Evaluation of Different Clinical Strategies for Emergency Treatment of Irreversible Pulpitis with Apical Periodontitis
Eman Mohamed Ahmed AdlyZalat;
Abstract
The aim of this clinical study was to evaluate different clinical strategiesfor emergency treatment of irreversible pulpitis withapical periodontitis regarding three aspects: effect of single file instrumentation technique, effect of intra canal medicament and the effect of occlusal reduction.
Eighty four patients participated in this study. All patients were treated in the post graduate clinic of Endodontic Department of Faculty of Dentistry, Ain Shams University. The Ethics Committee of the faculty of Dentistry approved the investigation and then informed consent of all subjects was obtained after the nature of the procedure and the possible discomfort and risks were fully explained. All patients included in this study met the inclusion and exclusion criteria described. Then clinical diagnosis of symptomatic irreversible pulpitis with apical periodontitis was confirmed by: electric pulp tester and percussion test.Before starting cleaning and shaping all teeth (upper premolars) were anesthetized by using 1 cartridge of local anaesthetic solutioncontain 2% Mepivicaine with 1:20000 levonordefrin. Straight line access to the root canal was carried out.Then proper isolation with rubber dam was applied. Root canals were instrumented initially with K-files size #10&15 followed by the use of Endoflare to prepare coronal portion of the canals.Then establishment of working length by using electronic root canal measuring deviceand confirming the measurements with periapical radiograph.
All Patientswere randomly classified into two main groupsaccording to the preparation technique:G1:in which cleaning and shaping was performed using with one shape rotary NiTi instrument G2: in which cleaning and shaping was performed using the wave one reciprocating NiTi instrument.Then each group was divided into 3 subgroupsaccording to the intra canal medication stepinto: subgroup A: in which calcium hydroxide paste (Ca(OH)2) was used , subgroup B: in which chlorhexidine gel (CHX) was used , and subgroup C: in which no ICM was used.Then each subgroup was divided into 2 subdivisionsaccording to the execution of occlusal reduction. All patients were instructed to complete a VRS to rate their pain at 4 hours, 12 hours, 24 hours and 2 days after the treatment. Data were collected, tabulated and statistically analyzed.
Results showed that there was no statistically significant differences between the two preparation techniques (rotation &reciprocation) through all time periods in all subgroups ofintra-canal medicaments even in presence or absence of occlusal reduction.
Within the limitations of this study, it can be concluded that:
1. Predictable emergency treatment for cases of irreversible pulpitis with apical periodontitis depends mainly on removal of diseased tissues.
2. Instrumentation kinematics, intra canal medication & occlusal reduction did not influence the degree of post- operative pain after emergency treatment of irreversible pulpitis with apical periodontitis.
Recommendations:
Conduction of randomized clinical trials with larger sample sizes and more sensitive evaluation tools.
Eighty four patients participated in this study. All patients were treated in the post graduate clinic of Endodontic Department of Faculty of Dentistry, Ain Shams University. The Ethics Committee of the faculty of Dentistry approved the investigation and then informed consent of all subjects was obtained after the nature of the procedure and the possible discomfort and risks were fully explained. All patients included in this study met the inclusion and exclusion criteria described. Then clinical diagnosis of symptomatic irreversible pulpitis with apical periodontitis was confirmed by: electric pulp tester and percussion test.Before starting cleaning and shaping all teeth (upper premolars) were anesthetized by using 1 cartridge of local anaesthetic solutioncontain 2% Mepivicaine with 1:20000 levonordefrin. Straight line access to the root canal was carried out.Then proper isolation with rubber dam was applied. Root canals were instrumented initially with K-files size #10&15 followed by the use of Endoflare to prepare coronal portion of the canals.Then establishment of working length by using electronic root canal measuring deviceand confirming the measurements with periapical radiograph.
All Patientswere randomly classified into two main groupsaccording to the preparation technique:G1:in which cleaning and shaping was performed using with one shape rotary NiTi instrument G2: in which cleaning and shaping was performed using the wave one reciprocating NiTi instrument.Then each group was divided into 3 subgroupsaccording to the intra canal medication stepinto: subgroup A: in which calcium hydroxide paste (Ca(OH)2) was used , subgroup B: in which chlorhexidine gel (CHX) was used , and subgroup C: in which no ICM was used.Then each subgroup was divided into 2 subdivisionsaccording to the execution of occlusal reduction. All patients were instructed to complete a VRS to rate their pain at 4 hours, 12 hours, 24 hours and 2 days after the treatment. Data were collected, tabulated and statistically analyzed.
Results showed that there was no statistically significant differences between the two preparation techniques (rotation &reciprocation) through all time periods in all subgroups ofintra-canal medicaments even in presence or absence of occlusal reduction.
Within the limitations of this study, it can be concluded that:
1. Predictable emergency treatment for cases of irreversible pulpitis with apical periodontitis depends mainly on removal of diseased tissues.
2. Instrumentation kinematics, intra canal medication & occlusal reduction did not influence the degree of post- operative pain after emergency treatment of irreversible pulpitis with apical periodontitis.
Recommendations:
Conduction of randomized clinical trials with larger sample sizes and more sensitive evaluation tools.
Other data
| Title | Evaluation of Different Clinical Strategies for Emergency Treatment of Irreversible Pulpitis with Apical Periodontitis | Other Titles | تقييم الاستراتيجيات المختلفة لمعالجة الحالات الطارئة لالتهاب اللارجعي للعصب والانسجة فوق قمية | Authors | Eman Mohamed Ahmed AdlyZalat | Issue Date | 2015 |
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