Inferior Alveolar Nerve Block Injection Research Articles

Comprehensive Survey on the Performance of Lignocaine in Root Canal Treatment

Objective: The study aimed to evaluate the efficacy of lignocaine as a local anesthetic in root canal treatment, particularly focusing on its use in lower teeth, different administration techniques, and its performance in patients with specific challenges such as inflammation or allergy. Methods: A survey-based approach was utilized to gather data from clinicians on their experiences with lignocaine in endodontic procedures. The study assessed the success rates of various techniques, including the inferior alveolar nerve block (IANB), intraligamentary, and intraosseous injections. The impact of different adrenaline ratios (1:100,000, 1:80,000, and 1:200,000) on anesthesia duration and effectiveness was also analyzed. Results: Lignocaine with 1:100,000 adrenaline was effective in the majority of cases, with IANB being the primary technique used for lower Lignocaine was identified as the anesthetic of choice by the majority of participants, preferred for its rapid onset and adequate duration of action. Most clinicians reported that lignocaine provided effective anesthesia for routine root canal procedures when inflammation was present or additional duration was required, clinicians recommended using supplemental techniques such as intraligamentary and intraosseous. Alternative anesthetics like articaine and bupivacaine were used successfully in patients with lignocaine allergies. Conclusion: Lignocaine remains a reliable anesthetic for root canal treatments, particularly in the lower jaw, when used with appropriate techniques and adrenaline ratios. However, challenges such as inflamed tissues and patient allergies require alternative strategies, including supplemental injection techniques and the use of different anesthetic agents. Clinicians should be adaptable in their approach to ensure effective anesthesia and patient safety. The study aimed to evaluate the efficacy of lignocaine as a local anesthetic in root canal treatment, particularly focusing on its use in lower teeth, different administration techniques, and its performance in patients with specific challenges such as inflammation or allergy.

Comparative Analysis of Different Variables on Complications of Local Anesthesia in Dentistry

Background: With continuous progress in medicine and treatments, anesthetists will more often have to treat risk patients in dental surgeries. Therefore there is a need to compare the rate of incidence of complications with risk factors so we can minimize the drug-related complications in patients undergoing dental anesthesia. The study aimed was to evaluate the incidence rate of local anesthetic complications in dentistry and also to analyze the effect of different risk factors on the incidence of local anesthetic complications. Methods: It was an observational cross-sectional study conducted at the Maxillofacial Department in Sardar Begum Dental College and Hospital. Once the patient signed a consent form, Performa was used to collect patient data. The patients were given lidocaine 2% with 1:100,000 epinephrine by either infiltration or inferior alveolar nerve block (IANB) injection or by both techniques to induce anesthesia, then underwent different dental procedures. We focused on six complications and six different risk factors regarding the total population in our study Performa. Results: Our study included 207 dental patients in total, of which 45% were men and 55% were women. The overall complications observed during the study were 11.5% of patients receiving dental local anesthesia in which non-risk factor patients were 6.7% and risk factor patients were 4.8%. Conclusion: The current study reports a high incidence of dental local anesthetic complications, including bleeding, tachycardia, and salivation. In addition, this study also reports the high incidence of bleeding and tachycardia in diabetic and hypertensive patients. Hence study recommends that dentists should take medical history before each procedure to reduce risk of complications associated with dental anesthesia.

Comparison of Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Periodontal Flap Surgery in the Mandible

Abstract Introduction: The efficacy of infiltration versus inferior alveolar nerve block (IANB) injection techniques during periodontal flap surgery in the mandible is crucial for optimising patient care. This comparative study aims to evaluate the pain management, ease of administration and clinical outcomes associated with both anaesthetic methods. Infiltration anaesthesia involves localised administration, targeting specific sites, whereas IANB provides a broader anaesthetic effect by numbing the entire mandibular nerve. Understanding the advantages and limitations of each technique will enhance procedural efficiency and patient comfort. This research contributes valuable insights into best practices for periodontal surgeries. Materials and Methods: Twenty-five subjects who required periodontal flap surgery were included in the study to treat chronic periodontitis in the mandibular jaw. The surgery was performed under local infiltration of an anaesthetic agent on one side of the jaw and by an IANB on the other side. Pain perception was evaluated using the Visual Analogue Scale (VAS) score at various intervals during periodontal flap surgery. The effect of anaesthesia between the two techniques was compared and evaluated by analysis of variance using IBM Corp. IBM Statistical Package for Social Sciences (SPSS) Statistics for Windows [Version 25]. Armonk, New York, USA. IBM Corp; 2017. Results: Analysis determined the onset, duration and termination of anaesthesia induced by infiltration and the IANB technique. The onset and duration of anaesthesia by both techniques were comparable. The pain perception evaluated using the VAS score while using both anaesthesia techniques was also comparable. Conclusion: Infiltration anaesthesia can be used as an alternative to overcome the disadvantages and complications of IANB for periodontal surgery in the mandibular jaw.

