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PubMed1995

Pulp and periodontal healing, root development and root resorption subsequent to transplantation and orthodontic rotation: a long-term study of autotransplanted premolars.

One hundred and eighteen premolars transplanted at a stage with 3/4 to 4/4 root development with a wide open apical foramen were followed with standardized clinical and radiographic techniques for signs of pulpal and periodontal ligament healing and root development. Pulp healing, evaluated first by radiographic presence of pulp canal obliteration, appeared to be an earlier sign of pulp healing than the detection of pulp vitality with an electrometric test. Continued root growth of premolars was seen in some cases. Complete arrest of root development was usually followed by development of the missing root structure at the donor site, indicating a separation of the Hertwig's epithelial root sheath. Orthodontic rotation performed on 11 premolars induced slight surface resorption and a significant shortening of tooth length (mean 1.2 mm), compared with nontreated but transplanted control teeth. However, the extent of the apical root resorption is of minor clinical importance, and is equivalent to what has been found in previous investigations of orthodontic treatment of nontransplanted premolars. Late pulp necrosis occurred in 2 of the 11 treated cases 6 years after transplantation and 5 years after orthodontic rotation. To prevent late pulp necrosis, orthodontic rotation is recommended after periodontal healing and before total pulp canal obliteration has taken place, i.e., 3 to 9 months after transplantation.

Bicuspid↗

PubMed1999

The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks.

OBJECTIVE: The degree of pulpal anesthesia obtained with an ultrasound-assisted inferior alveolar nerve block was compared to that obtained with a conventional inferior alveolar nerve block for mandibular teeth to determine whether needle placement assisted by ultrasound results in more successful anesthesia. STUDY DESIGN: Through use of a repeated-measures design, each of 40 subjects randomly received an ultrasound-assisted inferior alveolar nerve block and a conventional inferior alveolar nerve block at 2 separate appointments. Mandibular anterior and posterior teeth were blindly tested by means of a pulp tester at 4-minute cycles for 60 minutes postinjection. Anesthesia was considered successful when 2 consecutive readings of 80 were obtained. RESULTS: One hundred percent of the subjects had profound lip numbness with both the ultrasound-assisted inferior alveolar nerve block and the conventional inferior alveolar nerve block. For these 2 techniques, anesthetic success rates for individual teeth ranged from 38% to 92%. There were no significant differences (P > .05) between the 2 techniques. CONCLUSIONS: It was concluded that accurate needle placement with ultrasound for the inferior alveolar nerve block did not result in more successful pulpal anesthesia in the mandible. Therefore, accuracy of needle placement is not the primary reason for pulpal anesthetic failure with this block.

Adult↗

PubMedDate not supplied

Pulse oximetry evaluation of vitality in primary and immature permanent teeth.

Present methods of assessing pulp vitality (electric and thermal testing) are of limited use with children, often resulting in false positive or false negative results. Pulse oximetry is a proven, atraumatic method of measuring vascular health by evaluating oxygen saturation (SaO2). This pilot study explores the use of a modified pulse oximetry ear probe to assess pulpal vascular oxygen saturation in primary and immature permanent teeth. Pulse oximetry readily differentiated between known vital and nonvital teeth. Vital teeth consistently provided SaO2 values that were lower than the values recorded on the patients' fingers. Further study of the SaO2 changes in traumatized teeth, with a probe designed specifically for teeth, is warranted by these initial results. Although additional research is indicated, pulse oximetry is already an objective, atraumatic clinical alternative to the present electrical and thermal methods of assessing pulp vitality in children's teeth.

Child↗

PubMed1989

Canines erupted through grafted alveolar cleft defects in patients with alveolar clefts: a pulp testing evaluation study.

