Anesthetic efficacy of combinations of 0.5 mol/L mannitol and lidocaine with epinephrine for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis

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

Introduction

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.

Materials and methods

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.

Results

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.

Conclusion

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.

How to cite this article

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.

Present status and future directions - Mechanisms and management of local anaesthetic failures

Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.

New insight into the importance of formulation variables on parenteral growth hormone preparations: potential effect on the injection-site pain

Reducing injection-site pain (ISP) in patients with chronic conditions such as growth hormone deficiency is a valuable strategy to improve patient compliance and therapeutic efficiency. Thus understanding different aspects of pain induction following subcutaneous injection of biotherapeutics and identifying the responsible factors are vital. Here we have discussed the effects of formulation's viscosity, concentration, osmolality, buffering agents, pH, and temperature as well as injection volume, dosing frequency, and different excipients on ISP following subcutaneous injection of commercially available recombinant human growth hormone products. Our literature review found limited available data on the effects of different components of parenteral rhGH products on ISP. This may be due to high cost associated with conducting various clinical trials to assess each excipient in the formulation or to determine the complex interactions of different components and its impact on ISP. Recently, conducting molecular dynamics simulation studies before formulation design has been recommended as an alternative and less-expensive approach. On the other hand, the observed inconsistencies in the available data is mainly due to different pain measurement approaches used in each study. Moreover, it is difficult to translate data obtained from animal studies to human subjects. Despite all these limitations, our investigation showed that components of parenteral rhGH products can significantly contribute to ISP. We suggest further investigation is required for development of long acting, buffer-free, preservative-free formulations. Besides, various excipients are currently being investigated for reducing ISP which can be used as alternatives for common buffers, surfactants or preservatives in designing future rhGH formulations.

Comparative evaluation of ropivacaine and lidocaine as dental pulp anaesthesia

Root canal therapy linked to pulpal diseases or trauma is common in modern dental care. The 2% Lidocaine which is considered as the gold standard has some drawbacks in pulpal anaesthesia. Ropivacaine has beneficial anaesthetic effects on pulpal anaesthesia. Therefore, it is of interest to compare and evaluate the pulpal aesthetic effect using 0.5% Ropivacaine and 2% Lidocaine in symptomatic irreversible pulpitis. A double blinded randomized controlled clinical trial consisting of 110 lower molar and premolar tooth with irreversible pulpitis cases for root canal therapy were selected and randomly divided into 2 groups. Group A: 2% lidocaine with epinephrine and Group B: 0.5% ropivacaine. The pulp sensibility tests with heat test, cold test and electric pulp test were completed. The preoperative pain score was measured with Visual Analogue Scale (VAS) pain scale. The classical inferior alveolar nerve block (IANB) technique was administered to all patients by a single operator. Subjects were asked for lip numbness and presence or absence of lip numbness. Postoperative pain scores were recorded during access opening and on placing files in the canal. There is no statistical difference between the groups during pre operative conditions. The mean pain scores within group A and group B is recorded. The difference was found to be statistically significant with p value ≤ 0.05. Significant difference between the mean values after and before the treatment is observed. However, there is no statistical significance between the mean pain scores between the access and pulp. The 0.5% Ropivacaine and 2% Lidocaine with epinephrine does not have any significant difference during access opening. However, 0.5% Ropivacaine groups were effective while placing the file in the canal. Thus, 0.5% Ropivacaine showed better results even though it was not statistically significant for further consideration in this context.

