Electric Pulp Tester Research Articles

Clinical Aspects of Pulp Sensibility Tests

Clinical Aspects of Pulp Sensibility Tests

Diagnostic Role of Pulp Sensibility Testing

Diagnostic Role of Pulp Sensibility Testing

The Effect of Dental Flourosis on the Electric Pulp Tester Response and Probe Placement Site.

Introduction: The probe placement site for an electric pulp tester. (EPT) will have a significant outcome for the threshold readings. These relationships in previous studies have been documented. As dental flourosis is an endemic in regions of Pakistan the aim of this study was to compare and determine the appropriate EPT probe placement sites on fluorotic and non flourotic teeth.
 Methodology: In this cross-sectional clinical study equal number of flourotic and non flourotic maxillary central incisors(40 volunteers) were selected from a known region of Pakistan for endemic of flourosis to measure threshold levels on EPT on four different parts of each tooth. (Incisal edge, incisal third, middle third and cervical third). Before the readings were taken flourotic teeth were also categorized on the bases of severity (Deans Index).The purpose was to assess if severity of dental flourosis had an impact on the EPT readings. Once the mean values were taken the Dunn–Bonferroni post hoc tests was used to assess the statistical significance (p<0.05) between the four site in both groups.
 Results: Mean values from the EPT presented that the threshold values increased from incisal to cervical in gender and both age groups i.e. 20-29 and 30-40. It was also found that the threshold values increased from incisal edge to the cervical third in flourotic and non flourotic teeth. Statical significance was found between the reading of flourotic and non flourotic groups across the four probe site readings taken (p value= 0.00). Like previous literature the insical edge was considered the most ideal site for EPT assessment on anterior incisors. As this is where the lowest threshold response was recorded in our study .Dental flourosis does have a significant effect on the EPT threshold values. This is most likely due to structural changes because of dental flourosis.
 Recommendations: From the study conducted it can be recommended that clinicians need to be aware of the fact that fluorotic teeth response will vary from natural teeth on the EPT. Also further research needs to be done to assess if other vitality test methods will also alter in their response due to dental defects like flourosis.

Clinic and Radiographic Evaluation of Cemento-osseous Dysplasia: Case Series

Aim: Cemento-osseous dysplasia (COD) is usually asymptomatic and slowly progressive benign fibro-osseous lesion characterized by the replacement of normal bone with fibrous tissue. The aim of this presentation is to evaluate the clinical and radiographical findings of six COD cases that were detected incidentally during radiographic examination.
 Case Report: Six female patients who four (%66) of them with different dental complaints and two (%33) of them for routine control examination of the previously diagnosed COD with a mean age of 38 applied to our clinic. It was learned that the patients did not have any systemic disorders in their medical anamnesis. There is not any finding on extraoral examination. In intraoral examination, teeth associated with COD lesions were vital as a result of the electric pulp test, and there is no other finding related to the lesion. In the radiography examination, different sizes radiolucent, mixed, and radiopaque lesions were detected in the mandible on control panoramic radiographs. The lesions were examined in detail with cone-beam computed tomography. Local thinning and resorption were observed in the buccal and lingual cortical bone in the relevant region. Histopathological examination revealed that the lesions were definitively diagnosed as SOD in four patients. Based on clinical, radiographic, and histopathological examinations, three (%50) of the lesions were diagnosed as periapical COD and the others (%50) were diagnosed with fluoride COD. All patients were followed up periodically for six months.
 Conclusion: The findings of this case series showed that all lesions examined were clinically asymptomatic and mixed on radiography. Due to insufficient vascular support of the bone in the COD area, there is a risk of infection and osteomyelitis may occur. Therefore, dentists should be aware of the clinical and radiographic features of COD in clinical practice and follow the patients periodically.

