The effect of pre-anesthesia with a needle-free system versus topical anesthesia on injection pain of the inferior alveolar nerve block: a randomized clinical trial

Objective

The aim of this study was to compare the effectiveness of pain control between a needle-free system and topical anesthesia applied prior to inferior alveolar nerve block (IANB).

Materials and methods

The present study was designed as a randomized controlled cross-over clinical study on 60 children (aged 6 to 12 years) requiring dental treatment with IANB in bilateral mandibular molars. As pre-anesthesia, topical anesthesia (TA) was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions before IANB. The injection pain during IANB, at both the needle insertion and solution deposition phases, was analyzed using the Wong-Baker Faces Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability Scale (FLACC). The data were analyzed using the Wilcoxon signed-rank test, Spearman correlation, and Mann–Whitney U test.

Results

There were statistically significant differences between TA and CIS in subjective and objective pain evaluations during both the needle insertion and solution deposition. The use of a needle-free system in pre-anesthesia yielded a significant decrease in subjective and objective pain scores (p < 0.001). No statistical difference was found between TA and CIS in terms of patient preference, but patient preference for CIS was significantly higher in older patients (p < 0.01).

Conclusions

It was determined that the use of a needle-free system in pre-anesthesia yielded a decrease in injection pain of IANB.

Clinical relevance

Pediatric dentists should be aware of the new injection system in order to decrease the level of injection pain.

     

Physiological and pharmacological effects of melatonin on remote ischemic perconditioning after myocardial ischemia‐reperfusion injury in rats: Role of Cybb,Fas, NfκB,Irisin signaling pathway

It has been found that remote organ/limb temporary ischemia, known as remote ischemic conditioning, can provide protection against the formation of lethal ischemic outcome. Current evidence suggests that aging and age‐releated comorbidities impair the cardioprotective effects of conditionings. In conjuction with aging, decrease in melatonin synthesis from pineal gland can have role in the pathogenesis of aging and age‐related cardiovascular diseases. In this study, we investigated the effects of remote ischemic perconditioning (RIPerC) and physiological and pharmacological concentrations of melatonin on the infarct size, Fas gene, cytochrome b‐245 beta chain (Cybb) gene, nuclear factor‐kappa B (NfκB), and irisin using an in vivo model of myocardial ischemia/reperfusion (I/R) injury. Sprague‐Dawley rats that were divided into two groups first as non‐pinealectomized (Non‐Px) and pinealectomized (Px), and then (a) Control; (b) I/R (30‐minute ischemia, 120‐minute reperfusion caused by left coronary artery ligation); (c) I/R + RIPerC (when myocardial ischemia initiated, three cycles of 5‐minute occlusion followed by 5‐minute reperfusion); (d) I/R + Mel; (e) Px; (f) Px + I/R; (g) Px + I/R + RIPerC; (h) Px + I/R + RIPerC + Mel groups. The infarct size was determined by TTC staining and analyzed by the ImageJ program. Molecular parameters were evaluated by qRT‐PCR and Western blot. Results showed that increased infarct size in Non‐Px groups decreased with RIPerC and melatonin. However, increased infarct size in Px groups was decreased minimally with RIPerC and significantly decreased with RIPerC + Melatonin. Fold change in Fas gene was associated with the infarct size. RIPerC and melatonin reduced expressions of Cybb, NfκB, and irisin genes. The physiological release and pharmacological concentration of melatonin may improve protective effect of RIPerC against I/R‐induced infarct size by modulating Cybb, Fas, NfκB, Irisin signaling pathways.     

