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PubMed2005

A comparison of articaine and lidocaine for inferior alveolar nerve blocks.

The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks. Using a crossover design, inferior alveolar nerve blocks were randomly administered, in a double-blind manner, using 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine, at two separate appointments, to 57 subjects. A pulp tester was used to test for anesthesia, in 4-min cycles for 60 min, of the molars, premolars, central, and lateral incisors. Anesthesia was considered successful when two consecutive 80 readings were obtained within 15 min and the 80 reading was continuously sustained for 60 min. Using the articaine solution, successful pulpal anesthesia ranged from 4 to 54% from the central incisor to the second molar. Using the lidocaine solution, successful pulpal anesthesia ranged from 2 to 48%. There was no significant difference (p > 0.05) between the articaine and lidocaine solutions. We concluded that 4% articaine with 1:100,000 epinephrine was similar to 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks.

Adult↗

PubMed1999

A lesion of endodontic origin misdiagnosed as a globulomaxillary cyst.

This report presents a case of a lesion originating from a pulpless central incisor misdiagnosed as a globulomaxillary cyst. The initial diagnosis of globulomaxillary cyst was made solely from radiographs by observing an almond-shaped radiolucency between the lateral incisor and cuspid. No pulp testing was performed before surgical removal of the lesion. The final diagnosis of an endodontic lesion caused solely by a pulpless central incisor was complicated by the initial lack of a pulpal response from the lateral incisor next to the surgical site. By delaying the start of endodontic treatment, pulp sensibility returned to the lateral incisor and the diagnosis of an endodontic lesion caused only by a pulpless central incisor was confirmed.

Adolescent↗

PubMed1999

A study of the diagnostic location of pulpitis.

OBJECTIVE: To demonstrate the involvement of the root pulp in pulpitis, which may help in selecting a desirable therapy. METHODS: Symptoms of 158 cases of caries-caused pulpitis were recorded and histologic diagnosis was made. The location of lesions was determined, and contributive rates and diagnostic indices were developed on the basis of the characteristics of various symptoms. RESULTS: Computer analysis provided the following contributive rates in terms of symptoms: pain upon probing of the tooth (14.72%), duration of spontaneous pain of the diseased tooth (13.07%), intensified pain by cold stimulation (8.25%), and intensified pain by cold test during treatment (4.05%). The exact diagnostic rate was 76% on the basis of the above four contributive rates to demonstrate the involvement of the root of the tooth, while the dentist could only make a correct diagnosis 56.72% of the time. CONCLUSION: The four symptoms with the highest contributive rates improved the diagnostic rate of location, while other symptoms were excluded because of their uncertain contributive rates. As a result, the process of obtaining information was simplified. The tables of diagnostic indices are of value in clinical application as they are easy to learn and understand.

Bayes Theorem↗

PubMed2005

Reduction of excessive electrical stimulus during electric pulp testing.

AIM: To measure excessive electrical stimulus time during pulp testing via electromyography (EMG) in the anterior belly of the digastric muscle, voice and finger movement, and to determine whether excessive stimulus time could be attenuated by a specially designed automatic circuit breaker on the basis of the EMG signal. METHODOLOGY: The signals from three human responses (EMG, finger and voice), induced by the Digitest (Parkell Inc., Farmingdale, NY, USA) electric pulp tester, were captured using a MP100 (Biopac System Inc., Goleta, CA, USA) and recorded into a personal computer. The excessive stimulus time from activation to the end of electrical stimulation was calculated for each of these three responses. The automatic circuit breaker was designed to disconnect the electrical output of the electric pulp testing (EPT) unit immediately after detecting the preset EMG level (100 mV). Each of the right central incisors and first premolars of 23 healthy individuals (16 males and seven females) was tested to see whether there was a difference in tooth type or gender. This was analysed by Wilcoxon signed rank test (nonparametric paired t-test) and Mann-Whitney test (nonparametric independent t-test), respectively. RESULTS: Amongst three human responses, the electrical onset occurred in the order of EMG, finger and voice. Excessive stimulus time was 347.8 +/- 78.3 ms when observed by the EMG, 264.9 +/- 63.9 ms when observed by finger span and 229.4 +/- 41.8 ms when observed by the voice, which were all found to be significantly different (P < 0.05). When the automatic circuit breaker was used, the excessive stimulus time was 61.0 ms, which was 286.8 ms shorter than that measured from EMG onset when using the conventional EPT. CONCLUSIONS: When the automatic circuit breaker was used, excessive stimulus time on the basis of EMG was attenuated on average by 286.8 ms.

