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Janiak M, Gorniewski G, Kowalczyk R, Wasilewski P, Nowakowski P, Trzebicki J. Effect of Intramuscular Tramadol on the Duration of Clinically Relevant Sciatic Nerve Blockade in Patients Undergoing Calcaneal Fracture Fixation: A Randomized Controlled Trial. Healthcare (Basel) 2023; 11:healthcare11040498. [PMID: 36833031 PMCID: PMC9957384 DOI: 10.3390/healthcare11040498] [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: 12/23/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Calcaneal fracture fixation can generate severe postoperative pain and analgesia can be supported by a sciatic nerve block. However, following resolution of the sensory blockade, rebound pain may ensue. The aim of this study was to assess whether an incidental finding of two patients with an extension of the sciatic nerve block beyond 24 h following 100 mg of intramuscular tramadol administration could be confirmed. METHODS Thirty-seven patients scheduled for a calcaneal intramedullary fixation (Calcanail®) were randomly divided into two groups. The tramadol group (n = 19) received a sciatic nerve block with 20 mL of 0.25% bupivacaine and a concomitant dose of 100 mg of intramuscular tramadol, while the control group (n = 18) received an identical sciatic nerve block with concomitant injection of normal saline (placebo). All patients had a spinal anesthesia with light sedation for the procedure. The time to first analgesic request defined as appearance of any pain (NRS > 0) was assessed as the primary endpoint with a clinically relevant expected result of at least 50% elongation in sensory blockade. RESULTS The median time to first analgesic request from time of blockade in the tramadol group was 670 min compared with 578 min in the control group. The result was clinically not relevant and statistically not significant (p = 0.17). No statistical difference could be demonstrated in the time to first opioid request, although a trend for opioid sparing in the tramadol group could be seen. Total morphine consumption in the first 24 h was also statistically insignificant (the tramadol group 0.066 mg kg-1 compared with 0.125 mg kg-1 in the control group). In conclusion, intramuscular tramadol does not extend the duration of analgesia of a sciatic nerve block following a calcaneal fracture fixation beyond 2 h and an opioid sparing effect could not be demonstrated in this trial.
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Affiliation(s)
- Marek Janiak
- 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-005 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-502-1724
| | - Grzegorz Gorniewski
- Department of Anesthesiology and Intensive Care Education, Medical University of Warsaw, 02-007 Warsaw, Poland
| | - Rafal Kowalczyk
- 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Piotr Wasilewski
- Department of Orthopedics and Traumatology, Medical University of Warsaw, 02-005 Warsaw, Poland
| | - Piotr Nowakowski
- Department of Anesthesiology and Intensive Care, Gruca Orthopedic and Trauma Teaching Hospital, 05-400 Otwock, Poland
| | - Janusz Trzebicki
- 1st Department of Anesthesiology and Intensive Care, Medical University of Warsaw, 02-005 Warsaw, Poland
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Gómez-Sánchez E, Franco-de la Torre L, Bologna-Molina RE, Molina-Frechero N, Serafín-Higuera NA, Hernández-Gómez A, Alonso-Castro ÁJ, Sat-Muñoz D, Isiordia-Espinoza MA. Local Tramadol Improves the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis. Healthcare (Basel) 2022; 10:healthcare10101867. [PMID: 36292314 PMCID: PMC9602303 DOI: 10.3390/healthcare10101867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/12/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
Symptomatic irreversible pulpitis is a painful clinical condition with a broad inflammatory component. Dental anesthesia in these patients is affected by the inflammatory process, reporting a high incidence of anesthesia failure. The aim of this systematic review and meta-analytical evaluation was to determine the effect of pre-treatment with tramadol in patients with symptomatic irreversible pulpitis, as well as for pain control and adverse effects. This study was registered in PROSPERO (ID: CRD42021279262). PubMed was consulted to identify clinical investigations comparing tramadol and placebo/local anesthetics in patients with symptomatic irreversible pulpitis. Data about the anesthesia, pain control, and adverse effects were extracted. Both the anesthetic success index and the adverse effects of local tramadol and placebo were compared with the Mantel−Haenszel test and odds ratio. Data analysis showed that the local administration of tramadol increased the anesthetic success rate when compared to placebo in patients with symptomatic irreversible pulpitis (n = 228; I2 = 0; OR = 2.2; 95% CIs: 1.30 to 3.79; p < 0.004). However, local administration of tramadol increased the risk of adverse effects when compared to placebo/local anesthetics (n = 288; I2 = 0; OR = 7.72; 95% CIs: 1.37 to 43.46; p < 0.02). In conclusion, this study shows that the local administration of tramadol increases the anesthetic success index when compared to placebo in patients with symptomatic irreversible pulpitis.
