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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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Thayer S, Townsend JA, Peters M, Yu Q, Odom M, Sabey KA. Kovanaze Intranasal Spray vs Traditional Injected Anesthetics: a Study of Pulpal Blood Flow Utilizing Laser Doppler Flowmetry. Anesth Prog 2022; 69:31-38. [PMID: 35377931 DOI: 10.2344/anpr-68-03-10] [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: 06/20/2021] [Accepted: 07/06/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE An ideal local anesthetic would be effective, minimally reduce pulpal blood flow (PBF), and not require injection. This study compared the effects of 3% tetracaine plus 0.05% oxymetazoline nasal spray (Kovanaze; KNS) and injections using 2% lidocaine with 1:100,000 epinephrine (LE) or 3% mepivacaine plain (MP) on PBF, anesthetic efficacy, and participant preference. METHODS In a double-blind cross-over design, 20 subjects randomly received a test anesthetic and placebo at each of 3 visits (KNS/mock infiltration; mock nasal spray/LE; or mock nasal spray/MP). Nasal sprays and infiltration apical to a maxillary central incisor were delivered ipsilaterally. PBF was evaluated by laser Doppler flowmetry, and local anesthetic success was assessed with electric pulp testing. Postoperative pain levels, participant preference, and adverse events were also assessed. RESULTS LE injections demonstrated significant reductions in PBF at all time intervals compared with baseline (P < .05), whereas KNS and MP did not. Pulpal anesthesia success rates were higher for LE (85%) compared with MP (35%) and KNS (5%). Participants reported significantly higher postoperative pain levels for KNS compared with LE and MP. Additionally, KNS was the least preferred of the anesthetics administered and resulted in more reported adverse events. CONCLUSION Although KNS showed no significant effect on PBF, it was not effective in achieving pulpal anesthesia as used in this study.
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Affiliation(s)
- Scott Thayer
- Department of Endodontics, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, Louisiana
| | - Janice A Townsend
- Division of Pediatric Dentistry, The Ohio State University College of Dentistry, Department of Pediatric Dentistry, Nationwide Children's Hospital, Columbus, Ohio
| | - Mathilde Peters
- Cariology, Restorative Sciences, and Endodontics, University of Michigan, School of Dentistry, Ann Arbor, Michigan
| | - Qingzhao Yu
- Biostatistics Program, Louisiana State University Health Sciences Center, School of Public Health, New Orleans, Louisiana
| | - Mark Odom
- Department of Endodontics, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, Louisiana
| | - Kent A Sabey
- Department of Endodontics, Louisiana State University Health Sciences Center, School of Dentistry, New Orleans, Louisiana
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Bennett R, Loo Y, Ilyas N. IADT 2020 Guidelines: What should the dental professional know? Prim Dent J 2022; 10:95-99. [PMID: 35088633 DOI: 10.1177/20501684211066527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traumatic dental injuries are a common occurrence among children. Effective acute and long-term management of traumatic dental injuries can improve patient outcomes, especially in the paediatric patient. It is important that all dental professionals follow up-to-date, evidence-based guidance when treating patients. This article aims to highlight the main changes in the 2020 International Association of Dental Traumatology (IADT) Guidelines for Evaluation and Management of Traumatic Dental Injuries, to ensure that all dental professionals are fully aware of current guidelines and are managing patients appropriately.
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Affiliation(s)
- Reuben Bennett
- DCT1, Department of Paediatric Dentistry, King's College Hospital, London, UK
| | - Yi Loo
- Specialty Registrar in Paediatric Dentistry, King's College Hospital, London, UK
| | - Nabeel Ilyas
- Specialty Registrar in Paediatric Dentistry, King's College Hospital, London, UK
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Mouhat M, Stangvaltaite-Mouhat L, Mercer J, Nilsen BW, Örtengren U. Light-curing units used in dentistry: Effect of their characteristics on temperature development in teeth. Dent Mater J 2021; 40:1177-1188. [PMID: 34121022 DOI: 10.4012/dmj.2020-305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study aimed to investigate pulp chamber and surface temperature development using different LED light curing units (LCUs). Eight brands of LED-LCUs were tested in a laboratory bench model. The pulp chamber and surface temperature were recorded with a type T thermocouple and infrared cameras, respectively. The highest pulp chamber and surface temperature increase was 6.1±0.3°C and 20.1±1.7°C, respectively. Wide-spectrum LED-LCUs produced higher pulp chamber temperature increase at 0 mm and 2 mm but lower at 4 mm. Narrow-spectrum LED-LCUs produced higher surface temperature increase. LED-LCU featuring modulated output mode resulted in lower increase in pulp chamber temperature but higher on surface temperature. LED-LCU with light guide tip delivering an inhomogeneous beam caused higher increase in temperature on the surface and in the pulp chamber. LED-LCUs with different spectral emission, output mode and light guide tip design contributed to different temperature development in the pulp chamber and at the surface of teeth.
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Affiliation(s)
- Mathieu Mouhat
- Department for Clinical Dentistry/Faculty of Health Sciences, UiT the Arctic University of Norway
| | - Lina Stangvaltaite-Mouhat
- Department for Clinical Dentistry/Faculty of Health Sciences, UiT the Arctic University of Norway.,Oral Health Center of Expertise in Eastern Norway
| | - James Mercer
- Department of Medical Biology/Faculty of Health Sciences, UiT the Arctic University of Norway
| | - Bo Wold Nilsen
- Department for Clinical Dentistry/Faculty of Health Sciences, UiT the Arctic University of Norway
| | - Ulf Örtengren
- Department for Clinical Dentistry/Faculty of Health Sciences, UiT the Arctic University of Norway.,Department of Cariology, Institute of Odontology/Sahlgrenska Academy, University of Gothenburg
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Kijsamanmith K, Sriworapongpun C, Pawasut N, Huayhongthong N, Sakulyuenyong T, Krongyoungyuen P, Samdrup T. The effect of single buccal infiltration anesthesia of 4% articaine with either 1:100,000 or 1:200,000 epinephrine on pulpal blood flow and anesthesia of maxillary first molars and second premolars in humans. Clin Oral Investig 2021; 26:343-351. [PMID: 34041607 DOI: 10.1007/s00784-021-04005-4] [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: 01/22/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effect of single buccal infiltration of 4% articaine with either 1:100,000 (EP100) or 1:200,000 (EP200) epinephrine on pulpal blood flow (PBF), pulpal anesthesia and soft tissue anesthesia of maxillary first molars and second premolars in human subjects. MATERIALS AND METHODS Fifteen healthy volunteers with intact maxillary first molars and second premolars received an infiltration of 4% articaine with either EP100 or EP200 at buccal aspect of maxillary first molars. The PBF, pulpal anesthesia and soft tissue anesthesia were assessed with a laser Doppler flowmeter (LDF), an electric pulp tester (EPT) and Aesthesiometer II, respectively. RESULTS Articaine (4%) with either EP100 or EP200 produced PBF reduction in maxillary first molars (injected teeth) by 68.09 and 69.83%, and produced PBF reduction in second premolars (adjacent teeth) by 76.81 and 75.02%, respectively at 15 min post injection. Duration of PBF returned to baseline was 159.00 ± 21.06 (EP100) and 159.00 ± 31.97 (EP200) min in the molars, and 161.00 ± 20.02 (EP100) and 159.00 ± 25.86 (EP200) min in the premolars. The onset of pulpal anesthesia was 2.80 ± 1.26 (EP100) and 3.07 ± 1.28 (EP200) min in the molars, and 2.13 ± 0.52 (EP100) and 2.40 ± 0.83 (EP200) min in the premolars; the duration of pulpal anesthesia was 74.53 ± 24.16 (EP100) and 76.27 ± 34.03 (EP200) min in the molars, and 82.53 ± 31.03 (EP100) and 75.60 ± 37.17 (EP200) min in the premolars. Buccal tissue anesthesia was found in both teeth (100%), but palatal anesthesia was achieved by 13.33% in the premolars and 6.67% in the molars for each solution. CONCLUSIONS Single buccal infiltration to maxillary first molar produced PBF reduction and successful pulpal anesthesia, evaluated by EPT, in both first molar and second premolar. This anesthetic technique also produced high success of buccal tissue anesthesia, but demonstrated very low success for palatal tissue anesthesia. CLINICAL RELEVANCE Single buccal infiltration to maxillary first molar is potent enough for pulpal and buccal tissue anesthesia, except palatal tissue anesthesia, in both first molar and second premolar.
