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Yagudaev M, Yarom N, Ashkenazi M. Overcoming local anesthesia failure during routine dental treatments in children. Int J Paediatr Dent 2024. [PMID: 38409510 DOI: 10.1111/ipd.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/12/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Local anesthesia (LA) during routine dental treatment in children fails in 5%-35% of first attempts. No data, however, are available on the success rates of subsequent attempts. AIM To evaluate the effectiveness of primary, secondary, and tertiary LA attempts (P-LA, S-LA, and T-LA, respectively) for anesthetizing molars during routine dental treatments in children. DESIGN We retrospectively analyzed dental records of all children (2-18 years) who had been administered LA for the treatment of primary or permanent molars by a single paediatric dentist, between 2011 and 2022. All LAs were delivered using a computer-controlled local anesthetic delivery (CCLAD) system. RESULTS The failure rate of P-LA in 1312 molars was 13% and correlated with age (p < .001), type of tooth (p < .001), type of treatment (p < .001), and treated arch (p < .001). The effectiveness of S-LA for buccal infiltration, intrasulcular, inferior alveolar nerve block, greater palatine nerve block (GPNB), posterior superior alveolar nerve block (PSANB), or a combination of the last two was 50%, 87.2%, 66.7%, 63.6%, 33.3%, and 100%, respectively, and was not significantly associated with age or the type of tooth, treatment, or P-LA. CONCLUSION The optimal choice of S-LA for anesthetizing maxillary molars was a combination of PSANB and GPNB, whereas for mandibular molars, it was IS-CCLAD system.
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Affiliation(s)
- Michael Yagudaev
- Pediatric Dentistry Clinic, Oral Medicine Unit, Sheba Medical Center, Tel-HaShomer, Israel
| | - Noam Yarom
- Oral Medicine Unit, Sheba Medical Center, Tel-HaShomer, Israel
- School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Malka Ashkenazi
- Pediatric Dentistry Clinic, Oral Medicine Unit, Sheba Medical Center, Tel-HaShomer, Israel
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Vatankhah M, Zargar N, Naseri M, Sadeghi S, Baghban AA, Dianat O, Nusstein JM. Primary and supplementary anesthetic efficacy of a modified two-step buccal infiltration of 4% articaine in mandibular molars with symptomatic irreversible pulpitis: a randomized clinical trial. Clin Oral Investig 2023; 28:33. [PMID: 38147088 DOI: 10.1007/s00784-023-05417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES To evaluate a modified two-step buccal infiltration (MBI) of 1.7 mL 4% articaine as primary or supplemental anesthesia in mandibular first and second molars diagnosed with symptomatic irreversible pulpitis (SIP). MATERIALS AND METHODS One hundred and eight patients with SIP were randomly assigned to one of three groups (n = 36). They were given an inferior alveolar nerve block (IANB) of 2% lidocaine with 1:80.000 epinephrine or a primary MBI of 4% articaine with 1:100.000 epinephrine in the IANB and MBI groups, respectively. Patients in the IANB + MBI group received an IANB followed by an MBI. Pain levels during the injection, access cavity preparation, and initial filing were recorded on the Heft-Parker visual analog scale (HP-VAS). No or mild pain (HP-VAS ≤ 54) upon access cavity preparation and initial filing was considered a success. Chi-square and Kruskal-Wallis tests were used to analyze the data. RESULTS MBI (77.8%) and IANB + MBI (94.4%) had both significantly higher success rates than IANB (50.0%) (P < .001). However, when the Bonferroni adjustment was applied, there was no statistically significant difference between the MBI and IANB + MBI techniques (P = .041 > .017). MBI was associated with significantly less injection pain than IANB (P < .001). CONCLUSIONS Both primary and supplemental MBI with 4% articaine were superior to IANB with 2% lidocaine in mandibular first and second molars diagnosed with SIP. Further research may be needed to confirm the findings of this study. CLINICAL RELEVANCE The findings of this study suggest that supplemental or primary MBI can be a clinically viable alternative to IANB, which has a relatively low success rate when managing mandibular molars diagnosed with SIP.
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Affiliation(s)
- Mohammadreza Vatankhah
- Iranian Center for Endodontic Research, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mandana Naseri
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyeddavood Sadeghi
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, MD, 21201, USA.
| | - John M Nusstein
- Division of Endodontics, The Ohio State University, Columbus, OH, USA
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Singhal N, Vats A, Khetarpal A, Ahlawat M, Vijayran VKR, Harshita. Efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: An in vivo study. J Conserv Dent 2022; 25:654-660. [PMID: 36591593 PMCID: PMC9795688 DOI: 10.4103/jcd.jcd_299_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 01/04/2023] Open
Abstract
Aim The aim of the present study was to assess the efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block (IANB) with lidocaine in patients with irreversible pulpitis. Materials and Methods A total of 120 patients were included in the study. Patients were given IANB with 2 ml of 2% lidocaine hydrochloride with 1:80,000 epinephrine. Patients who showed subjective symptoms of IANB but did not secure pulpal anesthesia were randomly allocated to one of the following four groups by random sampling for supplementary local anesthesia - Group 1: buccal infiltration (BI) with 4% articaine with 1:100,000 epinephrine, Group 2: four-site intraligamentary (IL) injection with 4% articaine with 1:100,000 epinephrine, Group 3: BI with 2% mepivacaine with 1:100,000 epinephrine, and Group 4: four-site IL injection with 2% mepivacaine with 1:100,000 epinephrine. Results Group 1 - BI with articaine provided anesthesia success in 27 cases (90%, n = 30). Group 2 - IL injection with articaine provided anesthesia success in 20 cases (66.67%, n = 30). Group 3 - BI with mepivacaine provided anesthesia success in 21 cases (70%, n = 30). Group 4 - IL injection with mepivacaine provided anesthesia success in 15 cases (50%, n = 30). A significant difference between the four groups was found. Conclusion In patients with a mandibular first molar exhibiting symptomatic irreversible pulpitis, block injection with lidocaine along with supplemental BI with articaine allowed more pain-free treatments. Articaine showed better results when compared with mepivacaine.
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Affiliation(s)
- Neha Singhal
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Asit Vats
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Ambica Khetarpal
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Monika Ahlawat
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Vijay K. R. Vijayran
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Harshita
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
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A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis. Healthcare (Basel) 2022; 10:healthcare10081389. [PMID: 35893211 PMCID: PMC9330541 DOI: 10.3390/healthcare10081389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Accomplishing painless endodontic treatment, especially in the mandibular molar region, is challenging. Hence, the aim of the study was to compare the efficacy of 2% lidocaine and 4% articaine when used as supplemental intra-ligamentary (IL) anesthesia in mandibular molars having symptomatic irreversible pulpitis with symptomatic apical periodontitis after failed Inferior Alveolar Nerve Block (IANB) injection. In this prospective study, one-hundred and forty-seven adult patients diagnosed with irreversible pulpitis in a mandibular tooth were included who received IANB with 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Patients who experienced pain were recorded using the Heft–Parker visual analog scale (HP-VAS score ≥ 55 mm) and received supplement intra-ligament injection with either4% articaine or 2% lidocaine with 1:100,000 epinephrine. Supplementary intra-ligament injections resulted in 82.6% and 91.3% of profound anesthesia in the first molar region for 2% lidocaine and 4% articaine, respectively. Similarly, an additional IL injection of articaine success percent (78.9%) in the second molar region was higher than lidocaine (63.1%). The overall success ratio revealed no significant difference in achieving profound anesthesia of either solution. In this study population, there was no difference in the success ratio of anesthesia between 2% lidocaine and 4% articaine when used as supplemental IL injection.
