Quintessence International Volume 1 (eBook)

Editorial board's selected articles

Eli Eliav (Herausgeber)

eBook Download: EPUB

2025 | 1st Edition 2024
216 Seiten
QUINTESSENZ Verlag
978-3-86867-712-6 (ISBN)

Infos

This Quintessence International (QI) annual yearbook is a compilation of selected articles representing the most significant work from the past year. Through a double-blind process that ensures anonymity and quality, our team of editors and reviewers performed the remarkable and difficult task of reviewing and evaluating many deserving submissions to present you with this outstanding selection of 20 articles. Organized by disciplines and topics, the articles provide a valuable and user-friendly resource that we hope you find enjoyable and informative.

Dr. Eliav is a professor and the Director of the Eastman Institute for Oral Health, Vice President for Oral Health at the University of Rochester Medical Center and the Vice Dean for Oral Health within its School of Medicine and Dentistry. Dr. Eliav earned his Dental Degree (1991), MSc (1995) and PhD (2004) from the Hebrew University and Hadassah in Jerusalem. He specialized in Oral Medicine at the Hebrew University, Hadassah Jerusalem, Israel (1991-1995) and trained in Clinical and Basic Science Research Program in the National Institute of Health Bethesda, Maryland, USA (1995-1997). Since 2008 he is the Editor in Chief of Quintessence International and since 2018 an associate Editor of the Journal of Oral & Facial Pain and Headache.

Textauszug

Effectiveness of oral premedication of meloxicam, ketorolac, dexamethasone, and ibuprofen on the success rate of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, double-blind, randomized controlled trial

Amr M. Elnaghy, BDS, MSc, PhD/Alaa H. Elshazli, BDS, MSc, PhD/Shaymaa E. Elsaka, BDS, MSc, PhD

Objective: The aim of this prospective, double-blind, randomized controlled trial was to compare the effect of oral premedication of meloxicam, ketorolac, dexamethasone, ibuprofen, or placebo on the success of inferior alveolar nerve blocks (IANB) of mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis. Method and materials: Two hundred and fifty emergency patients in moderate to severe pain diagnosed with symptomatic irreversible pulpitis of a mandibular first or second molar randomly received, in a double-blind manner, identical capsules containing either meloxicam 7.5 mg, ketorolac 10 mg, dexamethasone 0.5 mg, ibuprofen 600 mg, or placebo 60 minutes before the administration of an IANB. Profound lip numbness was assessed after 15 minutes. Access cavities were then prepared and success of IANB was defined as no or mild pain (Heft-Parker visual analog scale recordings) during access preparation and root canal instrumentation. The data were analyzed using chi-square and Kruskal-Wallis tests. Results: The overall success rates for the meloxicam 7.5 mg, ketorolac 10 mg, dexamethasone 0.5 mg, and ibuprofen 600 mg groups were 52%, 64%, 54%, and 58%, respectively, with no significant differences in success rates among the premedications groups (P > .05). However, the tested premedications revealed significant differences compared with the placebo group (32% success rate) (P < .05). Conclusion: Premedication with meloxicam, ketorolac, dexamethasone, and ibuprofen increased the efficacy of IANB in mandibular molars with symptomatic irreversible pulpitis.
(Quintessence Int 2023;54:92–99; doi: 10.3290/j.qi.b3605097)

Key words: anesthesia, dexamethasone, inferior alveolar nerve block, ketorolac, meloxicam, symptomatic irreversible pulpitis

The inferior alveolar nerve block (IANB) is utilized to achieve pulpal anesthesia of mandibular teeth for endodontic treatments.1 Pain management and achieving anesthesia are more challenging in mandibular molar teeth with symptomatic irreversible pulpitis.2,3 It has been reported that the failure rate for IANB in patients with symptomatic irreversible pulpitis was between 43% and 83% because of inflammatory changes in the pulp.1,4 Buccal infiltration,5 intraosseous anesthesia,6 and oral premedication2 have been used to enhance the success of anesthesia for mandibular teeth.

Various pharmacologic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs) and steroids have been investigated as oral premedications to improve the success of anesthesia in randomized controlled trials.2,7,8 However, there are contradictory results about the effectiveness of oral premedications before administrating an IANB.8 It was reported that considerable enhancements in the success rate of IANBs in mandibular molars with inflamed pulps after premedication with ibuprofen and indomethacin.9 There was an improvement in the success rates in IANB anesthesia of mandibular molars with inflamed pulps after premedication with ibuprofen and acetaminophen while there was no considerable difference between the medicament and placebo groups.10 On the other hand, there were no significant differences in the success rates of IANB anesthesia of mandibular molars with inflamed pulps where the patients were premedicated with analgesics.11,12

Meloxicam is an NSAID with preferential activity on the cyclooxygenase 2 (COX-2) system.13 Shantiaee et al3 reported that premedication with meloxicam and ibuprofen significantly improved the success rates of IANB anesthesia for mandibular molars with irreversible pulpitis; however, neither drug provided profound anesthesia. Dexamethasone, a glucocorticoid with an anti-inflammatory effect, increased the efficiency of IANB compared to ibuprofen.8 Dexamethasone influences the acute inflammatory reaction by suppressing vasodilation, inhibiting the migration and phagocytosis of polymorphonuclear leucocytes, and preventing the production of prostaglandins and leukotrienes by blocking COX and lipoxygenase routes of inflammation.1,8

