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Só GB, Silva IA, Weissheimer T, Lenzi TL, Só MVR, da Rosa RA. Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review. Clin Oral Investig 2023; 27:1885-1897. [PMID: 36988825 DOI: 10.1007/s00784-023-04979-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The aim of the present umbrella review was to answer the following question: "Does the use of NSAIDs as premedication increase the efficacy of the standard inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?" MATERIAL AND METHODS Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were searched in six electronic databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Grey Literature Reports), without the restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. RESULTS Twelve systematic reviews were included. Only one did not perform a meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high. In general, the main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with acetaminophen, and ketorolac) increased the success rate of the inferior alveolar nerve block. CONCLUSIONS From the "very low" to "high"-quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenase pathways and block the synthesis of specific prostaglandins that complicate the mechanism of action of the anesthesia, improving its success rate. CLINICAL RELEVANCE Non-steroidal anti-inflammatory drugs can increase the success rate of the anesthetic technique of inferior alveolar nerve block efficacy in situations of mandibular molars with symptomatic irreversible pulpitis.
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Affiliation(s)
- Gabriel Barcelos Só
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Isadora Ames Silva
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Theodoro Weissheimer
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Tathiane Larissa Lenzi
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Marcus Vinicius Reis Só
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil
| | - Ricardo Abreu da Rosa
- Department of Conservative Dentistry, School of Dentistry, Rio Grande do Sul Federal University (UFRGS), 2492 Ramiro Barcelos Street, Porto Alegre, RS, 90040-060, Brazil.
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Iranmanesh P, Khazaei S, Nili M, Saatchi M, Aggarwal V, Kolahi J, Khademi A. Anesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta‐analysis and trial sequential analysis. Int Endod J 2022; 55:732-747. [DOI: 10.1111/iej.13746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Pedram Iranmanesh
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Saber Khazaei
- Department of Endodontics School of Dentistry Kermanshah University of Medical Sciences Kermanshah Iran
| | - Mahsa Nili
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Masoud Saatchi
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics Faculty of Dentistry Jamia Millia Islamia New Delhi India
| | - Jafar Kolahi
- Independent Research Scientist, Founder and Associate Editor of Dental Hypotheses Isfahan Iran
| | - Abbasali Khademi
- Dental Research Center and Department of Endodontics Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
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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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Aquilanti L, Mascitti M, Togni L, Contaldo M, Rappelli G, Santarelli A. A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031627. [PMID: 35162650 PMCID: PMC8835670 DOI: 10.3390/ijerph19031627] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/26/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients' reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.
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Affiliation(s)
- Luca Aquilanti
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
| | - Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Correspondence: ; Tel.: +39-071-2206-226
| | - Lucrezia Togni
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
| | - Maria Contaldo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania “Luigi Vanvitelli”, Via Armanni, 5, 80138 Naples, Italy;
| | - Giorgio Rappelli
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Via Tronto 10/A, 60126 Ancona, Italy
| | - Andrea Santarelli
- Department of Clinical Specialistic and Dental Sciences, Università Politecnica delle Marche, Via Tronto 10/A, 60126 Ancona, Italy; (L.A.); (L.T.); (G.R.); (A.S.)
- Dentistry Clinic, National Institute of Health and Science of Aging, IRCCS INRCA, Via Tronto 10/A, 60126 Ancona, Italy
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Almohaimede A, Al-Madi E. Is Intracanal Cryotherapy Effective in Reducing Postoperative Endodontic Pain? An Updated Systematic Review and Meta-Analysis of Randomized Clinical Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11750. [PMID: 34831517 PMCID: PMC8621421 DOI: 10.3390/ijerph182211750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 11/16/2022]
Abstract
This research aimed to assess the potency of intracanal cold therapy in diminishing postoperative endodontic pain. PubMed, Scopus, the Cochrane Library, EMBASE, the Web of Science, grey literature, and endodontic journals were used to identify randomized controlled clinical trials evaluating postoperative pain after a final irrigation with a cold irrigant (as an experimental group) and a room temperature irrigant (as a control group). The risk of bias was rated according to the Cochrane Collaboration's tool and the Grading Recommendation Assessment, Development, and Evaluation (GRADE) system was used to estimate the evidence quality. For the meta-analysis, a random effects model was utilized. The qualitative analysis contained 16 studies and the quantitative analysis contained 9 studies. The experimental groups showed a reduction in postoperative pain at 6 h (mean difference (MD) = -1.11; p = 0.0004; I2 = 72%; low quality evidence), 24 h (MD = -1.08; p = 0.003; I2 = 92%; low quality evidence), 48 h (MD = -0.38; p = 0.04; I2 = 81%; low quality evidence), and 72 h (MD = -0.69; p = 0.04; I2 = 90%; low quality evidence). A higher quality of evidence from more clinical trials is needed.