Adult↗

PubMed1993

Tooth discoloration and resolution following a luxation injury: significance of blood pigment in dentin to laser Doppler flowmetry readings.

Discoloration of teeth is common sequel of dental trauma and is often taken as a sign of irreversible pulpal degeneration, particularly if the crown becomes gray or blue-gray in appearance. If a viable blood supply remains or revascularization occurs following trauma to teeth, removal of blood pigments by normal biologic processes can occur. The assessment of blood flow with laser Doppler flowmetry is an additional diagnostic aid following dental injuries. This technology has been used to monitor the clinical progress of two central incisors that had been palatally luxated in a sporting accident. Color changes were observed and were correlated with symptomatic and radiographic evaluation, sensibility tests, and laser Doppler readings. The results of these examinations indicated that the blood pigment within a discolored tooth crown interfered with laser light transmission. The limitation of this new technology in the assessment of teeth discolored following trauma is significant. Visual radiographic and symptomatic assessment remain as the principal diagnostic criteria at the present time.

Adolescent↗

PubMed1992

Reproducibility of data from a hand-held digital pulp tester used on teeth and oral soft tissue.

Controlled studies of the reproducibility of data from electronic pulp testing instruments are limited and contain few statistical analyses. The reproducibility of these readings is important if the instrument is to be used for determining differences in sensitivity. Twenty human subjects (16 male) were used in this study. One incisor, one premolar, one molar tooth with small or no restorations, and two gingival soft tissue positions from each upper and lower arch of each subject were stimulated with the Analytic Technology vitality scanner. This procedure was repeated twice with a 5-minute rest between each trial, for a total of three trials. Each subject was then seen again after a period of at least 3 days, at which time the trials were repeated. The collected data were grouped by trial, tooth position, and day. Paired t test analysis of both the absolute difference between any two trials on the same day and the average of the absolute differences between corresponding trials on days 1 and 2 showed no statistically significant differences (p greater than 0.05). Accommodation to the stimulus was evaluated by examining differences in the mean values between the three same-day trials. The Analytic Technology vitality scanner was found to be reproducible both for consecutive same-day trials and for corresponding trials on different days. No same-day trends in meter readings were noted.

Adult↗

PubMed2005

Onset and duration periods of articaine and lidocaine on maxillary infiltration.

OBJECTIVES: The aim of this study was to compare the onset and duration of pulpal anesthesia by maxillary infiltration using 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. METHOD AND MATERIALS: Twenty healthy patients randomly received 1.8 mL of one of the three local anesthetics during operative dentistry procedures of low complexity on three maxillary posterior teeth. Onset and duration were determined using an electric pulp tester. RESULTS: The mean values for pulpal onset were 2.8, 1.6, and 1.4 minutes and for pulpal duration were 39.2, 56.7, and 66.3 minutes, respectively, for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. Statistical analysis by the Kruskal-Wallis nonparametric test showed significant differences with better results (shorter onset and longer duration periods) for both articaine solutions compared with the lidocaine solution. Although 4% articaine with 1:100,000 epinephrine clinically presented the shortest onset and the longest duration periods, there was no statistically significant difference between the articaine solutions. CONCLUSION: Both articaine solutions produced shorter onset and longer duration of pulpal anesthesia by maxillary infiltration than the lidocaine solution did. Statistical analysis did not confirm better clinical results of 4% articaine with 1:100,000 epinephrine than with 4% articaine with 1:200,000 epinephrine.

Adolescent↗

PubMed1994

Adult pulpal diagnosis. I. Evaluation of the positive and negative responses to cold and electrical pulp tests.

This study investigated the positive and negative responses of 1488 teeth in 60 patients to two electric pulp testers and a cold thermal pulp test. Three subgroups of known pulpless or pulpally diseased teeth (teeth receiving root canal therapy, teeth with root canal fillings, or teeth with confirmed associated apical radiolucencies) were identified and their responses evaluated separately. Testing was performed on two tooth surfaces, the facio-occlusal and faciocervical, and on all restorations. The gingival tissue of each patient also was tested using both electrical tests. The primary findings were: (a) teeth not responding to cold and either not responding or responding at readings greater than the tissue response to electrical had a high probability of being in the known pulpless or pulpally diseased subgroups; (b) the only false positive responses to cold in the three subgroups were in multirooted teeth with probable vital tissue remaining in at least one canal; and (c) in the three subgroups, if the false positive responses to electrical that responded at levels higher than the patient's tissue response were considered to be negative responses, the difference in false positives between cold and electrical became not statistically significant (p = 0.07).