Ketorolac was developed as an intramuscular NSAID with potent prostaglandin synthesis inhibition efficacy. Ketorolac is a pyrrolo-pyrrole derivative and is as effective as morphine or meperidine for pain relief after orthopedic or disc surgery.14-16 It was reported that the administration of ibuprofen or ketorolac has no significant effect on the success rate of IANB in patients with irreversible pulpitis.12 On the other hand, in another clinical trial, it was shown that ketorolac revealed a higher success rate of 70% while ibuprofen gave 50%.17

Previous studies showed that the use of oral premedication with NSAIDs enhanced the success rate of IANB in patients with irreversible pulpitis.18-21 However, more trials are required to compare dexamethasone and other oral premedications to validate their relative efficacy1 in the treatment of symptomatic irreversible pulpitis. Accordingly, the purpose of this prospective, randomized, double-blind study was to compare the efficacy of oral premedication of dexamethasone, meloxicam, ketorolac, ibuprofen, or placebo on anesthetic efficacy of IANB of mandibular posterior teeth in patients with symptomatic irreversible pulpitis.

Method and materials

The clinical trial protocol and informed consent were approved by the Vision Medical College Research Ethics Committee (approval number 21-8/1). The protocol was registered at clinicaltrials.gov under the code NCT05097768. The sample size was determined using the superiority trial mode of the sealed envelope calculator (www.sealedenvelope.com) based on the data from a previous study,8 with percentages of success in control and experimental groups 12.7% and 38.2%, respectively. The sample size was determined with a type I error of 5% and statistical power of 80%. The required sample size was 42 participants per group; however, the number was increased to 50 participants with a total sample size of 250 patients being determined (allocation ratio of 1:1). A postgraduate dentistry student who was not involved in the trial screened 290 adult patients for participation in the study (Fig 1). They were emergency patients at the Faculty of Dentistry, Vision Colleges, Jeddah, Saudi Arabia, and were in good health based on their medical histories and oral questioning. The differential diagnostic criteria for symptomatic irreversible pulpitis were followed according to the American Association of Endodontists.22 Patient exclusion criteria included those with a known allergy, sensitivity, or contraindications to an opioid or nonopioid analgesic including aspirin or NSAIDs, those with a history of the active peptic ulcer within the preceding 12 months, a history of bleeding problems or anticoagulant use within the last month, patients who were pregnant or breast-feeding, a history of known or suspected drug abuse, and those who had taken NSAIDs with 12 hours before administration of the study drugs.12 The approved consent form was signed by all the patients.

Fig 1 CONSORT flowchart.

The inclusion criteria included healthy patients experiencing pain in the first or second mandibular molar with prolonged response to cold testing (Endo-frost, Roeko), teeth with a vital pulp, and the absence of periapical radiolucency on radiographs.2 The Modified Dental Anxiety Scale23 was used to assess the patients’ anxiety levels. The pain of the patients was classified into four types using the Heft-Parker visual analog scale (HP VAS)12,24 as follows: no pain corresponded to 0 mm; faint, weak, or mild pain corresponded to 0 to 54 mm; moderate pain corresponded to 55 to 114 mm; and strong, intense, and maximum possible pain corresponded to more than 114 mm.

Randomization of patients was performed by using permuted block randomization (www.sealedenvelope.com) to ensure the consistency of the five groups. The patients were randomly given meloxicam 7.5 mg, ketorolac 10 mg, dexamethasone 0.5 mg, ibuprofen 600 mg, or placebo by mouth 60 minutes before administering IANB.1 To blind the study, each of the 50 patients in each group was randomly allocated a code consisting of two letters and one number. Only the random codes identified the medications; thus, the patient and clinicians were uninformed of which medication was given to them.25,26 The medication and placebo were blinded as follows: in opaque yellow size “000” capsules, a certified pharmacist prepared identical-appearing capsules of the medications and placebo in identical separate containers for each medication.25 After 1 hour of oral administration of the capsules or placebo, all patients received standard IANB injections and 0.9 mL long buccal injections containing 2% lidocaine and 1:100,000 epinephrine (Xylocaine, Astra Zeneca). The solution was injected by the same clinician (first author) by using self-aspirating syringes (Septodont) and 27-G long needles to inject the anesthetic solution (Septoject, Septodont).7 Every 5 minutes for 15 minutes, each patient was asked for lip...

Produkt-Details

• Erscheint lt. Verlag: 10.6.2025
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Zahnmedizin
• Schlagworte: Antibiotics • Composite Resins • general dentistry • Implantology • Irreversible Pulpitis • oral hygiene • oral premedication • Oral rehabilitation • Oral surgery • Ozone Therapy • Peri-implantitis • Periodontal Disease • periodontal regeneration • Periodontal surgery • Periodontitis • Periodontology • restorative dentistry • subgingival instrumentation • Systemic inflammation • wound healing
• ISBN-10: 3-86867-712-7 / 3868677127
• ISBN-13: 978-3-86867-712-6 / 9783868677126