Success Of Inferior Alveolar Nerve Block Research Articles

Comparative effectiveness of preemptive administration of ibuprofen and ibuprofen-arginine on the anesthetic success of inferior alveolar nerve block in teeth with symptomatic irreversible pulpitis - A double-blind randomized clinical trial.

This study examined the impact of premedication with ibuprofen and ibuprofen-arginine and the influence of preoperative pain and anxiety on inferior alveolar nerve block (IANB) efficacy in cases of symptomatic irreversible pulpitis. The study involved 150 SIP patients who were randomly assigned to receive ibuprofen (600mg), ibuprofen-arginine (1,155mg), or a placebo 30min before IANB. Preoperative anxiety and pain levels were assessed using the Modified Dental Anxiety Scale and the Heft-Parker visual scale. IANB efficacy was determined by the absence of or mild pain during the procedure. Statistical analysis included chi-square, z-tests, Analysis of Variance, and Student's t tests. The ibuprofen and ibuprofen-arginine groups exhibited significantly higher IANB success rates (62% and 78%, respectively) compared to the placebo group (34%). However, no significant difference was observed between the ibuprofen and ibuprofen-arginine groups. Patients with successful IANB in the ibuprofen and ibuprofen-arginine groups displayed lower median anxiety scores (8) than those with failed blocks (15) and lower mean preoperative pain scores (118.3). In cases of symptomatic irreversible pulpitis the preemptive medication with ibuprofen-arginine effectively increased the efficacy of the inferior alveolar nerve block The inferior alveolar nerve block efficacy was influenced by preoperative anxiety levels and the intensity of pain. This research underscores the potential benefits of oral premedication with ibuprofen and ibuprofen-arginine in improving anesthesia outcomes in cases of symptomatic irreversible pulpitis.

Mylohyoid Nerve Injection for Unsuccessful Anesthesia of Posterior Teeth with Successful Inferior Alveolar Nerve Block.

Background and objective: variations in mylohyoid could lead to failure of an inferior alveolar nerve blockade. This study aimed to evaluate the impact of mylohyoid nerve variation on the persistence of pain following a successful inferior alveolar nerve block. Method: This clinical study was performed at the oral and maxillofacial department/college of Dentistry, Hawler Medical University. All patients with pain following a successful inferior alveolar nerve block were enrolled in this study. An additional submucosal injection (infiltration technique) as few drops in the lingual mucosa of the offending tooth is given by the same surgeon Results: A total of fifty patients were enrolled in this study,30 males and 20 females. age range was (16-56). Among the total only 20 patients (60%females,40% males) experienced pain on the lingual side during the attempt of dental extraction. Following lingual infiltration, all the cases were treated successfully in a pain free environment. Descriptive statistics was used to analyze the data. Conclusion: Lingual submucosal injection of 1/3 of 1.8 ml of local anesthesia might be an effective way to block all possible nerve variation on the lingual side. Keywords: Inferior alveolar nerve block (IANB), mylohyoid nerve variation, lingual mucosal infiltration, pain.

Clinical Assessment of Preemptive Analgesia on Success of Pulpal Anesthesia and Postendodontic Pain in Children with Irreversible Pulpitis: A Randomized Comparative Study.

Optimal pain management of symptomatic pulpitis in formative years goes a long way in developing a positive dental attitude. Efforts should be made to increase the success of anesthesia, thus diminishing negative dental experiences. The aim of the study was to assess the efficacy of preemptive analgesia on the success of pulpal anesthesia following inferior alveolar nerve block (IANB) in children with symptomatic irreversible pulpitis and on reducing postendodontic pain. The research design was an in vivo, three-group, parallel, quadruple-blind study. A total of 75 patients were randomly allocated to one of the three groups-group I: ibuprofen, group II: combination of ibuprofen and paracetamol, and group III: multivitamin (placebo). Premedication was given 45 minutes before treatment, and patients received IANB in a standardized manner. Pain during pulpectomy was recorded using the face, legs, activity, cry, consolability (FLACC) scale and postoperatively using Wong-Baker's pain rating scale (WBPRS) at 4, 12, and 24 hours. Success was measured if the pain felt was of no or mild intensity. Success of IANB was 64% for ibuprofen, 72% for the combination group, and 40% for the placebo group, with no statistically significant difference between all groups (p = 0.06) on the FLACC scale. At 4 hours postoperatively, a significant difference (p = 0.02) was found among groups with more children experiencing no or mild pain in groups I and II and the highest number of rescue medications taken by the placebo group. Ibuprofen and a combination of ibuprofen and acetaminophen as preemptive analgesics had no significant effect on the success rate of IANB, although it was effective in reducing pain at 4 hours postoperatively. Gori NA, Patel MC, Bhatt RK, et al. Clinical Assessment of Preemptive Analgesia on Success of Pulpal Anesthesia and Postendodontic Pain in Children with Irreversible Pulpitis: A Randomized Comparative Study. Int J Clin Pediatr Dent 2024;17(1):72-78.