Adult↗

PubMed2006

Pulpal anaesthesia for mandibular permanent first molar teeth: a double-blind randomized cross-over trial comparing buccal and buccal plus lingual infiltration injections in volunteers.

AIM: To compare the efficacy of buccal and buccal plus lingual infiltration anaesthesia for permanent mandibular first molars. METHODOLOGY: Thirty one healthy adult volunteers received each of the following methods of anaesthesia for a mandibular first molar tooth in a randomised order, 1) Buccal infiltration of 1.8 mL and needle penetration lingually. 2) Buccal infiltration of 0.9 mL, plus lingual infiltration of 0.9 mL. Two percent lidocaine with 1:100,000 epinephrine was used. Electrical pulp testing was performed before, and every 2 minutes for 30 minutes after injection. A successful outcome was recorded as the absence of pulp sensation on two or more consecutive maximal pulp tester stimulations (80 microA). Injection discomfort was assessed using visual analogue scales. Data were compared with McNemar and Wilcoxon Signed Ranks tests. RESULTS: Buccal infiltration was successful in 38.7% of cases compared to 32.3% after combined infiltrations; the difference was not significant (P = 0.63). Buccal infiltration produced more episodes of no response to maximum stimulation than buccal and lingual infiltrations (129 and 114 respectively), this difference was not significant (P = 0.11). Peak anaesthetic effect occurred around 10-14 minutes after injection. There was no difference in injection discomfort between buccal injections of 0.9 mL and 1.8 mL of solution (P = 0.90). Lingual injection was more uncomfortable than lingual penetration (P = O.O02). CONCLUSIONS: Buccal and buccal plus lingual infiltrations did not differ in their efficacy in producing anaesthesia of permanent first molar teeth.

Adult↗

PubMed1990

[Vitality tests of the tooth pulp using laser Doppler flowmetry].

Laser-Doppler flowmetry allows a non-invasive assessment of the microcirculation in circumscribed tissue areas. However, measurements in intact human teeth prove to be extensive, as far as instrumental equipment and time requirements are concerned. Therefore we developed an application system which allows us to transfer the principle of measurement under clinical conditions. Thus we were able to prove that the signal recorded can be regarded as a specific expression of pulpal microcirculation. A comparison between vital teeth and root-filled teeth shows that the signal to noise ratio is sufficiently high to allow a definite assessment of pulp vitality.

Dental Pulp↗

PubMed1997

Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis.

OBJECTIVE: To determine the efficacy of a supplemental intraosseous injection of 3% mepivacaine in mandibular posterior teeth with irreversible pulpitis. Intraosseous injection pain, subjective heart rate increase, and pain ratings during endodontic treatment were also assessed. STUDY DESIGN: Forty-eight patients with irreversible pulpitis received conventional inferior alveolar nerve blocks. Electric pulp testing was used to determine pulpal anesthesia. Patients who were positive to the pulp testing, or negative to pulp testing but felt pain during endodontic treatment, received an intraosseous injection of 1.8 ml of 3% mepivacaine. A second intraosseous injection of 3% mepivacaine (1.8 ml) was given if the first injection was unsuccessful. RESULTS: Seventy-five percent of patients required an initial intraosseous injection because of failure to gain pulpal anesthesia. The inferior alveolar block was 25% successful; the first intraosseous injection increased success to 80%. A second intraosseous injection further increased success to 98%. These differences were significant (p < 0.05). Eight percent (4/48) of the initial intraosseous injections resulted in solution being expressed into the oral cavity: these were considered technique failures. CONCLUSIONS: For mandibular posterior teeth with irreversible pulpitis, a supplemental intraosseous injection of 3% mepivacaine increased anesthetic success. A second intraosseous injection, when necessary, further improved success.

Adolescent↗

PubMed1990

[Studies on pain suppression by means of transcutaneous electric nerve stimulation (TENS)].

