Heft-Parker Visual Analog Scale Research Articles

Comparative evaluation of intraligamentary injection and traditional inferior alveolar nerve block in endodontic management of mandibular molar with symptomatic irreversible pulpitis: A randomized double-blinded clinical trial

Background: Intraligamentary anesthesia (ILA) injection using a single-tooth anesthesia (STA) system has been used as a supplementary technique for pulpal anesthesia in cases of irreversible pulpitis. Aims and Objective: The current clinical trial was undertaken to assess and compare the effectiveness of the conventional inferior alveolar nerve block (IANB) and the ILA technique utilizing the STA system for endodontic management of mandibular molars presenting symptomatic irreversible pulpitis. Materials and Methods: Patients diagnosed with symptomatic irreversible pulpitis inmandibular molar were allocated into two groups: Group I IANB (n=30) and Group II- STA system (n=30). The onset of anesthesia was evaluated using the electric pulp test, whereas for pain perception the Heft-Parker Visual Analog Scale score was recorded before, during, and after anesthesia. Post-anesthetic pain was recorded at 3 h, 24 h, and 1 week. The collected data was evaluated for effectiveness pain perception, and acceptability of the anesthetic technique, using appropriate statistical tests. Results: The mean time of onset for the Group II STA system (2.93±1.80) was significantly higher (P=0.0001) than Group I IANB (1.40±0.86). Pain at the site of injection was insignificant (P>0.05) between both groups. The severity of pain during the root canal procedure was significantly different (P<0.0001) in both cohorts. For both groups, the patient’s acceptance of the anesthetic procedure was statistically insignificant (P=0.21). Conclusions: The STA system reported similar effectiveness in terms of effectiveness, pain perception, and acceptability of anesthetic technique when compared to IANB. Hence, the primary anesthetic treatment for conducting endodontic procedures on molars with symptomatic irreversible pulpitis appears to be the utilization of the ILA-employing STA system.

Anesthetic Efficacy of Endo-Ice and Intrapulpal Ice Sticks After Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomized Controlled Study.

There is a dearth of studies to assess the effectiveness of cryotherapy as a possible adjuvant in anesthesia. Therefore, this study aimed to compare the impact of pretreatment intraoral ice packs, application of Endo-ice, and a combination of Endo-ice and intrapulpal ice sticks use on the effectiveness of pulpal anesthesia as an adjunct in the management of pain and dental anxiety in mandibular second molars with symptomatic irreversible pulpitis (SIP) against traditional inferior alveolar nerve block (IANB) technique. The randomized controlled double-blind clinical study comprised of 200 subjects within the age group of 20-45 years with SIP involving mandibular second molars and divided into four groups of 50 each. Conventional IANB was administered in group 1. Intraoral compact ice packs, Endo-ice, and combined use of Endo-ice and intrapulpal ice sticks were employed following conventional IANB in groups 2, 3, and 4, respectively. The intensity of pain and anxiety before and after the intervention was documented using Heft-Parker visual analog scale (HP-VAS) and Corah's Dental Anxiety Scale-Revised (DAS-R). The average age of the overall study sample was 30.8±2.08 years, and the differences in age and gender distribution were found to be statistically insignificant. The mean HP-VAS scores on access opening and pulpectomy, using ANOVA paired with Tukey's post hoc multiple comparison tests were evaluated to be statistically highly significant (p<0.001). The greatest reduction in HP-VAS score was observed in group 4 receiving combined use of both Endo-ice and intrapulpal ice sticks. While the pretreatment DAS-R score was determined to be statistically insignificant between groups, group 1 subjects had the highest DAS-R score postoperatively (p<0.001). The effectiveness of pulpal anesthesia was found to be 84%, 96%, 92%, and 98% for groups 1 through 4, respectively, and demonstrated a statistically significant difference. The combined use of Endo-ice and intrapulpal ice sticks used as an adjuvant to local anesthesia (LA) was found to be significantly effective in lowering pain compared to the control groups in molars with SIP. Cold administration before and during the procedure was more effective than conventional LA in lowering intraoperative anxiety. Furthermore, the use of Endo-ice and intrapulpal cold after IANB significantly improves the effectiveness of pulpal anesthesia in mandibular second molars with SIP.

