BACKGROUND: The most commonly used technique to anesthetize maxillary teeth is the infiltration anesthesia that currently is the gold standard. However, infiltration uses a dental needle that is associated with its de merits also. This led to the discovery of novel methods to anesthetize teeth. We in our study have used lidocaine with xylometazoline in the form of an intranasal spray to achieve local anesthesia of maxillary teeth for restorative procedures. The most commonly used technique to anesthetize maxillary teeth is the infiltration anesthesia that currently is the gold standard. However, infiltration uses a dental needle that is associated with its de merits also. This led to the discovery of novel methods to anesthetize teeth. We in our study have used lidocaine with xylometazoline in the form of an intranasal spray to achieve local anesthesia of maxillary teeth for restorative procedures. A total of 60 patients were enrolled in the study. Thirty patients were randomized each to lidocaine/Xylometazoline or to control local anesthesia group. Group A participants received 4% Lidocaine and 0.1% Xylometazoline solution as intranasal spray while Group B participants received injectable local anesthesia. Local anesthesia was then assessed and reading was taken on the Visual Analog Scale. If the reading was ‘0’ the cavity preparation was performed. If the VAS reading was more than ‘0’ a third dose of intranasal spray anesthesia was delivered. If profound local anesthesia was still not achieved the case was labeled as failure of intranasal spray anesthesia and local anesthesia was achieved by conventional infiltration anesthesia. For Group B participants, local anesthesia was achieved by means of conventional infiltration anesthesia. SPSS v.16 was used to analyze the data with level of significance set at p<0.05. Demographic data were analyzed upon the basis of frequency and percentages. Chi-square test and Fischer exact test were applied to see the difference of efficacy among the two groups and any influence of variables on the efficacy. RESULTS: 21 out of 30 (70%) patients from Group A were anesthetized by intranasal spray anesthesia while all 30 (100%) patients from Group B had successful anesthesia by conventional infiltration. The p value computed is <0.05. No statistically significant effects of age group, gender, tooth location or the number of sprays was observed on the efficacy of intranasal spray anesthesia (p>0.05). There was a statistically significant effect of ICDAS score on the efficacy of intranasal spray anesthesia (p<0.05). CONCLUSION: Lidocaine xylometazoline intranasal spray solution was fairly efficacious in anesthetizing maxillary teeth with smaller carious lesions for restorative procedures in patients with a stable medical history. Intranasal spray solution can be used for patients with needle phobia.TRIAL REGISTRATION: The study is registered on clinical trials website via NCT04732104 on 26/01/2021.

Background and Objective: Despite a plethora of studies conducted to date, researchers continue to investigate the best sealer and obturation technique combinations. The aim of this study is to compare the apical seal provided by two bioceramic sealers (Endoseal and Endosequence) with that provided by a calcium hydroxide sealer (Sealapex), and to evaluate the effect of different obturation techniques (cold lateral condensation, continuous wave compaction and single cone) on the apical seal under a stereomicroscope. Materials and Methods: A total of 110 single-rooted mandibular premolar teeth were decoronated, cleaned and shaped using the Endosequence filing system to tip size 30/0.04 taper. Canals were irrigated with 5.25% NaOCl and 17% EDTA. The samples were randomly divided into 11 groups (9 experimental and 2 control groups) according to the designated sealer and technique. Samples were stored in an incubator for 7 days at 37 °C under 100% humidity. Samples were coated with nail varnish except for apical 2 mm and vertically placed in 0.2% rhodamine B dye solution for 48 h. Samples were split longitudinally and viewed under a stereomicroscope at 40× magnification. Results: Insignificant results were obtained between obturation techniques (p = 0.499) whereas statistically significant results were attained based on the type of endodontic sealer (p < 0.001). The overall lowest mean apical microleakage and best sealing ability was demonstrated by Sealapex (2.59 ± 1.20 mm) and amongst techniques by continuous wave compaction (3.90 ± 2.51 mm). Conclusions: Endosequence produced the best apical seal with the continuous wave compaction technique, whereas Endoseal did so with the bioceramic-coated single-cone technique. For the Sealapex sealer, the most effective apical seal was observed using cold lateral condensation. The quality and effectiveness of apical seal differed with the type of endodontic sealer and obturation technique used, and vice versa.

BACKGROUNDMany approaches have been investigated for pain relief after root canal procedure. In this study we compare the effectiveness of premedication drugs, given single dose Piroxicam and Prednisolone separately to evaluate post endodontic pain at different time intervals (24, 48, 72 and 96 hours) using visual analog scale (VAS) after single visit root canal treatment.METHODSTotal number of 120 patients identified with symptomatic irreversible pulpitis were made part of this research after signing informed consent. The pain intensity levels were marked through the use of VAS scale before the commencement of treatment. The participants were randomly placed in three groups (n=40) Group I: Control, Group II: Piroxicam (20 mg) and Group III: Prednisolone (20 mg). The drugs were administered thirty minutes before endodontic procedure was initiated. Root canal procedure was carried out followed by placement of provisional restoration on a single appointment. The patients were advised to continue marking their pain intensity levels after 24, 48, 72 and 96 hours using VAS. All patients were called for follow up after 4 days for clinical evaluation and placement of permanent restoration. The effectiveness of each drug over different time interval was studied employing repeated measure ANOVA. The significance level was considered p-value <0.05.RESULTSAdministration of pre-medication drug therapy with Piroxicam and Prednisolone was able to successfully alleviate post-endodontic pain. However, the long term effectiveness (96 hours) of both drugs to reduce post-endodontic pain was observed to be statistically insignificant.CONCLUSIONPre-medication with either single dose Piroxicam and Prednisolone was found to be effective against post-endodontic pain, in patients presenting with symptomatic irreversible pulpitis.TRIAL REGISTRATION: This single blinded, randomized clinical trial [registration no. NCT04124822(11/10/2019)] was performed in Operative Dentistry department of Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences.