***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: AIM To compare the anaesthetic efficacy of inferior alveolar nerve blocks ( IANB ) with 1.8 mL of 2 % lidocaine ( LI ) to a buccal infiltration ( BI ) with 1.8 mL of 4 % articaine ( AR ) , both with 1 : 100 000 epinephrine , in patients with symptomatic irreversible pulpits in a r and omized controlled trial . METHODOLOGY Volunteers presenting at the Emergency Centre ( FOP-UNICAMP ) were r and omly divided into two groups ( 30 for AR and 20 for LI ) . Operator and patient were not blinded . Success was recorded when complete pain-free treatment was achieved after a single injection ( IANB or BI ) or when one supplemental injection was needed for emergency endodontic procedures . Success rate of supplemental injection was evaluated between and within groups using Fisher 's exact test and chi-square test . RESULTS A higher success rate ( P = 0.03/Fisher 's exact test ) was observed with AR ( 40 % ) than with LI ( 10 % ) . No significant difference was found when a single injection plus one supplemental injection was compared between groups ( P = 1.0 ; AR = 70 % ; LI = 80 % ) . However , supplemental injection increased the anaesthetic success rates ( AR , P = 0.04 ; LI , P = 0.0001 ) within groups . CONCLUSIONS Single anaesthesia techniques ( IANB or BI ) were not able to achieve pain-free emergency endodontic treatment .  Supplemental anaesthetic techniques should be considered prior to treatment procedures in order to increase success rate ( consort : registration number - NCT01912755/Fapesp : # 2009/10834 - 4 ) OBJECTIVES This study aim ed to evaluate the degree of colour change after an in-office vital tooth bleaching procedure with a 35 % hydrogen peroxide gel using a spectrophotometer . The study also determined the patients ' perceptions of the colour change and assessed the post operative sensitivity during the first week of the intervention . METHODS The maxillary teeth ( from 15 to 25 ) of 22 patients comprising of 11 males and 11 females were bleached with a 35 % hydrogen peroxide ( HP ) gel in a single visit treatment procedure ( Yotuel Special , Biocosmetics Laboratories , Spain ) . Colour readings of the two maxillary central incisors were obtained using a spectrophotometer ( CM-2600d Konica , Minolta ) before and after the bleaching procedure . All the patients were requested to complete a form regarding post-operative tooth sensitivity and to record their perceptions toward the success of the bleaching treatment . RESULTS The quantitative effect of the bleaching material on tooth colour showed an increase in the L * values and a decrease in the a * and b * values . The changes were significant ( Wilcoxon Signed Rank Sum Test ; p < 0.05 ) from baseline until one month , except for the b * values one month after the bleaching procedure which were only significant at p < or = 0.1 . The median overall colour change ( deltaE ) between baseline and after the bleaching procedure was 3.56 . The mean value of the patients ' colour perception was found to be 2.14 immediately after bleaching on a 3 point visual analogue scale . A Spearman correlation test showed a positive relationship between the deltaE values immediately and one week after bleaching and a weak relationship one week and one month after the bleaching procedure . There was a significant consistency in the patients ' colour perception data immediately and one week after the bleaching process and a weak relationship between the deltaE values and the patients ' colour perception one month after bleaching . Ten out of the twenty two patients experienced tooth sensitivity on the first day , immediately after the bleaching procedure . However only five patients experienced sensitivity on the second day , four patients on the third day and only one patient experienced sensitivity on the fourth and the fifth days after bleaching which was described as mild . CONCLUSIONS Yotuel Special 35 % HP was able to bleach the patients ' teeth with a perceptive colour change noticeable by the patients ; however colour regression was evident quantitatively from the first week . Tooth sensitivity was a temporary side effect . The material cost is reasonable , it was easy to use and the procedure is not dependant on light activation . CLINICAL IMPLICATION S A single application of this product may not be sufficient to give patients the bright smile they desire . However it is important to monitor the rebound effect after this procedure . Patients may experience some tooth sensitivity after the use of this bleaching material but the sensitivity is of a transient nature Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The purpose of this prospect i ve , r and omized , double-blind study was to compare the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine to 2 % lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in m and ibular posterior teeth . Seventy-two emergency patients diagnosed with irreversible pulpitis of a m and ibular posterior tooth r and omly received , in a double-blind manner , 2.2 ml of 4 % articaine with 1:100,000 epinephrine or 2.2 ml of 2 % lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block . Endodontic access was begun 15 min after solution deposition , and all patients were required to have profound lip numbness . Success was defined as none or mild pain ( Visual Analogue Scale recordings ) on endodontic access or initial instrumentation . The success rate for the inferior alveolar nerve block using articaine was 24 % and for the lidocaine solution success was 23 % . There was no significant difference ( p = 0.89 ) between the articaine and lidocaine solutions . Neither solution result ed in an acceptable rate of anesthetic success in patients with irreversible pulpitis Introduction : The aim of this r and omized-controlled clinical trial was to assess the effect of intraligamentary ( PDL ) injection of dexamethasone on onset and severity of post-treatment pain in patients with symptomatic irreversible pulpitis . Methods and Material s : A total number of 60 volunteers were included according to the inclusion criteria and were assigned to three groups ( n=20 ) . After administration of local anesthesia and before treatment , group 1 ( control ) PDL injection was done with syringe containing empty cartridge , while in groups 2 and 3 the PDL injection was done with 0.2 mL of 2 % lidocaine or dexamethasone ( 8 mg/2 mL ) , respectively . Immediately after endodontic treatment patients were requested to mark their level of pain on a visual analogue scale ( VAS ) during the next 48 h ( on 6 , 12 , 24 and 48-h intervals ) . They were also asked to mention whether analgesics were taken and its dosage . Considering the 0 - 170 markings on the VAS ruler , the level of pain was scored as follows : score 0 ( mild pain ; 0 - 56 ) , score 1 ( moderate pain ; 57 - 113 ) and score 3 ( severe pain ; 114 - 170 ) . The data were analyzed using the Kruskal-Wallis and the Chi-square tests and the level of significance was set at 0.05 . Results : After 6 and 12 h , group 1 and group 3 had the highest and lowest pain values , respectively ( P<0.01 and P<0.001 for 6 and 12 h , respectively ) . However , after 24 and 48 h the difference in the pain was not significant between groups 1 and 2 ( P<0.6 ) but group 3 had lower pain levels ( P<0.01 and P<0.8 for 24 and 48 h , respectively ) . Conclusion : Pretreatment PDL injection of dexamethasone can significantly reduce the post-treatment endodontic pain in patients with symptomatic irreversible pulpitis INTRODUCTION In the treatment of patients with symptomatic irreversible pulpitis , endodontic debridement is a predictable method to relieve pain . However , there are clinical situations in which emergency care can not be provided immediately . An unexplored treatment option in these cases may be the use of a long-acting anesthetic to reduce pain in untreated irreversible pulpitis . Some medical studies have shown potential for infiltrations of liposomal bupivacaine ( Exparel ; Pacira Pharmaceuticals , San Diego , CA ) to prolong pain relief and reduce opioid use postoperatively . The Food and Drug Administration has approved Exparel only for infiltrations ; therefore , the purpose of this study was to compare an infiltration of liposomal bupivacaine versus bupivacaine for pain control in untreated , symptomatic irreversible pulpitis . METHODS Ninety-five emergency patients received 2 % lidocaine with 1:100,000 epinephrine via infiltration or an inferior alveolar nerve block to relieve their initial presenting pain . Patients then r and omly received either 4 mL liposomal bupivacaine ( 13.3 mg/mL ) or 4 mL 0.5 % bupivacaine with 1:200,000 epinephrine by infiltration . Patients received a diary for the day of the appointment and 3 days postinjection to record soft tissue numbness , pain levels , and analgesic ( non-narcotic and narcotic ) use . RESULTS No significant differences ( P < .05 ) were found between the 2 anesthetic formulations for pain or the use of pain medications . A statistically higher level of soft tissue numbness was found on days 1 to 3 for the liposomal bupivacaine group . CONCLUSIONS Although liposomal bupivacaine had some effect on soft tissue anesthesia , it did not reduce pain to manageable clinical levels in patients presenting with untreated , symptomatic irreversible pulpitis To determine whether a relatively large dose of oral dexamethasone given for a short period of time would be effective in reducing endodontic interappointment pain , the current double-blind , placebo-controlled study was undertaken . After the visit for instrumentation , 40 patients with asymptomatic teeth having vital-inflamed pulps were r and omly given either dexamethasone ( 3 tablets of 4 mg each ) or a dextrose placebo identical in appearance ( same dosage schedule ) . The outcome showed that the oral administration of dexamethasone result ed in a statistically significant reduction in endodontic interappointment pain at all three time periods evaluated , that is , at 8 hours , 24 hours , and 48 hours ( p less than 0.01 ) . It appears from the results of this study that this dosage schedule of oral dexamethasone is sufficient to significantly reduce endodontic interappointment pain for teeth with asymptomatic vital-inflamed pulps . Further studies are needed for teeth with other endodontic pulpal-periapical conditions and for symptomatic teeth INTRODUCTION The inferior alveolar nerve block ( IANB ) has a poor success rate in patients with irreversible pulpitis . The purpose of this study was to evaluate the effect of ketorolac and dexamethasone infiltration along with st and ard IANB on the success rate . METHODS Ninety-four adult volunteers who were actively experiencing pain participated in this prospect i ve , r and omized , double-blind study . All patients received st and ard IANB of 2 % lidocaine with 1:200,000 epinephrine . Twenty-four patients did not receive any supplemental infiltrations ( control ) . Twenty-four patients received supplemental buccal infiltration of 4 % articaine with 1:100,000 ephinephrine , and 24 patients received supplemental buccal infiltration of 1 mL/4 mg of dexamethasone . It was planned to give supplemental buccal infiltration of 1 mL/30 mg of ketorolac tromethamine in 26 patients , but the first 2 patients experienced severe injection pain after ketorlac infiltration and were excluded from the study . In the subsequent patients , 0.9 mL of 4 % articaine was infiltrated before injecting ketorolac . Endodontic access preparation was initiated after 15 minutes of initial IANB . Pain during treatment was recorded by using a Heft-Parker visual analog scale . Success was recorded as none or mild pain . RESULTS Statistical analysis was done by using nonparametric χ(2 ) tests . Control IANB gave 39 % success rate .  Buccal infiltration of articaine and articaine plus ketorolac significantly increased the success rate to 54 % and 62 % , respectively ( P < .05 ) . Supplementary dexamethasone infiltration gave 45 % success rate , which was insignificant with control IANB . CONCLUSIONS Articaine and ketorolac infiltration can increase the success rate of IANB in patients with irreversible pulpitis . None of the tested techniques gave 100 % success rate One hundred six patients with pretreatment pain presenting for endodontic treatment participated in a controlled double blind study . After root canal therapy , the patients were given an intraoral intramuscular injection of either a saline placebo or various dosages of dexamethasone . Posttreatment pain incidence and severity were evaluated at 4 , 8 
    Output:
    
HIGHLIGHTThis article highlights the use of dexamethasone for controlling pain in cases of symptomatic irreversible pulpitis