Pulpal anesthesia of maxillary first molars using 4% articaine infiltration in patients with symptomatic irreversible pulpitis: a randomized controlled clinical trial.

This study aimed to compare the anesthetic efficacy of 1.8mL (one cartridge) and 3.6mL (two cartridges) buccal infiltration and buccal plus palatal infiltration of 4% articaine in maxillary first molar teeth with symptomatic irreversible pulpitis. This randomized single-blind clinical trial was conducted on 45 patients with symptomatic irreversible pulpitis of maxillary first molars (Trial Registration No: IRCT2015011020238N2_2015). The patients were randomly divided into three groups (n = 15) for buccal infiltration of 1.8mL articaine plus 1:100,000 epinephrine (group 1), buccal infiltration of 3.6mL articaine (group 2), and buccal infiltration of 1.8mL articaine plus palatal infiltration of 0.5mL articaine (group 3). The pain intensity was measured by the Heft-Parker visual analog scale (VAS) during injection and during access cavity preparation. No pain or mild pain during treatment was considered as successful anesthesia. Data were analyzed by the Tukey's post hoc test. The three groups had a significant difference in frequency of the perceived pain during injection (P = 0.01). A higher volume of 4% articaine and injection of articaine in both buccal and palatal sides provided a significantly higher anesthesia success rate (P = 0.049 and P < 0.01, respectively). The highest success rate was recorded in group 3 (93.33%) followed by group 2 (80%) and then group 1 (53.33%). Increasing the administered volume of 4% articaine with 1:100,000 epinephrine and addition of palatal infiltration to buccal infiltration of articaine can significantly increase the success of anesthesia in maxillary first molars with symptomatic irreversible pulpitis. Achieving deep anesthesia in teeth with irreversible pulpitis is a critical parameter in management of patients who are in urgent need of root canal treatments.

Efficacy of pre-operative submucosal injection of dexamethasone and triamcinolone acetonide on post-operative pain following endodontic treatment of teeth with irreversible pulpitis: A randomised clinical trial

Post-endodontic pain is a challenge to clinicians. In this context the evidence for use of preoperative medication is not consistent. The study's objective is to assess the effects of dexamethasone and triamcinolone acetonide administered submucosally in single doses on postoperative pain following single-visit root canal treatment for teeth with symptomatic irreversible pulpitis. Thirty patients were randomly allocated in three groups. Group I received saline (control), Group II received dexamethasone (8mg) and Group III received triamcinolone acetonide (40mg) before endodontic treatment was initiated. Root canal treatment was performed in a single appointment for all the participants. Post-operative pain was assessed using Heft-Parker visual analogue scale (HP VAS). Comparison of HP VAS scores was done using Kruskal Wallis Test and Mann Whitney Test. There was no significant difference in the mean HP VAS scores between 3 groups at pre-op period (P=0.74). At 6,12 and 24h post-operative period the mean HP VAS scores in Group 2 and 3 was significantly lesser as compared to Group 1. Corticosteroid preoperative dosages led to a reduction in post endodontic pain after single visit root canal treatment of teeth with symptomatic irreversible pulpitis.

Incidence of Postoperative Pain after Single Visit Root Canal Treatment using XP-endo Shaper, 2Shape and ProTaper Gold Rotary Systems: A Prospective Randomized Clinical Trial.

To evaluate the incidence of postoperative pain, treatment time and analgesic intake after single visit endodontic treatment of mandibular molars using XP-endo Shaper, 2Shape and ProTaper Gold rotary systems. 150 patients with irreversible pulpitis were scheduled for single visit root canal treatment. Teeth were randomly assigned to one of the three groups: ProTaper Gold (PTG; Dentsply Tulsa Dental Specialties, Johnson City, TN), 2Shape (2S; Micro-Mega, Besancon, Cedex, France) and XP-endo Shaper (XPES; FKG Dentaire, La Chaux-de-Fonds, Switzerland). Preoperative and postoperative pain was rated by the patients at the beginning of treatment and after 24, 48, 72 hours and 7 days on Heft Parker's visual analog scale (HP-VAS). Highest mean postoperative pain score was recorded in PTG (P<0.05), followed by 2S and XPES respectively at all time intervals. XPES exhibited maximum reduction from preoperative pain at 24 (48.67%) and 48 hours (96.90 %) with no pain at 72 hours. Treatment time was significantly least in XPES (P<0.05) followed by 2S and PTG; but no significant difference in analgesic intake was noted. XPES exhibited least postoperative pain at all time intervals and treatment time, followed by 2S and PTG rotary systems respectively. (EEJ-2022-04-053).