Efficacy assessment of laser Doppler imager in diagnosing the pulp vitality after dental trauma

Background/purposeThis is the first paper evaluating the efficacy of laser Doppler imager in diagnosis of pulpal vitality. The purpose of this study was to evaluate and compare the diagnostic benefits of laser Doppler imaging and electric pulp test (EPT) in dental trauma. Materials and methodsSeven patients were selected for pulp vitality evaluation in Kaohsiung Medical University Hospital between 2018 and 2019. EPT and laser Doppler imager evaluation were performed for patients with traumatic injury to teeth. Statistical methods included the Kappa consistency test and the chi-square test. In addition, the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) were used. ResultsThere was a significant difference in Doppler flow values between the severe trauma group and the mild trauma group, regardless of patient self-reported symptoms (P = 0.043) or physicians’ diagnostic classification (P = 0.018). For an EPT instrument, the Kappa coefficient was 0.67 and 1-year pulpal status findings were highly consistent (P < 0.001). Using a Doppler instrument, the Kappa coefficient was 0.85. According to the ROC curve, the AUC for EPT was 0.94, the AUC for Doppler was 1, and the optimal cut-off value was 31.55, indicating that both were superior diagnostic tools. ConclusionBoth laser Doppler imager and EPT can be used as tools for diagnosing traumatic pulp necrosis. Doppler imaging instruments allow for a more timely and accurate assessment of pulp vitality in dental trauma. In the future, ongoing research and related training are necessary for interpretation of Doppler data.

Clinical and histological assessment of efficacy of theracal LC and biodentine as direct pulp capping agents- An in-vivo study

Context: Since there is paucity of clinical studies, concern arises regarding the safety of direct application of resin-containing material like TheraCal LC on the pulp tissue. Aim: To assess clinically and histologically the efficacy of TheraCal LC and Biodentine as Direct Pulp Capping agents Materials and Method: Sixty caries-free maxillary first premolar teeth which were scheduled for orthodontic extraction were selected for the study which were divided equally into Group 1 (Theracal LC) and Group 2 (Biodentine). Thermal and electric pulp testing was performed on the teeth to assess pulp vitality followed by tooth preparation to expose pulp horns under local anaesthesia. After achieving hemostasis, the direct pulp capping agent was placed and composite restoration was done. All the teeth were evaluated and compared in terms of clinical and histological findings after 6 weeks. Statistical analysis used was Kruskal-Wallis test. Results: Teeth with Theracal LC showed no sensitivity to heat, cold, or percussion, whereas sensitivity to heat, cold, or percussion was noted with Biodentine.

Pulp Regenerative Cell Therapy for Mature Molars: A Report of 2 Cases

Regenerative cell therapy using autologous dental pulp stem cells (DPSCs) in mature single-rooted teeth is a potential alternative to traditional endodontic treatment. However, there is no evidence supporting the use of DPSCs in multirooted teeth. This case report aimed to demonstrate the feasibility and outcomes of pulp regenerative cell therapy in mature multirooted molars, which typically have a higher prevalence of apical deltas. A 26-year-old male and a 29-year-old male were referred for the pulp regeneration of their maxillary molars. After access preparation and establishing apical patency, root canal preparation and disinfection were performed. Autologous DPSCs were isolated from extracted third molars, cultured according to the guidelines of good manufacturing practice, and transplanted into the prepared root canals with granulocyte colony-stimulating factor in atelocollagen. The access cavity was sealed with Biodentine and composite resin. Clinical evaluation during the follow-up period of 48 weeks and laboratory evaluation after 4 weeks revealed no adverse events or evidence of systemic toxicity. After 48 weeks, radiographs and cone-beam computed tomography showed no periapical radiolucency. The teeth showed a positive response to electric pulp testing in 4 weeks in both cases. The signal intensities on magnetic resonance imaging of the regenerated pulp tissue in the affected teeth were comparable to those of the normal pulp in adjacent teeth after 24 weeks. This report of 2 cases demonstrates the utility of DPSCs and the feasibility of pulp regenerative cell therapy in multirooted molars.

Diagnostic Accuracy of Pulp Vitality Tests and Pulp Sensibility Tests for Assessing Pulpal Health in Permanent Teeth: A Systematic Review and Meta-Analysis.