Effectiveness of Lignocaine with and without Pre-operative Oral Ibuprofen in Controlling Pain in Primary Mandibular Molars with Irreversible Pulpitis in 5 to 9-Year-Old Children: A Randomized Controlled Trial.

Childhood experiences of pain associated with dental treatment can induce dental anxiety. Infe-rior alveolar nerve blocks are eight times more likely to fail in patients with irreversible pulpitis. The objective was to compare the effectiveness of lignocaine with and without pre-operative oral ibuprofen for controlling pain in primary mandibular molars scheduled for pulpectomy procedures in 5 to 9-year-old children. One hundred and twenty-two children diagnosed with irreversible pulpitis in mandibular posterior teeth and scheduled for pulpectomy procedures were included. The children were assigned to one of the two groups, Treatment group A: Pre-operative with oral ibuprofen and local anaesthesia with 2% lignocaine (with adrenaline 1: 80000); Treatment group B: Pre-operative with oral placebo and local anaesthesia with 2% ligno-caine (with 1: 80000 adrenaline). Pain and pulse rate were recorded at baseline, one hour after administration of oral medication, fifteen minutes following administration of Inferior Alveolar Nerve Block (IANB), and also during the course pulpectomy. The results were statistically analysed using chi square test and repeated mea-sures analysis of variance (ANOVA). In treatment group A, 90.16% children had IANB success compared to 9.83% in group B.. The differ-ence in the success rate between two groups was statistically significant (p<0.001) with an odds ratio of 84. Oral medication with ibuprofen is effective in increasing the success rate of IANB with lignocaine for the treatment of irreversible pulpitis of 5 to 9-year-old children.

The location of mandibular foramen relative to the occlusal plane: a study on anatolian dry mandible.

The study aims to evaluate the location of mandibular foramen (MF) with respect to the occlusal plane (OP) and its location on the ramus using Anatolian dry mandibles. A total of 115 dry mandibles with mandibular molars were analyzed. The distance between the MF and the OP was examined with a flat metal plate. Group A was above the OP; group L was at level, and group B was below the OP. The distances between the MF and anterior border (A-MF), sigmoid notch (U-MF), posterior border (P-MF), and lower border (L-MF) were measured. The symmetry between the two sides was examined. Pearson chi-square and Student's t-test were performed for statistical analysis. According to the analysis, 50.23% of MF was located below the OP (p<0.05). The mean distances of Groups A and B were 3.45 and 4.78 mm, respectively. There was no difference between the left and right in groups (p>0.05). The distance A-MF was 14.71 mm. There was no statistical difference between the distances A-MF and P-MF or U-MF and L-MF. Half of the MF (50.23%) was located below the occlusal plane with a mean distance of 4.78 mm. It may be helpful to place the needle 3-4 mm above the OP and 1.5-2 mm back of the anterior border to obtain a successful inferior alveolar nerve block. The MF was located at the center of the medial surface of the ramus.

Effect of Magnesium Sulphate Added to Mepivacaine Hydrochloride on Inferior Alveolar Nerve Block Success in Patients with Symptomatic Irreversible Pulpitis in Mandibular Molars: A Randomized Clinical Trial

Effect of Magnesium Sulphate Added to Mepivacaine Hydrochloride on Inferior Alveolar Nerve Block Success in Patients with Symptomatic Irreversible Pulpitis in Mandibular Molars: A Randomized Clinical Trial

Evaluation of a Nishit-Rama Modification of a Gow-Gates Technique for Giving Mandibular Nerve Block: A Randomized Controlled Trial.

