Materials and Method:
- Randomized double-blinded clinical trial
- Mandibular molars - acute irreversible pulpitis
→ Confirmed by moderate-severe pain and lingering pain to cold pulp sensibility tests
→ BUT no spontaneous pain
→ AND no radiographic periapical changes
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i.e. without acute apical periodontitis
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==This targeted an earlier stage of irreversible pulpitis.==
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Materials and Method (Continued):[^9]
- 150 patients (50 per group) - given:
- Placebo
- Ibuprofen - 600 mg, or
- Indomethacin - 75 mg → Taken 1 hour before local anaesthesia
- 2% lignocaine + 1:80,000 adrenaline used → 1.8 ml given as an IAN block
- Pain scored on a visual analogue scale → Before taking the medication → 15 minutes after LA injection → In response to a cold pulp test → During access cavity preparation, and → During root canal instrumentation
J Endod 2010;36:1450–1454
Results:[^10]
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No sig. diff. in pre-treatment pain scores
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120 pt’s did not respond to the cold pulp sensibility tests 15 minutes after LA injn → But 34 (28%) had pain during treatment
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This confirms that sensibility testing is not a perfect predictor of profound anaesthesia.
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Overall 64 had ineffective LA → 30 of these had pain to cold testing
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Overall success → Placebo - 32% → Ibuprofen - 78% → Indomethacin - 62%
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Ibuprofen + Indomethacin → Sig. diff. to Placebo → But not sig. diff. to each other
Discussion:[^11]
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Pre-medication with a NSAID helped with pain control during treatment for acute irreversible pulpitis in mandibular molars → Ibuprofen more effective → **And has less side effects than Indomethacin
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Esp. higher risk of heart attack, stroke, GIT problems, ulcers, etc.
** - Esp. higher risk of heart attack, stroke, GIT problems, ulcers, etc.
J Endod 2010;36:1450–1454
Discussion (Continued):[^12]
-
Previous studies - mixed results → Pre-medication with NSAID is beneficial
- e.g. Seymour and Ward (1996)
- Ianiro et al (2010) → Others: Pre-medication NOT beneficial
- e.g. Aggarwal et al (2010), Oleson et al (2010)
- Their main criterion for acute irreversible pulpitis was “spontaneous pain”
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This represents a more advanced and inflamed state where premedication may be less effective.
- More advanced pulp inflammation - NSAID and LA less effective
J Endod 2010;36:1450–1454