The current systematic review and meta-analysis was carried out to compare the diagnostic accuracy of pulp vitality and pulp sensibility tests in assessing pulpal health. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar and Open Grey databases were searched and after assessing eligibility criteria the data were extracted. True-positive, false-positive, true-negative, false-negative, sensitivity and specificity values were extracted or calculated if not presented. Quality of studies was evaluated based on the QUADAS 2 tool. Meta-analysis was performed in MetaDTA (v2.0; Shinyapps, RStudio PBC, Boston, MA, USA) and Review Manager 5.3 (RevMan web; The Cochrane Collaboration, London, UK). Ten articles were included for qualitative synthesis and five for meta-analysis. The pooled diagnostic odds ratio for pulse oximeter (PO), electric pulp tester (EPT), cold test (CT) and heat test (HT) was 628.5, 10.75, 17.24 and 3.47, respectively. Pairwise comparison demonstrated a higher pooled mean sensitivity and specificity with PO compared with EPT. Comparison between PO and CT and between PO and HT also demonstrated a higher pooled mean sensitivity and specificity for PO. Summary points on receiver operating characteristic curves confirmed the ability of PO to correctly screen negatives in presenting patients as compared to EPT, CT and HT but no study was rated as good on quality assessment. PO can be considered as the most accurate diagnostic method as compared to EPT, CT and HT. This review provides information about the reliability and diagnostic accuracy of using pulp vitality and sensibility tests for assessing pulp status.

Effectiveness and Distribution of Anesthesia for a Modified Extra Oral Maxillo-Mandibular Nerve Block for Dento-Alveolar Procedures: A Prospective Cohort Study.

To evaluate the effectiveness of a modified maxillo-mandibular nerve block technique that includes anesthetizing the maxillary and mandibular nerve with single injection. A prospective, clinical cohort study was carried out including patients who presented for surgical removal of maxillary and mandibular third molars. All patients were administered maxilla-mandibular nerve block through a single injection on one side. Three clinical neurosensory tests were used for mapping the area of anesthesia and to assess and grade objectively the effect of the block. Light touch (LT), two-point discrimination (TPD), pin prick (PP) and Electric pulp testing (EPT) were used for all branches of maxillary and mandibular nerve. An extra oral mapping chart for depth of anesthesia was maintained for each patient to categorize the grades as nil, intermediate and highly anesthetized areas. 62 patients were assessed in the study. EPT showed greater depth of pulpal anesthesia in posterior teeth than the anterior in both maxilla and mandible. PP and TPD tests also showed that the anesthetic effect varied between posterior divisions demonstrating extreme anesthesia compared to the anterior divisions. This technique was found to be successful for surgical extractions involving the maxillary and mandibular regions. The online version contains supplementary material available at 10.1007/s12663-022-01755-w.

Effect of delayed photobiomodulation therapy on neurosensory recovery in patients with mandibular nerve neurotmesis following traumatic mandibular fracture: A randomized triple-blinded clinical trial.

There is a possibility of neurotmesis of the inferior alveolar nerve (IAN) in mandibular fractures, which leads to neurosensory impairment. In this study, we aimed to investigate the efficacy of photobiomodulation therapy (PBMT) in patients with neurotmesis following trauma and mandibular fracture. This triple-blind randomized trial was carried out on patients who suffered neurotmesis of the IAN following mandibular angle and body fracture at least for 6months. In the intervention group, laser irradiation was applied with a low-level GaAlAs diode laser (continuous wave of 810nm wavelength, power of 200mW, and energy density of 12-14J/cm2). In the control group, the laser probe was turned off and placed on the affected area. LLLT was done for 12 sessions (2 times/week for 6weeks). Light touch sensations, two-point discrimination, thermal discrimination (cold and warm stimulus), electric pulp test (EPT), and oral health impact profile (OHIP)-14 questionnaire were performed before the intervention, immediately after each PBMT session, and after 3, 6, 9 and 12months. In both groups, 3 and 23 patients were female and male, respectively. The results showed significantly improved light (cotton swab), light (wooden cotton swab), and sharp (dental needle) touch sensations, and two-point discrimination test in the PBMT group after the 10th, 11th, 10th, and 10th session, respectively. Two-way repeated measure ANOVA revealed that the trend of light touch sensation with cotton swab and two-point discrimination test was statistically significant (p-value=0.002 and 0.001, respectively). The results of OHIP-14 test showed a significantly higher mean in the PBMT group 3months after PBMT. There was no statistically significant difference in EPT and thermal discrimination tests regarding the patients' group. PBMT could be an effective treatment for late post-traumatic nerve neurotmesis following a traumatic mandibular fracture.

A Diagnostic Insight of Dental Pulp Testing Methods in Pediatric Dentistry.