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Affiliation(s)
- Kanittha Kijsamanmith
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand.
| | - Chayanit Sriworapongpun
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Nichanan Pawasut
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Nadpatchamon Huayhongthong
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Thanawin Sakulyuenyong
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Piyatida Krongyoungyuen
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Tshering Samdrup
- Dental Department, Lungtenphu Military Hospital, Royal Bhutan Army, 11001, Thimphu, Bhutan
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Vág J, Gánti B, Mikecs B, Szabó E, Molnár B, Lohinai Z. Epinephrine penetrates through gingival sulcus unlike keratinized gingiva and evokes remote vasoconstriction in human. BMC Oral Health 2020; 20:305. [PMID: 33148235 PMCID: PMC7640651 DOI: 10.1186/s12903-020-01296-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background It has been demonstrated in non-oral tissues that the locally evoked vasoconstriction could elicit remote vasoconstriction. This study aimed to investigate the spreading vasoconstrictor effects of epinephrine in the gingiva. Methods Gingival blood flow (GBF) was measured by laser speckle contrast imager in 21 healthy volunteers. In group A, two wells were fabricated from orthodontic elastic ligature and placed 2 mm apically to the free gingival margin at the mid buccal line of 12 (test side) and 21 (control side) teeth. The GBF was measured in the wells and tightly apical, coronal, distal and mesial to the wells. In group B, the wells were made on the buccal surface of the same teeth, including the gingival sulcus. Four regions were selected for measurement from the gingival margin reaching the mucogingival line (coronal, midway1, midway2 and apical). After the baseline recording, 3 µg epinephrine was applied into the test, and physiological saline into the control well. The GBF was recorded for 14 min. The gingival thickness was measured with a PIROP Ultrasonic Biometer. Results In group A, the GBF did not increase or decrease after the application of epinephrine. In group B, the GBF significantly decreased in all regions of the test side and remained low for the observation period. The vasoconstriction appeared with delays in more apical regions (at min 1 in the coronal and the midway1, at min 2 in the midway2, at min 4 in the apical region). Similarly, the amount of the decrease at 14 min was the largest close to sulcus (− 53 ± 2.9%), followed by the midway1 (− 51 ± 2.8%) and midway2 (− 42 ± 4.2%) and was the lowest in the apical region (− 32 ± 5.8%). No correlation was found between GBF and gingival thickness. Conclusion Epinephrine could evoke intense vasoconstriction propagating to the mucogingival junction, indicating the presence of spreading vasoconstriction in the human gingiva. The attached gingiva is impermeable to epinephrine, unlike the gingival sulcus. This trial was registered in ClinicalTrials.gov titled as Evidence of Spreading Vasoconstriction in Human Gingiva with the reference number of NCT04131283 on 16 October 2019. https://clinicaltrials.gov/show/NCT04131283
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Affiliation(s)
- János Vág
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary.
| | - Bernadett Gánti
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
| | - Barbara Mikecs
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
| | - Enikő Szabó
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
| | - Bálint Molnár
- Department of Periodontology, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
| | - Zsolt Lohinai
- Department of Conservative Dentistry, Semmelweis University, Szentkirályi Street 47, 1088, Budapest, Hungary
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Pippi R, Scorsolini MG, Luigetti L, Pietrantoni A, Cafolla A. Tooth extraction without discontinuation of oral antithrombotic treatment: A prospective study. Oral Dis 2020; 27:1300-1312. [PMID: 32920926 DOI: 10.1111/odi.13641] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify which variable, among those related to surgeries, to patients, or to antithrombotic treatments, could be considered as a bleeding indicator, and to analyze effectiveness of the local hemostatic protocols used, incidence of bleeding and healing index, depending on the number of extracted teeth, and patient antithrombotic treatment. METHODS Patients who underwent tooth extractions without interruption or reduction of antithrombotic treatment were prospectively followed. The exact two-tailed Fisher test was used to investigate the relationship between presence/absence of bleeding and type of hemostatic material. The effect of variables on the probability of bleeding and healing index was assessed by means of a multivariate logistic regression. RESULTS Two hundred and fifty-four procedures were analyzed. The incidence of bleeding was 15.75%. Severe bleeding occurred in only 6 patients (2.34%). The number of involved dental quadrants and pre-surgical antibiotic treatments were found to be positively related with bleeding. The use of vasoconstrictors during surgery resulted in a reduction of healing index scores. CONCLUSIONS Tooth extractions in patients on antithrombotic treatment were found to be free from significant bleeding although the involvement of more than 1 quadrant in the same procedure should be avoided.
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Affiliation(s)
- Roberto Pippi
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Giulia Scorsolini
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Luigetti
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra Pietrantoni
- Department of Odontostomatological and Maxillo Facial Sciences, Sapienza University of Rome, Rome, Italy
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Nilsen BW, Mouhat M, Haukland T, Örtengren UT, Mercer JB. Heat Development in the Pulp Chamber During Curing Process of Resin-Based Composite Using Multi-Wave LED Light Curing Unit. Clin Cosmet Investig Dent 2020; 12:271-280. [PMID: 32753976 PMCID: PMC7358186 DOI: 10.2147/ccide.s257450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The study aimed to investigate factors contributing to heat development during light curing of a flowable bulk-fill resin-based composite (SDRTM, Lot # 602000876, Dentsply Sirona, Konstanz, Germany) (RBC). Materials and Methods Temperatures were measured with calibrated thermocouples. A multi-wave light-emitting diode (LED) light curing unit (LCU) was used (Ivoclar Vivadent, Schaan, Lichtenstein). In all experiments, the RBC was first cured (cured) for 30 s and, after 5 min of recovery time, received a second LCU irradiation (post-cured) for 30 s. The exothermic reaction was measured by calculating the Δ temperature between cured and post-cured RBC. In a cylinder-shaped polymer mold, temperature was recorded inside of RBC during curing (part 1) and light transmission through RBC during curing was investigated (part 2). Pulpal temperatures were assessed in an extracted third molar during light curing (part 3). Data were statistically analyzed using one-way ANOVA (α=0.05). Results Increased thickness of RBC led to decreased pulp chamber temperatures. Inside RBC, there was a large variation in heat development between the cured and post-cured groups (p<0.05). The cured group absorbed more LCU irradiation than the post-cured group. Conclusion The irradiance of the LCU seemed to be a more important factor than exothermic reaction of RBCs for pulp chamber heat development. Flowable bulk-fill RBCs can act as a pulpal insulator against LCU irradiation, despite their exothermic curing reaction.