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Affiliation(s)
- Amal Almohaimede
- Department of Restorative Dental Sciences, Endodontic Division, College of Dentistry, King Saud University, Riyadh 11451, Saudi Arabia;
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Effect of Root Canal Therapy Combined with Full Crown Restoration on the Level of Inflammatory Factors and Chewing Function in Patients with Cracked Teeth and Chronic Pulpitis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:3299349. [PMID: 34504533 PMCID: PMC8423566 DOI: 10.1155/2021/3299349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/21/2021] [Indexed: 12/21/2022]
Abstract
Objective To explore the clinical effect of root canal therapy combined with full crown restoration in patients with cracked teeth and chronic pulpitis. Methods From May 2018 to June 2020, 87 patients with cracked teeth and chronic pulpitis in our hospital were selected; the patients were randomly divided into the control group and the research group by random number method. The control group only used root canal therapy; the research group used root canal therapy combined with full crown restoration. The therapeutic effect, levels of inflammatory factors, chewing function, periodontal index, complications, and quality of life were compared between the two groups. Results The total effective rate of the research group (97.78%) was better than the total effective rate of the control group (85.71%) (P < 0.05). Compared with before treatment, the serum levels of interleukin-1β (IL-1β), IL-6, and C-reactive protein (CRP) of the two groups of patients decreased after treatment. After treatment, compared with the control group, the serum levels of IL-1β, IL-6, and CRP in the research group decreased (P < 0.05). Compared with before treatment, the bite force of teeth and chewing efficiency of the two groups of patients increased after treatment. After treatment, compared with the control group, the bite force of teeth and chewing efficiency of the research group increased (P < 0.05). Compared with before treatment, the plaque index (PLI), probing depth (PD), gingival sulcus bleeding index (BI), and gingival index (GI) of the two groups of patients decreased after treatment. After treatment, compared with the control group, the PLI, PD, BI, and GI of the research group decreased (P < 0.05). The total incidence of complications in the research group was (11.11%), and the total incidence of complications in the control group was (16.67%); there was no significant difference between the two groups (P > 0.05). After treatment, compared with the control group, the quality of life scores of the patients in the research group were reduced (P < 0.05). Conclusion Root canal therapy and full crown restoration have a definite curative effect in patients with cracked teeth and chronic pulpitis, which can improve the inflammatory response, restore chewing function, maintain periodontal health, improve the quality of life, and do not increase the incidence of complications, so it has good application value.
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Local anesthesia in oral and maxillofacial surgery: A review of current opinion. J Dent Sci 2021; 16:1055-1065. [PMID: 34484571 PMCID: PMC8403808 DOI: 10.1016/j.jds.2020.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/03/2020] [Indexed: 02/06/2023] Open
Abstract
Local anesthesia (LA) is the most important pain management process in oral and maxillofacial surgery. Safe and effective LA not only enable patients to obtain high-quality treatment, but also relieve the anxiety of patients when they come to the clinic. The choices of local anesthetic and injection methods determine the success of LA to a great extent. At present, in most countries or regions, common local anesthetics used in oral and maxillofacial surgery belong to amides and they are injected into patients' body mainly through block or infiltration anesthesia. In addition, the operators' technique level, patient's subjective psychology and anatomical variation of maxillofacial structure also have a strong influence on LA in dental clinic. Due to the existence of above factors, the worldwide success rates of LA in oral and maxillofacial surgery is very different. There are no specific LA methods that ensure 100% successful LA rates. Fortunately, the development of new local anesthetic and injection technology are providing us with new ideas to solve this problem. This review mainly report the new research progress on LA in oral and maxillofacial surgery in recent decades and help clinicians with dental LA operation.