In pursuit of improving currently available anesthetic techniques for dental procedures, present study evaluated a novel mandibular nerve block technique in comparison with control group administered standard inferior alveolar nerve block (IANB) technique. A randomized, comparative, parallel design, double-blind study was conducted at Tata Main Hospital, Jamshedpur, India which enrolled 140 adult patients (70 in experimental group and 70 in control group) requiring minor surgical dental procedures involving normal forceps method extractions of mandibular molars. Tingling or numbness of the lower lip of the same side was considered suggestive of successful IANB blockage. Onset of anesthesia, aspiration of blood and failure of anesthesia were also assessed and compared between study groups. Mean age and gender distribution were statistically comparable between study groups (p > 0.05). Diagnosis of the enrolled cases was either acute or chronic apical periodontitis, which was distributed similarly in study groups (p > 0.05). Mean time to onset of the IANB blockage was found to be significantly longer in experimental group versus control (3.72 ± 0.84 versus 1.93 ± 0.62min, p < 0.05). Both, number of positive aspirations (7.14% versus 25.72%, p < 0.05) and need for additional injection were significantly lower in experimental group (18.58% versus 74.28%, p < 0.05). Incidence of pain while tooth removal was similar between study groups (p > 0.05). The novel technique for mandibular nerve block evaluated in present study has various advantages like avoidance of technical difficulties with absence of extra-oral landmark, lower chances of reinsertion reducing complication risk, and decreased systemic complications, evident by lower rates of aspirations.

Effect of premedication on the success of inferior alveolar nerve block in patients diagnosed with irreversible pulpitis: An umbrella review

Successful management of pain during endodontic treatment is essential for both patients and dentists. Achieving adequate pulp anesthesia in mandibular molars is a significant concern for patients with irreversible pulpitis during endodontic treatment. The increased sensitization of nociceptors due to inflammation decreases the success of inferior alveolar nerve block (IANB). The main focus is on reducing inflammation before delivery of local anesthesia to increase the success of anesthetic drugs. This umbrella review aimed to revise, qualify and summarize the existing body of evidence on the effect of premedication on IANB in patients with irreversible pulpitis. A literature search was conducted using electronic databases (PubMed, Scopus, the Web of Science, and the Cochrane Library) with no date restriction until September 2021 to identify the relevant studies. All the cross-references of the selected studies and grey literature were also screened. Four systematic reviews assessing the effect of premedication on the success of IANB were selected. A conclusion was drawn that premedication with &gt;400 mg of ibuprofen can positively affect the success of IANB.

Preoperative nonsteroidal anti-inflammatory drugs on the success of inferior alveolar nerve block in irreversible pulpitis

Introduction: The inflammatory conditions of pulp often lead to pain which is managed by adequate anesthesia. Achieving optimum anesthethic effect in such conditions is difficult; therefore, various supplemental techniques have been used to enhance the effect. Premedication is one such technique vastly studied. This study aimed to critically analyze the systematic reviews, including their respective meta-analyses, to summarize the data regarding the role of nonsteroidal anti-inflammatory drugs (NSAIDs) on the success of inferior alveolar nerve block (IANB) in patients with irreversible pulpitis. Materials and Methods: The protocol was formulated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist, and the formulated PICO question was “Is there any effect of oral premedication with NSAIDs on the anesthetic success of IANB in irreversible pulpitis?” The reviews were analyzed using a measurement tool to assess systematic reviews (AMSTAR). Results: Twelve reviews were selected, out of which three were finally included for detailed analysis and their AMSTAR scores were 'high.' Individual meta-analyses results pointed toward the anesthetic success of IANB with NSAIDs as oral premedication. Conclusion: The current overview justifies the use of NSAIDs by highlighting the supporting and conflicting data of each systematic review.