Association Between Single-nucleotide Polymorphisms in Candidate Genes and Success of Pulpal Anesthesia after Inferior Alveolar Nerve Block

IntroductionThe present study aimed to investigate the possible association between the single-nucleotide polymorphisms (SNPs) in the SCN9A, SCN10A, SCN11A, OPRM1, and COMT genes and the success rate of pulpal anesthesia after inferior alveolar nerve block (IANB). MethodsA total of 70 patients (45 females and 25 males) presenting mandibular molar teeth with symptomatic irreversible pulpitis were included. Saliva samples were collected from the participants before the application of IANB. A standard IANB was performed with 1.8 mL 4% articaine with 1:100,000 epinephrine. Endodontic treatment was initiated 15 minutes after injection, and the patients were asked to report their pain level during the procedure on a 170-mm Heft-Parker visual analog scale. If the patient recorded a pain level of lower than 54 on the visual analog scale (no pain or mild pain), the anesthesia was considered successful. The DNA isolation and genotyping were performed, and the association between rs4286289, rs6746030, rs6795970, rs6801957, rs11709492, rs1799971, rs1799973, rs4680, rs6269, rs4633, and rs740603 SNPs and the success rate of anesthesia was investigated. ResultsThe anesthesia success rate was significantly lower for the GG genotypes (45%) than the GA and AA genotypes (90%) for rs6795970 in the SCN10A gene. Additionally, the A allele for rs6795970 and the T allele for rs6801957 in the SCN10A gene were significantly associated with higher anesthesia success rates. ConclusionsSNPs in the SCN10A gene affect the success rate of pulpal anesthesia after IANB.

Dentapen versus traditional syringe infiltration - which LA technique is preferred by patients?

Design Single-blind randomised cross-over trial.Intervention The study compared solution deposition pain of a maxillary lateral incisor infiltration between a computer-controlled local anaesthesia delivery device (Dentapen) and traditional syringe. The Dentapen was given with a slow flow rate of 1.8 mL/162 sec and ramp-up mode, and the traditional syringe infiltration was delivered at a flow rate of 1.8 ml/60 sec. Patients were randomly assigned to a sequence to receive both interventions at two separate appointments, with each participant acting as their own control. Patients rated the pain of each intervention using a Heft-Parker visual analogue scale and completed a preference survey at the conclusion of the second appointment.Case selection A total of 130 adult patients with ASA I or II were included in the study. Criteria for exclusion were patients under 18 years of age or older than 65, allergies to local anaesthetics or sulphites, pregnant or nursing, history of significant medical conditions (ASA III or higher), taking any medications that may affect pain assessment, active pathosis at the injection site, or inability to give informed consent.Data analysis Differences in pain of solution deposition for the Dentapen and traditional infiltration techniques were analysed using paired t-tests and odds ratios. Interactions between study groups, gender and anxiety were analysed using a linear mixed-effect model with a P value <0.05.Results Solution deposition pain was significantly less (P <0.001) with the Dentapen infiltration than the traditional infiltration. The preference survey revealed that 75% of patients preferred the Dentapen infiltration over the traditional technique.Conclusions The findings of this clinical trial suggest that pain during maxillary lateral incisor infiltrations can be reduced by using the Dentapen with a slow flow rate and ramp-up mode compared with the traditional syringe technique.

A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis.