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Affiliation(s)
- Eduardo Gómez-Sánchez
- Departamento de Ciencias Fisiológicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad (UDG-CA-874), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Lorenzo Franco-de la Torre
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
| | | | - Nelly Molina-Frechero
- Departamento de Salud, Laboratorio de Cariología y Medicina Oral, Universidad Autónoma Metropolitana-Xochimilco, Mexico City 04960, Mexico
| | | | - Adriana Hernández-Gómez
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
- Departamento de Ciencias de la Salud, División de Ciencias Biomédicas, Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos 47620, Jalisco, Mexico
| | - Ángel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato City 36050, Guanajuato, Mexico
| | - Daniel Sat-Muñoz
- Departamento de Ciencias Fisiológicas, División de Disciplinas Básicas para la Salud, Cuerpo Académico Ciencias Morfológicas en el Diagnóstico y Tratamiento de la Enfermedad (UDG-CA-874), Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara 44340, Jalisco, Mexico
| | - Mario Alberto Isiordia-Espinoza
- Instituto de Investigación en Ciencias Médicas, Departamento de Clínicas, División de Ciencias Biomédicas, Cuerpo Académico Terapéutica y Biología Molecular (UDG-CA-973), Centro Universitario de los Altos, Universidad de Guadalajara, Tepatitlán de Morelos, Guadalajara 47620, Jalisco, Mexico
- Correspondence: ; Tel.: +52-(378)-119-57-86
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Dexamethasone Increases the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis. Pharmaceuticals (Basel) 2022; 15:ph15070878. [PMID: 35890176 PMCID: PMC9315658 DOI: 10.3390/ph15070878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/25/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
Inferior alveolar nerve block (IANB) has a high failure rate in subjects with symptomatic irreversible pulpitis (SIP). It has been suggested that drugs with anti-inflammatory activity could improve the efficacy of the anesthetic used for IANB. The aim of this study was to assess the effect of dexamethasone on the success of dental anesthesia in patients with SIP. An information search was performed using PubMed and Google Scholar. The risk of bias of the included studies was evaluated with the Cochrane Collaboration’s risk-of-bias tool. The anesthetic success rate, pain intensity (VAS), and adverse effects were extracted. Data were analyzed using the Mantel−Haenszel test and odds ratio or the inverse variance and standardized mean difference. Dexamethasone increased the anesthetic success in comparison with placebo (n = 502; p < 0.001; OR = 2.59; 95% CIs: 1.46 to 4.59). Moreover, patients who were given dexamethasone had lower pain scores at 6 h (n = 302; p < 0.001; MD= −1.43; 95% CIs: −2.28 to −0.58), 12 h (n = 302; p < 0.0001; MD = −1.65; 95% CIs: −2.39 to −0.92), and 24 h (n = 302; p < 0.0008; MD = −1.27; 95% CIs: −2.01 to −0.53) when compared with placebo. In conclusion, the systemic administration of dexamethasone increases the anesthetic success rate and improves pain management in patients with SIP.
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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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Mane RJ, Choi JJE, Sharpe-Davidson WF. Tramadol as a local anaesthetic agent in dentistry: A systematic review of local and systemic adverse effects. Saudi Dent J 2021; 33:842-852. [PMID: 34938024 PMCID: PMC8665189 DOI: 10.1016/j.sdentj.2021.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/14/2021] [Accepted: 09/06/2021] [Indexed: 10/27/2022] Open
Abstract
Tramadol is an effective alternative local anaesthetic (LA) agent available in dentistry. This review aims to help guide practice by providing clinicians with relevant data regarding adverse effects (AE) associated with locally administered tramadol in the oral environment. A systematic search of three electronic databases was performed to identify relevant studies reporting AE associated with locally administered tramadol in the oral setting. Selected studies were reviewed and included based on inclusion and exclusion criteria. Data collected included: publication year, study design, participant numbers, adverse effects and follow-up duration. Fifteen articles were included comprising of 547 tramadol participants across eight exodontia and seven non-exodontia studies. Thirty-eight associated AE were reported. Nausea was the most commonly reported (4.6%), followed by dizziness (1.3%), vomiting (0.7%) and local erythema (0.4%). No other AE were reported. The prevalence of total AE was similar in ≥ 50 mg tramadol doses (7.2-7.3%); however the total affected number is not dose dependent. The prevalence of AE and affected participants was less when tramadol was used as a sole LA rather than as an adjunct (5.6% vs. 7.9% and 3.4-5.6% vs. 6.3%, respectively). Thus, tramadol is a safe LA agent with a low prevalence of AE when administered in the dental setting.
