and Methods: Forty class II cavities were prepared on extracted proximally carious human mandibular first molars and were divided into two groups: Group I — self-etch adhesive system restorations and Group II — total-etch adhesive system restorations. Group I and II were further divided into sub-groups A (Without thermal and mechanical loading) and B (With thermal and mechanical loading of 5000 cycles, 5 ± 2°C to 55 ± 2°C, dwell time 30 seconds, and 150,000 cycles at 60N). The gingival margin of the proximal box was evaluated at 200X magnification for marginal adaptation in a low vacuum scanning electron microscope. The restorations were sectioned, perpendicular to the bonded surface, into 0.8 mm thick slabs. All the specimens were subjected to microtensile bond strength testing. The marginal adaptation was analyzed using descriptive studies, and the bond strength data was analyzed using the one-way analysis of variance (ANOVA) test. Results and Conclusions: The total-etch system performed better under thermomechanical loading.

Asyndromic hypodontia associated with tooth morphology alteration: A rare case report

Clinicians frequently encounter hypodontia in their practice. It can be associated with any syndrome or more commonly it is asyndromic. This asyndromic form is commonly familial and can be followed in heredity of the patient. The patient referred in this report presented with a rare anomaly of hypodontia with altered morphology where the patient had all the teeth single rooted and single canalled. Studies have indicated several genes that affect the tooth morphology and number. A genetic correlation of hypodontia with altered permanent teeth morphology may be explored further in studies.