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Parirokh M, Abbott P. Present status and future directions - Mechanisms and management of local anaesthetic failures. Int Endod J 2022; 55 Suppl 4:951-994. [PMID: 35119117 DOI: 10.1111/iej.13697] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Paul Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
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Effectiveness of different anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:6477-6500. [PMID: 34453595 DOI: 10.1007/s00784-021-04145-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION 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. CLINICAL SIGNIFICANCE Alternative primary methods of anesthesia might be indicated for mandibular posterior teeth presenting symptomatic irreversible pulpitis.
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Gupta A, Sahai A, Aggarwal V, Mehta N, Abraham D, Jala S, Singh A. Anesthetic efficacy of primary and supplemental buccal/lingual infiltration in patients with irreversible pulpitis in human mandibular molars: a systematic review and meta-analysis. J Dent Anesth Pain Med 2021; 21:283-309. [PMID: 34395897 PMCID: PMC8349668 DOI: 10.17245/jdapm.2021.21.4.283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/28/2021] [Accepted: 06/05/2021] [Indexed: 12/02/2022] Open
Abstract
Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review aimed at evaluating the success of buccal/lingual infiltrations administered with a primary inferior alveolar nerve block (IANB) injection or as a supplemental injection after the failure of the primary injection in symptomatic and asymptomatic patients with irreversible pulpitis in human mandibular molars. The review question was “What will be the success of primary and supplemental infiltration injection in the endodontic treatment of patients with irreversible pulpitis in human mandibular molars?” We searched electronic databases, including Pubmed, Scopus, and Ebsco host and we did a comprehensive manual search. The review protocol was framed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We included clinical studies that evaluated and compared the anesthetic outcomes of primary IANB with primary and/or supplementary infiltration injections. Standard evaluation of the included studies was performed and suitable data and inferences were assessed. Twenty-six studies were included, of which 13 were selected for the meta-analysis. In the forest plot representation of the studies evaluating infiltrations, the combined risk ratio (RR) was 1.88 (95% CI: 1.49, 2.37), in favor of the secondary infiltrations with a statistical heterogeneity of 77%. The forest plot analysis for studies comparing primary IANB + infiltration versus primary IANB alone showed a low heterogeneity (0%). The included studies had similar RRs and the combined RR was 1.84 (95% CI: 1.44, 2.34). These findings suggest that supplemental infiltrations given along with a primary IANB provide a better success rate. L'Abbe plots were generated to measure the statistical heterogeneity among the studies. Trial sequential analysis suggested that the number of patients included in the analysis was adequate. Based on the qualitative and quantitative analyses, we concluded that the infiltration technique, either as a primary injection or as a supplementary injection, given after the failure of primary IANB, increases the overall anesthetic efficacy.
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Affiliation(s)
- Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Aarushi Sahai
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Milia Islamia, New Delhi, India
| | - Namrata Mehta
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Sucheta Jala
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Arundeep Singh
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
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Paul S, Nandamuri S, Raina A, Bansal M. Efficacy of buccal piroxicam infiltration and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. Restor Dent Endod 2021; 46:e9. [PMID: 33680898 PMCID: PMC7906841 DOI: 10.5395/rde.2021.46.e9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/24/2020] [Accepted: 09/02/2020] [Indexed: 11/11/2022] Open
Abstract
Objectives This randomized clinical trial aimed to assess the effectiveness of buccal infiltration with piroxicam on the anesthetic efficacy of inferior alveolar nerve block (IANB) with buccal infiltration in irreversible pulpitis, with pain assessed using the Heft-Parker visual analogue scale (HP-VAS). Materials and Methods This study included 56 patients with irreversible pulpitis in mandibular molars, randomly distributed between 2 groups (n = 28). After evaluating the initial pain score with the HP-VAS, each patient received IANB followed by buccal infiltration of 2% lignocaine with adrenaline (1:80,000). Five minutes later, the patients in groups 1 and 2 were given buccal infiltration with 40 mg/2 mL of piroxicam or normal saline, respectively. An access opening procedure (AOP) was performed 15 minutes post-IANB once the individual showed signs of lip numbness as well as 2 negative responses to electric pulp testing. The HP-VAS was used to grade the patient's pain during caries removal (CR), AOP, and working length measurement (WLM). Successful anesthesia was identified either by the absence of pain or slight pain through CR, AOP, and WLM, with no requirement of a further anesthetic dose. A statistical analysis was done using the Shapiro-Wilk and Mann-Whitney U tests. Results The piroxicam group presented a significantly lower (p < 0.05) mean pain score than the saline group during AOP. Conclusions Buccal infiltration with piroxicam enhanced the efficacy of anesthesia with IANB and buccal infiltration with lignocaine in patients with irreversible pulpitis.
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Affiliation(s)
- Saurav Paul
- Department of Conservative Dentistry and Endodontics, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
| | - Sridevi Nandamuri
- Department of Conservative Dentistry and Endodontics, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
| | - Aakrati Raina
- Department of Conservative Dentistry and Endodontics, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
| | - Mukta Bansal
- Department of Conservative Dentistry and Endodontics, Rama Dental College, Hospital and Research Centre, Kanpur, Uttar Pradesh, India
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Retromolar canal infiltration as a supplement to the inferior alveolar nerve block injection: an uncontrolled clinical trial. Clin Oral Investig 2021; 25:5473-5478. [PMID: 33686469 DOI: 10.1007/s00784-021-03855-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to determine the success rate of retromolar canal (RMC) infiltration following the failure of inferior alveolar nerve block (IANB) injections for the anesthesia of mandibular first molars with acute irreversible pulpitis. MATERIALS AND METHODS An IANB injection was administered for 50 patients with acute irreversible pulpitis. Lip numbness was set as the sign of anesthesia and further evaluated and confirmed with pulp sensibility tests after 10-15 min. Access cavity preparation was commenced unless the patient felt any pain; in this case, an RMC infiltration injection was given. The success rate was determined through the patients' recording of the presence, absence, or reduction of pain severity during access cavity preparation using the Heft-Parker visual analog scale. RESULTS Seven patients (14%) did not experience any pain by pulp sensibility tests and during access cavity preparation after IANB injection. Twenty-five (58.1%) of the remaining 43 patients who had the RMC infiltration injection had reduced pain, and four patients (9.3%) experienced no pain after the RMC infiltration. Fourteen patients (32.5%) experienced no change in pain. Chi-squared test results revealed that the percentage of patients with reduced pain was higher than that of other patients (P < 0.001). CONCLUSIONS RMC infiltration, along with IANB, significantly reduced the pain felt by patients and increased the success of the anesthetic technique for root canal treatment of mandibular first molars with acute irreversible pulpitis. CLINICAL RELEVANCE The administration of RMC infiltration can enhance the success of the IANB technique for anesthetizing mandibular first molars exhibiting acute irreversible pulpitis.