Mannitol Enhances the Antinociceptive Effects of Diphenhydramine as an Alternative Local Anesthetic

Mannitol has recently been reported to be effective in enhancing the antinociceptive efficacy of lidocaine. No single study to date, however, has compared diphenhydramine with and without mannitol for nociceptive processing as an alternative local anesthetic. In this study, we examined the antinociceptive efficacy enhancements of diphenhydramine when combined with mannitol. Male Sprague-Dawley rats weighing 230–260 g were used in a hot plate test to evaluate the antinociceptive effects of diphenhydramine. All chemicals were dissolved in isotonic normal saline and administered subcutaneously into the plantar surface of the right hind paw at 10 min before the hot plate test. A subcutaneous injection of 0.5% or 1% diphenhydramine produced significant inhibition of the withdrawal latency time compared with the vehicle treatment. Antinociceptive effects appeared 10 min after the diphenhydramine injections and persisted for over 30 min. The antinociceptive effects of 1% diphenhydramine were not statistically different from those of 1% lidocaine. Although a subcutaneous injection of a 0.5 M mannitol solution alone did not affect the withdrawal latency time, 1% diphenhydramine with 0.5 M mannitol significantly enhanced antinociception. A subcutaneous injection of 1% diphenhydramine with epinephrine (1 : 100,000) solution did not increase the antinociceptive effect of the diphenhydramine. These results suggest that diphenhydramine with mannitol can be used as an alternative local anesthetic.

Anesthetic efficacy of articaine/epinephrine plus mannitol in comparison with articaine/epinephrine anesthesia for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial

Background. It is difficult to achieve successful pulpal anesthesia in mandibular posterior teeth with symptomatic irreversible pulpitis. The present study aimed to compare the effect of articaine/epinephrine anesthesia with articaine/epinephrine at a combination of 0.5 mol/mL of mannitol for the inferior alveolar nerve block (IANB) in patients presenting with symptomatic irreversible pulpitis in the mandibular first molar tooth.

Methods. One hundred patients with symptomatic irreversible pulpitis in the mandibular first molar tooth were selected and randomly divided into two groups based on the injection method. The first group underwent an IANB technique with 1.8 mL of articaine, whereas the second group received 2.9 mL of a formulation, consisting of 1.8 mL of articaine plus 1.1 mL of 0.5 mol/L of mannitol. Fifteen minutes after injections and anesthesia of the lip, the access cavity was prepared. According to the visual analog scale (VAS) criteria, no pain or mild pain for caries removal, pulp exposure and canal instrumentation were regarded as success. Chi-squared test was used for the analysis of data. The level of significance was set at 0.05.

Results. The success rate in the group with articaine/epinephrine anesthesia plus mannitol was higher than that in the group with articaine/epinephrine anesthesia, with no significant difference between the two groups (P>0.05).

Conclusion. It was concluded, under the limitations of this study, that adding mannitol to articaine/epinephrine anesthesia did not increase the success of IANB in mandibular posterior teeth with symptomatic irreversible pulpitis.

Interventions for anesthetic success in symptomatic irreversible pulpitis: A network meta-analysis of randomized controlled trials

Background

Local anesthetics alone or in combination with adjuncts, such as oral medications, have routinely been used for pain control during endodontic treatment. The best clinical choice amongst the vast numbers of agents and techniques available for pain control for irreversible pulpitis is unclear. This network meta-analysis combined the available evidence on agents and techniques for pulpal anesthesia in the maxilla and mandible, in order to identify the best amongst these approaches statistically, as a basis for future clinical trials.

Methods

Randomized trials in MEDLINE, DARE, and COCHRANE databases were screened based on inclusion criteria and data were extracted. Heterogeneity was assessed and odds ratios were used to estimate effects. Inconsistencies between direct and indirect pooled estimates were evaluated by H-statistics. The Grading of Recommendation, Assessment, Development, and Evaluation working group approach was used to assess evidence quality.

Results

Sixty-two studies (nine studies in the maxilla and 53 studies in the mandible) were included in the meta-analysis. Increased mandibular pulpal anesthesia success was observed on premedication with aceclofenac + paracetamol or supplemental 4% articaine buccal infiltration or ibuprofen+paracetamol premedication, all the above mentioned with 2% lignocaine inferior alveolar nerve block (IANB). No significant difference was noted for any of the agents investigated in terms of the success rate of maxillary pulpal anesthesia.