An electric pulp tester (EPT) was used to evaluate the pulpal response of erupted canines in 75 patients: 16 patients with unilateral cleft palate who received autogenous bone grafts to correct their alveolar cleft defects before canine eruption; 35 patients without cleft palate whose canines erupted spontaneously, but who required orthodontic treatment for alignment; and 24 patients without clefts whose canines required surgical uncovering and orthodontic assistance for eruption. Thirty-one percent of the erupted canines in the patients with grafted unilateral clefts did not respond to EPT, whereas all canines in the contralateral noncleft side responded to EPT. There was no clinical or radiographic evidence of pulpal pathosis of the canines that had erupted through the grafted alveolar clefts. However, these teeth had a high incidence of nonresponsiveness to pulp stimulation, therefore necessitating close follow-up in case they show eventual signs of pulpal degeneration that may require endodontic intervention.

Adolescent↗

PubMed1996

Anesthetic efficacy of the intraosseous injection after an inferior alveolar nerve block.

The purpose of this study was to determine the contribution of the intraosseous (IO) injection to the inferior alveolar nerve (IAN) block in human first molars. Using a repeated-measures design, 40 subjects randomly received either a combination IAN block + IO injection (on the distal of the first molar) using 2% lidocaine with 1:100,000 epinephrine or an IAN block+mock IO injection (gingival penetration only) at two successive appointments. The first molar and adjacent teeth, and contralateral canine (+/-controls) were blindly tested with an Analytic Technology pulp tester at 2-min cycles for 60 min. An 80 reading was used as the criterion for pulpal anesthesia. One hundred percent of the subjects had lip numbness with the IAN block. For the first molar, anesthetic success, defined as achieving an 80 reading within 15 min and keeping this reading for 60 min, was 42% with the IAN and 90% with the IAN + IO. Anesthetic failure defined as never achieving two 80 readings during the 60 min was 32% with the IAN and 0% with the IAN + IO. The onset of anesthesia was immediate with the IO injection. Eighty percent of the subjects sampled had a subjective increase in heart rate with the IO injection. The IO injection and postinjection questionnaire recorded low pain ratings.

Adolescent↗

PubMed2006

A double-blind comparison of 0.5% bupivacaine with 1:200,000 epinephrine and 0.5% levobupivacaine with 1:200,000 epinephrine for the inferior alveolar nerve block.

This double-blind cross-over study compared the anesthetic success and onset and duration of lip and pulpal anesthesia of 0.5% bupivacaine and levobupivacaine solutions, both with 1:200,000 epinephrine, when administered for inferior alveolar nerve anesthesia. Thirty healthy volunteers were randomly anesthetized using one of the solutions. The inferior canine, second premolar, and molar were tested with electric stimulation. The pulpal anesthetic success rates for bupivacaine and levobupivacaine were 80% and 76.66%, respectively, for molars, 76.66% (both solutions) for premolars, and 70% (both solutions) for canines. At least 250 minutes of pulpal anesthesia was achieved. There were no significant differences between the solutions considering the measured parameters (P > .05). Because of the similar anesthetic behavior of the 2 solutions in this study and the low toxicity related in the literature for levobupivacaine, there is justification for replacing bupivacaine with levobupivacaine for inferior alveolar nerve local anesthesia.

Adolescent↗

PubMed1989

Capacitance effect of rubber gloves on electric pulp testers.

Electric pulp testers (EPTs) are widely used to assess tooth pulp vitality. With many unipolar EPTs the electrical circuit is completed through the operator. Since dentists now routinely wear rubber gloves, these might be expected to provide electrical insulation, and therefore to break the circuit. The objective of this investigation was to define the electrical effect of wearing rubber gloves. Two battery-powered unipolar EPTs were examined using a digital storage oscilloscope with an input impedance of 1 M omega. The probe tip was connected directly to the positive input lead of the oscilloscope. Three conditions were tested: (i) with the conductive handle connected directly to the negative input lead; (ii) with the ungloved operator holding the negative input lead in one hand and the conductive handle of the EPT in the other; and (iii) holding the conductive handle in a gloved hand. While the two EPTs produced different patterns of voltage spike, for each there was no difference between conditions (i) and (ii). However, when the conductive handle was held in a gloved hand (condition iii), there was a reduction in peak negative voltage and a change in wave form with positive overshoot. The alteration in wave form could be reproduced by substitution of the operator's gloved hand with a capacitance of 47 pF. These results support the hypothesis that a rubber glove acts partly as a capacitor in series with the electric pulp tester, and will alter the performance of EPTs unless the glove is bypassed electrically.

