Intraosseous anesthesia in symptomatic irreversible pulpitis: Impact of bone thickness on perception and duration of pain

Expert consensus on digital guided therapy for endodontic diseases

Digital guided therapy (DGT) has been advocated as a contemporary computer-aided technique for treating endodontic diseases in recent decades. The concept of DGT for endodontic diseases is categorized into static guided endodontics (SGE), necessitating a meticulously designed template, and dynamic guided endodontics (DGE), which utilizes an optical triangulation tracking system. Based on cone-beam computed tomography (CBCT) images superimposed with or without oral scan (OS) data, a virtual template is crafted through software and subsequently translated into a 3-dimensional (3D) printing for SGE, while the system guides the drilling path with a real-time navigation in DGE. DGT was reported to resolve a series of challenging endodontic cases, including teeth with pulp obliteration, teeth with anatomical abnormalities, teeth requiring retreatment, posterior teeth needing endodontic microsurgery, and tooth autotransplantation. Case reports and basic researches all demonstrate that DGT stand as a precise, time-saving, and minimally invasive approach in contrast to conventional freehand method. This expert consensus mainly introduces the case selection, general workflow, evaluation, and impact factor of DGT, which could provide an alternative working strategy in endodontic treatment.

Optimised Implant Selection Using Digital Volume Tomography (DVT) Osteodensitometry

Purpose

The density of the jaw bone has an inhomogeneous distribution and, even within partial volumes, varies more or less strongly from the size of typical implants. Consequently, the primary stability of implants using conventional techniques can only ever be determined postimplantation. The aim of the present case report is to present digital volume tomography (DVT) osteodensitometry as a procedure for assessing the primary stability preimplantation and to evaluate its benefits.

Methods

An orthopantomogram (OPT) and vertical sections, including bone density measurement, were obtained from a DVT in the course of preimplantological diagnosis. Conventional implant planning and densitometric simulation were performed on this basis.

Results

Densitometric simulation enabled assessment of the bone density at the interface to the implant body preimplantation. This procedure provides not only an overall value (averaged density) but also allocation of bone areas with different densities to the adjacent areas on the implant surface. This then allows the implant with the best possible macroscopic geometry and optimum position to be selected, with the aim of maximising primary stability. In the present case, the maximum torques during insertion confirmed the densitometric values recorded in advance.

Conclusion

DVT osteodensitometry enables selection of an implant optimised to bone density distribution. At the same time, the point at which loading occurs can already be defined at the planning stage, thanks to the predictable primary stability. A standard integration of DVT osteodensitometry in the algorithms of implant planning software thus seems desirable.

Present status and future directions - Mechanisms and management of local anaesthetic failures

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.