A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis (original) (raw)
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Pain Research and Management, 2021
The objective of the current study was to compare the anaesthetic efficacy of supplemental intraligamentary (IL) injection of 4% articaine with that of 2% lidocaine in the mandibular first and second molars with irreversible pulpitis after an ineffective inferior alveolar nerve block injection (IANB) using the same anaesthetic in a randomised triple-blind clinical trial. Seventy-six adult patients, who were diagnosed with irreversible pulpitis in the mandibular first or second molars, were divided into 2 groups and received IANB randomly. In patients with lip numbness, anaesthesia was evaluated with the cold and electrical pulp (EPT) tests, and if the reported number on EPT was below 100, supplemental IL injection was administered using the same anaesthetic. The teeth were retested after 5 minutes. The Heft–Parker visual analogue scale was used to evaluate pain after IANB and IL injections. Statistical analysis was performed using repeated measures ANOVA, chi-square, and independent...
Journal of Dental Anesthesia and Pain Medicine
Introduction: This clinical trial aimed to evaluate the anesthetic effect of the addition of 2 mg (4 mg/ml) of dexamethasone to 2% lidocaine (plain or with 1:80,000 epinephrine). The solutions were injected for a primary inferior alveolar nerve block (IANB) to provide mandibular anesthesia for the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Methods: In a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as "failed" anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as "no pain or faint/weak/mild pain" during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates. Results: The 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, χ 2 = 9.07, df = 2). Conclusions: The addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.
IP innovative publication pvt. ltd, 2020
Introduction: Profound local anesthesia in permanent mandibular molars in irreversible pulpitis cases is difficult to attain with inferior alveolar nerve block (IANB) alone. In many cases, supplemental anesthesia is required during root canal therapy. The objectives of the present study are to compare the effectiveness of 2% Lidocaine and 4% Articaine when used for inferior alveolar nerve block (IANB) and supplemental buccal infiltration (BI) in irreversible pulpitis cases. Materials and Methods: Twenty five patients were randomly alloted to control and test groups. Test group included thirteen patients, anesthetized with 4% Articaine (with 1:100,000 epinephrine) and twelve patients were anesthetized with 2% Lidocaine (with 1:80,000 epinephrine) in control group. The pain experienced by patients during treatment was analyzed by using Heft-Parker visual analogue scale (HP-VAS). In case of pain after IANB, a supplemental buccal infiltration was given with the same anesthetic that was used for IANB. Absence of pain or presence of mild pain was considered as anesthetic success and presence of moderate or severe pain was considered as anesthetic failure. The data was recorded and evaluated using Chi-square test and proportion test. The level of significance was set at 0.05. Results: After inferior alveolar nerve block, anesthetic success was 54% in Articaine (test) group and 17% in Lidocaine (control) group.Following buccal infiltration, it was 83% in Articaine group and 70% in Lidocaine group. There was no significant difference between two groups after IANB and buccal infiltration. Overall success of Articaine was 92% and Lidocaine was 75%. Conclusion: There was no significant difference in the proportions of the overall success rate between the two groups. Articaine 4% can be considered as a useful alternative for 2% Lidocaine in teeth with irreversible pulpitis cases during root canal therapy.
Objective: The objective of this study was to compare the efficacy of supplementary repeat inferior alveolar nerve block with 2% lidocaine and epinephrine, buccal infiltration with 4% articaine with epinephrine, intraligamentary injection, or intraosseous injection (both with 2% lidocaine with epinephrine) after failed inferior alveolar nerve block (IANB) for securing pain-free treatment in patients experiencing irreversible pulpitis in mandibular permanent teeth. Methods: This randomized clinical trial included 182 patients diagnosed with irreversible pulpitis in mandibular teeth. Patients received 2.0 mL of 2% lidocaine with 1:80,000 epinephrine as an IANB injection. Patients who did not experience pain-free treatment received randomly 1 of 4 supplementary techniques, namely repeat lidocaine IANB (rIANB), articaine buccal infiltration (ABI), lidocaine intraligamentary injection (PDL), or lidocaine intraosseous injection (IO). Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation (80 reading) of the pulp tester, at which time treatment commenced. Treatment was regarded as being successfully completed when it was associated with no pain. Data were analyzed by c 2 and Fisher exact tests. Results: Of the 182 patients, 122 achieved successful pulpal anesthesia within 10 minutes after initial IANB injection; 82 experienced pain-free treatment. ABI and IO allowed more successful (pain-free) treatment (84% and 68%, respectively) than rIANB or PDL supplementary techniques (32% and 48%, respectively); this was statistically significant (P = .001). Conclusions: IANB injection alone does not always allow pain-free treatment for mandibular teeth with irreversible pulpitis. Supplementary buccal infiltration with 4% articaine with epinephrine and intraosseous injection with 2% lidocaine with epinephrine are more likely to allow pain-free treatment than intraligamentary and repeat IANB injections with 2% lidocaine with epinephrine for patients experiencing irreversible pulpitis in mandibular permanent teeth. (J Endod 2012;38:421-425)
Clinical Oral Investigations, 2018