Accomplishing painless endodontic treatment, especially in the mandibular molar region, is challenging. Hence, the aim of the study was to compare the efficacy of 2% lidocaine and 4% articaine when used as supplemental intra-ligamentary (IL) anesthesia in mandibular molars having symptomatic irreversible pulpitis with symptomatic apical periodontitis after failed Inferior Alveolar Nerve Block (IANB) injection. In this prospective study, one-hundred and forty-seven adult patients diagnosed with irreversible pulpitis in a mandibular tooth were included who received IANB with 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Patients who experienced pain were recorded using the Heft–Parker visual analog scale (HP-VAS score ≥ 55 mm) and received supplement intra-ligament injection with either4% articaine or 2% lidocaine with 1:100,000 epinephrine. Supplementary intra-ligament injections resulted in 82.6% and 91.3% of profound anesthesia in the first molar region for 2% lidocaine and 4% articaine, respectively. Similarly, an additional IL injection of articaine success percent (78.9%) in the second molar region was higher than lidocaine (63.1%). The overall success ratio revealed no significant difference in achieving profound anesthesia of either solution. In this study population, there was no difference in the success ratio of anesthesia between 2% lidocaine and 4% articaine when used as supplemental IL injection.

Effect of preoperative tramadol, ibuprofen, ibuprofen/acetaminophen on the anaesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis.

The purpose of this double-blind clinical trial was to compare the effect of preoperative tramadol 50 mg, tramadol 100 mg, ibuprofen 600 mg, ibuprofen 600 mg/acetaminophen 1000 mg or placebo 60 min before the administration of inferior alveolar nerve blocks (IANB) of mandibular teeth in patients experiencing symptomatic irreversible pulpitis (SIP). Two hundred and fifty emergency patients diagnosed with SIP were randomly divided into five groups and received medications. Endodontic access was begun 15 min after completion of the IANB, and all patients had profound lip numbness. The Heft-Parker visual analogue scale was used to evaluate pain. Premedication with tramadol 100 mg significantly increased the success rate to 62% than the other groups (p < 0.05). The success rates of ibuprofen, ibuprofen/acetaminophen and tramadol 50 mg groups were not significantly different (p > 0.05). Premedication with tramadol 100 mg enhanced the anaesthetic success of IANB in mandibular molars with SIP.

Prospective Study on PDL Anesthesia as an Aide to Decrease Palatal Infiltration Pain.

The purpose of this prospective randomized study was to assess using a periodontal ligament (PDL) injection as an aide to decrease palatal infiltration pain. A total of 133 subjects randomly received a PDL injection and alternative palatal infiltration or a mock PDL injection and conventional palatal infiltration at 2 separate appointments. PDL injection was given in the mid-palatal sulcus of the maxillary first molar. Mock PDL injection consisted of only needle insertion. All subjects then received a palatal infiltration administered into the blanched gingival tissue 3 mm (alternative palatal infiltration) or 7 mm (conventional palatal infiltration) from the gingival collar. Subjects recorded needle insertion and solution deposition pain using a Heft-Parker visual analog scale (VAS). The combined PDL injection and alternative palatal infiltration had significantly decreased mean VAS ratings for needle insertion and solution deposition pain (P < .0001). Incidence of moderate/severe pain for needle insertion and solution deposition was reduced from 65% to 1% and from 65% to 2%, respectively. Providing PDL anesthesia into the mid-palatal sulcus of the maxillary first molar and then administering an alternative palatal infiltration into the blanched collar around the PDL molar site led to significant reductions in needle insertion and solution deposition pain compared with a mock PDL and conventional palatal infiltration.

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.

Anesthetic efficacy of supplemental buccal infiltration versus intraligamentary injection in mandibular first and second molars with irreversible pulpitis: a prospective randomized clinical trial.

