Success Rate Of Inferior Alveolar Nerve Block Research Articles

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.

Comparison of the success of inferior alveolar nerve anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine: A randomized controlled clinical trial

Background: This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine.Materials and Methods: The current randomized controlled clinical trial was conducted on 100 patients in two groups (n = 50). Standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine plain in the first group and using two cartridges of 3% prilocaine with 0.03 IU felypressin in the second group. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, the tooth was isolated with a rubber dam. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation, entry into the pulp chamber, and initial instrumentation. Data were analyzed with SPSS 17 using the Chi-square test, and P < 0.05 was set as statistically significant.Results: The patients' pain severities during the three stages were significantly different (P = 0.001, 0.0001, and 0.001, respectively). The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 times higher with prilocaine than mepivacaine.Conclusion: The success rate of IANB in the teeth with symptomatic irreversible pulpitis was higher using 3% prilocaine with felypressin than using 3% mepivacaine.

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).

Cryotherapy as an adjunct to inferior alveolar nerve block in Symptomatic Irreversible Pulpitis: A randomised controlled clinical trial

: To evaluate and compare the effect of two approaches of cryotherapy for improving the success rate of Inferior alveolar nerve block and reduction of pain during access opening in mandibular molars with symptomatic irreversible pulpitis.: Thirty patients diagnosed with symptomatic irreversible pulpitis were selected based on inclusion and exclusion criteria to participate in the study. 3 groups were designed; Group 1(Control group) - inferior alveolar nerve block(IANB) with lignocaine (2%) adrenaline (1:80000), Group 2(IANB+ small ice pack)-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + small ice packs (wrapped in sterile gauze); Group 3 (IANB+Endo Ice) -inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + Endo Ice application. Patients were randomly allocated to any one of the groups: The level of preoperative pain was recorded using the Numeric visual analogue scale (VAS). Endodontic therapy was done 15 minutes after the IANB injection. The level of intra operative pain during access opening was recorded again using the same scale. If the patients reported moderate or severe pain during the procedure, the IANB was defined as “unsuccessful,” and a supplementary injection was administered.: There was statistically significant difference found in pain reduction among 3 groups (p=0.01). Post hoc analysis revealed significant difference between Group 1(Control) and Group 2(IANB+ small ice pack) with (p=0.003). Overall success rate of IANB was found to be 66.66 %.: Both the techniques of intraoral cryotherapy exhibited improved pain reduction as well as increased the success rate of IANBs in mandibular molar teeth with SIP. Hence based on the results obtained, it is suggested that cryotherapy can serve as a useful adjunct to anaesthesia during endodontic procedures.

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.

Effectiveness of different anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis: a systematic review and meta-analysis.

This systematic review aimed to assess the effectiveness of anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis, comparing to the inferior alveolar nerve block (IANB) by meta-analysis. Studies were identified from Cochrane Library, Embase, Lilacs, PubMed, Scopus, and Web of Science databases up to May 2021. Randomized clinical trials comparing the anesthetic success rate of IANB and any other alternative anesthetic method were included. The quality of the selected studies was assessed by the Cochrane Risk of Bias 2.0 tool. Meta-analyses using Mantel-Haenszel method and random-effect models were performed to find the pooled estimates of risk ratio (RR) with 95% confidence interval (CI). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. Twenty-two studies were selected, which included fourteen anesthetic methods. Two studies were classified as high risk of bias, five as uncertain risk and fifteen as low risk. Vazirani-Akinosi nerve block (VANB) [RR = 1.27; p = 0.007; 95% CI, 1.07-1.52; I2 = 0%] and intraosseous injection (IOI) [RR = 1.48; p = 0.04; 95% CI, 1.02-2.15; I2 = 46%] had superior effectiveness compared to IANB, with low certainty of evidence, as well as buccal infiltrations associated with IANB (BI + IANB) [RR = 1.84; p = 0.004; 95% CI, 1.22-2.79; I2 = 52%], with very low certainty. Evidence suggests that buccal infiltrations associated with IANB, VANB, and IOI are more effective than IANB at anesthetizing posterior mandibular teeth with symptomatic irreversible pulpitis. Alternative primary methods of anesthesia might be indicated for mandibular posterior teeth presenting symptomatic irreversible pulpitis.

