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Kamali M, Parirokh M, Manochehrifar H, Nakhaei N. Assessing the Impact of Mandibular Molar Root Length on Success in Supplemental Intraligamentary Injection for Irreversible Pulpitis. IRANIAN ENDODONTIC JOURNAL 2024; 19:28-34. [PMID: 38223836 PMCID: PMC10787187 DOI: 10.22037/iej.v19i1.42660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/23/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
Introduction This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following an inferior alveolar nerve (IAN) block. Various factors, including anatomical location, tooth type, and anesthetic solution, may affect supplemental anesthesia success. Materials and Methods A total of 251 patients diagnosed with irreversible pulpitis in mandibular first or second molars underwent buccal infiltration anesthesia (4% articaine with 1:100,000 epinephrine) after IAN block injection (3% prilocaine and 0.03 IU/mL of felypressin). Fifty patients experiencing pain during access cavity preparation received supplemental intraligamentary injection (0.3 mL of 2% lidocaine with 1:80,000 epinephrine) at each mesial and distal line angle. The root length of treated teeth was recorded using an apex locator. Data analysis involved independent t-tests, Chi-square tests, and logistic regression. Results Successful supplemental intraligamentary injection was observed in 21 (42%) out of 50 patients. No significant correlation was found between the mean length of mesiobuccal (P=0.61), mesiolingual (P=0.34), or distal (P=0.60) canals of mandibular molars and the injection's success. Logistic regression analysis, however, revealed a significant impact of mesiolingual canal length on the success rate [OR 0.09 (0.01-0.79), P=0.030]. Conclusion The root length of mandibular first and second molars does not significantly affect the success of supplemental intraligamentary injection.
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Affiliation(s)
- Marzieh Kamali
- Department of Endodontics, School of Dentistry, Guilan University of Medical Sciences, Iran;
| | - Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran;
| | - Hamed Manochehrifar
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran;
| | - Nouzar Nakhaei
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
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Parirokh M, Hatami N, Nakhaee N, Abbott P. Comparing the Efficacy of Premedication with Ibuprofen in Combination with an Inferior Alveolar Nerve Block and Primary Buccal Infiltration in Mandibular Molars with Irreversible Pulpitis: A Triple-blinded Randomized Clinical Trial. IRANIAN ENDODONTIC JOURNAL 2022; 17:165-171. [PMID: 36703687 PMCID: PMC9868997 DOI: 10.22037/iej.v17i4.37438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/09/2022] [Accepted: 09/17/2022] [Indexed: 01/28/2023]
Abstract
Introduction This study aimed to determine the success rate of the combination of buccal infiltration (BI) and inferior alveolar nerve block (IANB) injections in irreversible pulpitis in mandibular molars after premedication with ibuprofen. Materials and Methods From 132 patients participated in the study, 120 patients were included. One hour before root canal treatment, patients with mandibular molars with symptomatic irreversible pulpitis received either a 600 mg ibuprofen capsule or a placebo. All patients received 2% lidocaine with 1:80000 epinephrine and 4% articaine with 1:100000 epinephrine for IANB and BI, respectively. Patients' pain was evaluated using the Heft-Parker visual analog scale during the preparation of access cavity, exposure of pulp, and instrumentation of root canal. The success of anesthesia was defined as the absence of pain or mild pain. The Chi-square and t-test were employed for data analysis. Results The difference between patient age and gender in the two groups was not significant (P>0.05). The anesthesia success rate was 85% in the premedicated and 70% in the placebo group, with statistically significant results (P=0.049). Conclusion Based on this triple-blinded randomized clinical study, mandibular molars with irreversible pulpitis were not thoroughly anesthetized by a combination of IANB+BI after premedication with ibuprofen (600 mg), even though anesthesia success was improved significantly by ibuprofen premedication.
