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
2ZA
using an intraosseous injection of Depo-Medrol.
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 37C. 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 concentra-
tions 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.