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1.

Introduction

Profound pulpal anesthesia is difficult to achieve in mandibular molars with irreversible pulpitis (IP). However, there are no published randomized controlled clinical trials comparing the success of supplemental buccal infiltration (BI) in mandibular first versus second molars with IP. The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental BIs in mandibular first versus second molars with IP after a failed inferior alveolar nerve block (IANB). This study's sample was combined with data from a previous trial.

Methods

One hundred ninety-nine emergency subjects diagnosed with IP of a mandibular molar were selected and received an IANB with 4% articaine. Subjects who failed to achieve profound pulpal anesthesia, determined by a positive response to cold or pain upon access, randomly received 4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was begun 5 minutes after infiltration. Success was defined as less than mild pain during endodontic access and instrumentation on the Heft-Parker visual analog scale.

Results

There was a 25% IANB success rate with 4% articaine. The success rate for articaine supplemental BI in first molars was 61% versus 63% for second molars (P > .05). The success of lidocaine in first molars was 66%, but for second molars it was 32% (P = .004).

Conclusions

The success rate for IANB with 4% articaine was 25%. Articaine and lidocaine had similar success rates for supplemental infiltration in first molars, whereas articaine was significantly more successful for second molars. However, because BI often did not provide profound pulpal anesthesia, additional techniques including intraosseous anesthesia may still be required.  相似文献   

2.

Introduction

The purpose of this prospective, randomized clinical trial was to evaluate the anesthetic efficacy of the Gow-Gates nerve block (GGNB), the inferior alveolar nerve block (IANB), and their combination for mandibular molars in patients with symptomatic irreversible pulpitis.

Methods

One hundred fifty patients diagnosed with symptomatic irreversible pulpitis of a mandibular molar were selected. The patients randomly received 2 GGNB injections, 2 IANB injections, or 1 GGNB injection plus 1 IANB injection of 1.8 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after injections. Lip numbness was a requisite for all of the patients. Success was specified as no or mild pain on the basis of Heft-Parker visual analog scale recordings during access cavity preparation or initial instrumentation. Data were analyzed with the chi-square, Kruskal-Wallis, and analysis of variance tests.

Results

The success rates of anesthesia were 40%, 44%, and 70% for the GGNB, IANB, and GGNB + IANB groups, respectively. There was no statistically significant difference in the success rate of anesthesia between the GGNB and IANB groups (P > .05). The anesthesia success rate for the GGNB + IANB group was significantly different from those of the GGNB and IANB groups (P < .05).

Conclusions

A combination of GGNB and IANB could improve the efficacy of anesthesia in mandibular molars with symptomatic irreversible pulpitis, but it would still require supplemental anesthesia. Further research may be needed to confirm the results of this study.  相似文献   

3.

Introduction

Successful anesthesia with an inferior alveolar nerve block (IANB) is imperative for treating patients with irreversible pulpitis in mandibular teeth. This systematic review assessed the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDs) as oral premedications on the success of IANBs in irreversible pulpitis.

Methods

Three databases were searched to identify randomized clinical trials (RCTs) published up until September 2017. Retrieved RCTs were evaluated using the revised Cochrane Risk of Bias Tool. The primary efficacy outcome of interest was the success rate of IANB anesthesia. Meta-analytic estimates (risk ratio [RR] with 95% confidence intervals [CIs]) performed using a random effects model and publication bias determined using funnel plot analysis were assessed. Random errors were evaluated with trial sequential analyses, and the quality of evidence was appraised using a Grading of Recommendations, Assessment, Development and Evaluation approach.

Results

Thirteen RCTs (N = 1034) were included. Eight studies had low risk of bias. Statistical analysis of good-quality RCTs showed a significant beneficial effect of any NSAID in increasing the anesthetic success of IANBs compared with placebo (RR = 1.92; 95% CI, 1.55–2.38). Subgroup analyses showed a similar beneficial effect for ibuprofen, diclofenac, and ketorolac (RR = 1.83 [95% CI, 1.43–2.35], RR = 2.56 [95% CI, 1.46–4.50], and RR = 2.07 [95% CI, 1.47–2.90], respectively). Dose-dependent ibuprofen >400 mg/d (RR = 1.85; 95% CI, 1.39–2.45) was shown to be effective; however, ibuprofen ≤400 mg/d showed no association (RR = 1.78; 95% CI, 0.90–3.55). TSA confirmed conclusive evidence for a beneficial effect of NSAIDs for IANB premedication. The Grading of Recommendations, Assessment, Development and Evaluation approach did not reveal any concerns regarding the quality of the results.