Articaine improves anesthetic achievement for exodontia performed by undergraduate dental students: A clinical comparative study.

To assess the clinical performance of undergraduate dental students in delivering inferior alveolar nerve block (IANB) with either articaine or lidocaine, and to compare the success rate of their IANBs between articaine and lidocaine for the extraction of mandibular molar teeth. In this clinical trial, patients were randomly distributed into 2 study groups: articaine and lidocaine groups. In each group, dental students performed IANB followed by forceps extraction of 1 mandibular molar under close supervision. The operative parameters measured included: assessment of anesthetic technique (on 10 points visual analogue scale 'VAS-10'), onset and depth of anesthesia, intra-operative pain perceived by patients and their satisfaction level (on VAS-10), and the success rate of IANB (in terms of need to additional anesthesia). Data analyses used were descriptive statistics, t-test, χ2 test, and Pearson's correlation. One-hundred sixty patients were included in the final analysis, 80 in each group. The overall students' IANB technique was assessed as good (mean score 7.3). Articaine group showed significantly higher success rate of IANB (71%) compared to (55%) in lidocaine group, (P=0.03). Patients also reported significantly higher satisfaction scores in the articaine group (P=0.04). There were no significant difference in the onset of action and intra-operative pain level between the 2 groups. Students' IANBs were generally assessed as "good." Articaine IANBs performed by undergraduate students showed significantly higher success rate than lidocaine IANBs. By using articaine, the anesthetic achievement was greater for mandibular molar extraction performed by undergraduate students.

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.

Effect of pre-operative medication with paracetamol and ketorolac on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a double-blind randomized clinical trial.

BackgroundThe efficacy of local anesthesia decreases in patients with symptomatic irreversible pulpitis. Therefore, it was proposed that the use of premedication with an anti-inflammatory drug might increase the success rate of pulpal anesthesia in mandibular posterior teeth with vital inflamed pulp.MethodsOne hundred thirty-four patients who were actively experiencing pain willingly participated in this study. The Heft Parker (HP) visual analog scale (VAS) was used to record the initial pain intensity. Patients were randomly allocated to receive a placebo, 10 mg of ketorolac, and 650 mg of paracetamol. The standard inferior alveolar nerve block (IANB) was administered to all patients using 2% lidocaine with 1:200,000 adrenaline after one hour of medication. After 15 min, the patient was instructed to rate the discomfort during each step of the treatment procedure, such as access to remaining dentin, access to the pulp chamber, and during canal instrumentation on the HP VAS. IANB was considered successful if the patient reported no or mild pain during access preparation and instrumentation. Moderate or severe pain was classified as a failure of IANB and another method of anesthesia was used before continuing the treatment.ResultsThe rate of successful anesthesia in the placebo, paracetamol, and ketorolac groups was 29%, 33%, and 43%, respectively, and no statistically significant difference was found between the groups.ConclusionPreoperative administration of paracetamol or ketorolac did not significantly affect the success rate of IANB in patients with irreversible pulpitis. No significant difference was observed between the paracetamol and ketorolac groups.

Evaluation of aromatherapy on success rate of inferior alveolar nerve block in teeth with irreversible pulpitis: a prospective randomized clinical trial.

This prospective, block randomized clinical trial was conducted to evaluate the effect of aromatherapy on the success rate of inferior alveolar nerve block (IANB) in teeth with irreversible pulpitis. In this clinical trial, 46 patients fulfilling the inclusion criteria were randomly divided into two equal groups: group I (n = 22) received IANB in a closed operatory without any fragrance, whereas group II (n = 24) received IANB in a separate closed operatory saturated with lavender fragrance using a candle warmer. The modified dental anxiety scale (MDAS) for anxiety and visual analog scale (VAS) for pain were recorded preoperatively as well as during access cavity preparation. For MDAS, a total score of more than 18 was considered as tremendously anxious or dental phobic. No or mild pain on VAS was considered as success. Data were analyzed using paired t test and independent sample t test. P < .05 was considered as statistically significant. Difference in mean VAS (P = .749) and MDAS (P = 1.000) between both the groups was statistically nonsignificant. However there was a statistically significant difference in mean VAS (P = .000) and MDAS (P = .001) during access opening. Lavender aromatherapy can be used successfully to alleviate dental anxiety as well as to increase the anesthetic success rate of IANB in teeth with irreversible pulpitis.