Buccal Nerve Trunk Block Anesthetizes the Buccal Mucosa Beyond the Papilla of the Parotid Duct

The limited area of anesthesia of the buccal mucosa with concomitant conventional buccal nerve block (conventional BNB) may be involved in failed inferior alveolar nerve block (IANB). The aims of this study were to examine the extent of anesthesia by buccal nerve trunk block (BNTB) and compare the success rates of IANB with BNB. This prospective parallel-group randomized single-blinded clinical trial included patients scheduled for removal of a mandibular third molar at the Nippon Dental University Hospital between September 2021 and March 2022. The primary predictor variable was the approach for BNB (BNTB vs conventional BNB). The primary outcome was the extent of tactile sensory loss and anesthesia of the buccal mucosa. The secondary outcomes included onset time and duration of BNBs and the success rate of the IANB with concomitant BNB for third molar extraction, assessed by the proportions of intraoperative pain perception and supplemental infiltration anesthesia. The other study variables were sex, age, and injection side. Comparisons were analyzed by Fisher's exact test or the Mann-Whitney U test. The P value was set to .05. A total of 38 patients (14 male, 24 female) with a mean age of 28.9years (range, 18 to 67years) were enrolled, with 19 patients each in the BNTB group and conventional BNB group. The effective tactile sensory loss rates at ∼5mm above the height of the papilla of the parotid duct of the premolar and molar regions were greater following BNTB (71 and 95%, respectively) than following conventional BNB (37%; P<.01 and 58%; P<.01, respectively). The proportions of intraoperative pain perception of the BNTB group and the conventional BNB group were 10 and 42% (P=.06), respectively, and those of supplemental infiltration anesthesia were 5 and 26% (P=.18), respectively. BNTB provided a wider extent of anesthesia of the buccal mucosa than conventional BNB and may improve the anesthesia success of IANB for removal of mandibular third molars.

A pilot study of local anesthesia training using a mixed-reality haptic fidelity model.

One of the most difficult local anesthetic blocks to master in dentistry is the inferior alveolar nerve block (IANB). Historically, dental students have practiced local anesthesia on one another. At the University of Colorado, these practice sessions have been limited to one required laboratory session. The predictability and confidence of student IANB success have not been high in the past. Therefore, the objective of this study was to investigate the impact of a novel IANB simulator, built on a three dimensional (3D)-printed mixed-reality haptic model, for second-year dental students to practice on prior to their laboratory session. Thirty-nine student participants volunteered to practice with the IANB simulator. Participants were divided into two groups, Group A and Group B. Self-reported confidence and injection-specific accuracy were measured during IANB simulator practice and the laboratory session. During lab, partner numbness was assessed as a measure of IANB success. Groups A (n = 20) and B (n = 19) practiced with the simulator before and after laboratory, respectively. Injection domains were not assessed during Group B's practice with the IANB simulator. Self-reported confidence increased for both groups (p < 0.001). However, for anesthetic success, Group A exhibited significantly greater success (52.6%) than Group B (17.6%) (p = 0.029). Self-reported confidence in performing an IANB improved and higher anesthetic success was achieved for Group A. Further investigation is necessary to determine the long-term impact of using the IANB simulator in dental education.

Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double-blind single-centre clinical trial.

The aim of this study was to assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation. Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6ml 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4ml 4% articaine hydrochloride with 1:100 000 adrenalin (n=165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point Numerical Rating Scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need for supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analysed using Mann-Whitney U- and Chi-squared (χ2 ) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure were calculated. The effect of pre-disposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects. Baseline variables were balanced between groups (p > .05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p > .05). IOP intensity was associated with preoperative pain intensity and tooth type (p < .05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p > .05) with a relative risk of failure [95% CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p > .05; RR [95% CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia. 2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

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.

Relative position of mandibular foramen for inferior alveolar nerve block in children: A digital panoramic radiographic study

Background: For a successful inferior alveolar nerve block, good knowledge of position of mandibular foramen is imperative. Objectives: To evaluate the position of mandibular foramen in relation to mandibular occlusal plane and anterior border of ramus in a selected population of children in Nepal using digital panoramic radiographs. Methods: An analytical cross-sectional study was done after ethical approval in convenient sample of 180 children of 3-13 years in department of Paediatric and Preventive Dentistry, Dhulikhel Hospital from January 2021 to August 2021. Their digital panoramic radiographs were analysed using software Rainbow TM Image Viewer version 1.0.0.0. Mean with standard deviation were calculated for linear measurements taken from mandibular foramen to mandibular occlusal plane and deepest point on the anterior border of ramus. Paired t-test was used to compare measurements between right and left sides. Student t-test was used to evaluate the difference between boys and girls. Pearson correlation was used to observe the correlation of age with the linear measurements. Results: The mean linear measurements increased along with the increase in age (p &lt;0.05). There was statistically significant difference in linear measurements between the two sides of mandible except in 3-4 years children for mandibular foramen to anterior border of ramus which was not significant (p = 0.090). There was no significant difference in linear measurements between boys and girls. Conclusion: For inferior alveolar nerve block, the needle should be placed below the occlusal plane in children up to seven years of age and above for higher ages.

