Improved single visit management of old infected iatrogenic root perforations using Biodentine®


Abstract

Aim

The aim of this retrospective observational case series study was to evaluate the middle term outcomes on endodontic management of old infected iatrogenic root perforations using Biodentine. The treatments were always concluded in a single visit, without previous medication with calcium hydroxide. Our goal was to facilitate this kind of treatments and to make them more reproducible and manageable even for a general practitioner or a student.

Methodology and methods

Between January 2011 and June 2016, 51 patients with old infected root perforations have been enrolled. All the treatments were performed using Biodentine in a single visit. Infected root perforation repair was performed by supervised dental students (39%) or a qualified endodontist (61%), employing surgical microscope magnification during treatments. After the treatment, the 51 patients were monitored for 18–64 months. We used clinical and radiographic examinations.

Results

Of 51 examined teeth, 48 (94%) were classified as healed. The time, the size and the location of the perforations did not have a significant effect on the outcome. We proved the ineffectiveness of the null hypothesis. According to this latter, the single visit treatment of old infected perforations with Biodentine was inadequate.

Conclusions

In single visit treatments, Biodentine seems to provide a biocompatible and effective seal in acidic environment, in accidental root perforations, even if the treatment is performed by an inexperienced operator and regardless of the location, the size and the time of occurrence of the perforation.
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Anesthetic efficacy of mental/incisive nerve block compared to inferior alveolar nerve block using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis: a randomized clinical trial

Original Article

First Online: 07 June 2018

Abstract

Objectives

The aim of this study was to compare the onset, success rate, injection pain, and post-injection pain of mental/incisive nerve block (MINB) with that of inferior alveolar nerve block (IANB) using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis. The accuracy of electrical pulp test (EPT) in determining pulpal anesthesia was also examined.

Materials and methods

The study was designed as a randomized clinical trial with two study arms—MINB and IANB. Injections were performed using a standardized technique. Root canal treatment was initiated 10 min after the injection. Success was defined as no pain or mild pain during access cavity preparation and instrumentation. Injection pain and post-injection pain (up to 7 days) were recorded. All pain ratings were done using Heft-Parker Visual Analog Scale (HP VAS).

Results

Sixty-four patients were enrolled. The success rate of MINB (93.8%) was higher than IANB (81.2%) but the difference was not significant (p > 0.05). The onset of anesthesia with MINB was significantly quicker, and injection pain was significantly less (p < 0.05), but post-injection pain was significantly higher during the first 4 days (p < 0.001). The accuracy of EPT in determining pulpal anesthesia was 96.88%.

Conclusions

MINB and IANB with 4% articaine had similar efficacy in anesthetizing mandibular premolars with irreversible pulpitis. Post-injection pain with MINB was higher than with IANB.

Clinical relevance

MINB and IANB with 4% articaine can be used interchangeably to anesthetize mandibular premolars with irreversible pulpitis.
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