Background:Achieving profound pulpal anesthesia in mandibular molars with symptomatic irreversible pulpitis remains challenging, with inferior alveolar nerve block (IANB) failure rates up to 80%. This study evaluated the effect of supplemental buccal infiltration using tramadol, dexamethasone, ketorolac, and temperature-modified lidocaine on the efficacy of IANB. Materials and Methods:In this randomized, double-blind clinical trial, 120 patients were allocated to six groups (n = 20 each): Control (IANB only), dexamethasone (4 mg/mL), ketorolac (30 mg/mL), tramadol (50 mg/mL), warm lidocaine (40°C), and cold lidocaine (4°C). All received 2% lidocaine with 1:200,000 epinephrine for IANB, followed by 1 mL of the assigned infiltration. Pain intensity was recorded using the Numeric Pain Rating Scale (0-10) during access, chamber, and canal entry. Anesthetic success was defined as a score <3 at canal entry. Results:Anesthetic success rates were 90% (95% confidence interval [CI], 68%-99%) for tramadol, and 85% (95% CI, 62%-97%) for cold lidocaine, significantly higher than control (40%, P = 0.001 and P = 0.002, respectively). Dexamethasone (55%), ketorolac (50%), and warm lidocaine (60%) showed nonsignificant improvement (P > 0.05). Median pain scores were significantly lower in the tramadol and cold lidocaine groups across all the stages (P < 0.001). No adverse events occurred. Conclusion:Supplemental buccal infiltration with tramadol or cold lidocaine significantly enhances IANB success in mandibular molars with irreversible pulpitis, offering a simple, safe, and cost-effective approach to improve pulpal anesthesia.
INTRODUCTION:Successful full-arch rehabilitation depends not only on implant survival but also on long-term prosthetic stability and biomechanical harmony. Despite advancements in implant dentistry, prosthetic complications remain a significant challenge in full-arch fixed implant-supported prostheses. Implant positioning parameters, such as implant angulation, anteroposterior spread, and cantilever extension, may influence the stress distribution and contribute to prosthetic failure. This study aimed to evaluate the association between implant positioning parameters and prosthetic failure in full-arch fixed implant-supported prostheses. MATERIALS AND METHODS:This retrospective matched case-control study was conducted in the Department of Prosthodontics and Crown and Bridge, using archived patient records from January 2020 to December 2024. Ninety participants were included, comprising 30 patients with prosthetic failure and 60 matched controls without complications. Cone-beam computed tomography (CBCT) records were evaluated to assess the mesiodistal angulation, buccolingual angulation, vertical implant position, anteroposterior spread, distal cantilever length, cantilever-to-anteroposterior spread ratio, and inter-implant distance. Statistical analysis was performed, with a p-value less than 0.05, which was considered statistically significant. RESULTS:Repeated screw loosening was the most common prosthetic complication and was observed in 13 (43.3%) patients, followed by framework fracture in 11 (36.7%) patients and catastrophic veneering material fracture in 6 (20.0%) patients. The case group demonstrated significantly greater mesiodistal angulation (18.4 ± 4.2° versus 12.1 ± 3.8°), buccolingual angulation (15.7 ± 5.1° versus 10.3 ± 3.6°), vertical implant position (3.8 ± 1.4 mm versus 2.9 ± 0.9 mm), distal cantilever length (14.2 ± 3.1 mm versus 10.4 ± 2.6 mm), and cantilever-to-anteroposterior spread ratio (1.42 ± 0.31 versus 0.89 ± 0.22) compared with controls (p < 0.001). Greater anteroposterior spread and inter-implant distance demonstrated protective effects against prosthetic failure. CONCLUSION:Implant positioning parameters significantly influence prosthetic outcomes in full-arch fixed implant-supported prostheses. Increased implant angulation and cantilever extension are associated with a higher prosthetic failure risk, whereas greater anteroposterior spread and inter-implant distance improve biomechanical stability. Accurate prosthetically driven implant placement may reduce technical complications and improve the long-term prosthetic success.