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Affiliation(s)
- Robert Jonathon Mane
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 310 Great King Street, North Dunedin, Dunedin 9016, New Zealand)
| | - Joanne Jung Eun Choi
- Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, 310 Great King Street, North Dunedin, Dunedin 9016, New Zealand)
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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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Aksoy F, Ege B, Tosun S. The effect of pre-operative submucosal administration of dexamethasone, tramadol, articaine on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: A randomized, double-blind placebo-controlled clinical trial. Int Endod J 2021; 54:1982-1992. [PMID: 34347895 DOI: 10.1111/iej.13604] [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: 03/29/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
AIM To establish the effects of submucosal tramadol, dexamethasone and articaine on the success of inferior alveolar nerve blocks (IANB) during root canal treatment of mandibular molars with symptomatic irreversible pulpitis (SIP). METHODOLOGY In this randomized double-blind, controlled clinical trial, 120 patients with the diagnosis of SIP in their mandibular first or second molars were included and randomly divided into four groups (n = 30). The control group received normal saline and three experimental groups received a single dose of dexamethasone (8 mg/2 mL), or tramadol (100 mg/2 mL) or articaine (4% / 2 mL). The pre-operative pain levels of the patients were measured with the Heft-Parker visual analogue scale (HP VAS). All patients received standard IANB of 4% articaine with 1:200000 epinephrine. Following the observation of lip numbness, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars. After 15 min, standard root canal treatment was initiated, and the pain intensity levels recorded from the access cavity preparation to pulp extirpation were measured with HP VAS. The duration of the anaesthesia was also evaluated. The experimental groups were compared using one-way ANOVA or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using the Tukey Multiple Comparison test. The Chi-square test was used to compare the categorical variables. RESULTS The submucosal administration of articaine significantly increased the success rate to 63% in comparison with the control group that received submucosal saline (p < .05). The success rate of pulpal anaesthesia was 37% in the control group, 57% in the tramadol group and 47% in the dexamethasone group, with no significant difference in the success rate among these groups. In the dexamethasone group, the duration of the anaesthetic effect of IANB was significantly longer than those in the other groups (p < .001). CONCLUSIONS In patients with SIP, pre-operative submucosal administration of articaine increased the success rate of IANB, while administration of dexamethasone increased the duration of anaesthesia. These agents can be used in cases where effective anaesthesia cannot be obtained during root canal treatments.
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Affiliation(s)
- Fatih Aksoy
- Department of Endodontics, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Bilal Ege
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adıyaman University, Adıyaman, Turkey
| | - Samet Tosun
- Department of Endodontics, Faculty of Dentistry, Pamukkale University, Denizli, Turkey
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Postanesthetic Cold Sensibility Test as an Indicator for the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis of Mandibular Molars. Int J Dent 2021; 2021:9913221. [PMID: 34239568 PMCID: PMC8241520 DOI: 10.1155/2021/9913221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/16/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
Materials and Methods This study was conducted on the mandibular first molars of 54 patients (35 males and 19 females) with signs and symptoms of SIP. To anesthetize the affected molars, all patients received a single carpule of 2% lidocaine with 1 : 100000 epinephrine using a standardized inferior alveolar nerve block (IANB) technique. The cold test was conducted before beginning the endodontic procedures and after gaining lip numbness, and the results were reported as either positive or negative response. The root canal preparation (RCP) was then initiated and the patients' responses were documented (Gold standard test). True pulpal anesthetic failure was described as a pain perception during the access cavity and pulp tissue removal. True pulpal anesthesia was defined as no pain or discomfort during the access cavity and pulp extirpation. The qualitative variables frequencies and percentages of patients with true/false positive and negative responses were determined and then compared using the Chi-square test. The pain perception of male and female patients during the cold test and gold standard was compared using the Fisher exact test. The following diagnostic parameters were calculated using an online statistical calculator: sensitivity, specificity, predictive values, accuracy, and Youden index. In addition, a receiver operating characteristic curve (ROC) was constructed and the area under the curve (AUC) was calculated. Results The overall percentage of actual failure of pupal anesthesia was 57%. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden index for the cold test were 0.87, 0.91, 0.93, 0.84, 0.89, and 0.78, respectively. There was no statistically significant difference between male and female patients regarding their responses to cold testing and the gold standard test (P > 0.05). Besides, the patients' reactions to the cold test were significantly matched with their reactions to the gold standard test (P < 0.05). The area under the ROC was mostly 0.9. Conclusion The cold test could be a valuable and accurate method for predicting the potential pupal anesthesia before beginning the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis, particularly after obtaining postanesthetic soft tissue numbness.