Dental Pulp Test↗

PubMed1996

Anesthetic efficacy of the intraosseous injection in maxillary and mandibular teeth.

OBJECTIVE: The objective of this study was to determine the anesthetic efficacy of the intraosseous injection as a primary technique in human maxillary and mandibular teeth. STUDY DESIGN: Forty subjects received two sets of intraosseous injections with 1.8 ml of 2% lidocaine with 1:100,000 epinephrine at two successive appointments. The experimental teeth consisted of 40 groups of maxillary and mandibular first molars and lateral incisors. Each experimental tooth and adjacent teeth were tested with an electric pulp tester at 4-minute cycles for 60 minutes. Anesthetic success was defined as no subject response to the maximum output of the pulp tester (80 reading) for two consecutive readings. RESULTS: Anesthetic success occurred in 75% of mandibular first molars, in 93% of maxillary first molars, in 78% of mandibular lateral incisors, and in 90% of maxillary lateral incisors. Overall, for the intraosseous injection onset was immediate, the duration of pulpal anesthesia steadily declined over the 60 minutes, there was a 78% incidence of subjective increase in heart rate, the majority of the subjects had no pain or mild pain with perforation and solution deposition, and 3% of the subjects had slow healing perforation sites. CONCLUSIONS: The results of this study indicate that the intraosseous injection may provide pulpal anesthesia in 75% to 93% of noninflamed teeth as a primary technique. However, the duration of pulpal anesthesia declines steadily over an hour.

Adult↗

PubMed1999

Anesthetic efficacy of the mylohyoid nerve block and combination inferior alveolar nerve block/mylohyoid nerve block.

OBJECTIVE: The purpose of this study was to measure the degree of anesthesia obtained with the mylohyoid nerve block and the combination mylohyoid nerve block/conventional inferior alveolar nerve (IAN) block in mandibular teeth. STUDY DESIGN: With the use of a repeated-measures design, 30 subjects randomly received each of 3 combinations of injections at 3 separate appointments. The combinations were as follows: mylohyoid nerve block (1.8 mL of 2% lidocaine with 1:100,000 epinephrine) + IAN block (3.6 mL of 2% lidocaine with 1:100,000 epinephrine); mock mylohyoid nerve block + IAN block (3.6 mL of 2% lidocaine with 1:100,000 epinephrine); mylohyoid nerve block (1.8 mL of 2% lidocaine with 1:100,000 epinephrine) + mock IAN block. The mylohyoid injections were aided by the use of a peripheral nerve stimulator. Mandibular anterior and posterior teeth were blindly tested with a pulp tester at 4-minute cycles for 60 minutes postinjection. Anesthesia was considered successful when 2 consecutive 80 readings were obtained. RESULTS: One hundred percent of the subjects had lip numbness with the mylohyoid nerve block + IAN block and mock mylohyoid nerve block + IAN block techniques. For these 2 techniques, anesthetic success rates were higher in posterior teeth (73% to 93%) than in anterior teeth (33% to 60%). There were no significant differences (P > .05) between the 2 techniques. The mylohyoid nerve block + mock IAN block technique resulted in a very low success rate (0% to 17%) and was significantly different (P < .05) from the mylohyoid nerve block + IAN block technique. CONCLUSIONS: The results of this study suggest that the mylohyoid nerve block does not by itself predictably provide pulpal anesthesia in mandibular teeth and does not significantly enhance pulpal anesthesia when administered in combination with the IAN block.

Adult↗

PubMed1994

Reliability of laser Doppler flowmetry in testing vitality of human teeth.