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Bhatnagar NB, Mantri SP, Dube KA, Jaiswal NU, Singh VJ. Pulpal-anesthesia of a mandibular first molar with irreversible pulpitis by inferior alveolar nerve block plus buccal infiltration using articaine or lignocaine. J Conserv Dent 2021; 23:201-205. [PMID: 33384496 PMCID: PMC7720765 DOI: 10.4103/jcd.jcd_410_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 07/23/2020] [Accepted: 08/18/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: This study aims to compare the efficacy of a combination of an inferior alveolar nerve block (IANB) plus buccal infiltration using 4% articaine versus 2% lignocaine in achieving anesthesia of lower first molar teeth with irreversible pulpitis. Materials and Methods: Seventy adult patients were selected. A random sequence list was employed to administer IANB plus buccal infiltration. After the onset of lip numbness, cold test and electric pulp testing were performed. Five patients, four missed blocks and one no bleeding, were excluded. Heft Parker Visual Analog Scale scores during pulp extirpation were recorded. The data of sixty-five patients were statistically analyzed using Chi-square and Mann–Whitney U-test. Results: The success rate after lip-numbness for articaine is 91.42% and for lignocaine is 94.28%. The difference is statistically, not significant (P = 0.6425). During access, the success rate for lignocaine is 96.87%, whereas 96.96% for articaine. This difference is also not significant (P = 0.982366). Conclusion: IANB plus buccal infiltration using articaine or lignocaine is equally effective in anesthetizing mandibular first molar with irreversible pulpitis.
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Affiliation(s)
- Nupur B Bhatnagar
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
| | - Shivkumar P Mantri
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
| | - Kavita A Dube
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
| | - Neelam U Jaiswal
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
| | - Vaishnavi J Singh
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
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Nagendrababu V, Abbott PV, Pulikkotil SJ, Veettil SK, Dummer PMH. 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. Int Endod J 2020; 54:331-342. [PMID: 33040335 DOI: 10.1111/iej.13428] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND 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. OBJECTIVES To compare the efficacy of 1.8 and 3.6 mL of the same anaesthetic solution for IANBs when treating mandibular teeth with irreversible pulpitis. METHODS A literature search was performed in PubMed, Scopus and EBSCOhost databases until May 2020. Randomized clinical trials published in English, comparing 1.8 with 3.6 mL 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. RESULTS Four clinical trials involving 280 teeth from patients with ages ranging from 18 to 65 years 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 3.6 mL of anaesthetic solution when administered for IANBs was associated with significantly greater success rates compared with 1.8 mL (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 3.6 mL significantly increased the success of IANBs compared with 1.8 mL. The trial sequential analysis confirmed the evidence for the beneficial effect of 3.6 mL to achieve success for IANBs was 'conclusive'. The quality of evidence was graded as 'high'. CONCLUSION Increasing the volume of anaesthetic solution from 1.8 to 3.6 mL 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.
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Affiliation(s)
- V Nagendrababu
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.,Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - P V Abbott
- UWA Dental School, University of Western Australia, Nedlands, Australia
| | - S J Pulikkotil
- Division of Clinical Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - S K Veettil
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, USA
| | - P M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Li Z, Yang M, Liao T, Zhou Y, Yue H, Piao Z, Zhou L. Combined inferior alveolar nerve block anaesthesia and local infiltration anaesthesia in extraction of impacted mandibular third molars: a randomised controlled trial. Br Dent J 2020:10.1038/s41415-020-2002-z. [PMID: 32948833 DOI: 10.1038/s41415-020-2002-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aim To compare the anaesthetic effect of combination of inferior alveolar nerve block anaesthesia and local infiltration anaesthesia with nerve block anaesthesia techniques in the extraction of mandibular third molars.Materials and methods One hundred and fifty healthy adult volunteers were divided into three groups and were administered three different local anaesthetic techniques before tooth extractions: group A (inferior alveolar nerve, lingual nerve and buccal nerve block anaesthesia with lidocaine), group B (inferior alveolar nerve, lingual nerve and buccal nerve block anaesthesia with mepivacaine) and group C (inferior alveolar nerve block anaesthesia with lidocaine and infiltration anaesthesia with mepivacaine). The patients' reported pain on anaesthesia injection and tooth extraction, the surgeon's assessment of anaesthetic effect, the severity of intra-operative bleeding and post-operative complications were evaluated.Results There was no significant difference in visual analogue scale (VAS)-pain of anaesthesia among the three groups. Compared with groups A and B, group C had reduced VAS-pain of tooth extraction scores. Additionally, the surgeon's assessment of anaesthetic effect improved and intra-operative bleeding decreased.Conclusions The combination of inferior alveolar nerve block and infiltration anaesthesia provides a stronger anaesthetic effect in the extraction of mandibular third molars.
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Affiliation(s)
- Zhicong Li
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China
| | - Mi Yang
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China
| | - Ting Liao
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China
| | - Yang Zhou
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China
| | - Haiqiong Yue
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China
| | - Zhengguo Piao
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China
| | - Libin Zhou
- Department of Oral and Maxillofacial Surgery, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou Key Laboratory of Basic and Applied Research of Oral Regenerative Medicine, Guangzhou, Guangdong 510182, China.
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13
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Sivaramakrishnan G, Alsobaiei M, Sridharan K. Interventions for anesthetic success in symptomatic irreversible pulpitis: A network meta-analysis of randomized controlled trials. J Dent Anesth Pain Med 2019; 19:323-341. [PMID: 31942448 PMCID: PMC6946831 DOI: 10.17245/jdapm.2019.19.6.323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/05/2019] [Accepted: 12/06/2019] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
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14
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Malka A, Maya G. Pain-related Disruptive Behavior during Dental Treatment Interpreted as Uncooperative Behavior-Small Case Series. Int J Clin Pediatr Dent 2019; 12:347-351. [PMID: 31866722 PMCID: PMC6898878 DOI: 10.5005/jp-journals-10005-1618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aim To describe a small series of six cases of children who were diagnosed as uncooperative and referred to general anesthesia to complete their dental treatment. These children were actually exhibiting pain-related disruptive behaviors during previous dental treatments; we determined the reasons for ineffective anesthesia. Background One of the most common reasons for disruptive behaviors in children during operative dental treatment is the experiencing of pain during treatment. Disruptive behavior may lead to treatment under general anesthesia. Case description Parents of six uncooperative children referred to general anesthesia for dental treatment, arrived at our clinic, because they wanted a second opinion. The children were found to be nonresponsive to the common anesthetic technique and were treated by several approaches to increase the effectiveness of anesthesia. These included supplementary anesthesia to accessory innervation (in three cases), changing brands of anesthetic (in two cases), injecting the maximal dose at once to prevent tachyphylaxis, and waiting 5 minutes to achieve effectiveness of anesthesia (in one case). After achieving effective anesthesia, all the children fully cooperated during the operative treatment. Conclusion Ineffective anesthesia can lead to severe disruptive behavior when continuing the treatment irrespective to the sensation of pain. Several approaches were used to increase the effectiveness of anesthesia resulting in cooperation of the pediatric patients. Clinical significance Behavioral response to ineffective anesthesia may be diagnosed as uncooperativeness. Effort should be put to differentiate between ineffective anesthesia and uncooperative patient. How to cite this article Malka A, Maya G. Pain-related Disruptive Behavior during Dental Treatment Interpreted as Uncooperative Behavior—Small Case Series. Int J Clin Pediatr Dent 2019;12(4):347–351.