BackgroundTo compare the anesthetic efficacy of supplemental buccal infiltration (BI) (1.7 ml) versus intraligamentary (IL) injection containing 0.4 ml of 4% articaine with 1:100.000 epinephrine after an inferior alveolar nerve block (IANB) with 1.7 ml 2% lidocaine in the first and second mandibular molars diagnosed with irreversible pulpitis (IP).MethodsOne hundred subjects diagnosed with IP of either the mandibular first (n = 50) or second molars (n = 50) and failed profound anesthesia following an IANB were selected. They randomly received either the IL or BI techniques of anesthesia. Pain scores on a 170 mm Heft-Parker visual analog scale were recorded initially, before, and during supplemental injections. Furthermore, pulse rate was measured before and after each supplemental injection. During the access cavity preparation and initial filing, no or mild pain was assumed to indicate anesthetic success. The chi-square test, Mann-Whitney U test, and independent samples t-test were used for the analyses.ResultsThe overall success rates were 80% in the IL group and 74% in the BI group, with no significant difference (P = 0.63). In the first molars, there was no significant difference between the two techniques (P = 0.088). In the second molars, IL injection resulted in a significantly higher success rate (P = 0.017) than BI. IL injection was statistically more successful (P = 0.034) in the second molars (92%) than in the first molars (68%). However, BI was significantly more successful (P = 0.047) in the first molars (88%) than in the second molars (64%). The mean pulse rate increase was significantly higher in the IL group than in the BI group (P < 0.001).ConclusionsBoth the IL and BI techniques were advantageous when used as supplemental injections. However, more favorable outcomes were observed when the second molars received IL injection and the first molars received BI.

Comparing the Efficacy of Premedication with Ibuprofen in Combination with an Inferior Alveolar Nerve Block and Primary Buccal Infiltration in Mandibular Molars with Irreversible Pulpitis: A Triple-blinded Randomized Clinical Trial.

This study aimed to determine the success rate of the combination of buccal infiltration (BI) and inferior alveolar nerve block (IANB) injections in irreversible pulpitis in mandibular molars after premedication with ibuprofen. From 132 patients participated in the study, 120 patients were included. One hour before root canal treatment, patients with mandibular molars with symptomatic irreversible pulpitis received either a 600 mg ibuprofen capsule or a placebo. All patients received 2% lidocaine with 1:80000 epinephrine and 4% articaine with 1:100000 epinephrine for IANB and BI, respectively. Patients' pain was evaluated using the Heft-Parker visual analog scale during the preparation of access cavity, exposure of pulp, and instrumentation of root canal. The success of anesthesia was defined as the absence of pain or mild pain. The Chi-square and t-test were employed for data analysis. The difference between patient age and gender in the two groups was not significant (P>0.05). The anesthesia success rate was 85% in the premedicated and 70% in the placebo group, with statistically significant results (P=0.049). Based on this triple-blinded randomized clinical study, mandibular molars with irreversible pulpitis were not thoroughly anesthetized by a combination of IANB+BI after premedication with ibuprofen (600 mg), even though anesthesia success was improved significantly by ibuprofen premedication.

Anesthetic Success Rate of Inferior Alveolar Nerve Block for Mandibular Molars with Symptomatic Irreversible Pulpitis in Women Taking Antidepressants.

This study sought to evaluate the success rate of inferior alveolar nerve block (IANB) during the endodontic management of mandibular molars with symptomatic irreversible pulpitis in women taking selective serotonin reuptake inhibitor (SSRI) antidepressants. Ninety adult female patients over 18 years of age who were diagnosed with symptomatic irreversible pulpitis of a mandibular molar were recruited in this study. The patients were equally assigned to SSRI user group (including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), who had taken an SSRI, and non-SSRI user group, who had not taken any SSRIs at all. All patients in both groups received 3.6 mL of 2% lidocaine with 1:80,000 epinephrine using conventional IANB injection. Access cavity was prepared 15 min after the injection. Lip numbness was necessary for all patients. Success was determined as no or mild pain upon access cavity preparation and/or instrumentation based on the Heft-Parker visual analog scale recordings. Data were analyzed using the chi-square test Mann-Whitney U test, and t-test. The success rate was 55.6% for SSRI users and 44.4% for non-SSRI users, and no statistically significant difference was observed between the two groups (x 2=1.1, P=0.292). Based on the results of this study, taking SSRI antidepressants could not affect the anesthetic success rate of IANB for mandibular molars with symptomatic irreversible pulpitis in women.

Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual infiltration using articaine in mandibular molars with irreversible pulpitis: a preliminary prospective randomized single-blind clinical trial.