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Affiliation(s)
- Bo Wold Nilsen
- Department of Clinical Dentistry, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Mathieu Mouhat
- Department of Clinical Dentistry, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Torbjørn Haukland
- Department of Clinical Dentistry, UiT - the Arctic University of Norway, Tromsø, Norway
| | - Ulf Thore Örtengren
- Department of Clinical Dentistry, UiT - the Arctic University of Norway, Tromsø, Norway.,Department of Cariology, Institute of Odontology/Sahlgrenska Academy, Gothenburg, Sweden
| | - James B Mercer
- Department of Medical Biology, UiT - the Arctic University of Norway, Tromsø, Norway
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Fouad AF, Abbott PV, Tsilingaridis G, Cohenca N, Lauridsen E, Bourguignon C, O'Connell A, Flores MT, Day PF, Hicks L, Andreasen JO, Cehreli ZC, Harlamb S, Kahler B, Oginni A, Semper M, Levin L. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020; 36:331-342. [DOI: 10.1111/edt.12573] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Ashraf F. Fouad
- Adams School of Dentistry University of North Carolina Chapel Hill NC USA
| | - Paul V. Abbott
- UWA Dental School University of Western Australia Crawley WA Australia
| | - Georgios Tsilingaridis
- Division of Orthodontics and Pediatric Dentistry Department of Dental Medicine Karolinska Institutet Huddinge Sweden
- Center for Pediatric Oral Health Research Stockholm Sweden
| | - Nestor Cohenca
- Department of Pediatric Dentistry University of Washington and Seattle Children’s Hospital Seattle WA Australia
| | - Eva Lauridsen
- Resource Center for Rare Oral Diseases Copenhagen University Hospital Copenhagen Denmark
| | | | - Anne O'Connell
- Paediatric Dentistry Dublin Dental University Hospital Trinity College Dublin The University of Dublin Dublin Ireland
| | - Marie Therese Flores
- Department of Pediatric Dentistry Faculty of Dentistry Universidad de Valparaíso Valparaíso Chile
| | - Peter F. Day
- School of Dentistry Community Dental Service Bradford District Care NHS Trust University of Leeds Leeds UK
| | - Lamar Hicks
- Division of Endodontics University of Maryland School of DentistryUMB Baltimore MD USA
| | - Jens Ove Andreasen
- Department of Oral and Maxillofacial Surgery Resource Centre for Rare Oral Diseases University Hospital in Copenhagen (Rigshospitalet) Copenhagen Denmark
| | - Zafer C. Cehreli
- Department of Pediatric Dentistry Faculty of Dentistry Hacettepe University Ankara Turkey
| | - Stephen Harlamb
- Faculty of Medicine and Health The University of Sydney Sydney NSW Australia
| | - Bill Kahler
- School of Dentistry The University of Queensland St Lucia QLD Australia
| | - Adeleke Oginni
- Faculty of Dentistry College of Health Sciences Obafemi Awolowo University Ile‐Ife Nigeria
| | | | - Liran Levin
- Faculty of Medicine and Dentistry University of Alberta Edmonton AB Canada
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10
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Samdrup T, Kijsamanmith K, Vongsavan K, Rirattanapong P, Vongsavan N. The effect of inferior alveolar nerve block anesthesia of 4% articaine and epinephrine 1:100,000 on blood flow and anesthesia of human mandibular teeth. J Dent Sci 2020; 16:249-255. [PMID: 33384805 PMCID: PMC7770255 DOI: 10.1016/j.jds.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/17/2020] [Indexed: 11/15/2022] Open
Abstract
Background/purpose Local anesthetics and anesthetic techniques affect the patterns of pulpal blood flow (PBF) and pulpal anesthesia in human teeth. This study aimed to determine PBF changes and pulpal anesthesia of intact mandibular first molars and canines after administration of 4% articaine with epinephrine 1:100,000 using inferior alveolar nerve block (IANB). Materials and methods Ten healthy subjects received IANB of 4% articaine with epinephrine 1:100,000. Laser Doppler flowmetry and electrical pulp testing were combined to assess PBF changes and pulpal anesthesia of intact mandibular first molars and canines. The data were analyzed using one-way repeated-measures analysis of variance and Student-Newman-Keuls test. Results IANB with 4% articaine and epinephrine 1:100,000 did not have any significant change in PBF for the first 20 min post injection in mandibular first molars, and for 45 min post injection in the canines (P > 0.05). However, a hyperemic response occurred during 25-60 min post injection in the molars, and between 60 and 75 min post injection in the canines (P < 0.05). Thereafter, the PBF in both teeth returned to the baseline. Onset of pulpal anesthesia was 8.60 ± 2.12 min in the molars, and 9 ± 1.94 min in the canines. Duration of pulpal anesthesia was 82.40 ± 41.56 min in the molars, and 84 ± 47.40 min in the canines. Conclusion In case of successful IANB, 4% articaine and epinephrine 1:100,000 caused insignificant changes in PBF up to 30 min but a hyperemic response at later time points. Thereafter, the PBF returned to the baseline.
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Affiliation(s)
- Tshering Samdrup
- Dental Department, Lungtenphu Military Hospital, Royal Bhutan Army, Thimphu, Bhutan
| | - Kanittha Kijsamanmith
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Kadkao Vongsavan
- International College of Dentistry, Walailak University, Bangkok, Thailand
| | - Praphasri Rirattanapong
- Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Noppakun Vongsavan
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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GÜLER D, ŞEN TUNÇ E. Lazer Doppler Flovmetre. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2019. [DOI: 10.17944/mkutfd.538803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Tanaka K, Kudo K, Ambe K, Kawaai H, Yamazaki S. A Histological Study of Vasoconstriction by Local Anesthetics in Mandible. Anesth Prog 2019; 65:244-248. [PMID: 30715934 DOI: 10.2344/anpr-65-03-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
To assess the effect of epinephrine-containing local anesthetics on vasoconstriction, we immunohistochemically measured the intravascular lumen area in different regions of the mandible. Twelve male Wistar rats were used. General anesthesia was induced and maintained with sevoflurane. Infiltration anesthesia was performed with 0.2 mL of epinephrine-free 2% lidocaine (E-) near the left mandibular first molar and with 0.2 mL of epinephrine-containing 2% lidocaine (E+) near the right mandibular first molar. After decalcification, the specimens were paraffinized, and thin sections were prepared and immunohistologically stained with an antismooth muscle actin antibody. The intravascular lumen area was measured in the mucosa, periodontal membrane, Haversian/Volkmann's canal, and bone marrow. A Mann-Whitney U test was used for statistical processing, and p < .05 was considered to indicate a statistically significant difference. In the oral mucosa and the periodontal membrane, E+ had a significantly smaller vascular lumen area than E-. In the Haversian/Volkmann's canal and the bone marrow, no significant intergroup difference was observed in the intravascular lumen area. We postulate that this is due to a low smooth muscle content of blood vessels in the mandible and suggest that the vasoconstrictive effect of epinephrine-containing local anesthetics within the mandible is ineffective.
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Affiliation(s)
- Katsunori Tanaka
- Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan
| | - Kanae Kudo
- Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan
| | - Kimiharu Ambe
- Department of Oral Histology, Ohu University School of Dentistry, Fukushima, Japan
| | - Hiroyoshi Kawaai
- Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan
| | - Shinya Yamazaki
- Department of Dental Anesthesiology, Ohu University School of Dentistry, Fukushima, Japan
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Nagaveni NB, Poornima P, Bajaj M, Mathew MG, Soni AJ. Revascularization of a Nonvital, Immature Permanent Tooth Using Amniotic Membrane: A Novel Approach. Int J Clin Pediatr Dent 2019; 12:150-152. [PMID: 31571789 PMCID: PMC6749878 DOI: 10.5005/jp-journals-10005-1596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate the clinical and radiological results of a revascularization treatment done in a nonvital, immature permanent tooth using the amniotic membrane. Case description A 12-year-old boy reported with a complaint of pain in the lower left back tooth since 1 month due to dental caries. On clinical examination, the mandibular left second premolar was tender on percussion and discolored due to dental caries. Radiographic examination of the same tooth revealed open apex, thin root dentinal walls, and periodontal ligament widening. An access opening was prepared, necrotic pulp extirpated completely followed by thorough irrigation. After drying the canal, closed dressing with the 3-mix antibacterial paste was given for 15 days. After 15 days, the paste was removed and the amniotic membrane was placed inside the canal extending 1 mm beyond the apex and mineral tri-oxide aggregate was placed over this followed by sealing of the cavity. The patient was followed up at 1, 3, and 6 months for clinical and radiographic evaluation. Conclusion After 6 months, clinically the tooth found asymptomatic. Radiographic examination showed continued root elongation, closure in the periapical opening, thick root dentinal walls with narrowing of the canal space, and normal periradicular architecture. Clinical significance Amniotic membrane can be used as a scaffold for revascularization in nonvital immature teeth. How to cite this article NB Nagaveni, P Poornima, et al. Revascularization of a Nonvital, Immature Permanent Tooth Using Amniotic Membrane: A Novel Approach. Int J Clin Pediatr Dent 2019;12(2):150–152.