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Affiliation(s)
| | - Gotler Maya
- Multidisciplinary Dental Clinic, Petah Tikva, Israel
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15
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Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis. J Endod 2019; 45:1435-1464.e10. [DOI: 10.1016/j.joen.2019.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022]
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16
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Silva SA, Horliana ACRT, Pannuti CM, Braz-Silva PH, Bispo CGC, Buscariolo IA, Rocha RG, Tortamano IP. Comparative evaluation of anesthetic efficacy of 1.8 mL and 3.6 mL of articaine in irreversible pulpitis of the mandibular molar: A randomized clinical trial. PLoS One 2019; 14:e0219536. [PMID: 31365529 PMCID: PMC6668778 DOI: 10.1371/journal.pone.0219536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/26/2019] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of this study was to compare the anesthetic efficacy of two volumes of articaine in conventional inferior alveolar nerve block (IANB) of mandibular molars with irreversible pulpitis, and in cases of anesthetic failure, its complementation with periodontal ligament injection (PDL). Methods Ninety patients with irreversible pulpitis in mandibular molars received conventional IANB with 1.8 mL or 3.6 mL of 4% articaine with 1:100,000 epinephrine. In cases of IANB failure, the same volumes were administered in the PDL. Presence of pulpal anesthesia and absence/presence of pain during pulpectomy were evaluated by electric pulp stimulation and verbal analogue scale, respectively. Relative risks (RR) with corresponding 95% confidence intervals (95% CI) were calculated for each outcome. Results 27% and 42% of the patients achieved pulpal anesthesia following IANB with 1.8 mL and 3.6 mL, respectively (RR = 0.63, CI 95% 0.35 to 1.14, p = 0.12). Analgesia during pulpectomy was present in 64% and 73% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.87, CI 95% 0.66 to 1.16, p = 0.36). In cases of IANB failure, 75% and 42% of the patients that received 1.8 mL and 3.6 mL of PDL injection, respectively, achieved pulpal anesthesia (RR = 1.80, CI 95% 0.87 to 3.72, p = 0.11). During a new attempt at the pulpectomy procedure, analgesia was present in 69% and 75% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.91, CI 95% 0.57 to 1.45, p = 0.71). Conclusion Increasing the volume from 1.8 mL to 3.6 mL of the 4% articaine with 1:100,000 epinephrine in the IANB and in the PDL, did not significantly increase the success rate of pulpal anesthesia and clinical analgesia during the pulpectomy procedure. Therefore, both volumes presented a similar efficacy, though neither resulted in effective pain control during irreversible pulpitis treatment. Trial registration ClinicalTrials.gov NCT02422823.
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Affiliation(s)
- Stella Agra Silva
- Department of Stomatology, São Paulo University, São Paulo, SP, Brazil
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17
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Dianat O, Mozayeni MA, Layeghnejad MK, Shojaeian S. The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible pulpitis. Clin Oral Investig 2019; 24:1281-1286. [DOI: 10.1007/s00784-019-03006-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
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18
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Mohamed AA, Safan TF, Hamed HF, Elgendy MAA. Tumescent Local Infiltration Anesthesia for Mini Abdominoplasty with Liposuction. Open Access Maced J Med Sci 2018; 6:2073-2078. [PMID: 30559863 PMCID: PMC6290441 DOI: 10.3889/oamjms.2018.475] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 11/16/2022] Open
Abstract
AIM: To evaluate the feasibility and safety of mini abdominoplasty with liposuction under local tumescent anaesthesia (LA) as the sole anaesthetic modality. METHODS: The study included 60 female patients with a mean age of 33.3 ± 5.6 years. Local infiltration using a mixture of 1:1000 epinephrine (1 ml), 2% lidocaine (100 ml) and 0.5% Levobupivacaine (50 ml) in 2500 ml saline was started with Local infiltration started with the abdomen, outer thigh, hips, back, inner thighs and knees. After Mini Abdominoplasty with supplemental liposuction was conducted and application of suction drains wound closure was performed, and the tight bandage was applied. Pain during injection, incision and surgical manipulations was determined. Duration of postoperative analgesia, till oral intake and return home, patients and surgeon satisfaction scores were determined. RESULTS: All surgeries were conducted completely without conversion to general anaesthesia. Injection pain was mild in 46 patients, moderate in 10 and hardly tolerated in 4 patients. Incision pain was mild in 16 patients, while 44 patients reported no sensation. During the surgical procedure, 6 patients required an additional dose of LA. Meantime till resumption of oral intake was 1.6 ± 0.9 hours. Meantime till home return was 5.6 ± 2.4 hours. Twelve patients were highly satisfied, 18 patients were satisfied, and these 42 patients were willing to repeat the trial if required. Eight patients found the trial is good and only one patient refused to repeat the trial and was dissatisfied, for a mean total satisfaction score of 3.1 ± 0.9. CONCLUSION: Mini Abdominoplasty with liposuction could be conducted safely under tumescent LA with mostly pain-free intraoperative and PO courses and allowed such surgical procedure to be managed as an office procedure. The applied anaesthetic procedure provided patients’ satisfaction with varying degrees in about 97% of studied patients.
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Milani AS, Froughreyhani M, Rahimi S, Zand V, Jafarabadi MA. Volume of Anesthetic Agents and IANB Success: A Systematic Review. Anesth Prog 2018; 65:16-23. [PMID: 29509518 PMCID: PMC5841477 DOI: 10.2344/anpr-65-01-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/16/2017] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to provide an evidence-based answer to the question: "Is 3.6-mL volume of an anesthetic agent more effective than 1.8-mL volume in providing anesthesia for mandibular molars?" Following formulation of research question and keyword selection, a comprehensive search of the following databases was conducted: Cochrane library, PubMed, Scopus, Google Scholar, ProQuest, and Clinicaltrials.gov. Three-phase eligibility appraisal and quality assessment of the studies were carried out by 2 independent reviewers. To reduce clinical heterogeneity, the included studies were divided into 2 groups: studies on healthy teeth and studies on teeth with pulpitis. The data of included studies were statistically combined through meta-analysis using a fixed-effects model. A total of 20,778 records were initially retrieved from the search. Following screening and eligibility assessment, 8 studies met the eligibility criteria and were included for qualitative synthesis. Of those, 5 studies were qualified for meta-analysis. In the irreversible pulpitis group, increasing the volume of anesthetic agent from 1.8 to 3.6 mL significantly increased the success rate of inferior alveolar nerve block (risk ratio = 2.45, 95% CI: 1.67-3.59, p < .001). However, there was insufficient evidence to draw a conclusion regarding healthy teeth.