The accurate diagnosis of pulpal pathology in pediatric dentistry is essential for the success of vital pulp therapy. Pulp testing is often a challenging task due to understanding and cooperation issues of pediatric patients, as well as the particularities of pulpal physiology encountered in primary and immature permanent teeth. Sensibility tests, although still widely used by dental practitioners, are no longer recommended by pediatric specialists mainly due to their subjective nature. Vitality pulp tests have gained popularity in the last decade in light of some encouraging results of clinical studies. However, their use is not a routine practice yet. This paper is a literature review aimed to guide dental practitioners towards selecting the appropriate pulp testing method for their pediatric cases. It provides an overview on a multitude of pulp testing methods and an update in recommendations for primary and immature permanent teeth.

The impact of mini-implant hybrid hyrax maxillary expansion on pulp blood flow and sensibility in healthy and traumatized teeth: A prospective study

We aimed to assess pulp blood flow (PBF) and pulp sensibility changes in healthy and traumatized teeth undergoing maxillary expansion with a mini-implant hybrid hyrax appliance. Forty-five patients requiring maxillary expansion either with mini-implant supported hyrax expander (MARME) or tooth-borne hyrax expander (RME) had the pulp status of their maxillary anterior teeth assessed using laser Doppler flowmetry, electric pulp testing, and thermal testing (carbon dioxide snow). The study cohort was divided into 4 groups on the basis of expansion appliance (MARME or RME) and trauma experience (trauma or nontrauma). Each patient was tested before expansion, 2 weeks after expansion, and 3 months after expansion (T3). Relationships between PBF, time interval, and trauma were evaluated using linear mixed modeling. Healthy teeth with RME or MARME expansion had reestablished pretreatment PBF at T3 (P>0.05). Traumatized teeth undergoing RME did not reach pretreatment PBF at T3 (P≤0.05). There were no statistically significant changes in PBF in the MARME+Trauma group at all time intervals (P>0.05). A reduction in pulp blood flow occurred during rapid maxillary expansion from both expansion appliances; however, the relative reduction of PBF in MARME was less than with RME (P≤0.05) 2 weeks after expansion. Most teeth across all groups (≥85%) maintained pulp sensibility at all time intervals regardless of whether there was a history of trauma. Patients with transverse discrepancies and a history of trauma may benefit from MARME as evidenced by reduced changes in PBF compared with RME without affecting pulp sensibility.

Does MIH Affects Preoperative and Intraoperative Hypersensitivity?

Hypersensitivity is an important problem that is encountered during the treatment of hypomineralized teeth. The aim of this prospective study was to compare responses to electrical pulp tests (EPTs) and cold tests among carious teeth with and without molar incisor hypomineralization (MIH) before and after the administration of local anesthesia for caries removal Results: The EPT results of anesthetized carious teeth without MIH were significantly higher than those of carious teeth with MIH (p = 0.011). The cold test results were significantly higher for anesthetized carious teeth with MIH than for those without MIH (p = 0.0001). Intraoperative pain was significantly higher for carious teeth with MIH (p = 0.003). The results of this study suggest that even after achieving sufficient anesthesia, hypersensitivity remains a clinical problem in MIH-affected carious molars. The results presented in this study indicate that this phenomenon is not related to achieving effective local anesthesia; therefore, behavior management in such cases is of the utmost importance compared to relying on adjacent anesthetic methods.

Comparative Evaluation of Anaesthetic Efficacy of Ropivacaine and Articaine with Epinephrine for Buccal Infiltration Anaesthesia in Maxilla Central Incisor and their Effect on Cardiovascular Parameters – A Randomized Control Trial

Aim: To compare the effectiveness, latency time and onset of pulpal anaesthesia with 0.5% plain ropivacaine and 4% articaine with epinephrine 1:100 000 and to determine their probable effect on cardiovascular parameters.&#x0D; Place and Duration of Study: Department of Conservative Dentistry and Endodontics, NPDCH, Visnagar, Gujarat between January 1st 2022 and January 31st 2022.&#x0D; Methodology: 20 patients (10 male, 10 females) age range of 18-36 years were inserted 1.8 mL of the anaesthetic solution for buccal infiltration anaesthesia of maxillary central incisors deprived of caries, restorations or signs of pulpitis. The latency time, onset of pulpal anaesthesia and duration of pulp anaesthesia were assessed with an electric pulp tester. Heart rate and blood pressure were measured before, Immediate and after the onset of pulpal anaesthesia of the solutions. Data was sent for statistical analysis.&#x0D; Results: The efficacy of anaesthesia of central incisors was 100% for both anaesthetics. The comparison of latency time and onset of pulpal anaesthesia were statistically significant for ropivacaine and articaine. Mean duration was less in Articaine group (206.50 ± 9.34) than Ropivacaine group (318.30 ± 43.21). Ropivacaine caused significant increases in blood pressure and heart rate.&#x0D; Conclusion: Ropivacaine (0.5%) achieved effective and long duration of pulp anaesthesia. Ropivacaine could be beneficial for long lasting operative procedures without the need for a vasoconstrictor.