Expediting the reversal of inferior alveolar nerve block anesthesia in children with photobiomodulation therapy.

In pediatric dentistry, complications arising from extended soft tissue anesthesia can negatively impact patient comfort and trust in dental care. This study evaluates the clinical efficacy of diode laser-based photobiomodulation therapy (PBMT) in expediting the resolution of anesthesia in children aged 6-9 receiving inferior alveolar nerve block (IANB) injections. In this split-mouth double-blind randomized clinical trial, 36 pediatric subjects aged 6-9, requiring pulpotomy procedures on both sides of the mandible, received IANBs (single cartridge of 2% lidocaine/1:100,000 epinephrine). PBMT and sham laser were alternately applied to each side of the mandible, in two separate sessions, with the envelope method determining treatment allocation and intervention side on the first treatment day. During the laser session, laser (808nm, 250 mW, 23s continuous, 0.5cm², 11.5J/cm², direct contact) irradiated two points at the injection site, five intra-oral and five extra-oral points along the infra-alveolar nerve's pathway. Soft tissue anesthesia reversal was quantified through tactile assessment. Soft tissue trauma was also assessed by the researcher and reported by parents 24h post-dental visit. All data were analyzed using IBM SPSS Statistics v25.0 via Paired T-test, two-way repeated measures ANOVA, and McNemar's test. The laser group exhibited a mean lip anesthesia duration of 122.78 ± 2.26min, while the sham laser group experienced 134.44 ± 21.8min, indicating an 11.66-minute reduction in anesthesia duration for the laser group. (P < 0.001) Soft tissue trauma occurred in two sham laser group patients and one laser group patient, with no significant difference. (P = 1) The findings indicate that employing laser with defined parameters can reduce the length of IANB-induced anesthesia.

Effect of Back-Pressure Anesthesia on Postoperative Pain after the Endodontic Treatment in Patients with Symptomatic Irreversible Pulpitis: Randomized Double-Blind Clinical Trial

IntroductionThe present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis. MethodsOne-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance. ResultsThe initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them. ConclusionsPatients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.

Pain Perception between local infiltration and inferior alveolar nerve block (IANB) injection techniques in patients undergoing orthodontic lower premolar extractions

Pain Perception between local infiltration and inferior alveolar nerve block (IANB) injection techniques in patients undergoing orthodontic lower premolar extractions

Effectiveness of External Precooling and Vibration Induced by BUZZY on Pain and Anxiety During Inferior Alveolar Nerve Block Injection in Children.

Purpose: Children's fear of the injection of local anesthetic agents affects their cooperation in pediatric dentistry. Different techniques are available to decrease the injection pain, including the use of precooling agents or vibrators. The present study investigated the effectiveness of Buzzy (Buzzy MMJ Labs, Atlanta, GA, USA). This device transfers cold and external vibration to the injection site during the inferior alveolar nerve block (IANB) injection. Materials and Methods: The present self-control, randomized, and double-blind clinical trial evaluated 30 children aged 6-12, who had bilateral mandibular permanent or primary carious molar teeth. On one side, the BUZZY was applied before and during the IANB injection, and the other side was considered as control. On both sides, a topical anesthetic gel was applied before injection. The pain severity and children's anxiety were determined using Wong-Baker, face, leg, activity, cry, consolability (FLACC) scales, and the heart rate. Results: The mean age of the participants was 7.18 ± 1.5 years, with 12 girls and 18 boys. The Wong-Baker scale and FLACC scale did not show any statistically significant difference between BUZZY and control (p value = 0.9 and 0.15, respectively). In addition, BUZZY tool did not significantly decrease pain and anxiety during injection, assessed through the heart rate difference (p=0.38). Conclusion: Under the limitations of the present study, a combination of precooling and vibration using the BUZZY device did not decrease pain and anxiety in children during the IANB injection.