Conclusions

Oral premedication with NSAIDs and ibuprofen (>400 mg/d) increased the anesthetic success of IANBs in patients with irreversible pulpitis.  相似文献   

4.

Introduction

The present study comparatively evaluated the anesthetic efficacy of 4% articaine versus 2% lidocaine given as supplemental intraligamentary injections after a failed inferior alveolar nerve block.

Methods

One hundred six adult patients with symptomatic irreversible pulpitis in a mandibular first or second molar received an initial inferior alveolar nerve block with 2% lidocaine with 1:80,000 epinephrine. Pain during the endodontic treatment was assessed using the Heft-Parker visual analog scale. Eighty-two patients with unsuccessful anesthesia were randomly allocated to 2 treatment groups: 1 group received 0.6 mL/root of supplementary intraligamentary injection of 4% articaine with 1:100,000 epinephrine, and the second group received 2% lidocaine with 1:80,000 epinephrine. Endodontic treatment was reinitiated. Success after the primary injection or supplementary injection was defined as no or mild pain (less than 55 mm on the Heft-Parker visual analog scale) during access preparation and root canal instrumentation. Patients' heart rate was monitored using a finger pulse oximeter. The anesthetic success rates were analyzed with the Pearson chi-square test at 5% significance levels. The heart rate changes were analyzed using the t test.

Results

The patients receiving supplementary intraligamentary injections of 4% articaine had a success rate of 66%, whereas 2% lidocaine injections were successful in 78% of cases. The difference was statistically nonsignificant (χ2 = 1.51, P = .2). There was no significant effect of the different anesthetic agents on the heart rate.

Conclusions

Both 4% articaine and 2% lidocaine improved the success rates after a failed primary anesthetic injection, with no significant difference between them.  相似文献   

5.

Introduction

Profound pulpal anesthesia in mandibular molars with irreversible pulpitis (IP) is often difficult to obtain and often requires supplemental injections after an ineffective inferior alveolar nerve block (IANB). The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental buccal infiltrations (BIs) after an ineffective IANB in mandibular molars with IP. In addition, the use of articaine for IANB and intraosseous injections was investigated.

Methods

One hundred emergency patients diagnosed with IP of a mandibular molar were selected and received an IANB with 4% articaine. All injections were 1.7 mL with 1:100,000 epinephrine. All patients reported profound lip numbness after IANB. Patients with ineffective IANB (positive pulpal response to cold or pain on access) randomly received 4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was initiated 5 minutes after deposition of the infiltration solution. Success was defined as no pain or no more than mild pain during endodontic access and instrumentation as measured on a visual analogue scale.

Results

Seventy-four patients failed to achieve pulpal anesthesia after IANB with 4% articaine, resulting in IANB success rate of 26%. Success rates for supplemental BIs were 62% for articaine and 37% for lidocaine (P < .05). This effect was most pronounced in second molars (P < .05).

Conclusions

Supplemental BI with articaine was significantly more effective than lidocaine. The IANB success rate of 4% articaine confirmed published data.  相似文献   

6.

Introduction

Previous studies in patients with irreversible pulpitis have reported increased success of the inferior alveolar nerve block (IANB) using premedication with ketorolac. Preemptive nitrous oxide administration has also shown an increase in the success of the IANB. Recently, ketorolac has been made available for intranasal delivery. Perhaps combining ketorolac and nitrous oxide would increase success. Therefore, the purpose of this prospective, randomized, double-blind study was to determine the effect of a combination of intranasal ketorolac and nitrous oxide/oxygen on the anesthetic success of the IANB in patients presenting with symptomatic irreversible pulpitis.

Methods

One hundred two patients experiencing spontaneous moderate to severe pain with symptomatic irreversible pulpitis in a mandibular posterior tooth participated. Patients were randomly divided into 2 groups and received either 31.5 mg intranasal ketorolac or intranasal saline placebo 20 minutes before the administration of nitrous oxide/oxygen. Ten minutes after the administration of nitrous oxide/oxygen, the IANB was given. After profound lip numbness, endodontic treatment was performed. Success was defined as the ability to perform endodontic access and instrumentation with no pain or mild pain.

Results

The odds of success for the IANB was 1.631 in the intranasal saline/nitrous oxide group versus the intranasal ketorolac/nitrous oxide group with no significant difference between the groups (P = .2523).

