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Rodrigues GA, Hizatugu R, Bronzato JD, de-Jesus-Soares A, Frozoni M. Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double-blind placebo-controlled clinical trial. Int Endod J 2024; 57:520-532. [PMID: 38279778 DOI: 10.1111/iej.14030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
AIM The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome. METHODOLOGY Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain. RESULTS There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (p < .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (p < .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (p > .05). There was no significant difference amongst the groups at 12 h (p > .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (p < .001). CONCLUSION The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.
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Affiliation(s)
| | - Ruy Hizatugu
- Department of Endodontics, Paulista Association of Dental Surgeons School of Dentistry, São Paulo, SP, Brazil
| | - Juliana Delatorre Bronzato
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Adriana de-Jesus-Soares
- Division of Endodontics, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
| | - Marcos Frozoni
- Department of Endodontics, São Leopoldo Mandic School of Dentistry, Campinas, SP, Brazil
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Wang Y, Xia R, Pericic TP, Bekkering GE, Hou L, Bala MM, Gao Y, Wu M, Gloss D, Siemieniuk RA, Fei Y, Rochwerg B, Guyatt G, Brignardello-Petersen R. How do network meta-analyses address intransitivity when assessing certainty of evidence: a systematic survey. BMJ Open 2023; 13:e075212. [PMID: 38035750 PMCID: PMC10689416 DOI: 10.1136/bmjopen-2023-075212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES To describe how systematic reviews with network meta-analyses (NMAs) that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) NMA approach addressed intransitivity when assessing certainty of evidence. DESIGN Systematic survey. DATA SOURCES Medline, Embase and Cochrane Database of Systematic Reviews from September 2014 to October 2022. ELIGIBILITY CRITERIA Systematic reviews of randomised controlled trials with aggregate data NMAs that used the GRADE NMA approach for assessing certainty of evidence. DATA EXTRACTION AND SYNTHESIS We documented how reviewers described methods for addressing intransitivity when assessing certainty of evidence, how often they rated down for intransitivity and their explanations for rating down. RESULTS Of the 268 eligible systematic reviews, 44.8% (120/268) mentioned intransitivity when describing methods for assessing the certainty of evidence. Of these, 28.3% (34/120) considered effect modifiers and from this subset, 67.6% (23/34) specified the effect modifiers; however, no systematic review noted how they chose the effect modifiers. 15.0% (18/120) mentioned looking for differences between the direct comparisons that inform the indirect estimate. No review specified a threshold for difference in effect modifiers between the direct comparisons that would lead to rating down for intransitivity. Reviewers noted rating down indirect evidence for intransitivity in 33.1% of systematic reviews, and noted intransitivity for network estimates in 23.0% of reviews. Authors provided an explanation for rating down for intransitivity in 59.6% (31/52) of the cases in which they rated down. Of the 31 in which they provided an explanation, 74.2% (23/31) noted they detected differences in effect modifiers and 67.7% (21/31) specified in what effect modifiers they detected differences. CONCLUSIONS A third of systematic reviews with NMAs using the GRADE approach rated down for intransitivity. Limitations in reporting of methods to address intransitivity proved considerable. Whether the problem is that reviewers neglected to address rating down for transitivity at all, or whether they did consider but not report, is not clear. At minimum systematic reviews with NMAs need to improve their reporting practices regarding intransitivity; it may well be that they need to improve their practice in transitivity assessment. How to best address intransitivity may remain unclear for many reviewers thus additional GRADE guidance providing practical instructions for addressing intransitivity may be desirable.
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Affiliation(s)
- Ying Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Ruyu Xia
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | | | | | - Liangying Hou
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Cracow, Poland
| | - Ya Gao
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, People's Republic of China
| | - Michael Wu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - David Gloss
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Reed Alexander Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Yutong Fei
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People's Republic of China
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Só GB, Silva IA, Weissheimer T, Lenzi TL, Só MVR, da Rosa RA. Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review. Clin Oral Investig 2023; 27:1885-1897. [PMID: 36988825 DOI: 10.1007/s00784-023-04979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The aim of the present umbrella review was to answer the following question: "Does the use of NSAIDs as premedication increase the efficacy of the standard inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?" MATERIAL AND METHODS Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were searched in six electronic databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Grey Literature Reports), without the restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. RESULTS Twelve systematic reviews were included. Only one did not perform a meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high. In general, the main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with acetaminophen, and ketorolac) increased the success rate of the inferior alveolar nerve block. CONCLUSIONS From the "very low" to "high"-quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenase pathways and block the synthesis of specific prostaglandins that complicate the mechanism of action of the anesthesia, improving its success rate. CLINICAL RELEVANCE Non-steroidal anti-inflammatory drugs can increase the success rate of the anesthetic technique of inferior alveolar nerve block efficacy in situations of mandibular molars with symptomatic irreversible pulpitis.