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Affiliation(s)
- Amin Salem Milani
- Assistant Professor, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Froughreyhani
- Associate Professor, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Rahimi
- Professor of Endodontics, Dental and Periodontal Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Vahid Zand
- Associate Professor, Department of Endodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari Jafarabadi
- Associate Professor of Biostatistics, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
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20
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Affiliation(s)
- Paul V. Abbott
- UWA Dental School; The University of Western Australia; Nedlands Western Australia Australia
| | - Masoud Parirokh
- Endodontology Research Centre; Kerman University of Medical Sciences; Kerman Iran
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21
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Shapiro MR, McDonald NJ, Gardner RJ, Peters MC, Botero TM. Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis: A Prospective, Randomized, Double-blind Clinical Trial. J Endod 2018; 44:523-528. [PMID: 29397214 DOI: 10.1016/j.joen.2017.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/08/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Profound 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. METHODS One 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. RESULTS There 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). CONCLUSIONS The 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.
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Affiliation(s)
- Michael R Shapiro
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan; Private Practice Limited to Endodontics
| | - Neville J McDonald
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Richard J Gardner
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan; Private Practice Limited to Endodontics, Ann Arbor, MI
| | - Mathilde C Peters
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan
| | - Tatiana M Botero
- Department of Cariology, Restorative Sciences, and Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan.
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22
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Saatchi M, Shafiee M, Khademi A, Memarzadeh B. Anesthetic Efficacy of Gow-Gates Nerve Block, Inferior Alveolar Nerve Block, and Their Combination in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Clinical Trial. J Endod 2017; 44:384-388. [PMID: 29273494 DOI: 10.1016/j.joen.2017.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 10/12/2017] [Accepted: 10/14/2017] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The purpose of this prospective, randomized clinical trial was to evaluate the anesthetic efficacy of the Gow-Gates nerve block (GGNB), the inferior alveolar nerve block (IANB), and their combination for mandibular molars in patients with symptomatic irreversible pulpitis. METHODS One hundred fifty patients diagnosed with symptomatic irreversible pulpitis of a mandibular molar were selected. The patients randomly received 2 GGNB injections, 2 IANB injections, or 1 GGNB injection plus 1 IANB injection of 1.8 mL 2% lidocaine with 1:80,000 epinephrine. Access cavity preparation was initiated 15 minutes after injections. Lip numbness was a requisite for all of the patients. Success was specified as no or mild pain on the basis of Heft-Parker visual analog scale recordings during access cavity preparation or initial instrumentation. Data were analyzed with the chi-square, Kruskal-Wallis, and analysis of variance tests. RESULTS The success rates of anesthesia were 40%, 44%, and 70% for the GGNB, IANB, and GGNB + IANB groups, respectively. There was no statistically significant difference in the success rate of anesthesia between the GGNB and IANB groups (P > .05). The anesthesia success rate for the GGNB + IANB group was significantly different from those of the GGNB and IANB groups (P < .05). CONCLUSIONS A combination of GGNB and IANB could improve the efficacy of anesthesia in mandibular molars with symptomatic irreversible pulpitis, but it would still require supplemental anesthesia. Further research may be needed to confirm the results of this study.
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Affiliation(s)
- Masoud Saatchi
- Dental Research Center, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Shafiee
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbasali Khademi
- Dental Research Center, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Bahareh Memarzadeh
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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Tupyota P, Chailertvanitkul P, Laopaiboon M, Ngamjarus C, Abbott PV, Krisanaprakornkit S. Supplementary techniques for pain control during root canal treatment of lower posterior teeth with irreversible pulpitis: A systematic review and meta-analysis. AUST ENDOD J 2017; 44:14-25. [DOI: 10.1111/aej.12212] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Pinpana Tupyota
- Department of Restorative Dentistry; Faculty of Dentistry; Khon Kaen University; Khon Kaen Thailand
| | - Pattama Chailertvanitkul
- Department of Restorative Dentistry; Faculty of Dentistry; Khon Kaen University; Khon Kaen Thailand
| | - Malinee Laopaiboon
- Department of Biostatistics and Demography; Faculty of Public Health; Khon Kaen University; Khon Kaen Thailand
| | - Chetta Ngamjarus
- Department of Biostatistics and Demography; Faculty of Public Health; Khon Kaen University; Khon Kaen Thailand
| | - Paul V. Abbott
- School of Dentistry; University of Western Australia; Nedlands Western Australia Australia
| | - Suttichai Krisanaprakornkit
- Department of Oral Biology and Diagnostic Sciences; Faculty of Dentistry Center of Excellence in Oral and Maxillofacial Biology; Chiang Mai University; Chiang Mai Thailand
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Farzaneh S, Parirokh M, Nakhaee N, Abbott PV. Effect of two different concentrations of sodium hypochlorite on postoperative pain following single-visit root canal treatment: a triple-blind randomized clinical trial. Int Endod J 2017; 51 Suppl 1:e2-e11. [DOI: 10.1111/iej.12749] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- S. Farzaneh
- Oral and Dental Diseases Research Center; Kerman University of Medical Sciences; Kerman Iran
| | - M. Parirokh
- Endodontology Research Center; Kerman University of Medical Sciences; Kerman Iran
| | - N. Nakhaee
- Neuroscience Research Center; Kerman University of Medical Sciences; Kerman Iran
| | - P. V. Abbott
- School of Dentistry; University of Western Australia; Perth Australia
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Yu F, Xiao Y, Liu H, Wu F, Lou F, Chen D, Bai M, Huang D, Wang C, Ye L. Evaluation of Three Block Anesthesia Methods for Pain Management During Mandibular Third Molar Extraction: A Meta-analysis. Sci Rep 2017; 7:40987. [PMID: 28106160 PMCID: PMC5247732 DOI: 10.1038/srep40987] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 12/06/2016] [Indexed: 02/05/2023] Open
Abstract
A patient’s pain during mandibular third molar extraction often creates problems for a dental surgeon and can also cause immense patient discomfort, such as decreased quality of life, serious complications, or even danger to the patients’ lives. Effective pain management is therefore of great importance. Conventional block anesthesia method often fails to control such pain completely during an operation. Therefore, two available alternatives, Gow-Gates (G-G) and Vazirani-Akinosi (V-A) methods, have been developed. However, the results of current studies regarding their effectiveness and safety are somewhat ambiguous. The use of G-G and V-A techniques is therefore restricted. This study did a comprehensive review of the relevant research and finally 7 RCTs were included. The results of this meta-analysis indicate that both G-G and V-A techniques have a lower risk of positive aspiration. G-G technique also evidenced a higher success rate than the conventional method. V-A was faster while the G-G technique in contrast had a slower onset time than the conventional technique. In terms of the measurement of analgesic success, however, the V-A method was statistically indistinguishable from conventional techniques. These findings will hopefully endow clinicians with the knowledge required to make appropriate choices for effective anesthesia during lower third molar extraction.