Conclusions

Premedication with intranasal ketorolac did not significantly increase the odds of success for the IANB over the use of nitrous oxide/oxygen alone. Supplemental anesthesia will still be needed to achieve adequate anesthesia.  相似文献   

7.

Introduction

It has been recommended to place patients in an upright position after administration of an inferior alveolar nerve block (IANB), theoretically allowing the anesthetic to diffuse in an inferior direction and resulting in better pulpal anesthesia. The purpose of this study was to compare an upright versus a supine position on the success of pulpal anesthesia when an IANB was administered in asymptomatic teeth.

Methods

One hundred ten asymptomatic subjects were randomly given IANBs by using 2% lidocaine with 1:100,000 epinephrine while they were in an upright position and supine position at 2 different appointments spaced at least 2 weeks apart. Pulpal anesthesia was measured in the molars, premolars, and incisors with an electric pulp tester in 4-minute cycles for 60 minutes. Anesthetic success was defined as the subject achieving 2 consecutive 80 readings within 15 minutes of the injection and sustaining the 80 reading for 60 minutes. Success was analyzed by using a mixed model logistic regression.

Results

Pulpal anesthesia for the supine position was not statistically more successful than the upright position in the second molars (73% vs 65%), first molars (59% vs 54%), lateral incisors (28% vs 23%), and central incisors (11% vs 8%), respectively. The supine position significantly improved success in the second premolars (63% vs 53%) and first premolars (75% vs 64%).

Conclusions

The supine and upright positions were equally successful in the molars and anterior teeth. The supine position was more successful in the premolars. However, clinically, neither position for the IANB administration would provide complete pulpal anesthesia.  相似文献   

8.

Introduction

The study was designed as a randomized double-blind trial to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in inferior alveolar nerve block (IANB) and infiltration anesthetic techniques to anesthetize mandibular molars with irreversible pulpitis.

Methods

The study was composed of 2 test arms and 1 control arm. Subjects in the test arms received either a standard IANB or a buccal infiltration (B Infil) of 4% articaine with 1:100,000 epinephrine, whereas the subjects in the control arm received a standard IANB of 2% lidocaine with 1:100,000 epinephrine. Subject’s self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anesthetic administration during access preparation and pulp extirpation.

Results

For statistical analysis Pearson χ2, Student's paired t test, 1-way analysis of variance, and Friedman tests showed no significant difference in success rates among the 3 arms of the trial.

Conclusions

Although B Infil and IANB of 4% articaine were equally effective, B Infil can be considered a viable alterative in IANB for pulpal anesthesia in mandibular molars with irreversible pulpitis.  相似文献   

9.

Introduction

The inferior alveolar nerve block (IANB) has a poor success rate in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of ketorolac and dexamethasone infiltration along with standard IANB on the success rate.

Methods

Ninety-four adult volunteers who were actively experiencing pain participated in this prospective, randomized, double-blind study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive any supplemental infiltrations (control). Twenty-four patients received supplemental buccal infiltration of 4% articaine with 1:100,000 ephinephrine, and 24 patients received supplemental buccal infiltration of 1 mL/4 mg of dexamethasone. It was planned to give supplemental buccal infiltration of 1 mL/30 mg of ketorolac tromethamine in 26 patients, but the first 2 patients experienced severe injection pain after ketorlac infiltration and were excluded from the study. In the subsequent patients, 0.9 mL of 4% articaine was infiltrated before injecting ketorolac. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft-Parker visual analog scale. Success was recorded as none or mild pain.

Results

Statistical analysis was done by using nonparametric χ2 tests. Control IANB gave 39% success rate. Buccal infiltration of articaine and articaine plus ketorolac significantly increased the success rate to 54% and 62%, respectively (P < .05). Supplementary dexamethasone infiltration gave 45% success rate, which was insignificant with control IANB.

Conclusions

Articaine and ketorolac infiltration can increase the success rate of IANB in patients with irreversible pulpitis. None of the tested techniques gave 100% success rate.  相似文献   

10.

Introduction

Prilocaine plain has a high pH and concentration (4%), which could decrease the pain of injection and increase success. The purpose of this study was to compare pain associated with anesthetic solution deposition and the degree of pulpal anesthesia obtained with the combination of prilocaine and lidocaine versus a lidocaine and lidocaine combination when used for inferior alveolar nerve blocks (IANBs).