Regenerative endodontic procedures for two traumatized mature anterior teeth with transverse root fractures

BackgroundRegenerative endodontic procedures (REPs) are an alternative treatment in immature traumatized teeth with necrotic pulp/apical periodontitis. However, this procedure has been infrequently reported in multiple transverse root fractures of mature teeth. This case report describes management of a patient with multiple horizontal root fractures in 2 maxillary central incisors that were successfully treated with REPs.Case presentationA 17-year-old girl had a history of traumatic injury to mature teeth 11 and tooth 21 resulting in multiple transverse root fractures. Clinical examination showed that both teeth responded to electric and thermal pulp sensibility tests with prolonged severe pain and were tender to percussion and palpation. Periapical radiographic examination showed both teeth were fully developed and had multiple transverse fractures in the mid-root. The pulp diagnosis was consistent with symptomatic irreversible pulpitis. REPs were initiated with only the coronal fragments treated to preserve pulp vitality in the apical fragment for potential pulp tissue regeneration. After REPs, clinical signs/symptoms subsided, and the two teeth were followed for 48 months when cone beam computed tomography (CBCT) imaging was also undertaken. At the last review, the case demonstrated root fractures healing with calcified tissue and pulp calcification in the apical fragments. Both teeth were stable and in function.ConclusionsREPs have the potential to be used to treat traumatized and symptomatic mature permanent teeth that have sustained transverse root fractures.

Kovanaze Intranasal Spray vs Traditional Injected Anesthetics: a Study of Pulpal Blood Flow Utilizing Laser Doppler Flowmetry.

An ideal local anesthetic would be effective, minimally reduce pulpal blood flow (PBF), and not require injection. This study compared the effects of 3% tetracaine plus 0.05% oxymetazoline nasal spray (Kovanaze; KNS) and injections using 2% lidocaine with 1:100,000 epinephrine (LE) or 3% mepivacaine plain (MP) on PBF, anesthetic efficacy, and participant preference. In a double-blind cross-over design, 20 subjects randomly received a test anesthetic and placebo at each of 3 visits (KNS/mock infiltration; mock nasal spray/LE; or mock nasal spray/MP). Nasal sprays and infiltration apical to a maxillary central incisor were delivered ipsilaterally. PBF was evaluated by laser Doppler flowmetry, and local anesthetic success was assessed with electric pulp testing. Postoperative pain levels, participant preference, and adverse events were also assessed. LE injections demonstrated significant reductions in PBF at all time intervals compared with baseline (P < .05), whereas KNS and MP did not. Pulpal anesthesia success rates were higher for LE (85%) compared with MP (35%) and KNS (5%). Participants reported significantly higher postoperative pain levels for KNS compared with LE and MP. Additionally, KNS was the least preferred of the anesthetics administered and resulted in more reported adverse events. Although KNS showed no significant effect on PBF, it was not effective in achieving pulpal anesthesia as used in this study.

Evaluation of electric pulp test thresholds and correct probe tip placement site in developing incisors: a clinical study in 1200 teeth.

Although electric pulp tests (EPT) may play a valuable diagnostic role in traumatized immature permanent teeth, the EPT threshold values which can be used as reference are not known. The aim of this study was to determine the average range of EPT threshold values in healthy permanent incisors according to their stage of root development. A total of 1200 permanent incisors were examined in 273 children (142 girls, 131 boys) aged 6-12years. Panoramic radiographs were used to group teeth according to the stage of root development. A digitest II pulp vitality tester (Parkell, Inc, Edgewood, NY) was used along with toothpaste as the conducting medium to determine sensibility on three different sites (incisal, middle and cervical third). In all teeth, mean EPT values showed a tendency to decrease along with advanced root development. Irrespective of the stage of root development, the lowest EPT values were obtained when measurements were made on the incisal third of the crown (p < 0.001). Mandibular incisors had lower mean response thresholds than their maxillary counterparts. The present findings provide reference EPT threshold values according to stage of tooth development to monitor the post traumatic pulp status of permanent incisors.