Evaluation of the onset of pulpal, soft tissue anesthesia, and pain using buffered lidocaine in children: a randomized-controlled trial

The American Academy of Paediatric Dentistry (AAPD) has recently released guidelines that highlight the importance of conducting further research on the effects of buffered local anesthesia in children. Adjusting the pH of local anesthetics may reduce pain and reduce the onset time of anaesthesia. In this study, we evaluated the onset of pulpal, soft tissue anesthesia and pain during inferior alveolar nerve block injection to treat pulpally involved mandibular primary molars with buffered lidocaine in comparison with non-buffered lidocaine. We conducted a prospective, randomized, triple-blind, crossover trial involving 40 children aged 7 to 10 years. The onset time of soft tissue anaesthesia was assessed by probing the gingiva after ensuring numbness of the tongue, the lower lip, and the angle of the mouth, while the onset time for pulpal anaesthesia assessed using Endo-ice. We identified a significant difference between buffered lidocaine and non-buffered lidocaine in the onset time of pulpal and soft tissue anesthesia (p &lt; 0.001). Analysis also identified a showed a significant difference between the two groups for the Wong-Baker Faces pain rating scale (p &lt; 0.006) and the Sound, Eye and Motor scale (p &lt; 0.043). In conclusion, buffered lidocaine reduced the onset time for anaesthesia in pulpal and soft tissue, and reduced pain during the administration of inferior alveolar nerve block injections in children. According to the findings of this study, buffered lidocaine can be utilized as an alternative to non-buffered lidocaine in children.

Assessing the Impact of Mandibular Molar Root Length on Success in Supplemental Intraligamentary Injection for Irreversible Pulpitis.

This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following an inferior alveolar nerve (IAN) block. Various factors, including anatomical location, tooth type, and anesthetic solution, may affect supplemental anesthesia success. A total of 251 patients diagnosed with irreversible pulpitis in mandibular first or second molars underwent buccal infiltration anesthesia (4% articaine with 1:100,000 epinephrine) after IAN block injection (3% prilocaine and 0.03 IU/mL of felypressin). Fifty patients experiencing pain during access cavity preparation received supplemental intraligamentary injection (0.3 mL of 2% lidocaine with 1:80,000 epinephrine) at each mesial and distal line angle. The root length of treated teeth was recorded using an apex locator. Data analysis involved independent t-tests, Chi-square tests, and logistic regression. Successful supplemental intraligamentary injection was observed in 21 (42%) out of 50 patients. No significant correlation was found between the mean length of mesiobuccal (P=0.61), mesiolingual (P=0.34), or distal (P=0.60) canals of mandibular molars and the injection's success. Logistic regression analysis, however, revealed a significant impact of mesiolingual canal length on the success rate [OR 0.09 (0.01-0.79), P=0.030]. The root length of mandibular first and second molars does not significantly affect the success of supplemental intraligamentary injection.

Comparing the Efficacy of Local Intraligamentary Injection of Dexamethasone and Piroxicam on Postoperative Pain in Mandibular Molars with Symptomatic Irreversible Pulpitis