Methods

One hundred eighteen asymptomatic subjects were randomly given a combination of 1 cartridge of 4% prilocaine plain plus 1 cartridge of 2% lidocaine with 1:100,000 epinephrine or a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine for the IANB at 2 separate appointments. Subjects rated the pain associated with anesthetic solution deposition of injection. Mandibular teeth were tested with an electric pulp tester every 4 minutes for 57 minutes. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 17 minutes and the 80 reading was continuously sustained for 57 minutes. Comparisons for anesthetic success were analyzed using the exact McNemar test, and pain ratings associated with anesthetic solution deposition were analyzed using multiple Wilcoxon matched pairs signed rank tests; both were adjusted using the step-down Bonferroni method of Holm.

Results

Four percent prilocaine plain was significantly less painful upon anesthetic solution deposition. Pulpal anesthetic success was not significantly different between the 2 combinations.

Conclusions

The combination of 4% prilocaine plain plus 2% lidocaine with 1:100,000 epinephrine did not increase pulpal anesthetic success for IANBs compared with a combination of 2 cartridges of 2% lidocaine with 1:100,000 epinephrine. Pain associated with anesthetic solution deposition from the first cartridge of 4% prilocaine plain was significantly less when compared with the first cartridge of 2% lidocaine with 1:100,000 epinephrine.  相似文献   

11.

Introduction

The study was designed to evaluate the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth.

Methods

This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale.

Results

Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94 %, whereas by using IANB with the same anesthetic it was 92 %. No statistical differences were detected in the success rates between the two anesthetic techniques (P = 0.15).

Conclusions

Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.
  相似文献   

12.
目的:本研究对仅有刺激痛的早期不可复性牙髓炎的患者在下牙槽阻滞麻醉时,比较使用1.7 mL阿替卡因和3.4 mL阿替卡因的麻醉成功率的差异。方法:将76名患者随机分为两组,1.7 mL组和3.4 mL组(两组都为4%阿替卡因与1∶100000的肾上腺素),进行下牙槽阻滞麻醉。根管治疗过程中,使用Heft-Parker视觉模拟量表(VAS)记录患者的疼痛值。对数据进行T检验和卡方检验。结果:72名患者纳入了研究结果,两组的成功率都没有达到100%,组间有显著差异(P<0.001),3.4 mL组有较高的成功率74.4%,1.7 mL组成功率为27.8%。结论:在对下颌第一磨牙进行下牙槽阻滞时,提高阿替卡因的注射剂量可以显著提高麻醉的成功率,但也达不到100%的麻醉成功。  相似文献   

13.

Introduction

The present study aimed to anatomically assess mandibular posterior teeth using cone-beam computed tomographic (CBCT) imaging for endodontic surgery.

Methods

A total of 170 CBCT scans were evaluated for anatomic variations of mandibular posterior teeth. All the scans were obtained using a Planmeca Promax CBCT unit (Planmeca, Helsinki, Finland) with exposure settings of 90 kVp, 12 mA, 12 seconds, and 0.3-mm resolution. All CBCT images were reconstructed by Romexis Viewer 3.8.2. software (Planmeca) on a 16-inch LCD monitor (22MP47HQ; LG, Seoul, South Korea), and axial, coronal and sagittal views were evaluated.

Results

The thickest buccal cortical plate was observed over the distal root of second molars (12.30 mm) among the molar teeth and over the second premolar root (5.41 mm) among the premolar teeth. The thinnest buccal cortical plate was observed over both the first and second premolar roots (0.42 mm) and over the mesial root of the first molar (0.62 mm) tooth. A 20.38-mm section was removed for surgical access during buccal resection of the distal root of the left second molar, and the closest distance from the apex to the inferior alveolar canal was 0 mm.

Conclusions

Adequate knowledge of the anatomic dimensions of teeth and their surrounding structures is imperative for endodontic surgery. Information concerning the root thickness of mandibular posterior teeth at the site of root resection (apical 3 mm), buccal cortical plate thickness, and the distance from the apex of each tooth to the inferior alveolar canal and mental foramen can guide the surgeon before and during surgery.  相似文献   

14.

Introduction

Endodontic pain is a symptom of pulpal and/or periapical inflammation. One strategy for pain reduction is using medications, such as dexamethasone. A definitive protocol for preventing and controlling pain caused by irreversible pulpitis during endodontic treatment has not yet been established. This is a systematic review to answer the following question: is the use of dexamethasone effective in controlling pain associated with symptomatic irreversible pulpitis?