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Affiliation(s)
- Gabriel Barcelos Só
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Isadora Ames Silva
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Tathiane Larissa Lenzi
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil.
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Hegde V, Shanmugasundaram S, Shaikh S, Kulkarni V, Suresh N, Setzer FC, Nagendrababu V. Effect of Preoperative Oral Steroids in Comparison to Anti-inflammatory on Anesthetic Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis-A Double-blinded Randomized Clinical Trial. J Endod 2023; 49:354-361. [PMID: 36736586 DOI: 10.1016/j.joen.2023.01.007] [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: 12/14/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION This randomized double-blinded trial aimed to compare the anesthetic success of inferior alveolar nerve blocks (IANBs) with 2% lidocaine in mandibular molars with symptomatic irreversible pulpitis (SIP) after oral premedication of prednisolone, dexamethasone, and ketorolac with placebo. METHODS One hundred eighty-four patients diagnosed with SIP in mandibular molars randomly received prednisolone, dexamethasone, ketorolac, or placebo (n = 46 each) 60 minutes before the administration of an IANB. The access cavity preparation was initiated after successfully confirming lip numbness and two consecutive negative responses to electric pulp testing. The success of the anesthesia was clinically confirmed when pain was absent during the endodontic access or instrumentation. A one-way analysis of variance test was used to compare quantitative variables among the groups, and chi-square tests were used for comparing categorical variables. Binary logistic regression was performed to analyze the relationship of age, preoperative pain, and preoperative medications. RESULTS When premedicated with oral dexamethasone, ketorolac, prednisolone, and placebo, the success rate of IANB was determined to be 60.86 %, 65.21 %, 56.52 %, and 21.73 %, respectively. Compared to the placebo, the success rate of IANB was significantly increased when patients were premedicated with prednisolone, dexamethasone, or ketorolac. However, there were no statistically significant differences among prednisolone, dexamethasone, and ketorolac. One individual in the ketorolac group reported gastritis, whereas no adverse effects were reported in the dexamethasone or prednisolone groups. CONCLUSIONS Preoperative use of oral ketorolac, dexamethasone, or prednisolone may increase the anesthetic efficacy of IANB in mandibular molars with SIP.
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Affiliation(s)
- Vivek Hegde
- Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Srilatha Shanmugasundaram
- Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Samia Shaikh
- Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Vaidehi Kulkarni
- Department of Conservative Dentistry and Endodontics, M.A. Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Nandini Suresh
- Faculty of dentistry, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (MAHER), Tamilnadu, India
| | - Frank C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE.
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Rostami P, Eskandarinezhad M, Ghasemi N, Abdollahi A. Comparison of the success of inferior alveolar nerve anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine: A randomized controlled clinical trial. Dent Res J (Isfahan) 2023. [DOI: 10.4103/1735-3327.372661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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Modi J, Magee T, Rucker B, Flores H, Wise A, Kee M, Garrett M, Roberts W, Vassar M. An analysis of harms reporting in systematic reviews regarding ketorolac for management of perioperative pain. Br J Anaesth 2022; 129:767-775. [PMID: 36175184 DOI: 10.1016/j.bja.2022.08.007] [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: 06/27/2022] [Revised: 08/01/2022] [Accepted: 08/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Owing to the frequent perioperative use of ketorolac tromethamine and its ability to minimise postoperative opioid requirements, it is important to continually reassess harms associated with its use. Our primary objective was to investigate the extent of harms reporting in systematic reviews (SRs) on ketorolac for perioperative pain. METHODS In May 2022, we conducted a search of major databases, MEDLINE (PubMed and Ovid), Embase, Epistemonikos, and the Cochrane Database of Systematic Reviews to identify eligible SRs on ketorolac for perioperative pain. Screening and data extraction were performed in masked, duplicate fashion. A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) was used to appraise the methodological quality of included SRs. Corrected covered area (CCA) was calculated to determine overlap of primary studies between SR dyads. RESULTS A total of 28 SRs evaluating 630 primary studies met the inclusion criteria. Seven SRs (7/28, 25%) reported no harms and 17 SRs (17/28, 60.7%) reported ≤50% of harms items. A significant association was found between completeness of harms reporting and whether harms were specified as a primary outcome (P<0.001). No other associations were statistically significant. Regarding methodological quality, 22 SRs were appraised as 'critically low' (22/28, 78.6%), 5 as 'low' (5/28, 17.9%), and 1 as 'high' (1/28, 3.6%). One SR dyad had a CCA >50% but neither reported harms. CONCLUSIONS The extent of harms reporting in systematic reviews was inadequate. Given the importance that systematic reviews have on guiding perioperative decision-making, it is essential to improve the completeness of harms reporting.
