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OR 29 Pain reduction in symptomatic, necrotic teeth using an intraosseous injection of Depo-Medrol
Vol. 25, No. 4, April 1 9 9 9
__lOu~] Anesthetic efficacy of 0.5% ropivacaine in maxillary infiltration injections. M. Kennedy*, A. Reader, M. Beck, J. Weaver, E. Gallatin The Ohio State University, Columbus, Ohio Ropivacaine is a new long-acting local anesthetic agent with decreased cardiac toxicity compared to bupivacaine. Dermal studies have indicated that ropivacaine may have vasoconstrictive properties which would allow the solution to be used without a vasoconstrictor. Since no studies have been performed in dentistry, the purpose of this prospective, randomized, double-blind study was to determine the anesthetic efficacy of 0.5% ropivacaine compared to 0.5 % ropivacaine (1:200,000 epi.) and 0.5% bupivacaine (I :200,000 epi.) in maxillary lateral incisor infiltrations. Using a repeated-measures design, 40 adult subjects randomly received 3 blinded anesthetic solution injections over the maxillary lateral incisor at 3 separate appointments spaced at least 1 week apart: l. Infiltration of 1.8 ml of 0.5% ropivacaine (Naropin); 2. Infiltration of 1.8 ml of 0.5% ropivacaine (1:200,000 epinephrine); 3. Infiltration of 1.8 ml of 0.5% bupivacaine[Marcaine]( 1:200,000 epinephrine)[control solution]. The lateral incisor was blindly tested with an electric pulp tester at 2 minute cycles for 90 minutes. Between solution comparisons of total percent pulpal anesthesia (80 readings across time) were analyzed using a repeated-measures logistic regression. The results showed total percent pulpal anesthesia was not statistically significant (p>0.05) between ropivacaine with epinephrine (36%) and bupivacaine with epinephrine (35%). There was a significant difference (p<0.05) between ropivacaine (14%) and ropivacaine with epinephrine (36%). We concluded that the dura.tion of pulpal anesthesia was less for ropivacaine without epinephrine. Ropivacaine with epinephrine was equivalent to bupivacaine with epinephrine but neither agent provided pulpal anesthesia for an hour.
OO~[ Pain reduction in symptomatic, necrotic teeth using an intraosseous injection of Depo-Medrol.
2ZA
E. Bramy*, A. Reader, E. Gallatin, R. Nist, M. Beck, J. Weaver The Ohio State University, Columbus, O H In approximately one-thJa'dof patients with symptomatic necrotic teeth, moderate/severe postoperative pain persists for several days despite thorough endodontic debridement. The purpose of this prospective, randomized, double-blind study was to evaluate postoperative pain reduction using an intraosseous (IO) injection of long-acting methylprednisolone in symptomatic necrotic teeth. Thirty-eight patients with a clinical diagnosis of a symptomatic necrotic tooth experiencing moderate/severe pain, with mild or no clinical swelling, and an associated periapical radiolucency participated. Following endodontic treatment (complete debridement), patients randomly received, in a double-blind manner, an IO injection of either 1 ml of Depo-Medrol (40 rag) (19 patients) or 1 ml of sterile saline placebo (control) (19 patients). All subjects received ibuprofen and Tylenol #3 and a 7 day diary to record pain, percussion pain, and number and type of pain medications taken. The results of this study demonstrated the patients receiving the IO injection of Depo-Medrol reported significantly less postoperative pain and took significantly less pain medications (ibuprofen and Tylenol #3), as analyzed by Mann-Whitney-Wilcoxon tests (p<0.05), over the seven days. However, moderate to severe postoperative pain still occurred for the Depo-Medrol group. For each group, Depo-Medrol vs saline placebo respectively: 26% and 47% of the patients had moderate to severe pain on day 1, 0% and 10% on day 2, 16% and 5% on day 3, 5% and 16% on day 4, and 0% and 10% for days 5 through 7. In conclusion, while the Depo-Medrol reduced postoperative pain and the use of pain medications, it did not completely eliminate moderate to severe postoperative pain for patients with symptomatic, necrotic teeth.