Effect of Topical Application of Dentol Drop on the Success of Inferior Alveolar Nerve Block for Teeth with Irreversible Pulpitis: A Double-blind Randomized Clinical Trial.

The failure rate of inferior alveolar nerve (IAN) block is high for mandibular molars with irreversible pulpitis. This double-blind, randomized, clinical trial aimed to assess the effect of topical application of Dentol drop on the rate of successful anaesthesia of mandibular molars with irreversible pulpitis due to deep carious lesions. Seventy-two patients with mandibular first and second molars with irreversible pulpitis and deep cavitated carious lesions participated in this study. The patients were randomly assigned to the test and control groups (n=36). In the test group, a cotton pellet, dipped in Dentol drop, was placed in the cavity for 10 min. A placebo was used _in the same manner_ in the control group. Level of pain was measured before the intervention, 15 min after anaesthesia (when patients reported numbness at the corner of the mouth), during access cavity preparation, upon pulp exposure and after introduction of the initial file into the root canal; using a Heft-Parker "Visual Analog Scale" (VAS). Data were analysed using ANCOVA. Levels of pain were recorded during access cavity preparation (P<0.001), pulp exposure (P<0.001) and file introduction into the canal (P=0.018). In the test (Dentol) group, the obtained levels of pain were significantly lower than those of the corresponding values in the control group. Topical application of Dentol drop increased the success rate of IAN block for root canal treatment of mandibular molars with irreversible pulpitis.

Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial

IntroductionPrevious studies have reported that it is difficult to obtain proper anesthesia in mandibular molars with symptomatic irreversible pulpitis, and supplemental injections are usually unavoidable. The aim of the present study was to determine the anesthetic efficacy of articaine in mandibular first molars with symptomatic irreversible pulpitis with 3 injection methods: an inferior alveolar nerve block (IANB), an IANB with an intraligamentary injection, and an IANB with buccal infiltration before initiating the endodontic treatment. MethodsNinety-six patients (54 women and 42 men) with a diagnosis of symptomatic irreversible pulpitis in mandibular first molars were selected and randomly assigned into 3 groups (n = 32) according to the injection method as follows: group 1, a conventional IANB injection; group 2, an IANB injection, and after profound lip numbness after the IANB (after 15 minutes), buccal infiltration was administered; and group 3, an IANB injection, and after profound lip numbness after the IANB (after 15 minutes), an intraligamentary injection was performed, and after 20 minutes from the IANB, the endodontic treatment was initiated. The anesthetic solution was articaine 4% with 1:100,000 epinephrine. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation or initial instrumentation. Data were statistically analyzed using the chi-square and Mann-Whitney U tests, and P < .05 was set as significant. ResultsThe success rate for IANBs with an intraligamentary injection was 75%, and for IANBs with a buccal injection, it was 65.6%. For IANBs alone, the success rate was 28.1%. ConclusionsConsidering the limitations of the present study, in can be concluded that the success rate of IANBs increased with intraligamentary injections and buccal infiltrations with articaine that were performed before initiating treatment. Also, none of the injection methods showed complete success in anesthesia in all patients.

Oral Ketorolac with Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Review and Meta-analysis.

Background:Ketorolac has advantages over other analgesics as a pre-anaesthetic medication. Considering this in mind, the present meta-analysis aims to identify the effect of oral ketorolac premedication on the anaesthetic efficacy of Inferior Alveolar Nerve Block (IANB) in patients with irreversible pulpitis.Methods:Full-texts of eligible studies were obtained from electronic databases. The extracted data was analysed using non-Cochrane mode in RevMan 5.0 software. Relative risk [95% CI] was calculated for the success of IANB.Results:Four studies were included for the final review. The success rate of IANB on 221 patients with relative risk of 1.87 [1.36, 2.56] was statistically significant favouring ketorolac. The mean difference for VAS in 171 patients was not statistically significant {-13.55 [-33.91, 6.82]}.Conclusion:Oral ketorolac can be successfully administered as a premedication before conventional inferior alveolar nerve block for endodontic treatment for irreversible pulpitis.

Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis: A Prospective, Randomized, Double-blind Clinical Trial

IntroductionProfound pulpal anesthesia is difficult to achieve in mandibular molars with irreversible pulpitis (IP). However, there are no published randomized controlled clinical trials comparing the success of supplemental buccal infiltration (BI) in mandibular first versus second molars with IP. The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental BIs in mandibular first versus second molars with IP after a failed inferior alveolar nerve block (IANB). This study's sample was combined with data from a previous trial. MethodsOne hundred ninety-nine emergency subjects diagnosed with IP of a mandibular molar were selected and received an IANB with 4% articaine. Subjects who failed to achieve profound pulpal anesthesia, determined by a positive response to cold or pain upon access, randomly received 4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was begun 5 minutes after infiltration. Success was defined as less than mild pain during endodontic access and instrumentation on the Heft-Parker visual analog scale. ResultsThere was a 25% IANB success rate with 4% articaine. The success rate for articaine supplemental BI in first molars was 61% versus 63% for second molars (P > .05). The success of lidocaine in first molars was 66%, but for second molars it was 32% (P = .004). ConclusionsThe success rate for IANB with 4% articaine was 25%. Articaine and lidocaine had similar success rates for supplemental infiltration in first molars, whereas articaine was significantly more successful for second molars. However, because BI often did not provide profound pulpal anesthesia, additional techniques including intraosseous anesthesia may still be required.

Effect of relative head position on the anesthetic efficacy of inferior alveolar nerve block during endodontic treatment of patients with irreversible pulpitis.

BackgroundThe purpose of this prospective randomized single-blind clinical trial was to evaluate the effect of tilting the head on the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis.MethodsNinety-two patients were divided into two groups: the first group received IANB and the head was tilted in the direction of the block for 15 min, whereas the second group received IANB and the head was tilted to the opposite side. Access cavity preparation was initiated after 15 min. Success was defined as no pain or faint/weak/mild pain during endodontic access preparation and instrumentation. The anesthetic success rates were analyzed by Pearson chi-square test at 5% significance levels.ResultsThe same side position and opposite side position yielded 41% and 30% anesthetic success rates, respectively; there was no significant difference between the two sides.ConclusionsRelative head position has no effect on the anesthetic success rate of IANB.

Effect of Sodium Bicarbonate Buccal Infiltration on the Success of Inferior Alveolar Nerve Block in Mandibular First Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Double-blind Study

IntroductionThe purpose of this prospective, randomized, double-blind study was to evaluate the effect of a buccal infiltration of sodium bicarbonate on the anesthetic success of the inferior alveolar nerve block (IANB) for mandibular first molars in patients with symptomatic irreversible pulpitis. MethodsOne hundred patients diagnosed with symptomatic irreversible pulpitis of a mandibular first molar were selected. The patients randomly received a buccal infiltration injection of either 0.7 mL 8.4% sodium bicarbonate with 0.3 mL 2% lidocaine containing 1:80,000 epinephrine or 0.7 mL sterile distilled water with 0.3 mL 2% lidocaine containing 1:80,000 epinephrine in a double-blind manner. After 15 minutes, all the patients received conventional IANB injection using 3.6 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after the IANB injection. Lip numbness was a requisite for all the patients. Success was determined as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed using the t, chi-square and Mann-Whitney U tests. ResultsThe success rate after the buccal infiltration of sodium bicarbonate was 78%, whereas without the buccal infiltration of sodium bicarbonate it was 44% (P < .001). ConclusionsA buccal infiltration of 0.7 mL 8.4% sodium bicarbonate increased the success rate of IANBs in mandibular first molars with symptomatic irreversible pulpitis.