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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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Effect of intracanal cryotherapy application on postoperative endodontic pain: a systematic review and metaanalysis. Clin Oral Investig 2020; 25:23-35. [PMID: 33222053 DOI: 10.1007/s00784-020-03693-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To assess the influence of intracanal cryotherapy application on postoperative pain after endodontic treatment. MATERIALS AND METHODS A systematic review (SR) was conducted in seven databases. Articles that were published up to 04 February 2020 were included and randomized clinical trials that used a cold saline solution for final irrigation to manage postoperative endodontic pain were compared with those that used a saline solution at room temperature. Metaanalysis was performed to assess postoperative pain after 6, 24, 48, and 72 h using a random effects model, a confidence interval of 95%, and heterogeneity tested by the I2 index. The certainty of evidence was rated using GRADE. RESULTS Qualitative and quantitative analysis included eight and six studies, respectively. Individuals treated with cryotherapy presented lower means of postendodontic pain than the controls, 6 and 24 h after endodontic treatment (MD - 1.30 [- 2.32, - 0.28] p = 0.01 and SMD - 0.68 [ - 1.21, - 0.16] p = 0.01, respectively, with very low certainty of evidence). After 48 and 72 h, both groups demonstrated similar means of postendodontic pain (MD - 0.06 [- 0.18, 0.07] p = 0.38 and SMD - 0.54 [- 1.18, - 0.11] p = 0.10, with high and low certainty of evidence, respectively). CONCLUSIONS Based on the limited quality evidence, intracanal cryotherapy application reduced postoperative endodontic pain after 6 and 24 h. New clinical trials are needed to support the result of this review. CLINICAL SIGNIFICANCE This SR provides information about the use of intracanal cryotherapy in clinical practice, guides clinicians to make evidence-based decisions and suggests recommendations for further high-quality studies.
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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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Jamil FA, Asmael HM, Al-Jarsha MY. The success of using 2% lidocaine in pain removal during extraction of mandibular premolars: a prospective clinical study. BMC Oral Health 2020; 20:239. [PMID: 32867733 PMCID: PMC7457358 DOI: 10.1186/s12903-020-01228-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the anesthetic effectiveness of a buccal infiltration technique combined with local massage (using 2% lidocaine) in the extraction of mandibular premolars to be utilized as an alternative to the conventional inferior alveolar nerve block. METHODS Patients eligible included any subject with a clinical indication for tooth extraction of the mandibular 1st or 2nd premolars. All patients were anesthetized buccally by local infiltration technique followed by an external pressure applied for 1 min directly over the injection area. In each case, another local injection was given lingually. All operations were started at approximately 5 min after the buccal injection. The collected data included age, gender, pain perception and its intensity during treatment at three checkpoints, apical tenderness, and the type of extraction. Any associated complications or difficulties were also recorded. Then the results were analyzed and interpreted using appropriate statistical tests. The significance level was set at P ≤ 0.05. RESULTS A total of 247 cases (1st premolar, n = 119; 2nd premolar, n = 128), predominantly male, were included. In 95% of study sample, the patients were satisfied with the dental extraction without any pain. However, in 5% of cases, pain was reported at the stage of tooth removal. Apical tenderness was found to be present in 11% of the total cases. Three teeth required surgical removal. Upon analysis, no significant differences in the success rates were detected between the 2 premolar groups or amongst the various age groups. Minor and transient side effects were reported in this study. CONCLUSION The technique is simple and effective as well. It might be considered as an alternative anesthetic injection to the inferior alveolar nerve block for dental extraction of the mandibular premolars.