Abstract Background: Endodontic therapy may cause the expulsion of inflammatory agents into the nearby periapical tissues, directly stimulating or sensitizing pain fibers. With the help of glucocorticoids pharmacotherapeutic agents and nonsteroidal anti-inflammatory drugs, the majority of pain following an endodontic therapy is typically successfully controlled. The intraligamentary shot is thought to make it possible to apply localized anti-inflammatory medications precisely to the periapical area. Hence, the aim of the study was to evaluate the impact of piroxicam intraligamentary injection, dexamethasone intraligamentary injection, and local anesthetic agent intraligamentary injection on pain following endodontic therapy in teeth having symptomatic irrevocable pulpitis. Materials and Methods: To create the random order, 84 patients were separated into three comparable categories of 28 patients. Dexamethasone, piroxicam, and mepivacaine were the three interventions that received letters A, B, and C, respectively. On the Numeric Pain Rating Scale pain record form, patients who participated were requested to indicate their degree of preoperative pain. For the typical mandibular inferior alveolar nerve block injections, every individual got 1.8 mL of 2% mepivacaine plus 1:20,000 levonordefrin. When the procedure began, the operator blinding was being performed, the support worker loaded a vacant cartridge with 0.4 mL of either dexamethasone pharmaceutical agent (8 mg/2 mL) or 0.4 mL of piroxicam pharmaceutical agent (20 mg/mL) from the drug vial to the cartridges utilizing an insulin syringe. The study’s main finding was the degree of pain following a root canal therapy, which was assessed employing an eleven-point Numeric Rating Score (NRS) with the limits of no pain and severe pain as endpoints. Results: The postoperative pain was maximum in the mepivacaine category, while it was minimum in the piroxicam category at 4 and 12 h follow-up. Similar trends were observed when there was analysis at 24 h follow-up and 48 h follow up where the postoperative pain was maximum in the mepivacaine category while it was minimum in the piroxicam category. Mann–Whitney pairwise comparison at all postoperatively follow-up time intervals revealed no statistically significant variance in pain decrease after the therapy between the dexamethasone category and piroxicam category (P &gt; 0.05). At every postoperative follow-up, the decrease in pain was demonstrated to be statistically vital among the piroxicam subcategory and the mepivacaine category (P &lt; 0.05). Conclusion: Within the constraints of the present investigation, it could be determined that preventative intraligamentary injections of dexamethasone and piroxicam were significantly more effective than mepivacaine at decreasing postendodontic pain, however, there wasn’t statistical variance between the use of either drug.

Comparison of Pain Perception Between Local Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Patients Undergoing Orthodontic Lower Premolar Extractions

Comparison of Pain Perception Between Local Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Patients Undergoing Orthodontic Lower Premolar Extractions

Evaluating the effect of using anti-stress balls as a distraction technique in reducing pain during inferior alveolar nerve block injection: a randomized clinical trial.

The aim of this study is to evaluate the effect of using anti-stress balls in reducing patients' pain during injection of the inferior alveolar nerve block (IANB). In this randomized clinical trial, 32 individuals were divided into two groups. The conventional method of anesthesia injection was performed using IANB conventional injection technique. During the injection, individuals in the anti-stress ball group were asked to use the anti-stress ball as a distraction technique. For the control group, no supersede methods were used for pain control. Finally, both groups were asked to record their pain utilizing the numerical rating scale (NRS). The participants' vital signs were monitored before and after injection. Kolmogorov-Smirnov test, independent T-test, and Fisher's exact chi-square test were performed for statistical analysis (α = 0.05). Sixteen females and 16 males in the age range of 40 to 20years old participated in this study. The mean pain score in the anti-stress ball group was significantly lower (p < 0.001). In both sexes, the pain score in the anti-stress ball group was significantly lower (males p < 0.001 and females p = 0.001). In addition, in all age ranges, the pain score in the control group was higher except for the above 35years old participants (p = 0.078). Moreover, there were no significant differences in individuals' vital signs (p > 0.05). Utilizing an anti-stress ball reduces patients' pain significantly during IANB in both sexes and individuals who are below 35 yearswithout changing vital signs. IRCT20220815055704N1.

Comparing intraosseous computerized anaesthesia with inferior alveolar nerve block in the treatment of symptomatic irreversible pulpitis: A randomized controlled trial.

The aim of this study was to compare the cardiovascular effects [heart rate, oxygen saturation (SpO2 ), systolic and diastolic blood pressure] and the anaesthetic efficacy of intraosseous computerized anaesthesia (ICA) versus inferior alveolar nerve block (IANB) in Symptomatic irreversible pulpitis (SIP). The study protocol was registered with ClinicalTrials.gov (NCT03802305). In a randomized, prospective clinical trial, 72 mandibular molar teeth with SIP were randomly allocated to conventional IANB injection (n = 36) or ICA injection (n = 36), both with 1.8 mL of 4% articaine with 1:100 000 epinephrine. The primary objective was to assess the cardiovascular parameters (heart rate, oxygen saturation, blood pressure) before, during and after the anaesthesia. The secondary objectives were to compare ICA with IANB for success and postoperative outcomes for up to 3 days. The maximum increase in heart rate in the ICA group was greater than in the IANB. Other cardiovascular parameters did not show differences throughout the clinical procedure. There were no statistically significant differences (p > .05) between groups for sex, age, or anxiety. The total success rate of ICA (91.43%) was significantly higher (p = .0034) than that of IANB (69.44%). This study establishes that ICA is safe and efficient in the first intention for the treatment of SIP of the mandibular molar.