This study was designed as a prospective randomized single-blind clinical trial to compare the anesthetic efficacy of inferior alveolar nerve block (IANB), IANB plus buccal infiltration, and IANB plus lingual infiltration of 4% articaine with 1:100,000 epinephrine in mandibular molars with irreversible pulpitis. Sixty healthy volunteers who had a first or second mandibular molar diagnosed with irreversible pulpitis participated in the present study. This study was composed of three arms for the first molar and three arms for the second molar. Subjects in test arm A received two IANB injections (3.6 mL). Subjects in test arm B received 1.8 mL IANB injection plus 1.8 mL buccal infiltration. Subjects in test arm C received 1.8 mL IANB injection plus 1.8 mL lingual infiltration. Articaine (4%) with 1:100,000 epinephrine was used for all injections. The subject's pain during access preparation and pulp extirpation was recorded on the Heft-Parker visual analog scale. Success was defined as "none" or "mild" pain during treatment. Kruskal-Wallis test was used to compare pain categories in three groups of interventions for each mandibular molar. IANB with a supplemented buccal infiltration provided more success than IANB alone or IANB plus lingual infiltration, in first molars (P = .019). There were no significant differences between the three injection techniques in second molars (P = .795). Adding a supplemental buccal infiltration to a standard IANB was more successful in providing pain-free treatment for patients experiencing irreversible pulpitis in mandibular first molars.

Effect of precooling injection site and cold anesthetic administration on injection pain, onset, and anesthetic efficacy in maxillary molars with symptomatic irreversible pulpitis: a randomized controlled trial.

This randomized controlled clinical trial assessed the analgesic and anesthetic effects of precooling the injection site and administration of refrigerated 2% lignocaine HCl with 1:100,000 epinephrine (LE) in maxillary molars with symptomatic irreversible pulpitis (SIP). Sixty patients diagnosed with SIP (preoperative pain score ≥ 85mm) in maxillary first molars were randomly allocated to two groups. In group I (control), topical gel was applied for a minute followed by conventional LE infiltration, whereas in group II (experimental), topical ice application for 15s and refrigerated (4-6°C) LE administration was done prior to endodontic treatment. The primary outcome measure was anesthetic efficacy that was defined as none to weak pain (≤ 36mm) as measured on Heft Parker visual analog scale (HP-VAS) following access cavity preparation. Pain on injection and onset constituted the secondary outcome measures. The pain on injection was measured using HP-VAS, whereas the onset of anesthesia was assessed using an electric pulp tester (EPT) which was applied on the experimental tooth every minute until no response was elicited. Mann-Whitney U test was performed to analyze the data (p < 0.01). Experimental group reported a success rate of 86.6% when compared to control group (26.6%) and a statistically significant reduction on injection pain (20.0mm vs 54.5mm) (p < 0.01). The onset of anesthesia for experimental group was 2.4min which was also significantly lower than control group (4.5min) (p < 0.01). Cryotherapy can serve as an effective alternative to conventional anesthesia for achieving success, reduced pain, and faster onset during endodontic treatment of maxillary molars with SIP. Precooling the injection site and cold LE administration can result in effective pulpal anesthesia during endodontic management of maxillary molars in SIP patients.

The effect of pre-operative submucosal administration of dexamethasone, tramadol, articaine on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: A randomized, double-blind placebo-controlled clinical trial.

To establish the effects of submucosal tramadol, dexamethasone and articaine on the success of inferior alveolar nerve blocks (IANB) during root canal treatment of mandibular molars with symptomatic irreversible pulpitis (SIP). In this randomized double-blind, controlled clinical trial, 120 patients with the diagnosis of SIP in their mandibular first or second molars were included and randomly divided into four groups (n=30). The control group received normal saline and three experimental groups received a single dose of dexamethasone (8mg/2mL), or tramadol (100mg/2mL) or articaine (4% / 2mL). The pre-operative pain levels of the patients were measured with the Heft-Parker visual analogue scale (HP VAS). All patients received standard IANB of 4% articaine with 1:200000 epinephrine. Following the observation of lip numbness, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars. After 15min, standard root canal treatment was initiated, and the pain intensity levels recorded from the access cavity preparation to pulp extirpation were measured with HP VAS. The duration of the anaesthesia was also evaluated. The experimental groups were compared using one-way ANOVA or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using the Tukey Multiple Comparison test. The Chi-square test was used to compare the categorical variables. The submucosal administration of articaine significantly increased the success rate to 63% in comparison with the control group that received submucosal saline (p<.05). The success rate of pulpal anaesthesia was 37% in the control group, 57% in the tramadol group and 47% in the dexamethasone group, with no significant difference in the success rate among these groups. In the dexamethasone group, the duration of the anaesthetic effect of IANB was significantly longer than those in the other groups (p<.001). In patients with SIP, pre-operative submucosal administration of articaine increased the success rate of IANB, while administration of dexamethasone increased the duration of anaesthesia. These agents can be used in cases where effective anaesthesia cannot be obtained during root canal treatments.