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Affiliation(s)
- Firas A Jamil
- Department of Oral & Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Al Moadham, P.O.Box 1417, Baghdad, Iraq.
| | - Huda Moutaz Asmael
- Department of Oral & Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Al Moadham, P.O.Box 1417, Baghdad, Iraq
| | - Mohammed Yahya Al-Jarsha
- Department of Oral & Maxillofacial Surgery, Dental Teaching Hospital, College of Dentistry, University of Baghdad, Bab-Al Moadham, P.O.Box 1417, Baghdad, Iraq
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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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Nagendrababu V, Duncan HF, Whitworth J, Nekoofar MH, Pulikkotil SJ, Veettil SK, Dummer PMH. Is articaine more effective than lidocaine in patients with irreversible pulpitis? An umbrella review. Int Endod J 2019; 53:200-213. [DOI: 10.1111/iej.13215] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 12/21/2022]
Affiliation(s)
- V. Nagendrababu
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - H. F. Duncan
- Division of Restorative Dentistry Dublin Dental University Hospital Trinity College Dublin Dublin Ireland
| | - J. Whitworth
- Centre for Oral Health Research School of Dental Sciences Newcastle University Newcastle upon Tyne UK
| | - M. H. Nekoofar
- Department of Endodontics School of Dentistry Tehran University of Medical Sciences Tehran Iran
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
| | - S. J. Pulikkotil
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - S. K. Veettil
- School of Pharmacy International Medical University Kuala Lumpur Malaysia
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
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Ordinola‐Zapata R, Peters OA, Nagendrababu V, Azevedo B, Dummer PMH, Neelakantan P. What is of interest in Endodontology? A bibliometric review of research published in the
International Endodontic Journal
and the
Journal of Endodontics
from 1980 to 2019. Int Endod J 2019; 53:36-52. [DOI: 10.1111/iej.13210] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 12/24/2022]
Affiliation(s)
- R. Ordinola‐Zapata
- Division of Endodontics University of Minnesota School of Dentistry Minneapolis MN USA
| | - O. A. Peters
- Department of Endodontics Arthur A Dugoni School of Dentistry University of the Pacific San Francisco CA USA
- Oral Health Centre University of Queensland Herston Australia
| | - V. Nagendrababu
- Division of Clinical Dentistry School of Dentistry International Medical University Kuala Lumpur Malaysia
| | - B. Azevedo
- Oral & Maxillofacial Radiology Department of Surgical & Hospital Dentistry School of Dentistry University of Louisville Louisville Kentucky USA
| | - P. M. H. Dummer
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
| | - P. Neelakantan
- Faculty of Dentistry The University of Hong Kong Hong Kong
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Abou El Fadl R, Gowely M, Helmi M, Obeid M. Effects of pre-emptive analgesia on efficacy of buccal infiltration during pulpotomy of mandibular primary molars: a double-blinded randomized controlled trial. Acta Odontol Scand 2019; 77:552-558. [PMID: 31094614 DOI: 10.1080/00016357.2019.1614218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To assess the effect of preoperative administration of ibuprofen and acetaminophen on the efficacy of buccal infiltration for pulp therapy in mandibular primary molars. Materials and methods: A randomized controlled trial with an ID no. NCT03423329 in Clinical-Trials.gov was conducted in the outpatient clinic of Paediatric Dentistry Department at Ain Shams University. The study was designed with two test arms where either ibuprofen or acetaminophen was administered to children whereas in the control arm a multivitamin placebo was used. Children's self-reported pain responses were recorded using Wong-Baker FACES pain scale. For statistical analysis, Chi-square test or Fisher's exact test was used to compare between the three groups whereas Friedman's test was used to study changes within each group. Results: In a sample of 60 children, a significant decrease in the mean pain rating scores was detected in all groups where success rates ranged from 40% with ibuprofen to 55% and 65% with acetaminophen and placebo, respectively. However, there was no statistically significant difference between the three groups regarding severity of pain during access cavity preparation. Conclusions: Both analgesics have no clinical advantage over the placebo in increasing the efficacy of buccal infiltration during pulp therapy in mandibular primary molars.