TENS is used in many fields of medicine to provide safe and effective pain relief, yet the application of this technique to dentistry remains almost unexplored. In this study the effects of TENS at various stimulation frequencies on pulpal sensitivity to electrical vitality testing and to cavity preparation were investigated. Pulpal sensitivity to electric vitality testing was reduced by approximately 14% after TENS, with no significant differences between individual stimulation frequencies. During cavity preparation, TENS eliminated or minimised pain in approximately 67% of treatments, the best results being obtained under TENS at 99 Hz (the highest frequency investigated). Patients preferred high-frequency TENS because of the accompanying sensations of warmth and relaxation.

Dental Cavity Preparation↗

PubMed2000

Anesthetic efficacy and heart rate effects of the intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block.

OBJECTIVE: The purpose of this study was to determine the anesthetic efficacy and heart rate effects of an intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block. STUDY DESIGN: Through use of a repeated-measures design, each of 48 subjects randomly received 2 combinations of injections at 2 separate appointments. The combinations were (1) an inferior alveolar nerve block (with 1.8 mL of 3% mepivacaine) + intraosseous injection with 1.8 mL of 3% mepivacaine and (2) an inferior alveolar nerve (with 1. 8 mL of 3% mepivacaine) + mock intraosseous injection. The first molar was blindly pulp tested at 2-minute cycles for 60 minutes postinjection. Anesthesia was considered successful with 2 consecutive 80 readings. Heart rate (pulse rate) was measured with a pulse oximeter. RESULTS: All subjects had lip numbness with both of the inferior alveolar nerve + intraosseous techniques. Anesthetic success for the first molar was significantly increased for 30 minutes with intraosseous injection of mepivacaine in comparison with the inferior alveolar nerve block alone (mock intraosseous injection). Subjects receiving the intraosseous injection of mepivacaine experienced minimal increases in heart rate. CONCLUSIONS: The intraosseous injection of 1.8 mL of 3% mepivacaine, when used to augment an inferior alveolar nerve block, significantly increased anesthetic success for 30 minutes in the first molar. The 3% mepivacaine had a minimal effect on heart rate and would be useful in patients with contraindications to epinephrine use.

Adult↗

PubMed2002

Dependence of pulpal blood-flow responses on baseline blood-flow in the cat.

It has been shown earlier that electrical stimulation of the distal cut end of the inferior alveolar nerve (IAN) in the cat evokes three different patterns of pulpal blood-flow (PBF) response in the ipsilateral mandibular canine tooth (a decrease, a biphasic response, or an increase). The response to a given stimulus sometimes changed to another pattern even in one and the same experimental animal during the course of the experiment. It is known that the evoked decrease is due to activation of the sympathetics and that the increase is due to antidromic activation of sensory fibres; but, it is unknown why the response varies so much. It is hypothesised that the baseline blood-flow (BBF) modulates vasomotor responses in the dental pulp. To test this hypothesis, the effects of BBF on PBF responses elicited by the IAN stimulation mentioned above were investigated. Dynamic changes in PBF in cat mandibular canine teeth were elicited by electrical stimulation of the distal cut end of the IAN, at various BBF, with blood-flow monitored by laser Doppler flowmetry. The amplitude of the PBF vasodilator response increased as BBF was adjusted downwards (by cooling the tooth). In contrast, the amplitude of the PBF vasoconstrictor response increased as the BBF rose. Vasodilator responses could be transformed into vasoconstrictor responses, and vice versa, by alterations in the BBF. No systemic blood-pressure changes were elicited throughout the experiment. These results indicate that a consideration of baseline vascular tone is important, whenever the size of PBF responses to various stimuli is discussed or calculated.

Animals↗

PubMed2005

The efficacy of supplemental intraosseous anesthesia after insufficient mandibular block.

It is a well-known scientific fact that only a small percentage of infiltration of inferior alveolar nerve is clinically proven to be efficient. The objective of this study was to determine the anesthetic efficacy of supplemental intraosseous injection, used after the insufficient classical mandibular block that didn't provide deep pulp anesthesia of mandibular molar planed for extraction. The experimental teeth consisted of 98 mandibular molars with clinical indication for extraction. Based on the history of disease, we indicated the extraction of the tooth. After that each tooth was tested with a electric pulp tester P1. We tested the pulp vitality and precisely determined the level of vitality. After that, each patient received classical mandibular block, and the pulp vitality was tested again. If the pulp tester indicated negative vitality for the certain mandibular molar, and the patient didn't complain about pain or discomfort during the extraction, the molar was extracted and the result was added to anesthetic success rate for the classical mandibular block. If, five minutes after receiving the mandibular block, the pulp tester indicated positive vitality (parameters of vitality) or the patient complained about pain or discomfort (parameters of pain and discomfort), we used the Stabident intraosseous anesthesia system. Three minutes after the application of supplemental intraosseous injection the molar was tested with the pulp tester again. The anesthetic solution used in both anesthetic techniques is lidocaine with 1:100.000 epinephrine. The results of this study indicate that the anesthetic efficacy of the mandibular block is 74.5%, and that supplemental intraosseous anesthesia, applied after the insufficient mandibular block, provides pulpal anesthesia in 94.9% of mandibular molars. The difference between anesthetic efficacy of the classical mandibular block and anesthetic efficacy of the supplemental intraosseous anesthesia, applied after the insufficient mandibular block, is obvious.

