Page 17 - GP Spring 2020

dard anesthetic cartridges. The cartridges The cartridge was placed in a standard as- tality at the 7 day recall appointment was
th
were then emptied and washed, along with pirating syringe, and the solution was de- analyzed.
the rubber plungers, with soap and water posited through the perforation site using a
rinsed in tap water using a nylon bristle 27-gauge ultra-short needle with light pres- TEST GROUPS
brush and autoclaved. Using sterile tech- sure. The cartridge contents were delivered
nique, each anesthetic cartridge was filled into the cancellous space over a two minute NUMBER INJECTION
with either 1.0 ml of Depo-Medrol or 1.0 time period. If deposition required more GROUPS OF TECHNIQUE AGENTS
ml of 0.9% preservative-free sterile saline than light pressure, the needle was rotated PATIENTS
solution, delivered with a tuberculin sy- 90 degrees and the solution deposited.
ringe, and the rubber stopper replaced. The Intraosseous 1.0ml
cartridges were wrapped with opaque tape In Group III, 20 patients were given an- I 20 injection Depomedrol
and a 4-digit random number was written tibiotics (amoxicillin 500 mg) thrice dai- (Test group) (40mg/ml)
th
on the tape to blind the solutions. The enve- ly for 3 days and recalled on 7 day for
lopes were available to the primary inves- pulpectomy. Intraosseous
tigator at all times, in case of necessity. 40 injection 1.0 ml
cartridges are prepared and kept by co-in- In Group IV, 20 patients received an in- II 20 (Control Sterile
vestigator containing either of the solutions traosseous injection using 2% lidocaine group) Saline
and operator was unaware of the content with 1:100,000 epinephrine and the Sta- Oral
of solutions. Twenty intraosseous 2% lido- bident system. Emergency access opening III 20 medication Amoxicillin
caine cartridges were kept ready. and pulpectomy were performed. The ac- 500mg
cess cavity was temporized with IRM after (Test group)
In Groups I and II, all patients were anes- occlusal reduction. Patients were recalled Intraosseous 2%
thetized with 0.2ml 2% lidocaine with epi- after 7 days to continue root canal treat- IV 20 injection Lidocaine
nephrine at the intraosseous perforation ment. (Test group)
site. The co-investigator handed a cartridge
to the investigator, who was blind about the All 80 patients received a survey question-
contents, and an intraosseous injection of naire along with twenty acetominophen Results
1ml solution was administered to the pa- tablets (Tylenol). They were instructed to Out of eighty adult volunteers who partic-
tient in the attached gingiva distal to the take them only in the case of severe pain. ipated in the study, forty-four (55%) were
teeth using the Stabident system. Patients were advised to note the consump- males and thirty-six (45%) were females in
tion of analgesics on the form for 7 days the age group of 18 – 35 years, with a mean
The area of perforation was determined by and return the remaining tablets. Details age of 28 ±4.9 years.
the horizontal line of the buccal gingival about the dosage of medication and fre-
margins of adjacent teeth and a vertical line quency were labelled on the bottle. The 80 patients who participated in the
that passed through the distal interdental study had acute pain and clinical diagnosis
papilla of the symptomatic tooth. The point Each patient was asked to fill out a ques- of acute/symptomatic irreversible pulpitis
2mm below the intersection of these lines tionnaire every day. They were instructed associated with the test tooth. Only perma-
was the perforation site if the site was in to record pain and percussion pain using nent maxillary and mandibular posterior
attached gingiva. If the site was in alveo- the 4-point scale used for the initial pain teeth were included in this study.
lar mucosa, the perforation site was moved recordings. Percussion pain was measured
just above the junction of the attached gin- by tapping the tooth with the finger and rate In group I, all of the patients were admin-
giva and the alveolar mucosa on the same the pain. Each patient recorded the number istered methyl prednisolone acetate (De-
vertical line. of tablets taken each day along with the se- po-Medrol) intraosseously with the Stabi-
verity of pain. dent system at the emergency visit (day 0).
The cortical plate was perforated using the None of the patients in this group required
Stabident perforator (a bevel-ended solid At the recall appointment, pain evaluation prescribed analgesics during the 7-day pe-
27-gauge wire attached to a plastic hub) was done on all patients. Vitality was de- riod. Pulpectomy was performed at the end
in a contra-angle slow-speed hand piece. termined for each patient with electric pulp of the 7-day period under nerve block or
The perforator was placed through the tester and Endo-frost before treatment. All infiltration.
gingiva and oriented perpendicular to the patients were administered 2% lidocaine
cortical plate. With the beveled end resting with 1:100,000 epinephrine nerve block On day seven for group II (control
on the bone, the handpiece was activated or infiltration. In groups I, II and III ac- group-saline), 3 patients (15%) reported
in a series of short bursts, using light pres- cess opening was done and pulpectomy at- severe pain, 4 patients had moderate pain
sure, until a “breakthrough” feeling was tempted. In group IV endodontic treatment (20%), 3 patients had mild pain (15%), and
observed. If a “breakthrough” feeling was continued. 10 patients did not experience any pain. 7
not felt, the handpiece was activated again patients needed analgesics. Reduction in
until the perforator was inserted to length. Data was collected and statistically ana- pain intensity in this group from day 0 over
Before loading the cartridge into the sy- lyzed. The preoperative parameters were the 7 day period can be attributed to the
ringe, the investigator vigorously shook statistically analyzed using the chi squared intake of analgesics. After pain evaluation
the taped cartridge for one minute. Because test for nominally scaled variables (gen- and vitality testing, pulpectomy was initiat-
methylprednisolone acetate separates out der); the independent t test for ratio scaled ed in group II. 7 out of 20 patients reported
of solution upon standing, shaking of each variables (age); and the Pearson Chi square pain and discomfort during access opening
cartridge ensured that, if the cartridge did test for ordinally scaled variables (pain and pulpectomy under nerve block. Pulpec-
contain methylprednisolone, the drug was and percussion pain) for all 4 study groups tomy was achieved in the remaining 13 pa-
back in solution and ready for injection. which participated in this study. Tooth vi- tients without pain and discomfort.
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