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Affiliation(s)
- Fanyuan Yu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yao Xiao
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hanghang Liu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fanzi Wu
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Feng Lou
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Dian Chen
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Mingru Bai
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Dingming Huang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,Department of Endodontics, West China Stomatology Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chenglin Wang
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,Department of Endodontics, West China Stomatology Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling Ye
- State Key Laboratory of Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.,Department of Endodontics, West China Stomatology Hospital, Sichuan University, Chengdu, Sichuan, China
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Iranmanesh F, Parirokh M, Haghdoost AA, Abbott PV. Effect of Corticosteroids on Pain Relief Following Root Canal Treatment: A Systematic Review. IRANIAN ENDODONTIC JOURNAL 2017; 12:123-130. [PMID: 28496516 PMCID: PMC5421265 DOI: 10.22037/iej.2017.26] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/02/2017] [Accepted: 03/04/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Post-operative pain and flare-up may occur in up to 58% of patients following root canal treatment. The aim was to conduct a systematic review and a possible meta-analysis to determine the effect of glucocorticosteroid (GCS) on pain following root canal treatment. METHODS AND MATERIALS Scopus, MEDLINE and CENTRAL databases were searched up to 30th January 2017 with broad key words. In addition, the reference lists in eligible papers and text books were hand-searched. Assessment of the eligibility of papers and data extraction were performed by two independent reviewers. RESULTS Of 9891 articles, 18 were recruited as eligible papers. Most of these papers showed pain reducing effect of GCS on post-endodontic pain. Because of wide heterogeneity among the recruited papers, it was not possible to perform meta-analysis. CONCLUSION Based on the results of this systematic review, there is a vast heterogeneity amongst articles regarding the use of GCS and their effect on post-operative pain after endodontic treatment. Further investigations with similar methods and materials are needed before meta-analysis on the effect of GCS on post-operative pain following root canal treatment can be performed.
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Affiliation(s)
- Foad Iranmanesh
- Department ofEndodontics, Dental School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran;
| | - Masoud Parirokh
- Endodontology Research Center, Dental School, Kerman University of Medical Sciences, Kerman, Iran;
| | - Ali Akbar Haghdoost
- Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran;
| | - Paul V. Abbott
- Dental School, University of Western Australia, Perth, Australia
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Moradi Askari E, Parirokh M, Nakhaee N, Hosseini HR, Abbott PV. The Effect of Maxillary First Molar Root Length on the Success Rate of Buccal Infiltration Anesthesia. J Endod 2016; 42:1462-6. [DOI: 10.1016/j.joen.2016.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 06/28/2016] [Accepted: 07/03/2016] [Indexed: 11/28/2022]
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Kakooei S, Mostafavi M, Parirokh M, Asgary S. Indexing of Iranian Publications in Well-known Endodontic Textbooks: A Scientometric Analysis. IRANIAN ENDODONTIC JOURNAL 2016; 11:157-63. [PMID: 27471523 PMCID: PMC4947836 DOI: 10.7508/iej.2016.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/01/2016] [Accepted: 04/15/2016] [Indexed: 12/04/2022]
Abstract
Introduction: Quoting an article in well-known textbooks is held as a credit for that paper. The numbers of Iranian publications mentioned in endodontic textbooks have increased during recent years. The aim of this investigation was to evaluate the number of Iranian articles quoted in eminent endodontic textbooks. Methods and Materials: Three known textbooks (Ingle’s Endodontics, Seltzer and Bender’s Dental Pulp and Cohen’s Pathways of the Pulp) were chosen and all the editions of the textbooks since 2000 were investigated for quoted Iranian publications. Only Iranian authors with affiliations from a domestic university were chosen. All references at the end of each chapter were read by hand searching, and results were noted. The trend and percentage of Iranian publications in different editions of the textbooks were also calculated. The number of citations of these publications in Google Scholar and Scopus databases were also obtained. Results: The number of Iranian publications in all well-known textbooks have notably increased since 2000. The number and percentage of Iranian publications in the latest edition of Cohen’s Pathways of the Pulp was higher compared to other textbooks as well as the previous edition of the same text. Conclusion: Number and percentage of Iranian publications in the field of endodontics in all three textbooks have remarkably increased since 2000.
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Affiliation(s)
- Sina Kakooei
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mahshid Mostafavi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Parirokh
- Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeed Asgary
- Iranian Center for Endodontic Research, Research Institute of Dental Sciences, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Visconti RP, Tortamano IP, Buscariolo IA. Comparison of the Anesthetic Efficacy of Mepivacaine and Lidocaine in Patients with Irreversible Pulpitis: A Double-blind Randomized Clinical Trial. J Endod 2016; 42:1314-9. [PMID: 27475099 DOI: 10.1016/j.joen.2016.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/26/2016] [Accepted: 06/16/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The objective of this study was to compare the anesthetic efficacy of 2% mepivacaine combined with 1:100,000 epinephrine with 2% lidocaine combined with 1:100,000 epinephrine during pulpectomy of mandibular posterior teeth in patients with irreversible pulpitis. METHODS Forty-two patients with irreversible pulpitis who were admitted to the Emergency Center at the University of São Paulo School of Dentistry volunteered to take part in the study and were randomized to receive conventional inferior alveolar nerve block containing 1.8 or 3.6 mL of either 2% mepivacaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine. We recorded patients' subjective assessments of lip anesthesia, absence/presence of pulpal anesthesia tested by using electric pulp stimulation, and absence/presence of pain during the subsequent pulpectomy by using a verbal analogue scale. RESULTS All patients tested reported lip anesthesia after application of either type of inferior alveolar nerve block. Pulpal anesthesia success rates measured by using the pulp tester were satisfactory for both solutions (86% for mepivacaine and 67% for lidocaine). Success rates according to patient report of no pain or mild pain during pulpectomy were higher for mepivacaine solution (55%) than for lidocaine solution (14%). The differences between mepivacaine and lidocaine were statistically significant. CONCLUSIONS Mepivacaine resulted in effective pain control during irreversible pulpitis treatments. The success rates with either solution were not high enough to ensure complete pulpal anesthesia.