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Affiliation(s)
- N B Nagaveni
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | - P Poornima
- Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere, Karnataka, India
| | | | - Mebin G Mathew
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | - Ashu J Soni
- Dr Ashu's Dental Clinic, Vadodara, Gujarat, India
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Zarpellon DC, Runnacles P, Maucoski C, Gross DJ, Coelho U, Rueggeberg FA, Arrais CAG. Influence of Class V preparation on in vivo temperature rise in anesthetized human pulp during exposure to a Polywave ® LED light curing unit. Dent Mater 2018; 34:901-909. [PMID: 29606368 DOI: 10.1016/j.dental.2018.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/07/2018] [Accepted: 03/12/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This in vivo study evaluated pulp temperature (PT) rise in human premolars having deep Class V preparations during exposure to a light curing unit (LCU) using selected exposure modes (EMs). METHODS After local Ethics Committee approval, intact first premolars (n=8) requiring extraction for orthodontic reasons, from 8 volunteers, received infiltrative and intraligamental anesthesia and were isolated using rubber dam. A minute pulp exposure was attained and sterile probe from a wireless, NIST-traceable, temperature acquisition system was inserted into the coronal pulp chamber to continuously monitor PT (°C). A deep buccal Class V preparation was prepared using a high speed diamond bur under air-water spray cooling. The surface was exposed to a Polywave® LED LCU (Bluephase 20i, Ivoclar Vivadent) using selected EMs, allowing 7-min span between each exposure: 10-s in low (10-s/L), 10-s (10-s/H), 30-s (30-s/H), or 60-s (60-s/H) in high mode; and 5-s-Turbo (5-s/T). Peak PT values and PT increases over physiologic baseline levels (ΔT) were subjected to 1-way, repeated measures ANOVAs, and Bonferroni's post-hoc tests (α=0.05). Linear regression analysis was performed to establish the relationship between applied radiant exposure and ΔT. RESULTS All EMs produced higher peak PT than the baseline temperature (p<0.001). Only 60-s/H mode generated an average ΔT of 5.5°C (p<0.001). A significant, positive relationship was noted between applied radiant exposure and ΔT (r2=0.8962; p<0.001). SIGNIFICANCE In vivo exposure of deep Class V preparation to Polywave® LED LCU increases PT to values considered safe for the pulp, for most EMs. Only the longest evaluated EM caused higher PT increase than the critical ΔT, thought to be associated with pulpal necrosis.
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Affiliation(s)
- Driellen Christine Zarpellon
- Department of Restorative Dentistry, State University of Ponta Grossa, Rua General Carlos Cavalcanti, 4748, Uvaranas 84030-900, Ponta Grossa, Parana, Brazil
| | - Patrício Runnacles
- Department of Restorative Dentistry, State University of Ponta Grossa, Rua General Carlos Cavalcanti, 4748, Uvaranas 84030-900, Ponta Grossa, Parana, Brazil
| | - Cristiane Maucoski
- Department of Restorative Dentistry, State University of Ponta Grossa, Rua General Carlos Cavalcanti, 4748, Uvaranas 84030-900, Ponta Grossa, Parana, Brazil
| | - Dayane Jaqueline Gross
- Department of Restorative Dentistry, State University of Ponta Grossa, Rua General Carlos Cavalcanti, 4748, Uvaranas 84030-900, Ponta Grossa, Parana, Brazil
| | - Ulisses Coelho
- Department of Restorative Dentistry, State University of Ponta Grossa, Rua General Carlos Cavalcanti, 4748, Uvaranas 84030-900, Ponta Grossa, Parana, Brazil
| | - Frederick Allen Rueggeberg
- Dental Materials Section, Department of Restorative Sciences, Dental College of Georgia, Room GC 4344, Augusta University, 1430 John Wesley Gilbert Drive, Augusta, GA 30912, USA
| | - Cesar Augusto Galvão Arrais
- Department of Restorative Dentistry, State University of Ponta Grossa, Rua General Carlos Cavalcanti, 4748, Uvaranas 84030-900, Ponta Grossa, Parana, Brazil.
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Kouadio AA, Jordana F, Koffi NJ, Le Bars P, Soueidan A. The use of laser Doppler flowmetry to evaluate oral soft tissue blood flow in humans: A review. Arch Oral Biol 2017; 86:58-71. [PMID: 29182953 DOI: 10.1016/j.archoralbio.2017.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/17/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023]
Abstract
The objective of this work is to define the conditions for improving the use of laser Doppler flowmetry (LDF) and to determine the limits for the use of this technique. This article systematically reviews the literature on the evaluation of oral soft tissue blood microcirculation by LDF. We analysed the available literature through October 2016 using the database resources Medline/PubMed, the Cochrane Oral Health Group Specialist Trials Register and the ISI Web of Knowledge. Several points emerged from this literature review The use of LDF involves specific constraints; however, the influence of different factors (temperature, tobacco, pressure etc.) must be adequately controlled when using LDF. LDF measurements of soft tissue within the oral cavity vary depending on the anatomical site. In dentistry, LDF can be used to track healing progress in periodontal surgery and to diagnose vascular flow changes in the connective tissue of mucosae covered by a removable prosthesis at an early stage prior to the onset of clinical inflammation signs.
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Affiliation(s)
- Ayepa Alain Kouadio
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France; UFR d'Odonto-stomatologie, Université Félix Houphouët Boigny, 22 BP 612 Abidjan 22, Cote d'Ivoire.
| | - Fabienne Jordana
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
| | - N'goran Justin Koffi
- UFR d'Odonto-stomatologie, Université Félix Houphouët Boigny, 22 BP 612 Abidjan 22, Cote d'Ivoire.
| | - Pierre Le Bars
- Department of Prosthetic, UIC Odontology, Nantes Dental school 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
| | - Assem Soueidan
- Department of Periodontology, UIC Odontology, Nantes Dental School 1, Place Alexis-Ricordeau, 44042 Nantes Cedex 1, France.
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Zheng QH, Hong QC, Zhang L, Ye L, Huang DM. A Clinical Study on the Effect of Injection Sites on Efficacy of Anesthesia and Pulpal Blood Flow in Carious Teeth. Oper Dent 2017; 43:22-30. [PMID: 28976844 DOI: 10.2341/16-371-c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This randomized clinical trial evaluated the efficiency of maxillary infiltration anesthesia in carious teeth at two different injection sites and their impact on the laser Doppler recordings of pulpal blood flow (PBF) during a caries excavation procedure. The null hypothesis tested was that there are no differences in the efficiency of anesthesia and PBF reduction between maxillary infiltrations at the two injection sites. One hundred twenty patients were divided into three groups according to the degree of carious lesion of their maxillary left central incisors (moderate caries, deep caries, or no caries). Forty patients in each group randomly received infiltrations over the root apex of maxillary left central incisors (site X) or over the midpoint of the line connecting the root apexes of both maxillary left central and lateral incisors (site Y) using 0.9 mL 2% lidocaine with 1:100,000 adrenaline. Teeth were pulp tested at five-minute intervals after injection except for the period of cavity cutting, which was done 12 minutes after injection. The PBF changes after injection were monitored by laser Doppler flowmetry. The observation period in this study was 60 minutes. Success of anesthesia was defined as no or mild pain on cavity cutting by visual analog scale recordings. Deep caries group showed significantly higher baseline PBF ( p<0.05). All groups showed 100% success of anesthesia and similar duration time ( p>0.05). Subgroups that had the injection at site Y showed significantly less reduction of PBF ( p<0.05). Cavity-cutting procedures increased the amplitude of the PBF around the lowest value after injection. Independent of the cavity depth, carious anterior teeth anesthetized by infiltration further from the apex had significantly less reduction on the pulpal blood flow compared with teeth anesthetized by infiltration at the apex.