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Affiliation(s)
- Jay Modi
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA.
| | - Trevor Magee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Brayden Rucker
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Holly Flores
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Audrey Wise
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Morgan Garrett
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Will Roberts
- Department of Anesthesiology, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA; Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Aggarwal V, Ahmad T, Singla M, Gupta A, Saatchi M, Hasija M, Meena B, Kumar U. Addition of 2 mg dexamethasone to improve the anesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine administered for inferior alveolar nerve block to patients with symptomatic irreversible pulpitis in the mandibular molars: a randomized double-blind clinical trial. J Dent Anesth Pain Med 2022; 22:305-314. [PMID: 35991360 PMCID: PMC9358268 DOI: 10.17245/jdapm.2022.22.4.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction This clinical trial aimed to evaluate the anesthetic effect of the addition of 2 mg (4 mg/ml) of dexamethasone to 2% lidocaine (plain or with 1:80,000 epinephrine). The solutions were injected for a primary inferior alveolar nerve block (IANB) to provide mandibular anesthesia for the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Methods In a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as "failed" anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as "no pain or faint/weak/mild pain" during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates. Results The 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, χ2 = 9.07, df = 2). Conclusions The addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.
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Affiliation(s)
- Vivek Aggarwal
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Tanveer Ahmad
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Mamta Singla
- Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, Haryana, India
| | - Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Rachna Dental College, Faridabaad, India
| | - Masoud Saatchi
- Department of Endodontics, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mukesh Hasija
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Babita Meena
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
| | - Umesh Kumar
- Division of Conservative Dentistry and Endodontics, Post Graduate Institute of Medical Sciences, Chandigarh, India
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Elnaghy AM, Elshazli AH, Badr AE, Elsaka SE. Effect of preoperative tramadol, ibuprofen, ibuprofen/acetaminophen on the anaesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. AUST ENDOD J 2022; 49:165-173. [PMID: 35759555 DOI: 10.1111/aej.12642] [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: 08/19/2021] [Revised: 05/09/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022]
Abstract
The purpose of this double-blind clinical trial was to compare the effect of preoperative tramadol 50 mg, tramadol 100 mg, ibuprofen 600 mg, ibuprofen 600 mg/acetaminophen 1000 mg or placebo 60 min before the administration of inferior alveolar nerve blocks (IANB) of mandibular teeth in patients experiencing symptomatic irreversible pulpitis (SIP). Two hundred and fifty emergency patients diagnosed with SIP were randomly divided into five groups and received medications. Endodontic access was begun 15 min after completion of the IANB, and all patients had profound lip numbness. The Heft-Parker visual analogue scale was used to evaluate pain. Premedication with tramadol 100 mg significantly increased the success rate to 62% than the other groups (p < 0.05). The success rates of ibuprofen, ibuprofen/acetaminophen and tramadol 50 mg groups were not significantly different (p > 0.05). Premedication with tramadol 100 mg enhanced the anaesthetic success of IANB in mandibular molars with SIP.
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Affiliation(s)
- Amr M Elnaghy
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Alaa H Elshazli
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Amany E Badr
- Department of Endodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Shaymaa E Elsaka
- Department of Dental Biomaterials, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.,Department of Restorative Dental Sciences, Vision Colleges, Jeddah, Saudi Arabia
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Iranmanesh P, Khazaei S, Nili M, Saatchi M, Aggarwal V, Kolahi J, Khademi A. Anesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta‐analysis and trial sequential analysis. Int Endod J 2022; 55:732-747. [DOI: 10.1111/iej.13746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Pedram Iranmanesh
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Saber Khazaei
- Department of Endodontics School of Dentistry Kermanshah University of Medical Sciences Kermanshah Iran
| | - Mahsa Nili
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Masoud Saatchi
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics Faculty of Dentistry Jamia Millia Islamia New Delhi India
| | - Jafar Kolahi
- Independent Research Scientist, Founder and Associate Editor of Dental Hypotheses Isfahan Iran
| | - Abbasali Khademi
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
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Parirokh M, Abbott P. Present status and future directions - Mechanisms and management of local anaesthetic failures. Int Endod J 2022; 55 Suppl 4:951-994. [PMID: 35119117 DOI: 10.1111/iej.13697] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.