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Affiliation(s)
- Reham Abou El Fadl
- Paediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Mai Gowely
- Oral Health Department, Ministry of Health, Cairo, Egypt
| | - Muhammad Helmi
- Paediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Maram Obeid
- Endodontic Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Wong YJ. Does oral Nonsteroidal Anti-inflammatory Drugs (NSAIDs) premedication in patients with irreversible pulpitis increase the success rate of inferior alveolar nerve block? Evid Based Dent 2019; 20:20-21. [PMID: 30903123 DOI: 10.1038/s41432-019-0014-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Data sources PubMed, EBSCOhost and Scopus database up till 9 September 2017 in English language. Clinical trial registry and reference lists of published systematic reviews, textbooks and selected articles were also searched.Study selection Population-based randomised clinical trials comparing effects of any single NSAID versus placebo as an oral premedication on the efficacy of IANB in achieving anaesthesia in patients ranging from age 14-68 with irreversible pulpitis who were undergoing nonsurgical root canal therapy in mandibular posterior teeth.Data extraction and synthesis Studies were selected, reviewed and extracted by two independent reviewers using a standardised extraction form. They assessed risk of bias using the revised Cochrane Risk of Bias Tool for Randomised Trials (ROB 2.0). Meta-analysis was performed using a random effects model. I2 was used to evaluate heterogeneity. A subgroup analysis was conducted to investigate the dose-response effect of ibuprofen. Sensitivity analyses were performed by restricting studies with a low risk of bias and by using a fixed effects model (using STATA 14.1 software). Publication bias was assessed using funnel plot asymmetry and Egger regression tests. Trial Sequential Analysis (TSA) was conducted to assess the risk of random errors and to determine the required sample size, which helped to evaluate if evidence is conclusive. Quality of evidence was rated by GRADE pro GDT software.Results Thirteen randomised clinical studies that investigated the efficacy of oral premedication (30-60 minutes prior) with a single NSAID in promoting the anaesthetic success of IANBs involving 1,174 patients between the age of 14 to 68 were included. Of these, 1,034 were evaluated as a comparison to placebo while the remainder were comparisons to various medications.Among the 13 RCTs, eight showed a low risk of bias, four trials showed a high risk and the remaining one showed unclear risk. For all studies, intervention provision and outcome measurement were performed at the same visit with no follow-up periods. Of the 1,034 participants, 493 (47.6%) reported successful anaesthetic outcomes. Quantitative pooling of the results showed that the use of any NSAID significantly increased the anaesthetic success of IANB compared with placebo (RR=1.96; 95% CI, 1.63-2.35; I2= 6.8%).Subgroup analysis of nine trials showed that ibuprofen, diclofenac 50mg and ketorolac 10mg had a statistically significantly effect in increasing the anaesthetic success of IANBs compared with placebo (RR= 1.83, 95% CI, 1.43-2.35, I2= 20.8%; RR= 2.56, 95% CI, 1.46-4.50, I2= 44.8%; and RR= 2.07, 95% CI, 1.47-2.90, I2=0% respectively). While Ibuprofen >400mg was significantly more effective than placebo (RR= 1.85; 95% CI, 1.39-2.45; I2=26.7%), ibuprofen <400mg showed no statistical association (RR=1.78; 95% CI, 0.90-3.55; I2=38.70%). Funnel plot showed low publication bias. GRADE evaluation showed that the accumulated evidence for premedication with NSAIDs demonstrated high quality. I2 results showed a low heterogeneity among trials. TSA concluded that the results of the meta-analyses showing premedication with NSAIDs increased the success rate of IANB anaesthesia were valid.Conclusions High quality evidence demonstrated that the oral premedication with NSAIDs increases the success rate of IANB in patients with irreversible pulpitis.
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Affiliation(s)
- Ying J Wong
- Department of Cariology and Comprehensive Care, New York University, College of Dentistry, New York, USA.
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Effect of Premedication on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Systematic Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6587429. [PMID: 30881994 PMCID: PMC6387710 DOI: 10.1155/2019/6587429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/24/2018] [Accepted: 01/14/2019] [Indexed: 12/19/2022]
Abstract
Background Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth. Methods A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary. Results Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis. Conclusion Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.
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