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Alssum L, Eubank TD, Roy S, Erdal BS, Yildiz VO, Tatakis DN, Leblebicioglu B. Gingival Perfusion and Tissue Biomarkers During Early Healing of Postextraction Regenerative Procedures: A Prospective Case Series. J Periodontol 2017. [PMID: 28644107 DOI: 10.1902/jop.2017.170117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Postextraction alveolar bone loss, mostly affecting the buccal plate, occurs despite regenerative procedures. To better understand possible determinants, this prospective case series assesses gingival blood perfusion and tissue molecular responses in relation to postextraction regenerative outcomes. METHODS Adults scheduled to receive bone grafting in maxillary, non-molar, single-tooth extraction sites were recruited. Clinical documentation included the following: 1) probing depth (PD); 2) keratinized tissue width (KT); 3) tissue biotype (TB); and 4) plaque level. Wound closure was clinically evaluated. Gingival blood perfusion was measured by laser Doppler flowmetry (LDF). Wound fluid (WF) and gingival biopsies were analyzed for protein levels and gene expression, respectively, of relevant molecular markers. Bone healing outcomes were determined radiographically (cone-beam computed tomography). Healing was followed for 4 months. RESULTS Data from 15 patients are reported. Postoperatively, neither complications nor changes in PD, KT, or TB were observed. LDF revealed decreased perfusion followed by hyperemia that persisted for 1 month (P ≤0.05). WF levels of angiopoietin-2, interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), and vascular endothelial growth factor peaked on day 6 (P ≤0.05) and decreased thereafter. Only IL-8 and TNF-α exhibited increased gene expression. Linear bone changes were negligible. Volumetric bone changes were minimal but statistically significant, with more bone loss when membrane was used (P = 0.05). CONCLUSIONS Gingival blood perfusion after postextraction bone regenerative procedures follows an ischemia-reperfusion model. Transient increases in angiogenic factor levels and prolonged hyperemia characterize the soft tissue response. These soft tissue responses do not determine radiographic bone changes.
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Affiliation(s)
- Lamees Alssum
- Currently, Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia; previously, Division of Periodontology, College of Dentistry, The Ohio State University, Columbus, OH
| | - Timothy D Eubank
- Department of Microbiology, Immunology and Cell Biology; School of Medicine; West Virginia University; Morgantown, WV
| | - Sashwati Roy
- Department of Surgery, College of Medicine, The Ohio State University
| | - Barbaros S Erdal
- Department of Radiology, College of Medicine, The Ohio State University
| | - Vedat O Yildiz
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University
| | - Dimitris N Tatakis
- Division of Periodontology, College of Dentistry, The Ohio State University
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18
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Farah RI. Effect of simulated pulpal blood flow rate on the rise in pulp chamber temperature during direct fabrication of exothermic provisional restorations. Int Endod J 2016; 50:1097-1103. [PMID: 27977866 DOI: 10.1111/iej.12735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 12/07/2016] [Indexed: 11/30/2022]
Abstract
AIM To evaluate ex vivo the effect of several simulated pulpal blood flow rates on the change in pulp chamber temperature during direct fabrication of a provisional restoration using a polymethylmethacrylate (PMMA) resin. METHODOLOGY Fifteen noncarious human premolars were prepared for complete coverage restorations. A curved needle connected to a peristaltic pump simulated the pulp blood flow. Two K-type thermocouples connected to a digital thermometer were placed in the pulp chamber, and the assembly was placed in an incubator at 37 °C. Three provisional crowns were made for each specimen using no water flow (group 1), a 1-mL min-1 flow rate (group 2) and a 0.5-mL/min-1 flow rate (group 3). The pulp chamber temperature was recorded continuously during polymerization until the temperature increase peaked and started to decrease and reached the baseline temperature (37 °C). The temperature increase was measured for the three water flow conditions. Data were analysed statistically using descriptive statistics, repeated measures one-way analysis of variance (anova) with Greenhouse-Geisser correction and Bonferroni tests. The level of significance was set at P < 0.05. RESULTS All of the groups were associated with an increased pulp chamber temperature. Groups with flow rates at 1 and 0.5 mL min-1 had a significantly lower temperature rise when compared to the group without water flow (P < 0.001). CONCLUSIONS Direct fabrication of provisional restorations can cause a critical increase in pulp chamber temperature. However, in the presence of simulated pulpal blood flow rates of 1 or 0.5 mL min-1 , the increase in pulp chamber temperature did not exceed the critical threshold (5.6 °C).
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Affiliation(s)
- R I Farah
- Department of Prosthodontics, College of Dentistry, Qassim University, Al-Mulaydah, Qassim, Saudi Arabia
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19
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P Shetty K, V Satish S, Kilaru K, Chakravarthi Ponangi K, M Luke A, Neshangi S. An in vivo evaluation of the change in the pulpal oxygen saturation after administration of preoperative anxiolytics and local anesthesia. J Dent Res Dent Clin Dent Prospects 2016; 10:31-5. [PMID: 27092212 PMCID: PMC4831609 DOI: 10.15171/joddd.2016.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 02/27/2016] [Indexed: 11/09/2022] Open
Abstract
Background. Given the influence of systemic blood pressure on pulpal blood flow, anxiolytics prescribed may alter the pulpal blood flow along with the local anesthetic solution containing a vasoconstrictor. This study evaluated the impact of preoperative anxiolytics and vasoconstrictors in local anesthetic agents on pulpal oxygen saturation. Methods. Thirty anxious young healthy individuals with a mean age of 24 years were randomly selected using the Corah’s Dental Anxiety Scale (DAS). After checking the vital signs the initial pulpal oxygen saturation (initial SpO2) was measured using a pulse oximeter. Oral midzolam was administered at a dose of 7.5 mg. After 30 min, the vital signs were monitored and the pulpal oxygen saturation (anxiolytic SpO2) was measured. A total of 1.5 mL of 2% lidocaine with 1:200000 epinephrine was administered as buccal infiltration anesthesia and 10 min the final pulpal oxygen saturation (L.A SpO2) was measured. Results. The mean initial (SpO2) was 96.37% which significantly decreased to 90.76% (SpO2) after the administration of the anxiolytic agent. This drop was later accentuated to 85.17% (SpO2) after administration of local anesthetic solution. Statistical significance was set at P<0.0001. Conclusion. High concentrations of irritants may permeate dentin due to a considerable decrease in the pulpal blood flow from crown or cavity preparation. Therefore, maintaining optimal blood flow during restorative procedures may prevent pulpal injury.