Anaesthetic efficacy of lidocaine/clonidine for inferior alveolar nerve block in patients with irreversible pulpitis

This prospective, randomized, double-blind study aimed to compare the efficacy of lidocaine with epinephrine versus lidocaine with clonidine for inferior alveolar nerve block (IANB) and hemodynamic stability (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) in patients with irreversible pulpitis. One hundred patients with irreversible pulpitis in mandibular molar teeth randomly received 1.8 mL of 2% lidocaine with clonidine (15μgmL-1 ) or 1.8 mL of 2% lidocaine with epinephrine (12.5μgmL-1 ), using a conventional IANB technique. Endodontic access cavities were prepared 15min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recording) upon endodontic access cavity preparation or initial canal instrumentation. The hemodynamic parameters were measured before, during and 5, 10 and 30min after administration. Finally, the collected data were subjected to independent t-test, chi-square and Fisher's exact test using spss software ver.20 at a significant level of 0.05. The success rates for IANB using lidocaine with epinephrine and lidocaine with clonidine solutions were 29% and 59%, respectively. The clonidine group exhibited a significantly higher success rate (P<0.05). Five minutes after drug administration, systolic blood pressure and heart rate significantly increased in the lidocaine with epinephrine group and insignificantly decreased in lidocaine with clonidine group. For mandibular molars with irreversible pulpitis, addition of clonidine to lidocaine improved the success rate of IANB compared to a standard lidocaine/epinephrine solution.

A Comparison of Different Volumes of Articaine for Inferior Alveolar Nerve Block for Molar Teeth with Symptomatic Irreversible Pulpitis

IntroductionAchieving anesthesia in mandibular molar teeth with irreversible pulpitis is very difficult. The aim of this study was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve block (IANB) when treating molars with symptomatic irreversible pulpitis. MethodsIn a randomized, double-blind clinical trial, 82 first mandibular molar teeth with symptomatic irreversible pulpitis randomly received conventional IANB injection either with 1 (1.8 mL) or 2 cartridges (3.6 mL) of 4% articaine with 1:100,000 epinephrine. The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft-Parker visual analog scale. No or mild pain was considered as successful anesthesia. Data were analyzed by t and chi-square tests. ResultsEighty patients were eligible to participate in this study, which showed that 3.6 mL articaine provided a significantly higher success rate (77.5%) of IANBs compared with 1.8 mL of the same anesthetic solution (27.5%) although neither group had 100% successful anesthesia (P < .001). ConclusionsIncreasing the volume of articaine provided a significantly higher success rate of IANBs in mandibular first molar teeth with symptomatic irreversible pulpitis, but it did not result in 100% anesthetic success.

Comparative Evaluation of Local Infiltration of Articaine, Articaine Plus Ketorolac, and Dexamethasone on Anesthetic Efficacy of Inferior Alveolar Nerve Block with Lidocaine in Patients with Irreversible Pulpitis

Introduction The inferior alveolar nerve block (IANB) has a poor success rate in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of ketorolac and dexamethasone infiltration along with standard IANB on the success rate. Methods Ninety-four adult volunteers who were actively experiencing pain participated in this prospective, randomized, double-blind study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive any supplemental infiltrations (control). Twenty-four patients received supplemental buccal infiltration of 4% articaine with 1:100,000 ephinephrine, and 24 patients received supplemental buccal infiltration of 1 mL/4 mg of dexamethasone. It was planned to give supplemental buccal infiltration of 1 mL/30 mg of ketorolac tromethamine in 26 patients, but the first 2 patients experienced severe injection pain after ketorlac infiltration and were excluded from the study. In the subsequent patients, 0.9 mL of 4% articaine was infiltrated before injecting ketorolac. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft-Parker visual analog scale. Success was recorded as none or mild pain. Results Statistical analysis was done by using nonparametric χ 2 tests. Control IANB gave 39% success rate. Buccal infiltration of articaine and articaine plus ketorolac significantly increased the success rate to 54% and 62%, respectively ( P < .05). Supplementary dexamethasone infiltration gave 45% success rate, which was insignificant with control IANB. Conclusions Articaine and ketorolac infiltration can increase the success rate of IANB in patients with irreversible pulpitis. None of the tested techniques gave 100% success rate.