Conclusion

Direct and indirect comparisons indicated that some combinations of IANB with premedication and/or supplemental infiltration had a greater chance of producing successful mandibular pulpal anesthesia. No ideal technique for maxillary anesthesia emerged. Randomized clinical trials with increased sample size may be needed to provide more conclusive data. Our findings suggest that further high-quality studies are required in order to provide definitive direction to clinicians regarding the best agents and techniques to use for mandibular and maxillary anesthesia for irreversible pulpitis.

Effect of Premedication on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Systematic Review of the Literature

Background

Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth.

Methods

A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary.

Results

Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis.

Conclusion

Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.

Effect of Preoperative Pain on Inferior Alveolar Nerve Block

The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1-54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55-114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain

Objectives

Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis.

Materials and Methods

Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests.

Results

At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure.

Conclusions

There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Mannitol an adjuvant in local anaesthetic solution: recent concept & changing trends (review)

Various adjuncts have been utilized with lignocaine to decrement tourniquet pain and prolong postoperative analgesia and its efficacy during dental extraction and various other restorative procedures in dentistry. An obligatory part of the dental process is to sanction a patient to feel comfortable and pain-free during operational and remedial dental procedures. The most popular local anaesthetic injection for lower teeth is the inferior alveolar nerve (IAN) block. Instead of this the percentage of ineffectiveness is higher is inferior alveolar nerve block as compared to other local anaesthetic nerve block. The goal of cumulating different drugs is to engender the best therapeutic effects with the fewest or no unpropitious effects. There are fewer researches and evidence present which recommend and promote the application and effectiveness of mannitol other than in the administration in decreasing raised intracranial pressure. It is paramount to know how the drug interacts with each other to minimize the unexpected or perilous effects.

Effect of sodium bicarbonate-buffered lidocaine on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a prospective, randomized double-blind study

INTRODUCTION

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of buffered with nonbuffered 2% lidocaine with 1:80,000 epinephrine solution for inferior alveolar nerve (IAN) block in patients with mandibular posterior teeth experiencing symptomatic irreversible pulpitis.

METHODS

Eighty adult patients diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received 2 cartridges of either 2% lidocaine with 1:80,000 epinephrine buffered with 0.18 mL 8.4% sodium bicarbonate or 2% lidocaine with 1:80,000 epinephrine with 0.18 mL sterile distilled water using conventional IAN block injections. Endodontic access preparation was initiated 15 minutes after injection. Lip numbness was required 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 by the t, Mann-Whitney, and chi-square tests.

RESULTS

The success rates were 62.5% and 47.5% for buffered and nonbuffered groups, respectively, with no significant differences between the two groups (P = .381).

CONCLUSIONS

Buffering the 2% lidocaine with 1:80,000 epinephrine with 8.4% sodium bicarbonate did not improve the success of the IAN block in mandibular molars in patients with symptomatic irreversible pulpitis.

Anesthetic efficacy of a combination of 0.5 M mannitol plus 36.8 mg of lidocaine with 18.4 μg epinephrine in maxillary infiltration: a prospective, randomized, single-blind study

The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of lidocaine with epinephrine compared to lidocaine with epinephrine plus 0.5 M mannitol in maxillary lateral incisor infiltrations. Forty-one subjects randomly received 2 maxillary lateral infiltrations consisting of a 1.84-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (control solution) and a 2.90-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) in 2 separate appointments spaced at least 1 week apart. The maxillary lateral incisor was blindly electric pulp-tested in 2-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (a reading of 80) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all pulpal anesthesia readings (at output of 80) over the 60-minute test period. Pain during solution deposition and postoperative pain were also measured. The results demonstrated that a 2.90-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) was not statistically significantly superior to a 1.84-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine. The pain of solution deposition was lower with the lidocaine/mannitol formulation. Postoperative pain was not statistically significantly different between the lidocaine/mannitol formulation and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to a lidocaine with epinephrine formulation was not significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol in the maxillary lateral incisor.