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Affiliation(s)
- Renata Pieroni Visconti
- Department of Stomatology, Integrated Clinical Discipline, University of São Paulo School of Dentistry, São Paulo, Sao Paulo, Brazil.
| | - Isabel Peixoto Tortamano
- Department of Stomatology, Integrated Clinical Discipline, University of São Paulo School of Dentistry, São Paulo, Sao Paulo, Brazil
| | - Inês Aparecida Buscariolo
- Department of Stomatology, Integrated Clinical Discipline, University of São Paulo School of Dentistry, São Paulo, Sao Paulo, Brazil
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Hosseini HR, Parirokh M, Nakhaee N, V Abbott P, Samani S. Efficacy of Articaine and Lidocaine for Buccal Infiltration of First Maxillary Molars with Symptomatic Irreversible Pulpitis: A Randomized Double-blinded Clinical Trial. IRANIAN ENDODONTIC JOURNAL 2016; 11:79-84. [PMID: 27141212 PMCID: PMC4841339 DOI: 10.7508/iej.2016.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/01/2016] [Accepted: 01/15/2016] [Indexed: 11/30/2022]
Abstract
Introduction: The aim of the present study was to compare the efficacy of 2% lidocaine to 4% articaine in buccal infiltration of maxillary first molars with irreversible pulpitis. Moreover, the effect of root length on success of anesthesia irrespective of the type of anesthetic agent was assessed. Methods and Materials: Fifty patients suffering from painful maxillary first molars with irreversible pulpitis received an infiltration injection of either 4% articaine with 1:100000 epinephrine or 2% lidocaine with 1:80000 epinephrine. Each patient recorded their pain score in response to a cold test on a Heft-Parker visual analogue scale (VAS) before commencing the treatment, 5 min following injection, during access preparation, after pulp exposure and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analyzed using the multivariate logistic regression analysis, chi-square and t tests. Results: Finally, 47 out of 50 patients were eligible to be included in this study. The anesthetic success rates in the lidocaine and articaine groups were 56.52% and 66.67%, respectively and the difference was not significant (P=0.474). Irrespective of the anesthetic agent, the length of the palatal root (Odds Ratio=0.24, P=0.007) had an adverse effect on anesthetic success. There was an association between longer palatal root length and anesthetic failure. Conclusion: No significant difference was found between 2% lidocaine and 4% articaine in terms of anesthetic success in maxillary first molars with irreversible pulpitis. The length of the palatal root had a significant negative influence on anesthetic success.
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Affiliation(s)
- Hamid Reza Hosseini
- Endodontic Department, Dental School, Khorasan Shomali University of Medical Sciences, Bojnord, Iran
| | - Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Paul V Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
| | - Syamak Samani
- Endodontic Department, Dental School, Shahid Saddoghi University of Medical Sciences, Yazd, Iran
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Akhlaghi NM, Hormozi B, Abbott PV, Khalilak Z. Efficacy of Ketorolac Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial. J Endod 2016; 42:691-5. [PMID: 26964901 DOI: 10.1016/j.joen.2016.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 01/31/2016] [Accepted: 02/06/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine whether ketorolac buccal infiltrations (BIs) helped to improve the success of inferior alveolar nerve blocks (IANBs) in patients with acute irreversible pulpitis (AIP). METHODS Forty adult volunteers with AIP in a mandibular molar were included in this study. Patients were instructed to evaluate their pain by using a Heft-Parker visual analog scale. They were randomly divided into 2 groups (n = 20). All patients received standard IANB injection and after that a BI of 4% articaine with 1:100,000 epinephrine. After 5 minutes, 20 patients received a BI of 30 mg/mL ketorolac, and the other received a BI of normal saline (control group). Endodontic access cavity preparation (ACP) was initiated 15 minutes after the IANB when the patient reported lip numbness and had 2 electric pulp tests with no responses. The patient's pain during caries and dentin removal, ACP, and canal length measurements (CLM) was recorded by using Heft-Parker visual analog scale. Successful anesthesia was defined as no or mild pain during any of these steps, without the need for additional injection. Data were statistically analyzed by using Mann-Whitney U and χ(2) tests. RESULTS Successful anesthesia after an IANB plus BI of articaine was obtained in 15% of patients in the control group at the end of CLM. Adding BI of ketorolac significantly increased the success rate to 40% (P < .05). Patient's pain during ACP and CLM was significantly lower in the ketorolac group (P < .05). CONCLUSIONS Ketorolac BI can increase the success rate of anesthesia after IANB and BI with articaine in patients with AIP.
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Affiliation(s)
| | - Behnoush Hormozi
- Department of Endodontics, Dental Branch, Islamic Azad University, Tehran, Iran
| | - Paul V Abbott
- Department of Endodontics, School of Dentistry, University of Western Australia, Crawley, Perth, Western Australia
| | - Zohreh Khalilak
- Department of Endodontics, Dental Branch, Islamic Azad University, Tehran, Iran.
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Abazarpoor R, Parirokh M, Nakhaee N, Abbott PV. A Comparison of Different Volumes of Articaine for Inferior Alveolar Nerve Block for Molar Teeth with Symptomatic Irreversible Pulpitis. J Endod 2015; 41:1408-11. [DOI: 10.1016/j.joen.2015.05.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/16/2015] [Accepted: 05/17/2015] [Indexed: 11/30/2022]
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Yadav S. Anesthetic success of supplemental infiltration in mandibular molars with irreversible pulpitis: A systematic review. J Conserv Dent 2015; 18:182-6. [PMID: 26069400 PMCID: PMC4450520 DOI: 10.4103/0972-0707.157238] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/23/2015] [Accepted: 04/16/2015] [Indexed: 11/04/2022] Open
Abstract
Aim: To systematically review the anesthetic success rates of inferior alveolar nerve block (IANB) injection technique alone with that of combination of IANB and supplemental infiltration (SI) technique when used for pulpal anesthesia of mandibular posterior teeth with irreversible pulpitis during endodontic treatment. Settings and Design: The study follows a longitudinal study design involving original research. Materials and Methods: Electronic databases were systematically searched for randomized controlled clinical studies. Studies were selected by predefined inclusion and exclusion criteria. Statistical Analysis Used and Result: The statistical analysis used was based on the results of the original research. All the included studies showed that there is the difference in the values comparing the two techniques, but the data are not statistically significantly different. Conclusion: Based on this review, the better anesthetic efficacy of the SI was observed.
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Affiliation(s)
- Seema Yadav
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Parirokh M, Yosefi MH, Nakhaee N, Abbott PV, Manochehrifar H. The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain. Restor Dent Endod 2015; 40:155-60. [PMID: 25984478 PMCID: PMC4432259 DOI: 10.5395/rde.2015.40.2.155] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/24/2015] [Indexed: 11/29/2022] Open
Abstract
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.