Methods

This study was registered in the PROSPERO database (CRD42017058704), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations were followed. MEDLINE, Scopus, ScienceDirect, Web of Science, Latin American Caribbean Health Sciences Literature, Cochrane Library, and Google Scholar databases were used in our research. No restrictions were applied to dates or language of publication. All records identified electronically were organized and evaluated by 2 independent authors, and, in case of doubt, a third author made the decision. The Cochrane Collaboration tool was used. The data were analyzed with RevMan 5 software (The Cochrane Collaboration, Copenhagen, Denmark), and data from eligible studies were dichotomous (with and without pain).

Results

A total of 4825 studies were identified. After screening, 523 studies were selected, and, after careful evaluation, only 5 articles remained. All meta-analyses revealed a global effect (P < .05, P < .05, and P < .05), which means that 4 mg dexamethasone helps relieve pain, sometimes for up to 8, 12, and 24 hours.

Conclusions

The pain felt by patients diagnosed with symptomatic irreversible pulpitis may be alleviated by administering 4 mg dexamethasone either by mouth or through intraligamentary and mainly supraperiosteal injections into the root canal for up to 24 hours.  相似文献   

15.

Introduction

Vital pulp therapy (VPT) is a biological approach to minimally invasive endodontics. This randomized clinical trial aimed to evaluate and compare clinical and radiographic success of 4 VPTs (indirect pulp capping [IPC], direct pulp capping [DPC], miniature pulpotomy [MP], and full pulpotomy [FP]) using calcium-enriched mixture cement for deep caries management of mature permanent molars including teeth with clinical signs of irreversible pulpitis and the presence of apical periodontitis.

Methods

Blinded participants (N = 302) were randomly allocated to 4 study arms. Random allocation was disregarded when visible pulp exposures did not happen after complete caries removal and the tooth was transferred to the IPC arm. Pre- and intraoperative data including vitality test results, pulpal/periapical status, and exposure type/location were recorded. Pain was measured using a numeric rating scale before treatment initiation up to 1 week postoperatively. Participants were followed up for 1 year.

Results

The groups were homogenous in terms of age, sex, marital status, education, and practitioner; pre- and intraoperative conditions were similar in all arms and did not affect the long-term success. Preoperative pain and apical periodontitis were significantly different among arms (P < .05); however, it was not the case when the IPC group was excluded. After baseline pain adjustment, pain relief was continuous with similar patterns in all treatment groups. The 3- and 12-month success rates of the VPT techniques were comparable in the IPC (98.7% and 100%, respectively), DPC (98.4% and 94.7%, respectively), MP (98.4% and 91.4%, respectively), and FP (93.5% and 95.5%, respectively) arms, respectively (P > .05).

Conclusions

In deep caries management of mature permanent molars, the 4 VPTs were associated with favorable/comparable clinical and radiographic outcomes. The pulpal and periapical status as well as pulpal exposure type/location had no effect on treatment outcomes.  相似文献   

16.

Objectives

The purpose of this study was to investigate factors, such as the status of impaction, root developmental stage, depth of impaction, tooth angulation and eruption space, which can influence the spontaneous eruption of impacted mandibular first molars after surgical exposure.

Material and methods

Clinical dental records and panoramic radiographs of children aged 6 years or older were studied. In total, 59 impacted mandibular first molars of 54 children had undergone surgical exposure to induce eruption and were followed for more than 6 months. Fisher's exact test and independent-sample t-tests were used for analysis.

Results

The failure rates of tooth eruption in type I and type II cases were significantly higher than those in type III and IV cases (p = 0.012). Regarding the degree of root development, the failure rate of spontaneous eruption increased as root formation approached completion, but this trend was statistically insignificant (p = 0.275). Failure rate was higher in the cases of shallow impaction than cases of deep impaction (p = 0.011). The angulation of impacted teeth did not influence the spontaneous eruption after surgical exposure (p = 0.394). Spontaneous eruption failure was significantly more likely when the eruption space between the adjacent second premolar and the second molar was smaller than the crown width of the impacted tooth (p = 0.002).

Conclusion

The results showed that spontaneous eruption by surgical exposure occurred well when the impaction type was distally angulation, the depth of the impaction was deep, or eruption space was sufficient.  相似文献   

17.
18.