The aim of this investigation was to study the reliability of the laser Doppler flowmetry (LDF) output signals when testing from 4 different positions on the buccal surface of human teeth. Recordings were made from 10 intact anterior teeth in 10 patients, mean age 27.4 years. Five types of probes were used. Each probe had 3 fibers arranged in a triangle, one lighted fiber and 2 receiving ones. The separation of the fibers was 1500, 1000, 800, 500 and 250 microns. The diameter of the fibers was 200 microns in all probes except the one with the smallest separation of fibers where it was 125 microns. A rubber base splint was used to position the probe on the buccal surface of the teeth tested. The first recording was made with the ingoing light in a gingival position. Then 3 additional recordings were made turning the probe 90 degrees each time consequently changing the position of the ingoing light accordingly. Thus, gingival, mesial, incisal and distal recordings were obtained. The output signals were fed into a lap-top computer upon which all calculations were done. The output signals from the incisalmost position of the teeth were significantly lower than the output signals from the other 3 positions with all probes except one. The turning of the probes into the 4 different positions affected the output signals from the probe with the smallest separation of fibers significantly more than the output signals from the other probes.

Adult↗

PubMed2004

Anesthetic efficacy of the palatal-anterior superior alveolar injection.

BACKGROUND: A single palatal-anterior superior alveolar, or P-ASA, injection has been reported to provide pulpal anesthesia of the four maxillary incisors and usually the canines. The authors conducted a prospective, randomized, double-blind study to compare the anesthetic efficacy of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine using a computer-assisted injection system to administer the P-ASA injection. MATERIALS AND METHODS: In a double-blind manner, the authors used a crossover design to administer randomly P-ASA injections of 1.4 milliliters of the lidocaine solution and 1.4 mL of the mepivacaine solution using the computer-assisted injection system at two appointments to 40 subjects. They used a pulp tester to test for anesthesia of the central incisors, lateral incisors and canines in four-minute cycles for 72 minutes. Anesthesia was considered successful when two consecutive maximum readings (80 readings) with the pulp tester were obtained. RESULTS: For the lidocaine solution, successful pulpal anesthesia ranged from 32 to 58 percent for the six anterior teeth. For the mepivacaine solution, successful pulpal anesthesia ranged from 22 to 38 percent. Except for the left canine, the lidocaine solution was significantly more likely to result in pulpal anesthesia than the use of the mepivacaine solution. The duration of pulpal anesthesia, for both solutions, declined steadily over 72 minutes. CONCLUSIONS AND CLINICAL IMPLICATIONS: Using the computer-assisted injection system for the P-ASA injection, we concluded that the rather modest-to-low success rates of the lidocaine and mepivacaine solutions would not ensure predictable pulpal anesthesia of the four maxillary incisors and the canines.

Adult↗

PubMed1991

[Alternative solutions for postoperative pain in teeth with necrotic pulp].

Both the literature and clinical experience have verified that necrotic root canals, with or without periapical lesion, display a confusing response to the various tests for pulp vitality. As suggested by clinical and histopathological research studies, these lesions are due to a defense reaction from the periapical connective tissue, in response to bacterial infections which alter host tissues. Diminishing the frequency of postoperative pain in endodontic treatment is currently a leading concern, and this study aimed to evaluate the different variables involved in root canal therapy, so as to recommend the most suitable approach, without losing sight of the main goal at hand: a successful endodontic treatment. The present study was performed on 200 necrotic root canals, using frontal teeth, upper and lower premolars and molars, both with straight or curved canals. Avoiding damage to the periapical regions, the study concluded, is of prime importance in lowering the frequency of postoperatory pain. Also, the presence of periapical pain is vitally important in the appearance of postoperatory pain, and it is in such cases that cleansing must be adopted as a routine clinical procedure.

Adult↗

PubMed1998

Anesthetic efficacy of a repeated intraosseous injection given 30 min following an inferior alveolar nerve block/intraosseous injection.