Effect of the inferior alveolar nerve block injection versus maxillary infiltration with two local anesthetic agents on cardiovascular parameters: A randomized comparative double-blind clinical trial

Abstract This study aimed to assess the effect of inferior alveolar nerve (IAN) block of the mandible and infiltration anesthesia of the maxilla using lidocaine plus epinephrine or prilocaine with felypressin anesthetic agents on systolic and diastolic blood pressures, heart rate (HR) and peripheral oxygen saturation rate of patients. This randomized double-blind clinical trial evaluated 112 patients in four groups (n=28) based on the jaw (maxilla or mandible) and type of anesthetic agent (lidocaine with epinephrine or prilocaine with felypressin). Groups 1 and 2 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, with 2% lidocaine plus 1:80.000 epinephrine. Groups 3 and 4 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, using prilocaine with felypressin. Systolic and diastolic blood pressures and HR were measured by an automatic upper arm blood pressure monitor and the percentage of peripheral oxygen saturation rate was measured by a finger pulse oximeter 10 minutes before the injection, immediately after injection, 10 minutes after injection and 20 minutes after injection. The mean diastolic blood pressure showed a greater reduction following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p&lt;0.001). The mean HR showed a significantly greater increase following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p&lt;0.001). The effect of type of anesthetic agent on diastolic blood pressure depended on the type of injection (p=0.033). Administration of 2% lidocaine with 1:80.000 epinephrine, in comparison to prilocaine with felypressin, can cause changes in cardiovascular parameters such as heart rate and diastolic blood pressure in patients undergoing restoration of a maxillary or mandibular molar tooth. Type of injection has no significant effect on cardiovascular parameters.

The performance of inferior alveolar nerve block technique among undergraduate students.

This study aimed at evaluating the ability to feel bone touch, positive aspirations, and frequency of the success rate during the direct inferior alveolar nerve block (IANB) among dental students. This prospective cross-sectional study involved 203 cases of IANB injections for patients requiring extraction of mandibular posterior teeth who visited student dental clinics at Ajman University, Fujairah Campus. Students' performance of direct IANB including ability to perceive bone touch, frequency of positive aspirations, and success rate were reported. Students reported feeling bone contact in 148 (72.9%), 43 (21.2%), and 12 (5.9%) of the first, second, and third attempts during the IANB, respectively. Positive aspiration was found in 46 (22.7%) of the injections. The success was in 195 (96.1%) of the total injections. Spearman's correlation coefficient indicated that there was no significant correlation between the success rate and the result of aspiration (rho=.054, p= .440). Additionally, there was no correlation between attempts to touch the bone and the outcome of the aspiration (rho=-.091, p= .198) or success rate (rho=-.083, p= .240). There is a relatively high success rate of direct IANB technique among dental students. This confirms the inclusion of this technique in the curriculum. Furthermore, the high rate of positive aspiration reflects the awareness and competency of dental students with the aspiration technique. In turn, this will reduce the failure of anaesthesia and the subsequent systemic complications.

A survey to evaluate and compare patients perception to pain, pressure and discomfort induced by types of injection techniques used for mandibular anaesthesia

Local anaesthesia makes the patient and the dentist comfortable to do treatment with least amount of discomfort, but dental patient’s most frequent fear is of receiving local anaesthetic injections. The present study attempted to evaluate and compare patient’s perception to pain, pressure and discomfort induced by three types of injections (Infiltration, mental nerve block and inferior alveolar nerve block injection) for mandibular anaesthesia. Patients were asked to grade pain, pressure and discomfort associated with injection insertion on visual analog scale. Inferior alveolar nerve block was graded the most painful nerve block, while Infiltration was graded as the least painful. Patient’s perception to pressure and discomfort was highest for inferior alveolar nerve block and lowest to mental nerve block.