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Affiliation(s)
- Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Paul Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
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Nagendrababu V, Faggion CM, Pulikkotil SJ, Alatta A, Dummer PMH. Methodological assessment and overall confidence in the results of systematic reviews with network meta-analyses in Endodontics. Int Endod J 2022; 55:393-404. [PMID: 35080025 DOI: 10.1111/iej.13693] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
AIM The aims of the study were to assess the methodological quality of systematic reviews with network meta-analyses (NMAs) in Endodontics using the "A MeaSurement Tool to Assess systematic Reviews" (AMSTAR 2) tool, and to evaluate the overall confidence in the results of the individual reviews included in the analysis. METHODOLOGY Systematic reviews with NMAs within the specialty of Endodontics published in English were identified from the PubMed, EbBSCOhost and SCOPUS databases from inception to July 2021. Two reviewers were involved independently in the selection of the reviews, data extraction, methodological quality assessment and overall confidence rating. Disagreements were resolved by discussion between the reviewers to achieve consensus; if disagreements persisted, a third reviewer made the final decision. The methodological quality of the included NMAs was appraised using the AMSTAR 2 checklist, which contains 16 items. The reviewers scored each item - 'Yes' - when the item was fully addressed, 'Partial Yes' - when the item was not fully addressed, or 'No' - when the item was not addressed. The overall confidence in the results of each review was classified as 'High', 'Moderate', 'Low' or 'Critically low' based on the criteria reported by the AMSTAR 2 developers. RESULTS Twelve systematic reviews with NMAs were included. All the NMAs adequately reported Item 1 ("Did the research questions and inclusion criteria for the review include the components of PICO?"), Item 8 ("Did the review authors describe the included studies in adequate detail?"), Item 9 ("Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review?") and Item 16 ("Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?") , whereas only one NMA reported Item 10 adequately ("Did the review authors report on the sources of funding for the studies included in the review?"). The overall confidence in the results of eight reviews was categorised as "Critically low", one review was "Low", two reviews were "Moderate" and one review was "High". CONCLUSION The overall confidence in the results for the majority of systematic reviews with NMAs in Endodontics was judged to be 'Critically low' as their methodological quality was below the necessary standard. AMSTAR 2 and PRISMA for NMA guidelines are available to guide authors to produce high quality systematic reviews with NMAs and for Editors and peer-reviewers when assessing submissions to journals.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Clovis M Faggion
- Faculty of Dentistry, Department of Periodontology and Operative Dentistry, University Hospital Münster, Münster, Germany
| | | | - Alaa Alatta
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Kumar U, Rajput A, Rani N, Parmar P, Kaur A, Aggarwal V. Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial. J Dent Anesth Pain Med 2021; 21:441-449. [PMID: 34703893 PMCID: PMC8520841 DOI: 10.17245/jdapm.2021.21.5.441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/28/2021] [Accepted: 09/14/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp. METHODS One hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment. RESULTS The rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups. CONCLUSION Preoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.
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Affiliation(s)
- Umesh Kumar
- Unit of Conservative Dentistry & Endodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Akhil Rajput
- Department of Dentistry, BSA medical college and hospital, Rohini, Delhi, India
| | - Nidhi Rani
- Unit of Conservative Dentistry & Endodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Pragnesh Parmar
- Unit of Conservative Dentistry & Endodontics, Oral Health Sciences Centre, Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Amandeep Kaur
- Department of Conservative Dentistry & Endodontics, Dental College, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Vivek Aggarwal
- Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
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Khater AGA, Al-Hamed FS, Safwat EM, Hamouda MMA, Shehata MSA, Scarano A. EFFICACY OF HEMOSTATIC AGENTS IN ENDODONTIC SURGERY: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS. J Evid Based Dent Pract 2021; 21:101540. [PMID: 34479672 DOI: 10.1016/j.jebdp.2021.101540] [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: 01/14/2021] [Revised: 02/16/2021] [Accepted: 02/20/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Adequate hemostasis is a critical step in endodontic surgery. It facilitates the procedure and affects the success and prognosis of the operation. This systematic review and network meta-analysis (NMA) aimed to systematically assess the efficacy of hemostatic agents in endodontic surgery and to identify the most effective ones. METHODS PubMed, Scopus, Embase, Cochrane Library, Web of Science, ProQuest, and EBSCOhost databases were searched up to December 2020. We included randomized controlled trials (RCTs) evaluating the efficacy of different hemostatic measures in endodontic surgery, and their risk of bias was assessed using Cochrane's randomized trial tool (RoB 2.0). Frequentist network meta-analysis was conducted, with Odds Ratios and 95% confidence intervals (OR, 95% CI) as effect estimates using the "netmeta" package in R. The quality of evidence was assessed using the CINeMA approach. RESULTS Six RCTs involving 353 patients (mean age 48.12 y) were included. NMA revealed that aluminum chloride achieved higher hemostatic efficacy than epinephrine (OR = 2.55, 95% CI [1.41, 4.64]), while there was non-significant difference when compared with PTFE strips + epinephrine (OR = 1.00, 95% CI [0.35, 2.90]), electrocauterization (OR = 2.67, 95% CI [0.84, 8.46]), or ferric sulfate (OR = 8.65, 95% CI [0.31, 240.92]). Of all hemostatic agents, aluminum chloride ranked first in control bleeding during endodontic surgery (P-score = 0.84), followed by PTFE strips + epinephrine (P-score = 0.80), electrocauterization (P-score = 0.34), epinephrine (P-score = 0.34), ferric sulfate (P-score = 0.18). The quality of evidence was very low. CONCLUSIONS Based on the limited data, aluminum chloride provides better hemostasis than epinephrine, while there was no significant difference between the remaining hemostatic agents used in endodontic surgery, which could help clinicians choose the hemostatic agent that achieves adequate hemostasis. achieve adequate hemostasis. Given insufficient evidence, future RCTs addressing this evidence gap are required.