To determine whether a repeated intraosseous (IO) injection would increase or prolong pulpal anesthesia, we measured the degree of anesthesia obtained by a repeated IO injection given 30 min following a combination inferior alveolar nerve block/intraosseous injection (IAN/IO) in mandibular second premolars and in first and second molars. Using a repeated-measures design, we randomly assigned 38 subjects to receive two combinations of injections at two separate appointments. The combinations were an IAN/IO injection followed approximately 30 min later by another IO injection of 0.9 ml of 2% lidocaine with 1:100,000 epinephrine and a combination IAN/IO injection followed approximately 30 min later by a mock IO injection. The second premolar, first molar, and second molar were blindly tested with an Analytic Technology pulp tester at 2-min cycles for 120 min postinjection. Anesthesia was considered successful when two consecutive readings of 80 were obtained. One hundred percent of the subjects had lip numbness with IAN/IO and with IAN/IO plus repeated IO techniques. Rates of anesthetic success for the IAN/IO and for the IAN/IO plus repeated IO injection, respectively, were 100% and 97% for the second premolar, 95% and 95% for the first molar, and 87% and 87% for the second molar. The repeated IO injection increased pulpal anesthesia for approximately 14 min in the second premolar and for 6 min in the first molar, but no statistically significant differences (P > 0.05) were shown. In conclusion, the repeated IO injection of 0.9 ml of 2% lidocaine with 1:100,000 epinephrine given 30 min following a combination IAN/IO injection did not significantly increase pulpal anesthesia in mandibular second premolars or in first and second molars.

Adolescent↗

PubMed2001

Anesthetic efficacy of a combination of hyaluronidase and lidocaine with epinephrine in inferior alveolar nerve blocks.

The purpose of this prospective, randomized, double-blind study was to determine the anesthetic efficacy of a buffered lidocaine with epinephrine solution compared to a combination buffered lidocaine with epinephrine plus hyaluronidase solution in inferior alveolar nerve blocks. Thirty subjects randomly received an inferior alveolar nerve block using 1 of the 2 solutions at 2 separate appointments using a repeated-measures design. Mandibular anterior and posterior teeth were blindly pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Anesthesia was considered successful when 2 consecutive readings of 80 were obtained. A postoperative survey was used to measure pain and trismus. The results demonstrated 100% of the subjects had profound lip numbness with both solutions for inferior alveolar nerve blocks. The anesthetic success rates for individual teeth ranged from 20 to 80%. There were no significant differences (P > .05) between the 2 solutions. However, the combination lidocaine/hyaluronidase solution resulted in a significant increase in postoperative pain and trismus. It was concluded that adding hyaluronidase to a buffered lidocaine solution with epinephrine did not statistically increase the incidence of pulpal anesthesia in inferior alveolar nerve blocks and, because of its potential tissue damaging effect, it should not be added to local anesthetic solutions for inferior alveolar nerve blocks.

Adjuvants, Anesthesia↗

PubMed1997

Anesthetic efficacy of the intraosseous injection of 2% lidocaine (1:100,000 epinephrine) and 3% mepivacaine in mandibular first molars.

OBJECTIVES: This study compared the anesthetic efficacy of a primary intraosseous injection of 2% lidocaine with 1:100,000 epinephrine and 3% mepivacaine in human mandibular first molars. Injection pain and healing postoperatively were also assessed for the intraosseous injection. STUDY DESIGN: With the use of a repeated-measures design, 42 subjects randomly received intraosseous injections of 1.8 ml of 2% lidocaine with 1:100,000 epinephrine or 1.8 ml of 3% mepivacaine in a double-blind manner at two successive appointments. The first molar and adjacent teeth were blindly tested with an electric pulp tester at 2-minute cycles for 60 minutes. Anesthetic success was defined as no subject response to the maximum output of the pulp tester (80 reading) for two consecutive readings. RESULTS: Anesthetic success occurred in 74% of the first molars with 2% lidocaine with 1:100,000 epinephrine and in 45% with 3% mepivacaine. The difference was statistically significant (p < 0.05). Overall, onset was rapid for the intraosseous injections, the duration of pulpal anesthesia steadily declined over the 60 minutes, the majority of the subjects had no pain or mild pain with perforation and solution deposition, and 5% of the subjects had delayed healing at the perforation sites. CONCLUSIONS: The results of this study indicate that the primary intraosseous injection of 2% lidocaine with 1:100,000 epinephrine is more successful and results in a longer duration of pulpal anesthesia as compared with 3% mepivacaine in noninflamed mandibular first molars. Most subjects reported no or mild pain during perforation and injection.