Intraneural convection enhanced delivery of AAVrh20 for targeting primary sensory neurons

Gene therapy using adeno-associated virus (AAV) is an attractive strategy to treat disorders of the peripheral nervous system (PNS), such as chronic pain or peripheral neuropathies. Although intrathecal (IT) administration of AAV has been the standard in the field for targeting the PNS, it lacks anatomical specificity and results in wide rostro-caudal distribution of the vector. An alternative approach is to deliver AAV directly to the peripheral nerve axon. The present study employed convection-enhanced delivery (CED) of a novel AAV serotype, AAVrh20, expressing enhanced green fluorescent protein (EGFP) into rat sciatic nerve investigating its efficacy, anatomical selectivity, and safety, compared to the IT route. Intraneural CED resulted in transduction confined to the ipsilateral L4 and L5 DRG while IT administration led to promiscuous DRG transduction encompassing the entire lumbar region bilaterally. The transduction rate for intraneural AAV administration was similar to IT delivery (24% for L4 and 31.5% for L5 DRG versus 50% for L4 and 19.5% for L5 DRG). The use of hyperosmotic diluent did not further improve the transduction efficiency. AAVrh20 was superior to reference serotypes previously described to be most active for each route. Intraneural CED of AAV was associated with transient allodynia that resolved spontaneously. These findings establish intraneural CED as an alternative to IT administration for AAV mediated gene transfer to the PNS and, based on a reference rodent model, suggest AAVrh20 as a superior serotype for targeting the PNS.

Comparison of the anaesthetic efficacy of different volumes of 4% articaine (1.8 and 3.6 mL) as supplemental buccal infiltration after failed inferior alveolar nerve block

AIM

To compare the anaesthetic efficacy of different volumes (1.8 mL vs. 3.6 mL) of 4% articaine with 1 : 100 000 epinephrine injected as buccal infiltrations after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis.

METHODOLOGY

Two hundred and thirty-four adult patients, diagnosed with irreversible pulpitis in a mandibular tooth, participated in this multicentre, randomized double-blinded trial. Patients received IANB with 1.8 mL of 4% articaine with 1 : 100 000 epinephrine. Pain during treatment was recorded using the Heft-Parker visual analogue scale (HP VAS). The primary outcome measure, and the definition of 'success', was the ability to undertake pulp chamber access and canal instrumentation with no or mild pain (HP VAS score <55 mm). Patients who experienced 'moderate-to-severe' pain (HP VAS score ≥ 55 mm) were randomly allocated into two groups and received buccal infiltrations with either 1.8 mL or 3.6 mL of 4% articaine with 1 : 100 000 epinephrine. Root canal treatment was re-initiated after 10 min. Success was again defined as no pain or weak/mild pain during endodontic access preparation and instrumentation. Statistical analysis was performed using Mann-Whitney U and chi-square tests.

RESULTS

The initial IANB of 4% articaine gave an overall success rate of 37%. The success rate of supplementary buccal infiltration with 1.8 and 3.6 mL volumes was 62% and 64%, respectively. The difference between the success rates of the two volumes was not statistically significant.

CONCLUSIONS

Increasing the volume of 4% articaine with 1 : 100 000 epinephrine from 1.8 to 3.6 mL, given as supplementary buccal infiltrations after a failed primary IANB with 1.8 mL of 4% articaine with 1 : 100 000, did not improve the anaesthetic success rates in patients with symptomatic irreversible pulpitis.

Anesthetic efficacy of a combination of 0.9 M mannitol plus 68.8 mg of lidocaine with 50 μg epinephrine in inferior alveolar nerve blocks: a prospective randomized, single blind study

The purpose of this prospective randomized, single blind study was to determine the anesthetic efficacy of 68.8 mg of lidocaine with 50 μg epinephrine compared to 68.8 mg lidocaine with 50 μg epinephrine plus 0.9 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received 2 IAN blocks consisting of a 1.72-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine and a 5-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine (1.72 mL) plus 0.9 M mannitol (3.28 mL) in 2 separate appointments spaced at least 1 week apart. Mandibular anterior and posterior teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings), for each tooth, over the 60 minutes. One hundred percent of the subjects had profound lip numbness with both inferior alveolar nerve blocks. The results demonstrated that the 5 mL-formulation of 68.8 mg lidocaine with 50 μg epinephrine plus 0.9 M mannitol was significantly better than the 1.72-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine for all teeth, except the lateral incisor. We concluded that adding 0.9 M mannitol to a lidocaine with epinephrine formulation was significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol. However, the 0.9 M mannitol/lidocaine formulation would not provide 100% pulpal anesthesia for all the mandibular teeth.

Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: a randomized controlled trial

AIM

This randomized double-blinded controlled trial was performed to compare the efficacy of inferior alveolar nerve block (IANB) injection for mandibular first molar teeth with irreversible pulpitis with or without supplementary buccal infiltration and intraligamentary injection.

METHODOLOGY

Eighty-two patients with asymptomatic irreversible pulpitis received either a combination of intraligamentary injection + buccal infiltration+ IANB or with traditional IANB injection in mandibular first molar teeth with irreversible pulpitis. Each patient recorded their pain score on a Heft-Parker visual analogue scale before commencing treatment, in response to a cold test 15 min after the designated anaesthetic injection, during access cavity preparation and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analysed by chi-square test.

RESULTS

At the final stage of treatment, 69 of the 82 patients were eligible to be included in the study. No significant difference was found between age (P = 0.569) and gender (P = 0.570) amongst the patients in the two groups. The success rate of anaesthesia in the IANB and the combination groups were 22% and 58%, respectively. The success rate of anaesthesia in the combination group was significantly higher than the traditional IANB injection (P = 0.003).

CONCLUSION

A combination of anaesthetic techniques can improve the success rate of anaesthesia for mandibular first molar teeth with irreversible pulpitis.

A prospective, randomized single-blind evaluation of effect of injection speed on anesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis

INTRODUCTION

Speed of injection may affect the solution spread in the pterygomandibular space. It was hypothesized that speed of injection will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis.

METHODS

Fifty-nine adult volunteers who were actively experiencing pain participated in this prospective, randomized, single-blind study. The patients were divided into 2 groups on a random basis and received either slow or rapid IANB with 3.6 mL of 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated after 15 minutes of the initial IANB. Pain during treatment was recorded by using the Heft-Parker visual analogue scale. The primary outcome measure, and the definition of success, was the ability to undertake pulp access and canal instrumentation with no or mild pain (Heft-Parker visual analog scale score < 55 mm). Secondary outcome measure was the solution deposition pain. Statistical analysis was performed by using Mann-Whitney U test and χ(2) test.

RESULTS

Slow and rapid injections gave 43% and 51% success rates, respectively. The difference was statistically insignificant. Slow injections produced less solution deposition pain than rapid injections.

CONCLUSIONS

Rate of injection has no effect on anesthetic success of IANB, but slow injections were more comfortable than rapid injections.

Effect of topical anesthesia on pain during infiltration injection and success of anesthesia for maxillary central incisors

INTRODUCTION

This study was performed to investigate the effect of topical anesthesia on pain during needle penetration and infiltration injection as well as the effect of pain during injection on success rate of anesthesia in maxillary central incisors.

METHODS

In a crossover double-blind study, 25 volunteers randomly received either topical anesthesia or placebo before infiltration injection with prilocaine for their maxillary central incisors in 2 separate appointments. The pain after needle penetration and during injection was separately recorded. An electric pulp tester was used to evaluate the success of the anesthetic injection. Data were analyzed by McNemar, Wilcoxon, and χ(2) tests.

RESULTS

Overall for 50 injections, 72% of the teeth had successful anesthesia. No significant difference was found between placebo and topical anesthetic groups for the pain of needle penetration as well as pain during injection (P > .05). The volunteers who reported moderate-to-severe pain during injection showed no significant difference in the success rate of anesthesia compared with those with no or mild pain during injections (P > .05).

CONCLUSIONS

Use of topical anesthesia had no significant effect on pain during either needle penetration or injection. Pain during injection had no significant effect on the success of anesthesia.