Journal of Endodontics • 289
Colonization of E.faecalis in root canal bovine dentin treated with different chlorhexidine formulations. B.J. Lenet*, R. Komorowski, H.P. Lawrence, S. Friedman Faculty of Dentistry, University o f Toronto, C a n a d a Root canal dentin may acquire a substantive antimicrobial property when exposed to chlorhexidine gluconate (CHX). A method to deliver CHX as an intracanal medicament is therefore desirable. This in vitro study assessed the efficacy of two CHX delivery methods. Roots of bovine incisors were cross-sectioned and prepared to form 60 cylindrical dentin test specimens with a standardised lumen of 0.033 ram. Four groups (n=l 5) were treated for 7 d with the following: sterile saline (Group 1), Ca(OH) 2 (Group 2), controlled release device containing 2.5% CHX (Group 3), and 2% CHX gel (Group 4). Specimens were then incubated with Brain Heart Infusion (BHI) broth containing E. faecalis and stored at 370 C. A fresh overnight inoculum was added every second day, and the broth replenished daily. Supernatant samples were taken weekly to confirm viable bacteria and purity of the inoculum. After 21 d, root canal dentin samples were obtained from the specimens using sterile burs in ascending diameter sequence, from ISO 0.035 to 0.042. Dentin samples were incubated in BHI broth for 24 h at 37°C. The optical density was then measured using spectrophotometry. Optical density in Group 1 was significantly higher (p<0.001) than in the other 3 groups, and significantly lower in Group 4 than in Groups 2 and 3. These results sugeest that bovine root canals treated with 2% CHX gel for 7 d acquire increased resistance to dentin colonization by E. faecalis.
The effects of calcium hydroxide inhibition on L P S induced release of IL-I[~ from human
monocytes in whole blood. M.H. Olsen*, P.M. DiFiore, S.N. Dixit, A. Veis N o r t h w e s t e r n University Dental School The purpose of this study was to evaluate the effects of calcium hydroxide inhibition on LPS induced release of IL-1 [3 from human monocytes in a time dependant manner. Human whole blood in an ex vivo environment was subjected to 1000ng/ml, 100ng/ml, 10ng/ml and 1ng/ml of LPS from Pseudomonas aeruginosa and then treated with a saturated solution of Ca(OH) 2 for various time periods ranging from 10 minutes to 24 hours. LPS not subjected to calcium hydroxide served as a positive control. A saturated solution of Ca(OH) 2added to whole blood as well as whole blood alone served as negative controls. Forty-eight experimental samples were treated in triplicate. The concentrations of IL-113 released were measured by Elisa analysis from the serum supernatants of the experimental and control samples. Statistical analysis showed that for all time periods Ca(OH): significantly reduced the production of IL- 113 P<.01 using one way anova. Results showed levels of IL-I13 where at 300pg/ml to 1,500pg/ml for LPS only samples. Levels of IL-113 detected fiom the Ca(OH)z inhibited LPS were in the order of 10-20pg/ml for all time periods. These low levels of IL- 1[3 found in the Ca(OH) z treated samples were similar to those found in the negative controls. Conclusion: Calcium hydroxide inhibition of LPS dramatically decreased the release of IL- t ~ from monocytes in human whole blood at all time periods.
__lOu~] Anesthetic efficacy of 0.5% ropivacaine in maxillary infiltration injections. M. Kennedy*, A. Reader, M. Beck, J. Weaver, E. Gallatin The Ohio State University, Columbus, Ohio Ropivacaine is a new long-acting local anesthetic agent with decreased cardiac toxicity compared to bupivacaine. Dermal studies have indicated that ropivacaine may have vasoconstrictive properties which would allow the solution to be used without a vasoconstrictor. Since no studies have been performed in dentistry, the purpose of this prospective, randomized, double-blind study was to determine the anesthetic efficacy of 0.5% ropivacaine compared to 0.5 % ropivacaine (1:200,000 epi.) and 0.5% bupivacaine (I :200,000 epi.) in maxillary lateral incisor infiltrations. Using a repeated-measures design, 40 adult subjects randomly received 3 blinded anesthetic solution injections over the maxillary lateral incisor at 3 separate appointments spaced at least 1 week apart: l. Infiltration of 1.8 ml of 0.5% ropivacaine (Naropin); 2. Infiltration of 1.8 ml of 0.5% ropivacaine (1:200,000 epinephrine); 3. Infiltration of 1.8 ml of 0.5% bupivacaine[Marcaine]( 1:200,000 epinephrine)[control solution]. The lateral incisor was blindly tested with an electric pulp tester at 2 minute cycles for 90 minutes. Between solution comparisons of total percent pulpal anesthesia (80 readings across time) were analyzed using a repeated-measures logistic regression. The results showed total percent pulpal anesthesia was not statistically significant (p>0.05) between ropivacaine with epinephrine (36%) and bupivacaine with epinephrine (35%). There was a significant difference (p<0.05) between ropivacaine (14%) and ropivacaine with epinephrine (36%). We concluded that the dura.tion of pulpal anesthesia was less for ropivacaine without epinephrine. Ropivacaine with epinephrine was equivalent to bupivacaine with epinephrine but neither agent provided pulpal anesthesia for an hour.
OO~[ Pain reduction in symptomatic, necrotic teeth using an intraosseous injection of Depo-Medrol.