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Affiliation(s)
- Krishna P Shetty
- Professor and Head, Department of Conservative Dentistry and Endodontics, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | - Sarvepalli V Satish
- Professor, Department of Conservative Dentistry and Endodontics, Navodaya Dental College and Hospital, Raichur, Karnataka, India
| | | | - Kalyana Chakravarthi Ponangi
- Postgraduate Student, Department of Conservative Dentistry and Endodontics, Navodaya Dental College and Hospital, Raichur, Karnataka. India
| | - Alexander M Luke
- Senior Lecturer, College of Dentistry, Ajman, United Arab Emirates
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Systematic Injection Patterned-Technique of One-Per-Mil Tumescent Solution for Perforator-Based Skin Flap: Is it Better Than the Random Patterned-Technique? Int Surg 2015. [DOI: 10.9738/intsurg-d-14-00290.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of the study is to compare the systematic injection patterned-technique of 1-per-mil tumescent solution versus the random patterned-technique. Several incidences of perforator flap necrosis have been encountered with tumescent technique. Among the possible causes, the most probable cause is the injury of perforator artery due to the multi-passing needle injections. Thus, an evaluation regarding the needle injection pattern needs to be done in order to avoid necrotic flap incidence. A randomized controlled experimental study was conducted on both groins of 20 healthy Wistar stained-Rattus novergicus weighing 220 to 270 g. A comparison of a systematic injection pattern and a random injection pattern was performed. Three mL of 1-per-mil tumescent solution was injected subcutaneously before elevation of the islanded groin flap. Clarity of the operative field along with the size of the pedicle were recorded. The photos of survival area of the skin flap on postoperative day 7 were analyzed using Analyzing Digital Images. Totally bloodless operative field was observed in all subjects. Three out of 19 flaps in group A (15.78%) and 4 out of 18 flaps in group B (22.22%), were found to be necrotic, either total or partial. No significant difference (P > 0.05) was found between the injection technique groups, in terms of flap necrosis. Although the 1-per-mil tumescent technique is advantageous in a way that it provides a totally bloodless operative field, the systematic injection patterned-technique was not found to be more superior compared to the custom random patterned-multi-passing needle injection technique.
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21
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Runnacles P, Arrais CAG, Pochapski MT, dos Santos FA, Coelho U, Gomes JC, De Goes MF, Gomes OMM, Rueggeberg FA. In vivo temperature rise in anesthetized human pulp during exposure to a polywave LED light curing unit. Dent Mater 2015; 31:505-13. [DOI: 10.1016/j.dental.2015.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/08/2015] [Accepted: 02/02/2015] [Indexed: 11/26/2022]
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Direct measurement of time-dependent anesthetized in vivo human pulp temperature. Dent Mater 2015; 31:53-9. [DOI: 10.1016/j.dental.2014.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/12/2014] [Accepted: 11/14/2014] [Indexed: 11/20/2022]
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Ogawa S, Watanabe M, Kawaai H, Tada H, Yamazaki S. Lidocaine concentration in mandibular bone after subperiosteal infiltration anesthesia decreases with elevation of periosteal flap and irrigation with saline. Anesth Prog 2014; 61:53-62. [PMID: 24932978 DOI: 10.2344/0003-3006-61.2.53] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
It has been reported that the action of infiltration anesthesia on the jawbone is attenuated significantly by elevation of the periosteal flap with saline irrigation in clinical studies; however, the reason is unclear. Therefore, the lidocaine concentration in mandibular bone after subperiosteal infiltration anesthesia was measured under several surgical conditions. The subjects were 48 rabbits. Infiltration anesthesia by 0.5 mL of 2% lidocaine with 1 : 80,000 epinephrine (adrenaline) was injected into the right mandibular angle and left mandibular body, respectively. Under several surgical conditions (presence or absence of periosteal flap, and presence or absence of saline irrigation), both mandibular bone samples were removed at a fixed time after subperiosteal infiltration anesthesia. The lidocaine concentration in each mandibular bone sample was measured by high-performance liquid chromatography. As a result, elevation of the periosteal flap with saline irrigation significantly decreased the lidocaine concentration in the mandibular bone. It is suggested that the anesthetic in the bone was washed out by saline irrigation. Therefore, supplemental conduction and/or general anesthesia should be utilized for long operations that include elevation of the periosteal flap with saline irrigation.
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Affiliation(s)
- Sachie Ogawa
- Department of Dental Anesthesiology, School of Dentistry
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Lobo E, Nguyen S, Pogrel M. The effect of exercise on pulpal and gingival blood flow in physically active and inactive subjects as assessed by laser Doppler. Open Dent J 2012; 6:56-60. [PMID: 22654999 PMCID: PMC3362865 DOI: 10.2174/1874210601206010056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/19/2012] [Accepted: 01/30/2012] [Indexed: 11/24/2022] Open
Abstract
The effects of exercise on pulpal and gingival blood flow are undefined. The autonomic nervous system response suggests that they could increase or decrease with exercise, and they may be independent of each other. This study attempts to answer these questions.
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Affiliation(s)
- Ec Lobo
- Department of Oral and Maxillofacial Surgery University of California San Francisco
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25
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Yoon MJ, Lee SJ, Kim E, Park SH. Doppler ultrasound to detect pulpal blood flow changes during local anaesthesia. Int Endod J 2011; 45:83-7. [DOI: 10.1111/j.1365-2591.2011.01960.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goto T, Mamiya H, Ichinohe T, Kaneko Y. Localization of 14C-labeled 2% lidocaine hydrochloride after intraosseous anesthesia in the rabbit. J Endod 2011; 37:1376-9. [PMID: 21924185 DOI: 10.1016/j.joen.2011.05.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the tissue distribution of lidocaine hydrochloride in mandibular bone marrow after intraosseous anesthesia (IOA) in rabbits. METHODS We used macroautoradiography to examine the tissue distribution of a (14)C-labeled 2% lidocaine hydrochloride solution containing 1:80,000 epinephrine ((14)C-lidocaine). Under general anesthesia, (14)C-lidocaine was injected intraosseously or paraperiosteally. After IOA, animals were divided into three groups and observed at 1 (IOA-1), 5 (IOA-5), and 10 minutes (IOA-10) after injection. After infiltration anesthesia (IA), animals were observed at 1 minute after injection. RESULTS The accumulation of (14)C-lidocaine was observed around the injection site in both the IA and the IOA groups. Paraperiosteally injected (14)C-lidocaine diffused to the surrounding tissues such as the lip, whereas IOA showed concentrated accumulation around the root apex throughout the experiment. The distribution area was significantly smaller in the IOA-1 group than in the IA group. The distribution area in the IOA-5 group was larger than those in the IOA-1 and IOA-10 groups. CONCLUSIONS The accumulation of (14)C-lidocaine injected by IOA in rabbits was concentrated around the root apex. These results may explain the rapid onset time of IOA.
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Affiliation(s)
- Takashi Goto
- Department of Dental Anesthesiology, Tokyo Dental College, Chiba-shi, Japan.
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Park SH, Roulet JF, Heintze SD. Parameters influencing increase in pulp chamber temperature with light-curing devices: curing lights and pulpal flow rates. Oper Dent 2010; 35:353-61. [PMID: 20533637 DOI: 10.2341/09-234-l] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED This laboratory study examined the effects of curing lights with different light intensities and changing flow rate on the increase in pulpal temperature during the light curing process and the rate of the subsequent decrease in temperature after the termination of light curing. The tip of a temperature sensor was positioned on the pulpal dentinal wall of the buccal side of the maxillary premolar. Metal tubes were inserted in the palatal and buccal root of the tooth, one for water inflow and the other for water outflow. The tubes were connected to a pump to control the flow rate. The water flow rate was set to 4.2 microl/minute, 28 microl/minute or 70 microl/minute. At each flow rate, the unprepared tooth was light cured from the buccal side 1 mm from the buccalsurface, using four different curing lights. The temperature data were recorded and stored on a computer every second for three minutes. The curing lights that were used were: Astralis 10 (QTH(high), Ivoclar Vivadent), Bluephase 16i (LED(conv), Ivoclar Vivadent) and two experimental LED-curing lights (LED(exp2000), LED(exp3000), Ivoclar Vivadent). The power densities were 1200 mW/cm2, 1600 mW/cm2, 2000 mW/cm2 and 3000 mW/cm2, respectively. The curing lights, LED(conv), LED(exp2000) and LED(exp3000) were activated for 60 seconds, and the QTH(high) was activated for 30 sec- onds. The maximum intrapulpal temperature (TM) and rate of temperature change at 30 seconds after turning off the light (S(30LO)) were analyzed by two-way ANOVA with a post-hoc Tukey test (p < 0.05). The influencing factors were the flow rates and curing lights. RESULTS The T(MAX) ranged from 41.0 degrees C to 53.5 degrees C. There was a difference between the curing lights (p < 0.05), with LED(exp3000) > LED(exp2000) > LED(conv) > QTH(high). There was no difference in T(MAX) between the different flow rates (p > 0.05). Both the curing lights and flow rates affected the SE(30LO) (p < 0.05). The S(30LO) was LED(exp3000) < LED(exp2000) > LEDon, , QTH(high) (p < 0.05). The S(30LO) at 70 microl/minutes was higher than at 4.2 pd/minutes and 28 microl/minutes (p < 0.05). CLINICAL IMPLICATION Because the increase in temperature is directly related to the light intensity and exposure time, curing devices with high power density (> 1200 mW/cm2) should only be activated for a short period of time (< 15 seconds) even in teeth without cavity preparation. The flow rate had only a negligible effect on the temperature increase.