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Efficacy of submucosal tramadol and lidocaine on success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis. Odontology 2020; 108:433-440. [DOI: 10.1007/s10266-020-00485-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
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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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Mousavi SA, Sadaghiani L, Shahnaseri S, Zandian A, Farnell DJJ, Vianna ME. Effect of magnesium sulphate added to lidocaine on inferior alveolar nerve block success in patients with symptoms of irreversible pulpitis: a prospective, randomized clinical trial. Int Endod J 2019; 53:145-153. [DOI: 10.1111/iej.13186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/10/2019] [Indexed: 11/30/2022]
Affiliation(s)
- S. A. Mousavi
- Department of Endodontics Dental Research Center Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - L. Sadaghiani
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
| | - S. Shahnaseri
- Department of Oral and Maxillofacial Surgery Dental Implant Research Center School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - A. Zandian
- Department of Endodontics Dental Research Center Dental Research Institute School of Dentistry Isfahan University of Medical Sciences Isfahan Iran
| | - D. J. J. Farnell
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
| | - M. E. Vianna
- School of Dentistry College of Biomedical and Life Sciences Cardiff University Cardiff UK
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12
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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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13
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Aksoy F, Ege B. The effect of pretreatment submucosal injections of tramadol and dexamethasone on post‐endodontic pain in mandibular molar teeth with symptomatic irreversible pulpitis: a randomized controlled clinical trial. Int Endod J 2019; 53:176-185. [DOI: 10.1111/iej.13246] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022]
Affiliation(s)
- F. Aksoy
- Department of EndodonticsFaculty of DentistryAdiyaman University Adiyaman Turkey
| | - B. Ege
- Department of Oral and Maxillofacial Surgery Faculty of Dentistry Adiyaman University Adiyaman Turkey
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Kandemir Demirci G, Kaval ME, Güneri P, Çalışkan MK. Treatment of immature teeth with nonvital pulps in adults: a prospective comparative clinical study comparing MTA with Ca(OH) 2. Int Endod J 2019; 53:5-18. [PMID: 31397907 DOI: 10.1111/iej.13201] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Abstract
AIM To evaluate and compare the influence of various predictors on outcomes of apexification using either mineral trioxide aggregate (MTA) or calcium hydroxide (CH) in permanent immature anterior teeth with necrotic pulps and periapical lesions of adults. METHODOLOGY Ninety immature teeth with necrotic pulps and periapical lesions on adult patients (aged 18-40 years) were treated with MTA (45 teeth) or CH (45 teeth) between 2015 and 2018. Patients of both groups were recalled for follow-up examinations after the first intervention at 1,3,6 and 12 months for the first year, every 6 months for the second year and every year thereafter until the end of the study (median 32.3 months). The treatment outcome based on clinical and radiographic criteria was assessed by calibrated examiners and dichotomized as 'healed+healing' or 'not healed'. The age, gender, stage of root development, preoperative signs and symptoms of apical periodontitis and size of periapical lesion were recorded. The cumulative success proportion and mean time were analysed with the Kaplan-Meier test. The generalized logrank statistic was used to describe prognostic clinical variables. Fisher's exact test was applied for the evaluation of the healing rates. RESULTS Thirty-nine of the 45 teeth treated with MTA were available for recall. Of these, 29 teeth (74%) revealed calcific apical barrier formation with complete resolution of periapical lesions, 7 teeth (18%) were healing, and 3 teeth (8%) had persistent disease. Thirty-four of the 45 teeth in the CH group were available for recall. Of these, 27 teeth (79%) had complete healing of periapical lesions and had calcific barrier formation, 4 teeth (12%) were healing, and the remaining 3 teeth (9%) had not healed. The survival rate of teeth treated with MTA was similar to the survival rates observed in teeth treated with CH (90% and 91%, respectively, P > 0.05). The generalized logrank statistic revealed that the cumulative success rate of both materials was not significantly different (P > 0.05). None of the tested predictors had an influence on the treatment outcomes of teeth in both groups (P > 0.05). CONCLUSIONS Apexification with both MTA and CH was associated with similar treatment outcomes. MTA may be proposed as a material for apexification treatment in immature teeth of adult patients due to the shorter treatment time associated with its use.