Adolescent↗

PubMed1999

Effect of the type carrier used on the results of dichlorodifluoromethane application to teeth.

Thermal testing, especially cold, is an important part of diagnosing pulpal vitality. It was the purpose of this study to determine (i) if a difference exists in temperature when Endo ice is used with four different applicators, and (ii) if there is one applicator device that provides the greatest thermal change for a tooth. Endo ice was used with the following applicators: a #2 standard size large cotton pellet, a #4 standard size small cotton pellet, a wood stick cotton tip applicator, and a cotton roll. The temperature of a mandibular incisor pulp chamber was measured in degree C 10 s after the application of the dichlorodifluoromethane (DDM) to the midfacial surface of the crown. Also, the DDM was applied to each applicator either by direct spray or by submergence in DDM liquid. This study found that the greatest temperature change was recorded by Endo Ice (DDM) sprayed directly onto a large cotton pellet. There was no significant difference between directly spraying or submerging the applicator in DDM liquid.

Aerosols↗

PubMed2004

Anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection.

The purpose of this prospective, randomized, blinded study was to determine the anesthetic efficacy of the anterior middle superior alveolar (AMSA) injection using the computer-assisted Wand Plus injection system versus a conventional syringe. The authors, using a crossover design, randomly administered in a blind manner 2 AMSA injections utilizing the computer-assisted injection system and a conventional syringe to 40 subjects during 2 separate appointments. A pulp tester was used to test for anesthesia, in 4-minute cycles for 60 minutes, of the central and lateral incisors, canine, and first and second premolars. Anesthesia was considered successful when 2 consecutive no responses (80 readings) with the pulp tester were obtained. For all teeth, except the central incisor, the use of the computer-assisted injection system was significantly (P < .05) more likely to result in pulpal anesthesia than the use of the conventional syringe technique. For the computer-assisted injection system, successful pulpal anesthesia ranged from 35 to 58%, and for the conventional syringe, successful pulpal anesthesia ranged from 20 to 42%. For both techniques, the onset of pulpal anesthesia was slow, and duration of pulpal anesthesia declined steadily over 60 minutes. We conclude that although the AMSA injection using the computer-assisted injection system was more successful than the conventional syringe technique, the rather modest to low success rates, slow onset, and declining duration of pulpal anesthesia over 60 minutes would not ensure predictable pulpal anesthesia from the second premolar to the central incisor.

Adult↗

PubMed2003

Comparison of preoperative pain and medication use in emergency patients presenting with irreversible pulpitis or teeth with necrotic pulps.

OBJECTIVE: This retrospective study compared differences in preoperative pain and medication use in patients with moderate to severe pain who sought emergency endodontic care for teeth with irreversible pulpitis and for symptomatic teeth with necrotic pulps. STUDY DESIGN: A total of 323 patients seeking emergency endodontic treatment completed questionnaires regarding their biographical information, pain, pain history, and medications. Teeth were tested for vitality, mobility, percussion, and palpation pain. Lymphadenopathy was also evaluated. RESULTS: Patients with irreversible pulpitis waited significantly (P <.05) longer before seeking emergency care (9 days vs 4 days) than patients with symptomatic teeth with necrotic pulps. No differences (P >.05) were found between the groups in terms of analgesic or antibiotic use and pain relief from preoperative narcotic medications. Nonnarcotic analgesics were reported to significantly reduce pain more often in patients with symptomatic teeth with necrotic pulps. There were sex differences in the group of patients with irreversible pulpitis: More women than men were taking analgesic medications and, in the group having symptomatic teeth with necrotic pulps, more men than women reported pain relief from their analgesic medications. CONCLUSION: Patients with irreversible pulpitis wait longer to seek emergency treatment. A majority (81%-83%) of emergency patients with moderate to severe pain will have taken some type of medication(s) to help control their pain, and more women than men with irreversible pulpitis will take an analgesic. By taking their preoperative medication(s), this group of patients will get relief 62% to 65% of the time; furthermore, more men than women with symptomatic teeth with necrotic pulps will experience pain relief.

Adult↗