English

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 supplemental buccal infiltration was given with the same anaesthetic used for IANB. Complete pain absence or mild pain was regarded as an anaesthetic efficacy, and moderate to severe pain was regarded as an anaesthetic failure. Recorded data was analyzed using the chi-square test and two proportion Z test. The set significance level was 0.05. RESULTS After an IANB, observed anaesthetic success was 56 % in the articaine (test) group and that in the lidocaine (control) group was 33 %. After buccal infiltration, it was 92 % in the articaine group and 75 % in the lidocaine group. The difference was not found significant between the two groups statistically following IANB and infiltration buccally. The overall success of articaine was 96 %, and lidocaine was 83 %. CONCLUSIONS Compared to 2 % lidocaine, 4 % articaine was found more efficient in achieving profound pulpal anaesthesia in mandibular molars suffering irreversible pulpitis after IANB and buccal infiltration though the difference was insignificant statistically. KEY WORDS Articaine, Lidocaine, Inferior Alveolar Nerve Block, Buccal Infiltration, Heft-Parker Visual Analog Scale, Irreversible Pulpitis

Anaesthetic Efficacy of 4% Articaine in Comparison with 2% Lidocaine as Intraligamentary Injections after an Ineffective Inferior Alveolar Nerve Block in Mandibular Molars with Irreversible Pulpitis: A Prospective Randomised Triple-Blind Clinical Trial.

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-sample and paired-sample t-tests. The results showed that there was no significant difference in the success rates of supplemental IL and IANB injections between articaine and lidocaine. Furthermore, there was no significant difference in the success rates of supplemental IL injection with lidocaine between the mandibular first and second molars. However, there was a significant difference in the success rates of supplemental IL injection with articaine between the mandibular first and second molars. Moreover, supplemental IL injections indicated no significant difference in the anaesthetic efficacy between articaine and lidocaine; nevertheless, they were more effective in the mandibular second molars, especially with articaine.

Association between psychological factors and pain perception in patients with symptomatic irreversible pulpitis during endodontic treatment

Aim: To investigate the association of pain perception of inferior alveolar nerve (IAN) block injection and access cavity preparation with psychological factors in patients undergoing endodontic treatment. Methodology: In this observational study, out of 208 patients who had lower molar with symptomatic irreversible pulpitis, 165 patients completed the study. Psychological factors comprising anxiety, depression and personality traits were evaluated by Hospital Anxiety and Depression scale and short form of NEO Five-Factor Inventory. Procedural pain comprising needle insertion and anesthesia solution deposition during IAN block injection as well as access cavity preparation was rated based on the Heft-Parker visual analog scale. Binary logistic regression was used to determine odd ratio (OR) with 95% confidence interval (CI). Results: The mean (standard deviation) age of patients was 34.63 (12.42) in which, females comprised 72.7% (n=120). Considering the psychological factors, the anxious and depressed individuals constituted 38.8 % and 32.7% of the participants, respectively. By adjusting the socio-demographic factors, depression score during needle injection and anesthetic solution deposition were the risk factors for higher levels of pain (OR=1.12; 95% CI=1.03_1.29 and OR=1.13; 95% CI=1.05_1.32 respectively). Among the personality traits, just neuroticism at needle insertion and anesthetic solution deposition associated with higher levels of pain (OR=1.11; 95% CI=1.02_1.28 and OR=1.09; 95% CI=1.01_1.20 respectively). Conclusions: Coupling with the effect of physiological aspects (depression and neuroticism) on the perception of pain at the needle insertion and anesthetic solution during IAN block injection, a multidisciplinary effort both by dentists and by psychologists might improve dental services for some patients.