Introduction

Dental pulp inflammation is an excellent model for the interaction between tissue inflammation and regenerative processes. It is worthwhile to better understand molecular signaling of repair and regeneration in inflammatory processes. Emerging evidence suggests that long noncoding RNA (lncRNA) participates in immune system inflammatory processes. Here we investigate the expression of lncRNAs in pulpitis, the inflammation of dental pulp tissue, and identify lncRNAs that possibly participate in inflammation responses and odontogenesis.

Methods

Integrated comparative lncRNA microarray was used to examine lncRNA and mRNA expression between inflamed and normal human pulp tissue. The differential expression of lncRNAs and mRNAs was then validated by quantitative real-time polymerase chain reaction. A bioinformatics analysis was performed to predict the function of differentially expressed lncRNAs and mRNAs.

Results

Our data indicated 752 lncRNAs were significantly differentially expressed (fold change > 2.0; P < .05) in inflamed pulp tissues compared with normal pulp tissues, including 338 upregulated and 414 downregulated lncRNAs. Among the 646 differentially expressed mRNAs (fold change > 2.0; P < .05), 460 were upregulated, and 186 were downregulated. The differentially downregulated genes are enriched for gene ontology terms related to odontogenesis and cell development in biological processes, whereas the differentially upregulated genes are related to immune and inflammation processes.

Conclusions

LncRNAs are differentially expressed in inflamed human pulp tissue compared with normal pulp tissue, indicating that lncRNAs may play key roles in pulpitis pathogenesis and development.  相似文献   

19.

Statement of problem

Dentin surface contamination before the cementation of indirect restorations may impact bonding effectiveness.

Purpose

The purpose of this in vitro study was to analyze the influence of immediate dentin sealing (IDS) and interim cementation on the adhesion of indirect restorations with a dual-polymerizing resin cement.

Material and methods

Composite resin inlays were placed in class V cavities prepared in the buccal and lingual surfaces of 30 extracted human molars with a dual-polymerizing resin cement in 3 different ways (n=10): CG, directly on dentin; PG, after 14 days interim cementation; SG, after IDS and 14 days interim cementation. Buccal restorations were sectioned into sticks and submitted to the microtensile bond strength (μTBS) test. Lingual restorations were submitted to micro-Raman spectroscopy (MRS). Data were analyzed with 1-way ANOVA and the Tukey-Kramer post hoc test (α=.05).

Results

Significantly higher μTBS results were found for SG (35.7 ±8.2 MPa) when compared with CG (23.1 ±7.1 MPa) and PG (17.0 ±6.0 MPa) (P<.05), but no differences were observed between CG and PG. MRS showed that the diffusion zone in SG (3.7 ±0.5 μm) was significantly thicker than that of CG (1.8 ±1.2 μm) or PG (1.5 ±0.3 μm) (P<.05). Additionally, a new interface peak (at approximately 1330 cm-1) was found in SG, indicating a chemical interaction.

Conclusions

The use of IDS before cementation resulted in a chemical interaction at the interface and significantly higher μTBS and diffusion zone thickness values. Interim cementation did not interfere with adhesion quality when compared with the control group.  相似文献   

20.

Introduction

The purpose of this study was to evaluate the accuracy of small-volume cone-beam computed tomography (CBCT) to detect and measure isthmi in the apical root canals of mandibular molars by using micro–computed tomography (μ-CT) as the reference standard.

Methods

Forty mandibular first molars selected on the basis of μ-CT scan and presenting isthmi in the apical 3-mm mesial roots were scanned by using the highest-resolution settings of a small-volume CBCT unit. Isthmi lengths were measured and compared between both μ-CT and CBCT images to study the accuracy of CBCT readings. Quantitative data for sensitivity rate were depicted as percentage value with 95% confidence interval. Results were analyzed by using linear regression between true lengths (μ-CT) and CBCT lengths, Bland-Altman plot and t test, at α = 0.05.

Results

CBCT sensitivity for isthmi detection was 65% (95% confidence interval, 0.4667–0.8333). An average of 74.7% of the lengths could be measured, and differences among the lengths in μ-CT and CBCT were significant (P < .05; mean, 0.756 ± 0.655; t test), showing that there was no agreement between both methods.

Conclusions

Accuracy of identifying apical isthmi of mandibular molars was highly influenced by the evaluation method. Small-volume CBCT imaging could not detect and measure apical isthmi length accurately. Moreover, using high-resolution settings in CBCT, it was not reliable to forecast the actual apical root canal anatomy.  相似文献   

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