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Affiliation(s)
- Ahmad G A Khater
- Faculty of Oral and Dental Medicine, Ahram Canadian University, Egypt..
| | - Faez Saleh Al-Hamed
- Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada
| | - Engie M Safwat
- Restorative and Dental Materials Department, National Research Centre, Egypt
| | | | | | - Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), University of Chieti-Pescara, Chieti, Italy; Research staff at Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD, USA
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14
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Aksoy F, Ege B, Tosun S. The effect of pre-operative submucosal administration of dexamethasone, tramadol, articaine on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: A randomized, double-blind placebo-controlled clinical trial. Int Endod J 2021; 54:1982-1992. [PMID: 34347895 DOI: 10.1111/iej.13604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
AIM To establish the effects of submucosal tramadol, dexamethasone and articaine on the success of inferior alveolar nerve blocks (IANB) during root canal treatment of mandibular molars with symptomatic irreversible pulpitis (SIP). METHODOLOGY In this randomized double-blind, controlled clinical trial, 120 patients with the diagnosis of SIP in their mandibular first or second molars were included and randomly divided into four groups (n = 30). The control group received normal saline and three experimental groups received a single dose of dexamethasone (8 mg/2 mL), or tramadol (100 mg/2 mL) or articaine (4% / 2 mL). The pre-operative pain levels of the patients were measured with the Heft-Parker visual analogue scale (HP VAS). All patients received standard IANB of 4% articaine with 1:200000 epinephrine. Following the observation of lip numbness, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars. After 15 min, standard root canal treatment was initiated, and the pain intensity levels recorded from the access cavity preparation to pulp extirpation were measured with HP VAS. The duration of the anaesthesia was also evaluated. The experimental groups were compared using one-way ANOVA or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using the Tukey Multiple Comparison test. The Chi-square test was used to compare the categorical variables. RESULTS The submucosal administration of articaine significantly increased the success rate to 63% in comparison with the control group that received submucosal saline (p < .05). The success rate of pulpal anaesthesia was 37% in the control group, 57% in the tramadol group and 47% in the dexamethasone group, with no significant difference in the success rate among these groups. In the dexamethasone group, the duration of the anaesthetic effect of IANB was significantly longer than those in the other groups (p < .001). CONCLUSIONS In patients with SIP, pre-operative submucosal administration of articaine increased the success rate of IANB, while administration of dexamethasone increased the duration of anaesthesia. These agents can be used in cases where effective anaesthesia cannot be obtained during root canal treatments.
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Affiliation(s)
- Fatih Aksoy
- Department of Endodontics, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Bilal Ege
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Samet Tosun
- Department of Endodontics, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
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Karobari MI, Khijmatgar S, Bhandary R, Krishna Nayak US, Del Fabbro M, Horn R, Marya A. A Multicultural Demographic Study to Analyze Antibiotic Prescription Practices and the Need for Continuing Education in Dentistry. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5599724. [PMID: 34327231 PMCID: PMC8310454 DOI: 10.1155/2021/5599724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/12/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The objective of the study was to understand and analyze the prescription patterns of dentists across various demographic locations for managing oral infections and pain with antibiotics and explore the evidence-based practices by clinicians as well as the need for further education. Materials and methods. This cross-sectional study was carried out using an online questionnaire framed to explore the knowledge, attitude, and practices among dentists with varying levels of experience and qualifications, regarding antimicrobial prescription. The questions were validated from previous published studies that explored the knowledge, attitude, and practice (KAP) with respect to antimicrobial prescription. In total, N = 300 of dentists from four different countries responded to the online questionnaire out of which 53% were specialists while 47% were general dentists. After data collection, descriptive analysis was carried out along with a one-sided hypothesis test to depict the power of the sample. RESULTS It was seen from the results of the study that the first-choice antibiotics for 67.8% of dentists were found to be the β-lactam group while sulfonamides and tetracyclines at 20% were the second most prescribed group. Another important finding was that 45.6% of dentists ignored hypersensitivity testing before prescription of antibiotics even though 83.3% of the total dentists interviewed were aware of the increase in antibiotic resistance. CONCLUSION In conclusion, the dentists are partially aware of the guidelines but need further training and education on antimicrobial prescription that enables evidence-based decision-making for better practices and outcomes.