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Affiliation(s)
- Masoud Parirokh
- Oral and Dental Diseases Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Hosein Yosefi
- Endodontic Department, School of Dentistry, Yazd University of Medical Sciences, Yazd, Iran
| | - Nouzar Nakhaee
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Paul V Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
| | - Hamed Manochehrifar
- Endodontology Research Center, School of Dentistry, Kerman University of Medical Sciences, Kerman, Iran
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Monteiro MRFP, Groppo FC, Haiter-Neto F, Volpato MC, Almeida JFA. 4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: a randomized clinical study. Int Endod J 2014; 48:145-52. [PMID: 24702239 DOI: 10.1111/iej.12293] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/02/2014] [Indexed: 11/29/2022]
Abstract
AIM To compare the anaesthetic efficacy of inferior alveolar nerve blocks (IANB) with 1.8 mL of 2% lidocaine (LI) to a buccal infiltration (BI) with 1.8 mL of 4% articaine (AR), both with 1 : 100 000 epinephrine, in patients with symptomatic irreversible pulpits in a randomized controlled trial. METHODOLOGY Volunteers presenting at the Emergency Centre (FOP-UNICAMP) were randomly divided into two groups (30 for AR and 20 for LI). Operator and patient were not blinded. Success was recorded when complete pain-free treatment was achieved after a single injection (IANB or BI) or when one supplemental injection was needed for emergency endodontic procedures. Success rate of supplemental injection was evaluated between and within groups using Fisher's exact test and chi-square test. RESULTS A higher success rate (P = 0.03/Fisher's exact test) was observed with AR (40%) than with LI (10%). No significant difference was found when a single injection plus one supplemental injection was compared between groups (P = 1.0; AR = 70%; LI = 80%). However, supplemental injection increased the anaesthetic success rates (AR, P = 0.04; LI, P = 0.0001) within groups. CONCLUSIONS Single anaesthesia techniques (IANB or BI) were not able to achieve pain-free emergency endodontic treatment. Supplemental anaesthetic techniques should be considered prior to treatment procedures in order to increase success rate (consort: registration number - NCT01912755/Fapesp: #2009/10834-4).
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Affiliation(s)
- M R F P Monteiro
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
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Parirokh M, Sadr S, Nakhaee N, Abbott PV, Askarifard S. 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. Int Endod J 2014; 47:926-33. [PMID: 24359138 DOI: 10.1111/iej.12236] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 12/17/2013] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- M Parirokh
- Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Eftekhar B, Moghimipour E, Pourakbar Jahandideh P, Jalali S, Mahmoudian M. Analgesic effect of odontopaste and a compound intracanal medicament between root canal therapy appointments. Jundishapur J Nat Pharm Prod 2013; 8:169-74. [PMID: 24624209 PMCID: PMC3941894 DOI: 10.17795/jjnpp-12473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 08/12/2013] [Accepted: 08/19/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Pain experience makes a serious anxiety for both patient and clinician before and after root canal treatment. Pain is a complex psychophysiologic phenomenon. OBJECTIVES The aim of this randomized control trial study was to evaluate the analgesic effect of Odontopaste® and a corticosteroid containing compound medicament between root canal therapy appointments. MATERIALS AND METHODS One hundred and twenty lower first and second mandibular molars with spontaneous pain and sensitivity to percussion were selected and divided into three groups (40 patients per each group). After root canal preparation, patients were entered one of these groups randomly. Root canals in group 1 were dressed with Odontopaste, in group 2 with a compound intracanal medicament, and in group 3 with placebo. Patients determined their pain rate and percussion sensitivity on Heft-parker VAS diagram, before the first appointment and 24 hours and 7 days after that. RESULTS Spontaneous pain and Percussion sensitivity score averages of 24 hours after the first appointment in group 1 and group 2 were less than group 3, which indicates statistically significant difference between these groups. There was no statistically significant difference between these groups after 7 days neither on spontaneous pain nor percussion sensitivity. CONCLUSIONS Odontopaste® and compound intracanal medicaments resulted in statistically significant reduction in postoperative pain and percussion sensitivity after 24 hours, but there was no statistically significant difference after 7 days with placebo.
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Affiliation(s)
- Behrooz Eftekhar
- Endodontic Department, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Eskandar Moghimipour
- Cellular and Molecular Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Pejman Pourakbar Jahandideh
- Endodontic Department, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Sahar Jalali
- Endodontic Department, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mahsa Mahmoudian
- Endodontic Department, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
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Fowler S, Reader A. Is a Volume of 3.6 mL Better than 1.8 mL for Inferior Alveolar Nerve Blocks in Patients with Symptomatic Irreversible Pulpitis? J Endod 2013; 39:970-2. [DOI: 10.1016/j.joen.2013.04.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 03/17/2013] [Accepted: 04/03/2013] [Indexed: 11/28/2022]
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Aravena P, Bustos N, Cerón A, Castillo V, González C. Éxito anestésico de 1,8ml de Lidocaína 2% en exodoncia de dientes mandibulares. Estudio piloto. JOURNAL OF ORAL RESEARCH 2013. [DOI: 10.17126/joralres.2013.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Dou L, Luo J, Yang D. Anaesthetic efficacy of supplemental lingual infiltration of mandibular molars after inferior alveolar nerve block plus buccal infiltration in patients with irreversible pulpitis. Int Endod J 2013; 46:660-5. [DOI: 10.1111/iej.12042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 11/16/2012] [Indexed: 11/28/2022]
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Parirokh M, Sadeghi AS, Nakhaee N, Pardakhty A, Abbott PV, Yosefi MH. Effect of topical anesthesia on pain during infiltration injection and success of anesthesia for maxillary central incisors. J Endod 2012; 38:1553-6. [PMID: 23146636 DOI: 10.1016/j.joen.2012.08.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 08/19/2012] [Accepted: 08/21/2012] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Masoud Parirokh
- Kerman Oral and Dental Diseases Research Center, Endodontic Department, Kerman University of Medical Sciences, Kerman, Iran.
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Martín-González J, Echevarría-Pérez M, Sánchez-Domínguez B, Tarilonte-Delgado ML, Castellanos-Cosano L, López-Frías FJ, Segura-Egea JJ. Influence of root canal instrumentation and obturation techniques on intra-operative pain during endodontic therapy. Med Oral Patol Oral Cir Bucal 2012; 17:e912-8. [PMID: 22549694 PMCID: PMC3482542 DOI: 10.4317/medoral.18234] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 03/25/2012] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy. METHOD AND MATERIALS A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis. RESULTS The mean pain level during root canal treatment was 2.9±3.0 (median=2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p>0.05). Pain during root canal treatment was significantly greater in molar teeth (OR=10.1; 95% C.I.=1.6-63.5; p=0.013). Root canal instrumentation and obturation techniques did not affect significantly patients' pain during root canal treatment (p>0.05). CONCLUSION Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients' pain during RCT.
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Affiliation(s)
- Jenifer Martín-González
- Department of Endodontics, School of Dentistry, University of Sevilla, Facultad de Odontología, C/ Avicena s/n, 41009-Seville, Spain
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Parirokh M, Ashouri R, Rekabi AR, Nakhaee N, Pardakhti A, Askarifard S, Abbott PV. The Effect of Premedication with Ibuprofen and Indomethacin on the Success of Inferior Alveolar Nerve Block for Teeth with Irreversible Pulpitis. J Endod 2010; 36:1450-4. [DOI: 10.1016/j.joen.2010.05.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 05/01/2010] [Accepted: 05/19/2010] [Indexed: 11/26/2022]
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