Objectives The aim of this study was to compare the onset, success rate, injection pain, and post-injection pain of mental/incisive nerve block (MINB) with that of inferior alveolar nerve block (IANB) using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis. The accuracy of electrical pulp test (EPT) in determining pulpal anesthesia was also examined. Materials and methods The study was designed as a randomized clinical trial with two study arms-MINB and IANB. Injections were performed using a standardized technique. Root canal treatment was initiated 10 min after the injection. Success was defined as no pain or mild pain during access cavity preparation and instrumentation. Injection pain and post-injection pain (up to 7 days) were recorded. All pain ratings were done using Heft-Parker Visual Analog Scale (HP VAS). Results Sixty-four patients were enrolled. The success rate of MINB (93.8%) was higher than IANB (81.2%) but the difference was not significant (p > 0.05). The onset of anesthesia with MINB was significantly quicker, and injection pain was significantly less (p < 0.05), but post-injection pain was significantly higher during the first 4 days (p < 0.001). The accuracy of EPT in determining pulpal anesthesia was 96.88%. Conclusions MINB and IANB with 4% articaine had similar efficacy in anesthetizing mandibular premolars with irreversible pulpitis. Post-injection pain with MINB was higher than with IANB. Clinical relevance MINB and IANB with 4% articaine can be used interchangeably to anesthetize mandibular premolars with irreversible pulpitis. Keywords 4% articaine. Local anesthesia. Mental/incisive nerve block. Inferior alveolar nerve block. Pain
Study of the anesthetic efficacy of inferior alveolar nerve block using articaine in irreversible pulpitis." J Contemp Dent Pract 15(1): 71-74. AIM: The purpose of this study was to determine the anesthetic efficacy of inferior alveolar nerve block (IANB) using 4% articaine and 2% lidocaine supplemented with buccal infiltration. MATERIALS AND METHODS: Forty five patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth were included in the study. The first group of 15 patients received 2% lidocaine with 1:200000 epinephrine, the second group 2% lidocaine with 1: 80,000 epinephrine and the third group of 15 subjects received 4% articaine with 1:100000 epinephrine. During the access cavity preparation those patients who complained of pain received an additional buccal infiltration. The percentage of subjects who got profound anesthesia and failure to achieve anesthesia were calculated and tabulated using a visual analog scale. RESULTS: The results revealed that 87% of subjects who received 4% Articaine with 1:100,000 epinephrine got satisfactory anesthesia with inferior alveolar nerve block alone. Only 2 (13%) subjects received an additional buccal infiltration and none of the patients failed to obtain complete anesthesia with articaine. In comparison only 40% of subjects got complete anesthesia with 2% lidocaine with 1:200000 and 60% with 2% lidocaine with 1:80,000. CONCLUSION: It can be concluded that 4% articaine can be used effectively for obtaining profound anesthesia for endodontic procedures in patients with irreversible pulpitis.
Brief Summary: Ninety patients with irreversible pulpitis diagnostic will participate in this clinical study. The participants will be divided into 2 groups of 45 patients, who will receive the inferior alveolar nerve block injections of 1.8 mL of 4% articaine (Articaine 100; DFL, Rio de Janeiro, RJ, Brazil) with 1:100,000 epinephrine or 3.6mL of the same solution. Two consecutive negative responses to the maximum pulp stimulus (80 µA) at the electric pulp test were the criterion to determine a pulpal anesthesia as successful. Ten minutes after the IAN block, subjective lip anesthesia will be evaluated by asking the patient whether his/her lip was numb. Thereafter and immediately before the pulpectomy, the electric pulp stimulations will be repeated to determine pulpal anesthesia. During the pulpectomy procedure, the patients were instructed to report any painful discomfort. To evaluate the intensity of pain during the pulpectomy, a verbal analogue scale will be used. The anesthesia will be defined as successful when the dentist accessed the pulp chamber without pain being reported by the patient. In these cases, the pulpectomy will be continued. If report pain will classified the IAN block as unsuccessful.
2022
Pain control during endodontic access is important to ensure patient comfort. Achieving adequate anesthesia in an acutely inflamed mandibular molar poses a treatment challenge as the reported failure rate is 30-83%. A number of pre-medications, anesthetic techniques and adjuncts have been researched to determine their effect on the anesthetic success of the inferior alveolar nerve block (IANB). The purpose of this research was to describe the current clinical practices used by the members of the American Association of Endodontists in pain control of inflamed mandibular molars. Methods: A cross-sectional observational study design was used. The study frame was the members of the American Association of Endodontists (n=5736). All members were invited to participate in the online survey about their treatment of acutely inflamed mandibular molars. Descriptive statistics and logistic regression analyses were conducted to compare practices of board-certified endodontists, board eligible endodontists, resident post graduate students and other endodontists who were neither board certified nor board eligible. Results: There were 917 responses. Of all the techniques surveyed, buccal infiltration with 4% Articaine was most likely to be used 100% of the time to increase the success rate of the IANB.
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Achieving profound pulpal anaesthesia with an inferior alveolar nerve block (IANB) in lower molars suffering irreversible pulpitis is difficult and quite challenging. In many instances, supplemental anaesthesia is required during endodontic therapy. The present study was done to evaluate the efficiency of 2 % lidocaine and 4 % articaine comparatively, as an inferior alveolar nerve block (IANB) and supplemental infiltration buccally in providing complete mandibular molar anaesthesia. METHODS This is a randomized double-blinded study. Sixty patients were categorized randomly into test group (n= 30) and control group (n= 30). Patients in the test group were anaesthetized with 4 % articaine (1:100,000 epinephrine dilution), and those in the control group were anaesthetized with 2 % lidocaine (1:80,000 epinephrine dilution). The Heft-Parker visual analog scale (HP-VAS) was utilized for rating patient’s pain during the treatment procedure. In case of pain after IANB, a suppleme...