Exenatide enhances cognitive performance and upregulates neurotrophic factor gene expression levels in diabetic mice

Exenatide is a potent and selective agonist for the GLP‐1 (glucagon‐like peptide‐1) receptor. Recent studies are focused on the effects of GLP‐1 analogues on hippocampal neurogenesis, cognition, learning and memory functions. The aim of this study was to assess the effects of chronic exenatide treatment (0.1 μg/kg, s.c, twice daily for 2 weeks) on spatial memory functions by using the modified elevated plus maze (mEPM) test and emotional memory functions by using the passive avoidance (PA) test in streptozotocin/nicotinamide (STZ‐NA)‐induced diabetic mice. As the genes involved in neurite remodelling are among the primary targets of regulation, the effects of diabetes and chronic administration of exenatide on brain‐derived neurotrophic factor (BDNF) and cyclic adenosine monophosphate (cAMP) response element binding protein (CREB) messenger ribonucleic acid (mRNA) levels in the hippocampus of mice were also determined using quantitative real‐time polymerase chain reaction (RT‐PCR). This study revealed that in the mEPM and PA tests, type‐2 diabetes‐induced mice exhibited significant impairment of learning and memory which were ameliorated by GLP‐1 receptor agonist exenatide. Quantitative RT‐PCR revealed that CREB and BDNF gene expression levels were downregulated in diabetic mice, and these alterations were increased by exenatide treatment. Since, exenatide improves cognitive ability in STZ/NA‐induced diabetic mice and activates molecular mechanisms of memory storage in response to a learning experience, it may be a candidate for alleviation of mood and cognitive disorder.     

Residual and recurrent disease rates following LEEP treatment in high-grade cervical intraepithelial lesions

Introduction  

Loop electrosurgical excision procedure (LEEP) is a basic procedure in the conization performed on patients with CIN II/III. After excisional therapy, close follow up is essential for the earlier detection of residual and recurrent disease. The value of PAP-smear and HPV-DNA tests for investigation of residual and recurrent disease in patients diagnosed with high-grade intraepithelial lesion after LEEP treatment was purposed.     

Effect of novel restorative materials and retention slots on fracture resistance of endodontically-treated teeth

Objectives. The aim of this study was to evaluate the fracture resistance of endodontically-treated teeth restored with nano-hybrid composite resin, bulk-fill flowable and short fibre-reinforced-composite in the absence/presence of retention slots. Materials and methods. One hundred and ten extracted non-carious human mandibular molars received endodontic treatment followed by mesio-occlusodistal (MOD) cavities with 3 ± 0.2 mm thicknesses of buccal and lingual walls. Teeth were divided into two main groups according to the retention slot preparation. The dove-tail retention slots were prepared on the middle of opposite buccal and lingual walls to create mechanical interlocking. Each group was further divided into four sub-groups according to restorative material types: control (no restoration), nano-hybrid composite resin (Filtek^TM Z550), bulk-fill flowable (Filtek^TM Bulk Fill) and short fibre-reinforced-composite (everX Posterior^TM). Restored teeth were subjected to compressive load at a strain rate of 1 mm/min. The data were statistically analysed using two-way ANOVA and Tukey’s test for multiple comparisons. Results. The fracture resistance was significantly affected by the presence of the retentive slots and restorative material (p < 0.05). Restored teeth with retentive slots significantly increased the fracture resistance compared with restored teeth without retentive slots (p < 0.05). Short fibre-reinforced-composite with retentive slot cavities had significantly higher fracture resistance values compared with the other test groups (p < 0.05). Conclusions. The preparation of retention slots may increase the fracture resistance of endodontically-treated teeth, especially, when restored with short fibre-reinforced composite. The use of short fibre-reinforced composite with retentive slots could be an alternative technique to prevent cuspal fracture on endodontically-treated teeth with MOD cavity.     

Comparison of biomarkers of oxidative stress, 8-isoprostane,advanced oxidation protein products,and 8-hydroxy-2′-deoxyguanosine and pro-apoptosis,cytokeratin 18 M30, in women with normal glucose tolerance and gestational diabetes mellitus

International Journal of Diabetes in Developing Countries - We aimed to compare the values of selected biomarkers of oxidative stress, 8-isoprostane (8IsoP), advanced oxidation protein products...