A digital workflow for the inferior alveolar nerve block in the edentulous mandible

The inferior alveolar nerve block is the most frequently used anesthetic method for implant placement in the completely edentulous mandible. However, achieving a successful inferior alveolar nerve block in edentulous mandibles is challenging. The present clinical report describes a novel digital workflow for precise local anesthetic injections at the mandibular foramen.

Nitrous Oxide/Oxygen Effect on IANB Injection Pain and Mandibular Pulpal Anesthesia in Asymptomatic Subjects.

The inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia. Nitrous oxide may increase the success of the IANB. The purpose of this investigation was to study the effect of nitrous oxide/oxygen (N2O/O2) on IANB injection pain and mandibular pulpal anesthesia in asymptomatic subjects. One hundred five asymptomatic subjects received an IANB after the administration of N2O/O2 or room air/oxygen (air/O2) at 2 separate appointments. After the IANB, subjects rated their level of pain for each phase of the injection (needle insertion, needle placement, and solution deposition) using a Heft Parker visual analog scale. Pulpal anesthesia was evaluated with an electric pulp tester for 60 minutes. The mean pain rating for all 3 injection phases showed a statistically significant reduction in pain when N2O/O2 was used compared with Air/O2 (P < .05). Odds ratios demonstrated a statistically significant increase in IANB success for the N2O/O2 group compared with the air/O2 group. N2O/O2 administration statistically decreased pain for all 3 injection phases of the IANB. In addition, nitrous oxide statistically increased the likelihood of pulpal anesthesia for posterior mandibular teeth. However, the incidence of pulpal anesthesia was not 100%.

Do length and gauge of dental needle affect success in performing an inferior alveolar nerve block during extraction of adult mandibular molars? A prospective, randomized observer-blind, clinical trial.

Association between length and gauge of dental needle and success rate and pain perception during an inferior alveolar nerve block (IANB) has not been investigated using a randomized clinical trial (RCT). This RCT aimed to compare the success rate of IANB and perceived pain using 27- or 30-gauge needles for the extraction of adult mandibular molars. A prospective RCT was conducted on two hundred and twelve adult patients requiring extraction of mandibular molars using standard methods as described by Malamed with 1.8ml of 2% lidocaine with 1:80,000 adrenaline. One hundred six patients received IANB using 27-gauge needles (32mm × 0.2mm) and one hundred six patients received IANB using 30-gauge needles (25mm × 0.15mm). Predictor variables were 27-gauge and short and 30-gauge. Outcome variables were the success rate of IANB and pain perception during injection using a visual analogue scale. There was a highly significantly increase in the success of IANB using 27-gauge needle (95.28%) versus 30-gauge needle (41.51%) (P = 0.001). There was a significant increase in pain perception for patients who received IANB by shorter and thinner needle (30-gauge) when compared to the long and thicker needle (27-gauge). This RCT demonstrated that 27-gauge needle seems to be associated with a higher success rate of IANB and lower pain perception during injection when compared to 30-gauge needle in the extraction of adult mandibular molars when compared to 30-gauge needles. For adult patients, when thickness of soft tissue to be penetrated is essential to achieve bony contact, long or large gauge dental needle is preferred to get a higher success rate of IANB with less pain perception during injection.

Relative position of mandibular foramen in 4–9-year-old children: A retrospective study

Introduction: Most common nerve block used in children is the inferior alveolar nerve block (IANB) for anesthetizing mandibular teeth. Therefore, knowledge of the location of the mandibular foramen is necessary for a successful IANB anesthesia. Aim: The study aimed to correlate the position of mandibular foramen in relation to the mandibular occlusal plane and the deepest point of the coronoid notch as a clinical guide for IANB injection in 4–9-year-old children. Materials and Methods: One-hundred orthopantamographs were analyzed and divided into two groups; Group 1 (4–6 years) and Group 2 (7–9 years). The orthopantamographs were traced on the acetate paper using a radiograph viewer and measurements were taken from mandibular lingula (ML) to the occlusal plane and to the deepest point of the coronoid notch. Results: Statistical analysis of the data revealed that there was a significant difference in mean distance between the two groups on both sides by measuring the position of ML to the mandibular occlusal plane and to the deepest point of the coronoid notch. Intergroup comparison of the distance from ML to the deepest point of the coronoid notch on the right and left sides shows a statistically significant difference (P