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Affiliation(s)
- Mohmed Isaqali Karobari
- Conservative Dentistry Unit, School of Dental Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia
- Department of Conservative Dentistry & Endodontics, Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai 600077, Tamil Nadu, India
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy
- Nitte (Deemed to Be University), AB Shetty Memorial Institute of Dental Sciences, Department of Oral Biology and Genomic Studies, Mangalore, India
| | - Rahul Bhandary
- Nitte (Deemed to Be University), AB Shetty Memorial Institute of Dental Sciences, Department of Periodontics, Mangalore, India
| | - U. S. Krishna Nayak
- Nitte (Deemed to Be University), AB Shetty Memorial Institute of Dental Sciences, Department of Orthodontics, Mangalore, India
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Italy
- IRCCS Galeazzi Orthopedic Institute, Via Riccardo Galeazzi, 4, 20161 Milano, Italy
| | - Rithvitou Horn
- Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - Anand Marya
- Department of Orthodontics, Faculty of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
- Department of Orthodontics, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
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Kaushik M, Mehra N, Sharma R, Moturi K, Podugu UK, George A. Comparing the Efficacy of Twin Mix and Lidocaine for Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis. Anesth Prog 2021; 67:207-213. [PMID: 33393600 DOI: 10.2344/anpr-67-03-11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/20/2020] [Indexed: 11/11/2022] Open
Abstract
This randomized, active-controlled, double-blind, prospective clinical trial evaluated the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine versus an admixture of 2% lidocaine with 1:200,000 epinephrine and 1 mL of 4 mg dexamethasone (Twin mix) for inferior alveolar nerve blocks (IANBs) in patients with symptomatic irreversible pulpitis (SIP) of the mandibular molars. Seventy-eight patients with SIP of mandibular molars were randomly allocated to the 2 groups of 39 subjects. All patients were required to have profound lip numbness within 10 minutes of local anesthetic deposition. The efficacy of pulpal anesthesia was confirmed by absence of pain or mild pain (Heft-Parker visual analogue scale ≤54 mm) during access cavity preparation and placement of glide path files. The collected data were subjected to independent t test, chi-square test, and Fisher exact test using SPSS software version 20.0 at a significance level of 0.05. IANB success rates for the lidocaine group and the Twin mix group was 66% and 68% respectively, which was not a statistically significant difference (p > .05). This study demonstrated that the anesthetic efficacy of Twin mix was equivalent to 2% lidocaine for IANBs in teeth with SIP.
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Affiliation(s)
- Mamta Kaushik
- Professor and Head, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, India
| | - Neha Mehra
- Reader, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, India
| | | | - Kishore Moturi
- Professor and Head, Department of Oral and Maxillofacial Surgery, Vishnu Dental College, Bhimavaram, India
| | - Uday Kumar Podugu
- Senior Lecturer, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, India
| | - Alvin George
- Ex-PG student, Department of Conservative Dentistry and Endodontics, Army College of Dental Sciences, Secunderabad, India
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Jamil FA, Asmael HM, Al-Jarsha MY. The success of using 2% lidocaine in pain removal during extraction of mandibular premolars: a prospective clinical study. BMC Oral Health 2020; 20:239. [PMID: 32867733 PMCID: PMC7457358 DOI: 10.1186/s12903-020-01228-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the anesthetic effectiveness of a buccal infiltration technique combined with local massage (using 2% lidocaine) in the extraction of mandibular premolars to be utilized as an alternative to the conventional inferior alveolar nerve block. METHODS Patients eligible included any subject with a clinical indication for tooth extraction of the mandibular 1st or 2nd premolars. All patients were anesthetized buccally by local infiltration technique followed by an external pressure applied for 1 min directly over the injection area. In each case, another local injection was given lingually. All operations were started at approximately 5 min after the buccal injection. The collected data included age, gender, pain perception and its intensity during treatment at three checkpoints, apical tenderness, and the type of extraction. Any associated complications or difficulties were also recorded. Then the results were analyzed and interpreted using appropriate statistical tests. The significance level was set at P ≤ 0.05. RESULTS A total of 247 cases (1st premolar, n = 119; 2nd premolar, n = 128), predominantly male, were included. In 95% of study sample, the patients were satisfied with the dental extraction without any pain. However, in 5% of cases, pain was reported at the stage of tooth removal. Apical tenderness was found to be present in 11% of the total cases. Three teeth required surgical removal. Upon analysis, no significant differences in the success rates were detected between the 2 premolar groups or amongst the various age groups. Minor and transient side effects were reported in this study. CONCLUSION The technique is simple and effective as well. It might be considered as an alternative anesthetic injection to the inferior alveolar nerve block for dental extraction of the mandibular premolars.