Anesthesia, Dental↗

PubMed1998

The CO2 laser as an aid in direct pulp capping.

Two hundred direct pulp capping procedures were conducted in the present study. One hundred of them were performed with the CO2 laser, and 100 were conducted conventionally as a control by using a calcium hydroxide preparation. Follow-up examinations were performed after 1 wk and monthly for 12 months after treatment. Thermal tests were used for vitality assessments and laser Doppler flowmetry for direct measurement of pulpal blood. In the group of pulps treated with the CO2 laser, the last recall examination at 12 months demonstrated that 89 teeth remained vital, corresponding to a success rate of 89%. In the control group, the success rate was considerably lower (68%). Exposure sizes and mean patient age were nearly identical in both groups. The CO2 laser seems to be a valuable aid in direct pulp capping.

Adolescent↗

PubMed2002

Pulpal anaesthesia for mandibular central incisor teeth: a comparison of infiltration and intraligamentary injections.

AIM: This study compared the anaesthetic efficacy of infiltration and intraligamentary injections in the permanent mandibular central incisor. METHODOLOGY: Twelve healthy volunteers received each of the following methods of anaesthesia for one of their mandibular central incisors over four visits. 1 Labial infiltration of 1.0 mL. 2 Lingual infiltration of 1.0 mL. 3 Labial infiltration of 0.5 mL plus lingual infiltration of 0.5 mL. 4 Intraligamentary injection of (118 mL. Two percent lidocaine with 1: 80 000 adrenaline and 30 gauge needles were used throughout. Electrical pulp testing was performed before injection and every 2 min up to 30 min after the injection. Injection discomfort was recorded on a 100-mm visual analogue scale. Data were compared with ANOVA, Student's t-test and chi2 tests. RESULTS: Anaesthesia varied between techniques(F = 9.3, P < 0.001). The incidence of anaesthesia at any time was as follows: 50% success for labial infiltration; 50% success for lingual infiltration: 92% success for combined labial and lingual infiltration; 0% success for intraligamentary injections (chi2 = 20; P < 0.001). The mean (+/-SD) VAS score for intraligamentary injection discomfort was 28 +/- 12 mm, for buccal infiltrations 17 +/- 8 mm and for lingual infiltrations 16 +16 mm. Intraligamentary injections were more uncomfortable than buccal (t = 3.7: P < 0.01) and lingual infiltrations (t = 2.67: P < 0.05). CONCLUSIONS: The most reliable method of the techniques investigated for obtaining pulpal anaesthesia in mandibular permanent central incisors was a combination of labial and lingual infiltration. Intraligamentary injections were unreliable and were more uncomfortable than infiltrations in the mandibular central incisor region.

Adult↗

PubMed2002

Response of autotransplanted teeth to electric pulp testing.

OBJECTIVE: The purpose of this retrospective study was to assess the results of third molar autotransplantation by using electric pulp testing (EPT) and to determine the correlation of EPT response and bone formation. STUDY DESIGN: Fourteen patients with 22 transplanted teeth were studied. The patients had received autotransplantation of third molars and regularly came for follow-up on the third, sixth, ninth, and twelfth months. Postoperative clinical assessment included pain, inflammation of surrounding soft tissues, tooth mobility, and the EPT response. Periapical radiographs were subsequently evaluated during follow-up. The correlation between pulpal response to EPT and bone healing was analyzed. RESULTS: Most of the teeth had normal mobility within 3 months, which corresponded to bone formation. Bone healing at the recipient sites completely occurred within 6 months, and more than 50% had lamina dura. The teeth with EPT response increased to 95% within 12 months. There was no significant association between the EPT response and bone formation. CONCLUSIONS: The EPT response subsequently increased with time, and it seemed to be unchanged after 1 year.

Adolescent↗