Anesthetic Success Using Nitrous Oxide and a Combination of Lidocaine/Clonidine for the Inferior Alveolar Nerve Block and the Effects on Blood Pressure and Pulse in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study

IntroductionThe pulpal anesthetic success rates for an inferior alveolar nerve block (IANB) alone in patients presenting with symptomatic irreversible pulpitis are less than adequate. Nitrous oxide and clonidine have shown increases in IANB success when administered individually, but their success has not been evaluated when used together. The purpose of this prospective, randomized, double-blind study was to determine the effect of nitrous oxide/oxygen plus an IANB using lidocaine/clonidine on the success of the IANB in patients with symptomatic irreversible pulpitis and to evaluate the effect of clonidine on blood pressure and pulse. MethodsSixty-two emergency patients experiencing moderate to severe pain and a diagnosis of symptomatic irreversible pulpitis were enrolled. Subjects were randomly divided into 2 groups and received nitrous oxide/oxygen and an IANB using 2% lidocaine with either 27 μg clonidine or 18 μg epinephrine as vasoconstrictors. Blood pressure and pulse were recorded before and during the emergency endodontic treatment. Anesthetic success was defined as no or mild pain upon access and instrumentation of the canals. ResultsThe pulpal anesthetic success rate in both treatments was 58%, with no significant difference between the groups. There was no statistically significant difference in pulse or systolic blood pressure with the use of clonidine compared with epinephrine. Diastolic blood pressure was significant. ConclusionsThe use of nitrous/oxide plus the addition of lidocaine/clonidine for the IANB in teeth with symptomatic irreversible pulpitis resulted in no statistically significant difference in anesthetic success of the IANB. There were no statistically significant differences in pulse or systolic blood pressure with the use of clonidine compared with epinephrine; diastolic blood pressure was significant.

Comparing the anaesthetic efficacy of 1.8 mL and 3.6 mL of anaesthetic solution for inferior alveolar nerve blocks for teeth with irreversible pulpitis: a systematic review and meta-analysis with trial sequential analysis.

The scientific literature is contradictory in relation to selecting the appropriate volume of local anaesthetic solution for inferior alveolar nerve blocks (IANB) when attempting to anaesthetize mandibular teeth with irreversible pulpitis. To compare the efficacy of 1.8 and 3.6mL of the same anaesthetic solution for IANBs when treating mandibular teeth with irreversible pulpitis. A literature search was performed in PubMed, Scopus and EBSCOhost databases until May 2020. Randomized clinical trials published in English, comparing 1.8 with 3.6mL of the same anaesthetic solution for IANBs in permanent mandibular teeth with irreversible pulpitis, were included. The risk of bias of the included trials was appraised using the revised Cochrane risk of bias tool. A meta-analysis was performed using the random-effects model. The effect of random errors on the results of the meta-analysis was evaluated by trial sequential analysis and the quality of evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Four clinical trials involving 280 teeth from patients with ages ranging from 18 to 65years were included. Among the four trials, three were categorized as having a 'low' risk of bias and one was categorized as having 'some concerns'. The primary meta-analysis revealed that 3.6mL of anaesthetic solution when administered for IANBs was associated with significantly greater success rates compared with 1.8mL (RR=1.94; 95% CI, 1.07, 3.52; I2 =77%). Similarly, the results of the sensitivity analysis (restricting trials only to those that used the Heft-Parker visual analogue pain scale) revealed that the use of 3.6mL significantly increased the success of IANBs compared with 1.8mL. The trial sequential analysis confirmed the evidence for the beneficial effect of 3.6mL to achieve success for IANBs was 'conclusive'. The quality of evidence was graded as 'high'. Increasing the volume of anaesthetic solution from 1.8 to 3.6mL improved the success rate for IANBs in mandibular molars with irreversible pulpitis. The quality of the evidence was 'high'. Future high-quality clinical trials are required with different types of anaesthetic solutions and other types of teeth.