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Affiliation(s)
- Firas A Jamil
- Department of Oral & Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Al Moadham, P.O.Box 1417, Baghdad, Iraq.
| | - Huda Moutaz Asmael
- Department of Oral & Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Al Moadham, P.O.Box 1417, Baghdad, Iraq
| | - Mohammed Yahya Al-Jarsha
- Department of Oral & Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Al Moadham, P.O.Box 1417, Baghdad, Iraq
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Nagendrababu V, Aly Ahmed HM, Pulikkotil SJ, Veettil SK, Dharmarajan L, Setzer FC. Anesthetic Efficacy of Gow-Gates, Vazirani-Akinosi, and Mental Incisive Nerve Blocks for Treatment of Symptomatic Irreversible Pulpitis: A Systematic Review and Meta-analysis with Trial Sequential Analysis. J Endod 2020; 45:1175-1183.e3. [PMID: 31551112 DOI: 10.1016/j.joen.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/15/2019] [Accepted: 06/24/2019] [Indexed: 01/20/2023]
Abstract
INTRODUCTION This systematic review compared the anesthetic efficacy between Gow-Gates (GG), Vazirani-Akinosi (VA), and mental incisive (MI) nerve blocks (NBs) with inferior alveolar nerve blocks (IANBs) in mandibular teeth with irreversible pulpitis using meta-analysis and trial sequential analysis (TSA). METHODS Studies were identified from 4 electronic databases up to June 2019. Randomized clinical trials (RCTs) comparing the anesthetic success rate of GG, VA, and MI NBs with IANBs in mandibular premolars and molars with irreversible pulpitis were included. The quality of selected RCTs was appraised using the revised Cochrane risk of bias tool. Random-effects meta-analyses of risk ratio (RR) and 95% confidence intervals (CIs) were calculated, and random errors were evaluated by TSA. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS Five RCTs were included; 2 of them were classified as low risk of bias. No significant difference was observed in the anesthesia success rate compared between GG and IA NBs (RR = 1.10; 95% CI, 0.82-1.48; I2 = 0%). Similarly, no difference was evident between MINB and IANB (RR = 1.15; 95% CI, 0.97-1.36; I2 = 0%). Overall, the cumulative success rates for the 3 anesthetic techniques were low. TSA showed a lack of firm evidence for the results of the meta-analysis between GG NB and IANB. The Grading of Recommendations, Assessment, Development and Evaluation approach evaluation showed that the evidence was of moderate quality for GG NB and IANB compared with low quality for MI and IA NBs. Because only 1 study was available comparing VA NB and IANB, a meta-analysis was not performed. The adverse effect associated with MI NB was swelling, whereas it was prolonged numbness for IANB. CONCLUSIONS GG NB and IANB showed similar anesthetic efficacy compared with IANB in mandibular teeth with irreversible pulpitis. However, the success rates for each technique indicate the need for supplemental anesthesia. Further well-designed RCTs evaluating different anesthetic techniques with and without supplemental injection are required to provide stronger evidence.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
| | - Hany Mohamed Aly Ahmed
- Department of Restorative Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia
| | - Shaju Jacob Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Sajesh K Veettil
- School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Lalli Dharmarajan
- School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - Frank C Setzer
- Department of Endodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis. J Endod 2019; 45:1435-1464.e10. [DOI: 10.1016/j.joen.2019.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022]
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Topçuoğlu HS, Arslan H, Topçuoğlu G, Demirbuga S. The Effect of Cryotherapy Application on the Success Rate of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis. J Endod 2019; 45:965-969. [DOI: 10.1016/j.joen.2019.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/12/2019] [Accepted: 05/01/2019] [Indexed: 11/16/2022]
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21
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Nagendrababu V, Duncan HF, Tsesis I, Sathorn C, Pulikkotil SJ, Dharmarajan L, Dummer PMH. PRISMA for abstracts: best practice for reporting abstracts of systematic reviews in Endodontology. Int Endod J 2019; 52:1096-1107. [PMID: 30891775 DOI: 10.1111/iej.13118] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 02/03/2023]
Abstract
An abstract is a brief overview of a scientific, clinical or review manuscript as well as a stand-alone summary of a conference abstract. Scientists, clinician-scientists and clinicians rely on the summary information provided in the abstracts of systematic reviews to assist in subsequent clinical decision-making. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Abstracts checklist was developed to improve the quality, accuracy and completeness of abstracts associated with systematic reviews and meta-analyses. The PRISMA for Abstracts checklist provides a framework for authors to follow, which helps them provide in the abstract the key information from the systematic review that is required by stakeholders. The PRISMA for Abstracts checklist contains 12 items (title, objectives, eligibility criteria, information sources, risk of bias, included studies, synthesis of results, description of the effect, strength and limitations, interpretation, funding and systematic review registration) under six sections (title, background, methods, results, discussion, other). The current article highlights the relevance and importance of the items in the PRISMA for Abstracts checklist to the specialty of Endodontology, while offering explanations and specific examples to assist authors when writing abstracts for systematic reviews when reported in manuscripts or submitted to conferences. Strict adherence to the PRISMA for Abstracts checklist by authors, reviewers, and journal editors will result in the consistent publication of high-quality abstracts within Endodontology. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- V Nagendrababu