Assessment of Anatomical Location and Variation of Mandibular Foramen Using Cone-Beam Computed Tomography: A Cross-Sectional Study

Background: Determining the exact location of mandibular foramen is an important factor prior to Inferior Alveolar Nerve (IAN) block injection. The aim of this study is to assess the position of Mandibular Foramen (MF) and its variations using Cone-Beam Computed Tomography (CBCT).&#x0D; Methods: This study was conducted on CBCT images of 80 females and 80 males (18 to 68 years). The distance between the MF and the anterior border of ramus (A), inferior border of mandible (B), superior border of mandible (C), and occlusal plane was measured. Data were analyzed by the student t-test, bivariate correlation analysis, paired sample t-test, and Pearson’s correlation coefficient.&#x0D; Results: The mean amount of A, B and C distances, and the mean distance from the occlusal plane to the center of MF were 13.76, 24.24, 12.32, and 7.59 mm, respectively, with no significant difference between the right and left sides (p&gt;0.05). The mean B and C distances were significantly smaller in females than males (p&lt;0.05). The mean size of the measured angle was 43.2°. Significant correlations were noted between aging and decreased A distance, and reduction in the angle between the contralateral premolars and MF (p&lt;0.05).&#x0D; Conclusion: Knowledge about the position of MF can enhance the surgical procedures in this region. Using a 21-25 mm needle would be associated with lower risk of needle fracture during IAN block injection. Also, needle insertion angle &lt;45-degrees is optimal for the samples assessed in this study.

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.

Onset of action and duration of efficacy of inferior alveolar nerve block versus single lingual subperi-osteal injection of 4% articaine in mandibular second molars: A randomized clinical trial

Onset of action and duration of efficacy of inferior alveolar nerve block versus single lingual subperi-osteal injection of 4% articaine in mandibular second molars: A randomized clinical trial

Anaesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta-analysis and trial sequential analysis.

Incorporating an additive into lidocaine is a method to enhance the efficacy of the inferior alveolar nerve block (IANB) in mandibular posterior teeth. To assess the efficacy of incorporating additives into lidocaine in the success rate of IANB for teeth with the diagnosis of normal pulp (NP) or symptomatic irreversible pulpitis (SIP). Randomized controlled trials (RCTs) assessing the incorporation of additives into lidocaine on the pulpal anaesthesia success rate of mandibular posterior teeth were searched in PubMed, Scopus, Web of Science, Ovid, EBSCO, Embase, and Cochrane databases up to 1 December 2021. The risk of bias (RoB) was assessed by the Cochrane Risk of Bias Tool. A random-effects model was employed to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI), using STATA 16. The trial sequential analysis (TSA) was applied to calculate the required information size (RIS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of the evidence. Of 6966 records retrieved initially, 14 trials (8 for NP and 6 for SIP groups) were included in qualitative and quantitative syntheses. All trials were categorized as low and unclear RoB for NP and SIP groups, respectively. In the NP group, with 307 participants, no significant effect was observed for additives incorporated into lidocaine (RR: 0.84; 95% CI: 0.53-1.32; I2 =98%). Subgroup analysis revealed that adding mannitol led to a higher success rate (RR=1.24; 95% CI: 1.15-1.34; I2 =7.16%). In the SIP group, with 434 participants, no significant effect was shown when the additives were incorporated (RR=1.22; 95% CI: 0.98-1.52; I2 =0%). Likewise, in subgroup analysis, incorporating mannitol or sodium bicarbonate demonstrated no significant effect (RR=1.76; 95% CI: 0.93-3.32; I2 =18.41% and RR=1.06; 95% CI: 0.65-1.72; I2 =53.5%, respectively). TSA revealed that the outcome was "inconclusive" for each group. The certainty of the evidence was graded as "very low" and "low" for NP and SIP groups, respectively. The very low to low certainty of evidence indicated that incorporating additives into lidocaine did not increase the efficacy of IANB and supplemental injections are still necessary to help practitioners achieve painless dentistry. PROSPERO database (CRD42020132585).