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Affiliation(s)
- Sung-Ho Park
- Department of Conservative Dentistry, College of Dentistry, Yonsei University, Seoul, Korea.
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Caviedes-Bucheli J, Rojas P, Escalona M, Estrada A, Sandoval C, Rivero C, Lombana N, Muñoz HR. The effect of different vasoconstrictors and local anesthetic solutions on substance P expression in human dental pulp. J Endod 2009; 35:631-3. [PMID: 19410073 DOI: 10.1016/j.joen.2008.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 12/17/2008] [Accepted: 12/24/2008] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to quantify the effect of the infiltration injection of different vasoconstrictor and anesthetic solutions on substance P (SP) expression in healthy human dental pulp. Thirty pulp samples were obtained from healthy upper premolars in which extraction was indicated for orthodontic reasons and were randomly assigned into three groups of 10 samples each: 2% lidocaine with 1:80,000 epinephrine (Lido group), 3% Prilocaine with 1:200000 felypressin (Prilo group); and 4% Prilocaine without vasoconstrictor (Prilo-no-VC group). All teeth were extracted 10 minutes after anesthetic application. Pulp samples were processed and SP was measured by radioimmunoassay. SP expression for the Lido, Prilo, and Prilo-no-VC groups were 616.49, 663.76, and 760.79 pmol/mg pulp tissue, respectively. Analysis of variance showed statistically significant differences between groups (p = 0.001). Tukey Honestly Significant Difference (HSD) post hoc tests showed significant statistical differences between the Prilo-no-VC group and the Lido group (p < 0.01) and between the Prilo-no-VC group and the Prilo group (p < 0.05). It can be concluded that infiltration injection of local anesthetics with vasoconstrictor attenuate SP expression in human dental pulp.
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Affiliation(s)
- Javier Caviedes-Bucheli
- Department of Endodontics, School of Dentistry, Pontificia Universidad Javeriana, Bogotá, Colombia.
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Paranjpe A, Sung E, Cacalano N, Hume W, Jewett A. N-acetyl Cysteine Protects Pulp Cells from Resin Toxins in vivo. J Dent Res 2008; 87:537-41. [DOI: 10.1177/154405910808700603] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Potential risks of the use of resin-based restorative materials include direct damage to the pulp cells and the induction of hypersensitivity reactions in patients. In this study, we tested the hypothesis that N-acetyl cysteine (NAC) inhibits resin toxicity and restores the function of pulp cells. Analysis of our data demonstrates toxicity of composite resins on pulp cells in both an in vivo rat and an ex vivo human model system. Moreover, cells that survive after the placement of composites are weaker, and they are induced to undergo cell death when exposed to 2-hydroxyethyl methacrylate (HEMA). The toxic effect of composites on pulp cells is neutralized by NAC. Therefore, NAC protects the cells from damage induced by clinically relevant levels of restorative materials, in both rat and human model systems. The addition of N-acetyl cysteine prior to or concomitant with the application of restorative materials may be beneficial for the health and safety of dental patients.
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Affiliation(s)
- A. Paranjpe
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, The Jonsson Comprehensive Cancer Center -JCCC-, Dental Research Institute, Division of Oral Biology and Medicine, UCLA Schools of Dentistry and Medicine, University of California, 10833 Le Conte Ave., Los Angeles, CA 90095, USA
| | - E.C. Sung
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, The Jonsson Comprehensive Cancer Center -JCCC-, Dental Research Institute, Division of Oral Biology and Medicine, UCLA Schools of Dentistry and Medicine, University of California, 10833 Le Conte Ave., Los Angeles, CA 90095, USA
| | - N.A. Cacalano
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, The Jonsson Comprehensive Cancer Center -JCCC-, Dental Research Institute, Division of Oral Biology and Medicine, UCLA Schools of Dentistry and Medicine, University of California, 10833 Le Conte Ave., Los Angeles, CA 90095, USA
| | - W.R. Hume
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, The Jonsson Comprehensive Cancer Center -JCCC-, Dental Research Institute, Division of Oral Biology and Medicine, UCLA Schools of Dentistry and Medicine, University of California, 10833 Le Conte Ave., Los Angeles, CA 90095, USA
| | - A. Jewett
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, The Jonsson Comprehensive Cancer Center -JCCC-, Dental Research Institute, Division of Oral Biology and Medicine, UCLA Schools of Dentistry and Medicine, University of California, 10833 Le Conte Ave., Los Angeles, CA 90095, USA
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31
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Banomyong D, Palamara JE, Burrow MF, Messer HH. Effect of dentin conditioning on dentin permeability and micro-shear bond strength. Eur J Oral Sci 2007; 115:502-9. [DOI: 10.1111/j.1600-0722.2007.00483.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hebling J, Castro FLA, Costa CAS. Adhesive performance of dentin bonding agents appliedin vivo andin vitro. Effect of intrapulpal pressure and dentin depth. J Biomed Mater Res B Appl Biomater 2007; 83:295-303. [PMID: 17410570 DOI: 10.1002/jbm.b.30795] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to evaluate the influence of intrapulpal pressure and dentin depth on bond strengths of an etch-and-rinse and a self-etching bonding agent to dentin in vitro and in vivo. Twenty-four pairs of premolars were randomly divided into four groups (n = 6) according to the dentin bonding agent, Single Bond and Clearfil SE Bond, and intrapulpal pressure, null or positive. Each tooth of the pair was further designated to be treated in vivo or in vitro. The intrapulpal pressure was controlled in vivo by the delivery of local anesthetics containing or not a vasoconstrictor, while in vitro, it was achieved by keeping the teeth under hydrostatic pressure. Class I cavities were prepared and the dentin bonding agents were applied followed by incremental resin restoration. For the teeth treated in vitro, the same restorative procedures were performed after a 6 month-storage period. Beams with 1 mm(2) cross-sectional area were prepared and microtensile tested. Clearfil SE Bond was not influenced by any of the variables of the study, while bond strengths produced in vitro were significantly higher for Single Bond. Overall, lower bond strengths were produced in deep dentin, which reached statistical significance when Single Bond was applied under physiological or simulated intrapulpal pressure. In conclusion, in vitro bonding may overestimate the immediate adhesive performance of more technique-sensitive dentin bonding systems. The impact of intrapulpal pressure on bond strength seems to be more adhesive dependent than dentin morphological characteristics related to depth.
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Affiliation(s)
- Josimeri Hebling
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of São Paulo State (UNESP), Araraquara, São Paulo, Brazil.