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Affiliation(s)
- G Kandemir Demirci
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - M E Kaval
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
| | - P Güneri
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Ege University, Izmir, Turkey
| | - M K Çalışkan
- Department of Endodontology, School of Dentistry, Ege University, Izmir, Turkey
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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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Cho SY, Choi W, Kim J, Kim ST, Kim HJ, Jung IY. Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia. Clin Oral Investig 2018; 23:1061-1065. [PMID: 29943368 DOI: 10.1007/s00784-018-2532-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study was aimed at evaluating the anesthetic success rates in various regions of soft tissue after inferior alveolar nerve (IAN) block and comparing the success rates of soft tissue anesthesia with those of pulpal anesthesia to find correlations. MATERIALS AND METHODS Fifty-nine dental students received an IAN block injection. A total of four test sites were used for soft tissue anesthesia using a pressure algometer (PA): the corner of the lower lip vermilion border (LL); the buccal-attached gingiva of the lateral incisor (BGI), the molar (BGM), and the lingual gingiva (LG). The lateral incisor (LI) and the first molar (M1) were evaluated for pulpal anesthesia using an electric pulp tester. To evaluate whether soft tissue anesthesia can be an indicator of pulpal anesthesia, the positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS The highest success rate for soft tissue anesthesia was seen on the LG (93.9%), followed by LL (79.6%), BGI (53.1%), and BGM (14.3%). The PPVs of LL for the M1 and Ll were 74.4 and 59.0%. The NPVs for the M1 and LI were much higher in the LL (90.0 and 100%, respectively) than in the BGI (56.5 and 69.6%, respectively). CONCLUSIONS The highest success rate was found in the LG. Lip numbness was not an indicator of pulpal anesthesia of M1 and LI. However, if the LL was not anesthetized, the probabilities of failed pulpal anesthesia were very high in the LI and M1. CLINICAL RELEVANCE The clinicians need to consider not doing an additional lingual nerve block after IAN block.
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Affiliation(s)
- Sin-Yeon Cho
- Department of Conservative Dentistry, National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, South Korea
| | - Wonwoo Choi
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Junyoung Kim
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Sung-Taek Kim
- Department of Oral Medicine, TMJ and Orofacial Pain Clinic, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Hee-Jin Kim
- Division in Anatomy and Developmental Biology, Department of Oral Biology, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Il-Young Jung
- Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, South Korea.
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Vieira WA, Paranhos LR, Cericato GO, Franco A, Ribeiro MAG. Is mepivacaine as effective as lidocaine during inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. Int Endod J 2018; 51:1104-1117. [PMID: 29577321 DOI: 10.1111/iej.12926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
Abstract
This study aimed to compare the effectiveness of mepivacaine and lidocaine for pulpal anaesthesia and pain control when administered via an inferior alveolar nerve block during the root canal treatment of mandibular molars in patients with symptomatic irreversible pulpitis. A research protocol was developed and registered in PROSPERO. The systematic search was conducted during May 2017 in eight databases. The studies were selected based on inclusion and exclusion criteria. Two examiners analysed the sample independently, decided the eligibility for inclusion and classified the articles according to their quality. Statistical analysis was performed with Mantel-Haenszel and I-square (I2 ) tests considering a confidence interval of 95%. The initial sample consisted of 1130 articles, out of which four were eligible. The articles were published between 1993 and 2016. For both pulpal anaesthesia and pain control, there was no significant difference between mepivacaine and lidocaine (P = 0.843, I2 = 0%, and P = 0.183, I2 = 21.1%, respectively). Mepivacaine and lidocaine were similarly effective for pulpal anaesthesia and pain control after inferior alveolar nerve blocks for root canal treatment.