Dental Pulp Regeneration Induced by Allogenic Mesenchymal Stromal Cell Transplantation in a Mature Tooth: A Case Report

IntroductionCellular therapy constitutes a new therapeutic alternative in regenerative endodontics. In this case report, we evaluated the capacity of allogeneic mesenchymal stromal cells (MSCs) to induce dental pulp and apical bone regeneration in a tooth previously endodontically treated. MethodsA healthy 55-year-old female patient consulting for swelling and a sinus tract associated with tooth #8 was referred for an endodontic evaluation. Previously, tooth #8 had undergone root canal treatment and apical resection and had no response to thermal or electric pulp testing. Radiographically, tooth #8 showed root canal treatment, a cut apex angle, and periapical radiolucency. The root canal was recleaned and shaped, and calcium hydroxide was used as an interappointment medication. Cryopreserved allogeneic bone marrow MSCs were thawed, expanded, incorporated into preclotted platelet-rich plasma, and implanted into the pulp cavity of tooth #8. The cervical part of the canal was sealed with bioceramic cement and a composite. ResultsAfter 14 months of MSC transplantation, tooth #8 showed sensitivity to cold and electric pulp tests. Radiographic and cone-beam computed tomographic imaging showed signs of increased periapical bone density, healing of the periapical lesion, and almost complete apical remodeling. ConclusionsThis case report shows periodontal bone formation, apex remodeling, and dental pulp regeneration induced by allogeneic MSC transplantation in a mature nonvital tooth. Allogeneic MSCs may constitute a first-line therapy in regenerative endodontics.

Making sense of sensibility: part 1.

Thermal and electric pulp sensibility tests are commonly used by the majority of clinicians when diagnosing endodontic disease. These tests indirectly determine the state of pulpal health by assessing the response of the Aδ nerve fibres within the pulp-dentine complex. A positive response to sensibility testing indicates that the nerve fibres are functioning but does not give any quantitative information on nerve function, pulpal blood flow or histological status of the dental pulp. These tests have inherent limitations, including a reliance on a patient's subjective response to the test and the dentist's interpretation of the patient's response. This two-part series aims to help clinicians to reach an accurate endodontic diagnosis by providing an overview of how to undertake common pulpal sensibility tests correctly, how to interpret their results and understand their limitations. This section provides an overview of pulp testing, definitions of terminology relevant to pulp testing, the diagnostic uses of pulp testing and a summary of the diagnostic accuracy of different pulp tests.

Efficacy of adding dexmedetomidine to lidocaine to enhance inferior alveolar nerve block in patients with asymptomatic irreversible pulpitis: double-blind randomized clinical trial.

This randomized, double-blind study was to determine whether dexmedetomidine (DEX) helped to improve the inferior alveolar nerve block's (IANB) success in patients with asymptomatic irreversible pulpitis (AIP). We hypothesized that adding DEX to lidocaine enhances the anesthetic effect of lidocaine to a satisfactory level by localizing anesthesia in a safer way. Fifty adult volunteers with AIP in a first or second mandibular molar were randomly assigned to two groups to either receive 1.4ml 2% plain lidocaine or 1.4ml 2% lidocaine + 0.4ml (40μg) DEX, for standard IANB injection. Access cavity preparation initiated 10-15min postinjection when the patient reported lower lip numbness and had two negative electric pulp tests (EPTs) with 5-min intervals. Heft-Parker visual analog scale (VAS) was used to report pain in three steps: during caries and dentin removal, access cavity preparation, and canal working-length determinations; EPT and VAS were analyzed by Friedman test; and success rates were analyzed by Mann-Whitney and Fisher's exact test using SPSS software version 20. Successful anesthesia (defined as no or mild pain during any of steps and no need for additional injection) is obtained in 12% of patients in the lidocaine group, while DEX-lidocaine group increased the success rate of IANB to 72% (p-value = 0.0001). DEX significantly increases the anesthetic effect of lidocaine in IANB injection in patients with AIP. DEX would be a safe adjunct to lidocaine to increase the success rate in IANB and could be a suitable alternative for conventional vasoconstrictors in sensitive groups.