Background:Impacted teeth usually remain symptom-free, but cause various symptoms and pathologies due to pain, swelling, bone loss, distal caries, periodontitis, infections, occlusion disturbances, pericoronitis, root resorption of adjacent teeth, periapical infections, cysts and tumors. Associated complications to the surgical removal of IMTM can be divided into intra-operative and postoperative. Am of this study is to assess the predictive value of preoperative radiological assessment of mandibular third molar impactions in relation to the inferior alveolar canal and postoperative complications. Methodology:Independent variables evaluated in this study were depth of impaction, angulation of impacted mandibular third molars and Proximity to the mandibular canal of the impacted mandibular third molar. The postoperative assessment parameters were measured after 24 hours, 3rd and 7th day after extraction of the mandibular third molar. Results:The maximum number of patients with the complaint of impacted mandibular third molar falls in the age group of 18-30 years, with no sex predilection. The most common angulation found was mesioangular (44.3%), with Level A (57.4%). The most common warning radiographic sign on OPG, according to Rood and Shehab classification, was interruption of the white line of the canal (29.6%). The correlation was found to be highly significant (p=0.000) between radiologist and surgeon according to Paderson's scale before surgical removal of impacted third molars. Conclusion:The pre-operative assessment of mandibular third molar impactions in relation to the inferior alveolar canal was found to be predictive in assessing the postoperative complications after extraction.
BACKGROUND:Tooth avulsion is a dental emergency requiring immediate, evidence-based intervention to optimise periodontal and pulpal outcomes. Adequate education of dental students in avulsion management is therefore critical. While distance learning platforms, including online video modules, are increasingly used in dental education, their effectiveness relative to traditional face-to-face instruction in teaching avulsion management remains unclear. AIM:To compare the effectiveness of distance learning and face-to-face education approaches in improving knowledge, clinical decision-making, and confidence regarding the management of tooth avulsion among undergraduate dental students. METHODS:This randomised controlled educational trial enrolled 120 undergraduate dental students (4th year). Participants were randomly allocated to either a distance learning group (Group I), which received guideline-based video modules on tooth avulsion management delivered via online platforms, or a face-to-face learning group (Group II), which received conventional interactive lectures and interactions. Knowledge acquisition was assessed using validated multiple-choice questionnaires, while clinical decision-making skills were evaluated through standardised, scenario-based simulated avulsion cases, with a rubric used to assign scores. Secondary outcomes include knowledge retention, self-reported confidence, and learner satisfaction. RESULTS:A total of 120 4th-year undergraduate dental students were randomised, and 113 completed the 8-week follow-up. Both educational approaches significantly improved knowledge scores compared with baseline (p < 0.001). The face-to-face learning group achieved significantly higher post-intervention knowledge scores than the distance- learning group (18.2 ± 1.4 vs. 16.8 ± 1.7; mean difference, 1.4 points; 95% CI, 0.84-1.96; p < 0.001) and demonstrated superior scenario-based clinical decision-making, knowledge retention, and self-reported confidence at the 8-week follow-up (p < 0.001). Learner satisfaction was high in both groups but was significantly greater following face-to-face instruction (p < 0.001). CONCLUSION:Distance learning platforms are effective tools for enhancing academic knowledge and awareness of guidelines in tooth avulsion management, especially in remote areas. However, face-to-face instruction was associated with higher knowledge retention, confidence, and scenario-based clinical decision-making scores. These findings support integrating distance learning as a complementary component rather than a replacement for conventional face-to-face training in dental trauma education.
Background:The long-term success of dental implants is intrinsically linked to the stability of surrounding peri-implant tissues. Dehiscence and fenestration defects represent significant clinical challenges that can compromise functional and aesthetic outcomes. This review provides a comprehensive analysis of modern strategies for managing these defects at implant sites. Methodology:We evaluate defect etiology and classification while underscoring the necessity of 3D diagnostic tools like Cone-Beam Computed Tomography (CBCT). The review critically examines Guided Bone Regeneration (GBR) components, comparing resorbable and non-resorbable membranes alongside various bone grafting materials. Additionally, we explore the roles of biologics, soft tissue management, and digital CAD/CAM workflows. Results:Analysis indicates that implants with corrected defects achieve survival rates comparable to those in pristine bone, reaching up to 97.2% for dehiscences over 10 years. Resorbable collagen membranes and slow-resorbing xenografts (DBBM) are the clinical standards for routine defects due to predictable volume maintenance. Biologics like PRF enhance graft handling, while rhBMP-2 provides potent osteoinduction for complex cases. Literature confirms that hard tissue regeneration must be paired with soft tissue augmentation-specifically connective tissue grafts to convert thin phenotypes into recession-resistant architecture. Conclusion:Successful regeneration requires a holistic approach combining biological principles, meticulous soft tissue management, and digital precision to ensure long-term stability.