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Affiliation(s)
- W A Vieira
- Department of Dentistry, Federal University of Sergipe, Aracaju, SE, Brazil
| | - L R Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlandia, Uberlândia, MG, Brazil
| | - G O Cericato
- Department of Dentistry, Faculdade Meridional (IMED), Passo Fundo, RS, Brazil
| | - A Franco
- Department of Stomatology, Federal University of Paraná, Curitiba, PR, Brazil
| | - M A G Ribeiro
- Department of Dentistry, Federal University of Sergipe, Aracaju, SE, Brazil
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Sakhaeimanesh V, Khazaei S, Kaviani N, Saatchi M, Shafiei M, Khademi A. Anesthetic Efficacy of Articaine and Ketamine for Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Prospective Randomized Double-Blind Study. IRANIAN ENDODONTIC JOURNAL 2017; 12:449-453. [PMID: 29225640 PMCID: PMC5722109 DOI: 10.22037/iej.v12i4.16224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction The aim of this prospective, randomized, double-blind study was to investigate the effect of articaine combined with ketamine on the success rate of inferior alveolar nerve block (IANB) in posterior mandible teeth with symptomatic irreversible pulpitis. Methods and Materials Forty two adult patients with diagnosis of symptomatic irreversible pulpitis of a mandibular posterior tooth were selected. The patients received two cartridges of either containing 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL 50 mg/mL ketamine hydrochloride (A-ketamine group) or 3.2 mL 4% articaine with epinephrine 1:200000 and 0.4 mL normal saline (A-saline group) using conventional IANB injections. Access cavity preparation started 15 min after injection. Lip numbness was required for all the patients. Success was considered as no or mild pain on the basis of Heft-Parker visual analog scale recordings upon access cavity preparation or initial instrumentation. Data were analyzed by independent student t, Mann-Whitney and Chi-square tests. Results The success rates were 55% and 42.9% for A-ketamine and A-saline group, respectively, with no significant differences between the two groups (P=0.437). Conclusion Adding 0.4 mL 50 mg/mL ketamine hydrochloride to the articaine local anesthetic did not increase the efficacy of IANB for posterior mandibular teeth with symptomatic irreversible pulpitis.
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Affiliation(s)
- Vahid Sakhaeimanesh
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saber Khazaei
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Naser Kaviani
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Saatchi
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Shafiei
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbasali Khademi
- Department of Endodontics, Dental Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis. Pain Res Manag 2017; 2017:3108940. [PMID: 28694714 PMCID: PMC5488488 DOI: 10.1155/2017/3108940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/24/2017] [Accepted: 05/21/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The inferior alveolar nerve block (IANB) is the most common anesthetic technique used on mandibular teeth during root canal treatment. Its success in the presence of preoperative inflammation is still controversial. The aim of this study was to evaluate the sensitivity, specificity, predictive values, and accuracy of three diagnostic tests used to predict IANB failure in symptomatic irreversible pulpitis (SIP). METHODOLOGY A cross-sectional study was carried out on the mandibular molars of 53 patients with SIP. All patients received a single cartridge of mepivacaine 2% with 1 : 100000 epinephrine using the IANB technique. Three diagnostic clinical tests were performed to detect anesthetic failure. Anesthetic failure was defined as a positive painful response to any of the three tests. Sensitivity, specificity, predictive values, accuracy, and ROC curves were calculated and compared and significant differences were analyzed. RESULTS IANB failure was determined in 71.7% of the patients. The sensitivity scores for the three tests (lip numbness, the cold stimuli test, and responsiveness during endodontic access) were 0.03, 0.35, and 0.55, respectively, and the specificity score was determined as 1 for all of the tests. Clinically, none of the evaluated tests demonstrated a high enough accuracy (0.30, 0.53, and 0.68 for lip numbness, the cold stimuli test, and responsiveness during endodontic access, resp.). A comparison of the areas under the curve in the ROC analyses showed statistically significant differences between the three tests (p < 0.05). CONCLUSION None of the analyzed tests demonstrated a high enough accuracy to be considered a reliable diagnostic tool for the prediction of anesthetic failure.
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De Pedro-Muñoz A, Mena-Álvarez J. The effect of preoperative submucosal administration of tramadol on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: a randomized, double-blind placebo-controlled clinical trial. Int Endod J 2017; 50:1134-1142. [DOI: 10.1111/iej.12755] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- A. De Pedro-Muñoz
- Private Practice in Endodontics; Alfonso X el Sabio University; Madrid Spain
| | - J. Mena-Álvarez
- Department of Endodontics; Faculty of Health Sciences; Alfonso X el Sabio University; Madrid Spain
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How Effective Is Supplemental Intraseptal Anesthesia in Patients with Symptomatic Irreversible Pulpitis? J Endod 2016; 42:1453-7. [DOI: 10.1016/j.joen.2016.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/16/2016] [Accepted: 07/04/2016] [Indexed: 11/23/2022]
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