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - H F Duncan
- Division of Restorative Dentistry, Dublin Dental University Hospital, Trinity College Dublin, Dublin, Ireland
| | - I Tsesis
- Department of Endodontology, Goldschlager School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Sathorn
- School of Dentistry, La Trobe University, Melbourne, Vic., Australia
| | - S J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - L Dharmarajan
- Department of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Maran BM, Ziegelmann PK, Burey A, de Paris Matos T, Loguercio AD, Reis A. Different light-activation systems associated with dental bleaching: a systematic review and a network meta-analysis. Clin Oral Investig 2019; 23:1499-1512. [PMID: 30767069 DOI: 10.1007/s00784-019-02835-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES A systematic review and a network meta-analysis were performed to answer the following research question: "Is there any light-activation protocol capable of improving color change efficacy when associated with an in-office bleaching gel in adults?" MATERIAL AND METHODS A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without date and/or language restrictions in April 23, 2017 (updated on March 30, 2018). IADR abstracts (1990-2018), unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials conducted in adults that included at least one group treated with in-office dental bleaching with light activation were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A random-effects Bayesian-mixed treatment comparison (MTC) model was used to combine light-activated versus light-free in-office bleaching with direct light-free comparison trials. A meta-analysis with independent analysis (high- and low-concentrate hydrogen peroxide [HP]) was conducted for color change (∆E*, ∆SGU). RESULTS After the removal of duplicates, title, and abstract screening, 28 studies remained. Nine were considered to be at a low RoB, five were at a high RoB, and the remaining were at an unclear RoB. The MTC analysis showed no significant difference in color change (ΔE* and ΔSGU) between light-activation protocols and light-free in-office bleaching, regardless of the HP concentration in the efficacy of the bleaching. CONCLUSION No type of light-activated in-office bleaching was superior to light-free in-office bleaching for both high- and low-concentrate in-office bleaching gels (PROSPERO-CRD42017078743). CLINICAL RELEVANCE Although many times dental professionals use "laser whitening" as a form of marketing, this study confirmed that no type of light-activation for in-office bleaching can improve the bleaching efficacy.
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Affiliation(s)
- Bianca Medeiros Maran
- Department of Restorative Dentistry, School of Dentistry, State University of Western Paraná, Rua Engenharia, 464 - Universitário, Cascavel, Paraná, 85819-190, Brazil
| | - Patrícia K Ziegelmann
- Statistics Department and Post-Graduation Program in Epidemiology, Federal University of Rio Grande do Sul, Rua Paulo Gama, 110 - Farroupilha, Porto Alegre, Rio Grande do Sul, 90040-060, Brazil
| | - Adrieli Burey
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Rua Carlos Cavalcanti, 4748, BlocoM, Sala 64-A, Uvaranas, Ponta Grossa, Paraná, 84030-900, Brazil
| | - Thalita de Paris Matos
- Department of Restorative Dentistry, School of Dentistry, State University of Ponta Grossa, Rua Carlos Cavalcanti, 4748, BlocoM, Sala 64-A, Uvaranas, Ponta Grossa, Paraná, 84030-900, Brazil
| | - Alessandro D Loguercio
- Department of Restorative Dentistry, State University of Ponta Grossa, Rua Carlos Cavalcanti, 4748, Bloco M, Sala 64-A, Uvaranas, Ponta Grossa, Paraná, 84030-900, Brazil
| | - Alessandra Reis
- Department of Restorative Dentistry, State University of Ponta Grossa, Rua Carlos Cavalcanti, 4748, Bloco M, Sala 64-A, Uvaranas, Ponta Grossa, Paraná, 84030-900, Brazil.
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Nagendrababu V, Pulikkotil SJ, Suresh A, Veettil SK, Bhatia S, Setzer FC. Efficacy of local anaesthetic solutions on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a systematic review and network meta‐analysis of randomized clinical trials. Int Endod J 2019; 52:779-789. [DOI: 10.1111/iej.13072] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 01/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- V. Nagendrababu
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - S. J. Pulikkotil
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - A. Suresh
- Department of Conservative Dentistry and Endodontics Penang International Dental College Butterworth Penang Malaysia
| | - S. K. Veettil
- Department of Pharmacy Practice School of Pharmacy International Medical University Kuala Lumpur Malaysia
| | - S. Bhatia
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - F. C. Setzer
- Department of Endodontics School of Dental Medicine University of Pennsylvania Philadelphia PA USA
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Effect of Premedication on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Systematic Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6587429. [PMID: 30881994 PMCID: PMC6387710 DOI: 10.1155/2019/6587429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/24/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022]
Abstract
Background Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth. Methods A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary. Results Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis. Conclusion Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.
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