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Donos N, D'Aiuto F, Retzepi M, Tonetti M. Evaluation of gingival blood flow by the use of laser Doppler flowmetry following periodontal surgery. A pilot study. J Periodontal Res 2005; 40:129-37. [PMID: 15733147 DOI: 10.1111/j.1600-0765.2005.00777.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this pilot study was to evaluate the applicability of laser Doppler flowmetry (LDF) in recording the gingival blood flow following periodontal surgery. MATERIAL AND METHODS Five patients suffering from advanced chronic generalized periodontitis were included in the study. After completion of basic periodontal therapy, full-mouth plaque score, bleeding on probing, gingival recession and clinical attachment level were recorded. The upper anterior areas with a pocket probing depth of 6 mm or more were treated with an access flap. LDF recordings were performed in both the buccal and palatal aspect of the operated areas with the aid of an individual acrylic stent at the day of the surgery, prior to local anaesthesia, 3 min following anaesthesia, immediately after the operation and at days 1, 2, 3, 4, 7, 15, 30 and 60 following operation. RESULTS Overall, the blood flow decreased immediately following anaesthesia and remained in lower values compared to baseline immediately following operation. The gingival blood flow presented an overall increase in comparison to baseline values until the 7th day following surgery at the buccal and palatal interdental sites, as well as at the alveolar mucosa sites. By the 15th day, as well as at the following observation periods of 30 and 60 days, the gingival blood flow values at the palatal and alveolar mucosa sites were very similar to baseline. Increased blood flow changes were observed at 30 and 60 days following operation at the buccal interdental sites. CONCLUSION The results of the present pilot study suggest that the LDF might present clinical applicability in recording changes in gingival blood flow following periodontal surgery.
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Affiliation(s)
- Nikolaos Donos
- Eastman Dental Institute, Department of Periodontology, University College London, UK.
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Atabey A, Galdino G, El-Shahat A, Ramirez OM. The Effects of Tumescent Solutions Containing Lidocaine and Epinephrine on Skin Flap Survival in Rats. Ann Plast Surg 2004; 53:70-2. [PMID: 15211203 DOI: 10.1097/01.sap.0000112348.92360.5c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The effects of tumescent solutions consisting of lidocaine and epinephrine on skin flap survival in rats were studied. Dorsal skin flaps of rats were infiltrated using lidocaine (1%) with epinephrine in concentrations of 1:100,000, 1:200,000, 1:400,000, and 1:800,000 prior to elevating flaps of the different experimental groups. The solutions were applied intradermally or subcutaneously, and the flaps were raised "immediately" or "delayed" after injection in the different groups. Control flaps were infiltrated by lidocaine (1%) only. The survival of the flaps was assessed on the seventh day after the operation. As a result, the flaps showed higher necrosis rates in the groups injected by lidocaine with epinephrine in concentration of 1:100,000 and 1:200,000 than of the other experimental or all control groups (P < 0.01). In conclusion, lidocaine with epinephrine in concentrations of 1:400,000 and 1:800,000 was found safe on skin flap survival for tumescent technique in rats.
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Affiliation(s)
- Atay Atabey
- Department of Plastic, Reconstructive and Esthetic Surgery, Medical School, Dokuz Eylül University, Izmir, Turkey.
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35
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Oztürk M, Doruk C, Ozeç I, Polat S, Babacan H, Biçakci AA. Pulpal blood flow: effects of corticotomy and midline osteotomy in surgically assisted rapid palatal expansion. J Craniomaxillofac Surg 2003; 31:97-100. [PMID: 12628599 DOI: 10.1016/s1010-5182(02)00188-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION/PURPOSE Surgically assisted rapid palatal expansion is used for the management of transverse maxillary deficiency in the early permanent dentition. The success depends on the maintenance of an adequate blood supply to the mobilized segments. The aim of this study was to assess the effects of corticotomy and midline osteotomy on the tooth pulpal blood flow. MATERIAL Laser Doppler flowmetry was applied as a non-invasive and reliable technique for the assessment of pulpal blood flow in the maxillary centrals, canines and first molars. The blood flow was investigated pre- and postoperatively, on the first, third, and seventh postoperative days bilaterally in 13 cases. RESULTS The results of this study indicate that ischaemia of the pulp can occur following osteotomy at the Le Fort I level. CONCLUSION Corticotomy 5mm above the dental apices and separating the midpalatal suture did not have any serious effect on pulpal blood flow in this study.
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Affiliation(s)
- Mustafa Oztürk
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery and Orthodontics, Cumhuriyet University, Sivas, Turkey.
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Tanaka T, Kaneko Y. Measurement of pulpal blood flow in dogs with nonradioactive colored microspheres. THE BULLETIN OF TOKYO DENTAL COLLEGE 2001; 42:201-10. [PMID: 11915297 DOI: 10.2209/tdcpublication.42.201] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The viability of dental pulp depends largely on regional blood flow, as in other organs. Measurement of absolute pulpal blood flow (PBF) and comparisons with blood flow in other organs allow the prediction of microvascular regulation in dental pulp. In previous studies, PBF was measured in dogs mainly with radioactive microspheres. However, this established technique is inaccessible to many investigators due to concerns over radiation safety and radioactive waste. To overcome these limitations, a new method has been introduced that involves the use of nonradioactive colored microspheres for measuring regional blood flow in the myocardium and in other organs in animals. However, no previous studies have investigated the use of this method to measure PBF in dogs. We attempted to determine whether blood flow in dental pulp, which comprises a small amount of the total tissue in dogs, could be measured using this technique by comparing the measured values with those for regional myocardial blood flow. Mean blood flow values were between 0.148 and 0.182 ml/min/g for dental pulp at four different sites and about 1.0 ml/min/g in regional myocardium. These values are comparable to those previously reported using radioactive microspheres. As nonradioactive colored microspheres safety permitted measurement of absolute PBF in dogs, this technique appears to be useful for research into microvascular blood flow in dental pulp.
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Affiliation(s)
- T Tanaka
- Department of Dental Anesthesiology, Tokyo Dental College, 1-2-2 Masago, Mihama-ku, Chiba 261-8502, Japan
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Heckmann JG, Hilz MJ, Hummel T, Popp M, Marthol H, Neundörfer B, Heckmann SM. Oral mucosal blood flow following dry ice stimulation in humans. Clin Auton Res 2000; 10:317-21. [PMID: 11198489 DOI: 10.1007/bf02281116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of the current pilot study was to establish a procedure that would allow the investigation of microcirculatory changes in the oral cavity. The authors studied the effects of painful stimulation using dry ice (CO2). To investigate potential regional differences in the change of blood flow, recordings were made for the tongue and at the mucosa of the hard palate, lip, and oral vestibule. The authors investigated 26 patients divided into groups of younger subjects (10 men, 3 women; age range 21-31 y) and older patients (2 men, 11 women; age range 54-74 y). Mucosal blood flow (mBF) was obtained at the hard palate, at the tip of the tongue, on the midline of the oral vestibule, and at the lip. Measurements were made during rest and for 2 minutes after application of dry ice for a 10-second duration, using a pencil-shaped apparatus. Blood pressure, heart rate, cutaneous blood flow, transcutaneous partial pressure of carbon dioxiode (PCO2) and partial pressure of oxygen (PO2) were recorded. Mucosal blood flow increased at all sites in response to application of dry ice (p <0.001), with peak flow at 0.5 minute to 1.5 minutes after onset of stimulation. During the 1.5 minutes to 2 minutes, blood flow decreased at all measurement sites with a tendency to return to baseline. Heart rate, blood pressure, pCO2, PO2, and cutaneous blood flow did not show significant changes. Overall, responses in older patients showed more variance when compared with younger patients. Stimulation by dry ice appears to be an effective, noninvasive, and tolerable means to investigate mucosal blood flow at different mucosal sites. Preliminary data indicate different levels of responsiveness to painful cold stimulation at different sites on the oral and perioral mucosa; particularly, mucosal blood flow response at the tongue was least pronounced. Therefore, assessment of stimulated mucosal blood flow appears to be a promising tool to investigate the pathophysiology of a number of neurologic symptoms, eg, the burning mouth syndrome.
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Affiliation(s)
- J G Heckmann
- Department of Neurology, University of Erlangen-Nuremberg, Germany.
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