2ZA
E. Bramy*, A. Reader, E. Gallatin, R. Nist, M. Beck, J. Weaver The Ohio State University, Columbus, O H In approximately one-thJa'dof patients with symptomatic necrotic teeth, moderate/severe postoperative pain persists for several days despite thorough endodontic debridement. The purpose of this prospective, randomized, double-blind study was to evaluate postoperative pain reduction using an intraosseous (IO) injection of long-acting methylprednisolone in symptomatic necrotic teeth. Thirty-eight patients with a clinical diagnosis of a symptomatic necrotic tooth experiencing moderate/severe pain, with mild or no clinical swelling, and an associated periapical radiolucency participated. Following endodontic treatment (complete debridement), patients randomly received, in a double-blind manner, an IO injection of either 1 ml of Depo-Medrol (40 rag) (19 patients) or 1 ml of sterile saline placebo (control) (19 patients). All subjects received ibuprofen and Tylenol #3 and a 7 day diary to record pain, percussion pain, and number and type of pain medications taken. The results of this study demonstrated the patients receiving the IO injection of Depo-Medrol reported significantly less postoperative pain and took significantly less pain medications (ibuprofen and Tylenol #3), as analyzed by Mann-Whitney-Wilcoxon tests (p<0.05), over the seven days. However, moderate to severe postoperative pain still occurred for the Depo-Medrol group. For each group, Depo-Medrol vs saline placebo respectively: 26% and 47% of the patients had moderate to severe pain on day 1, 0% and 10% on day 2, 16% and 5% on day 3, 5% and 16% on day 4, and 0% and 10% for days 5 through 7. In conclusion, while the Depo-Medrol reduced postoperative pain and the use of pain medications, it did not completely eliminate moderate to severe postoperative pain for patients with symptomatic, necrotic teeth.
Journal of Endodontics • 289
Colonization of E.faecalis in root canal bovine dentin treated with different chlorhexidine formulations. B.J. Lenet*, R. Komorowski, H.P. Lawrence, S. Friedman Faculty of Dentistry, University o f Toronto, C a n a d a Root canal dentin may acquire a substantive antimicrobial property when exposed to chlorhexidine gluconate (CHX). A method to deliver CHX as an intracanal medicament is therefore desirable. This in vitro study assessed the efficacy of two CHX delivery methods. Roots of bovine incisors were cross-sectioned and prepared to form 60 cylindrical dentin test specimens with a standardised lumen of 0.033 ram. Four groups (n=l 5) were treated for 7 d with the following: sterile saline (Group 1), Ca(OH) 2 (Group 2), controlled release device containing 2.5% CHX (Group 3), and 2% CHX gel (Group 4). Specimens were then incubated with Brain Heart Infusion (BHI) broth containing E. faecalis and stored at 370 C. A fresh overnight inoculum was added every second day, and the broth replenished daily. Supernatant samples were taken weekly to confirm viable bacteria and purity of the inoculum. After 21 d, root canal dentin samples were obtained from the specimens using sterile burs in ascending diameter sequence, from ISO 0.035 to 0.042. Dentin samples were incubated in BHI broth for 24 h at 37°C. The optical density was then measured using spectrophotometry. Optical density in Group 1 was significantly higher (p<0.001) than in the other 3 groups, and significantly lower in Group 4 than in Groups 2 and 3. These results sugeest that bovine root canals treated with 2% CHX gel for 7 d acquire increased resistance to dentin colonization by E. faecalis.
The effects of calcium hydroxide inhibition on L P S induced release of IL-I[~ from human
monocytes in whole blood. M.H. Olsen*, P.M. DiFiore, S.N. Dixit, A. Veis N o r t h w e s t e r n University Dental School The purpose of this study was to evaluate the effects of calcium hydroxide inhibition on LPS induced release of IL-1 [3 from human monocytes in a time dependant manner. Human whole blood in an ex vivo environment was subjected to 1000ng/ml, 100ng/ml, 10ng/ml and 1ng/ml of LPS from Pseudomonas aeruginosa and then treated with a saturated solution of Ca(OH) 2 for various time periods ranging from 10 minutes to 24 hours. LPS not subjected to calcium hydroxide served as a positive control. A saturated solution of Ca(OH) 2added to whole blood as well as whole blood alone served as negative controls. Forty-eight experimental samples were treated in triplicate. The concentrations of IL-113 released were measured by Elisa analysis from the serum supernatants of the experimental and control samples. Statistical analysis showed that for all time periods Ca(OH): significantly reduced the production of IL- 113 P<.01 using one way anova. Results showed levels of IL-I13 where at 300pg/ml to 1,500pg/ml for LPS only samples. Levels of IL-113 detected fiom the Ca(OH)z inhibited LPS were in the order of 10-20pg/ml for all time periods. These low levels of IL- 1[3 found in the Ca(OH) z treated samples were similar to those found in the negative controls. Conclusion: Calcium hydroxide inhibition of LPS dramatically decreased the release of IL- t ~ from monocytes in human whole blood at all time periods.