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Affiliation(s)
- Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran;
| | - Nima Hatami
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran; ,Corresponding author: Nima Hatami, Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran. E-mail:
| | - Nouzar Nakhaee
- Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran;
| | - Paul.v Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
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Khademi A, Memarzadeh B, Saatchi M, Aggarwal V, Shafiee M, Minaiyan M, Omranifard V. Anesthetic Success Rate of Inferior Alveolar Nerve Block for Mandibular Molars with Symptomatic Irreversible Pulpitis in Women Taking Antidepressants. IRANIAN ENDODONTIC JOURNAL 2022; 17:52-56. [PMID: 36704013 PMCID: PMC9868978 DOI: 10.22037/iej.v17i2.34921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/08/2022] [Accepted: 02/12/2022] [Indexed: 01/28/2023]
Abstract
Introduction This study sought to evaluate the success rate of inferior alveolar nerve block (IANB) during the endodontic management of mandibular molars with symptomatic irreversible pulpitis in women taking selective serotonin reuptake inhibitor (SSRI) antidepressants. Materials and Methods Ninety adult female patients over 18 years of age who were diagnosed with symptomatic irreversible pulpitis of a mandibular molar were recruited in this study. The patients were equally assigned to SSRI user group (including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), who had taken an SSRI, and non-SSRI user group, who had not taken any SSRIs at all. All patients in both groups received 3.6 mL of 2% lidocaine with 1:80,000 epinephrine using conventional IANB injection. Access cavity was prepared 15 min after the injection. Lip numbness was necessary for all patients. Success was determined as no or mild pain upon access cavity preparation and/or instrumentation based on the Heft-Parker visual analog scale recordings. Data were analyzed using the chi-square test Mann-Whitney U test, and t-test. Results The success rate was 55.6% for SSRI users and 44.4% for non-SSRI users, and no statistically significant difference was observed between the two groups (x 2=1.1, P=0.292). Conclusions Based on the results of this study, taking SSRI antidepressants could not affect the anesthetic success rate of IANB for mandibular molars with symptomatic irreversible pulpitis in women.
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Affiliation(s)
- Abbasali Khademi
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran;
| | - Bahareh Memarzadeh
- Department of Endodontics, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran;
| | - Masoud Saatchi
- Department of Endodontics, Dental Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran; ,Corresponding author: Masoud Saatchi, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran. Zip Code: 81746-73461. E-mail:
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India;
| | - Maryam Shafiee
- Department of Endodontics, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran;
| | - Mohsen Minaiyan
- Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, Iran;
| | - Victoria Omranifard
- Department of Psychiatry, Behavioral Science Research center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Shadmehr E, Hashemi S, Hashemi SS, Chung YJ, Goudarzi A, Khademi A. The Effect of Adding Clonidine to Articaine and Epinephrine on Post-treatment Pain: A Randomized Clinical Trial Study. IRANIAN ENDODONTIC JOURNAL 2021; 16:210-216. [PMID: 36704779 PMCID: PMC9735314 DOI: 10.22037/iej.v16i4.33555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 07/26/2021] [Accepted: 08/19/2021] [Indexed: 01/28/2023]
Abstract
Introduction Articaine is reported to have a fast onset and a short-acting pulpal anesthesia in inferior alveolar nerve blocks. Clonidine is an α 2-adrenoceptor agonist and is used as an adjunct to enhance the anesthetic efficacy and induce greater analgesia. In an attempt to search for more effective ways to achieve profound analgesia after root canal treatment, this randomized clinical trial assessed the efficacy of clonidine added to articaine/epinephrine solution on post-operative pain relief after root canal treatment in mandibular molars with irreversible pulpitis. Materials and Methods Our randomized clinical trial study enrolled one hundred patients with symptomatic irreversible pulpitis in mandibular molars. They were divided into two groups, each group received either 0.2 mL 150 µg/mL clonidine or distilled water added to 1.8 mL of 4% articaine with 1:100,000 epinephrine cartridge. The alveolar nerve block in the two groups was administered by the same clinician and the subject's pain scores were recorded at 6, 12, 24, 48 and 72 h post-operatively using a Heft-Parker visual analog scale. Data were analyzed using t, chi-square and repeated-measures ANOVA statistical tests. Results The mean pain scores for clonidine group were significantly lower than control at all the time intervals after treatment (P<0.05). We did not notice any clinical and there were no complaints from the patients either. Conclusion Based on this randomized clinical trial study the addition of clonidine to the articaine/epinephrine solution using an inferior alveolar nerve block during root canal treatment in mandibular molars with irreversible pulpitis may be effective in reducing post-operative pain.
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Affiliation(s)
- Elham Shadmehr
- Department of Endodontics and Periodontics, Division of Endodontics, School of Dentistry, University of California, San Francisco, USA;,Corresponding author: Elham Shadmehr, UCSF Preventive & Restorative Dental Science, School of Dentistry, 707 Parnassus Avenue, D3214, San Francisco, CA 94143-0758, USA
| | - Sara Hashemi
- Dental Students' Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran;
| | | | - Yoo Jung Chung
- School of Dentistry, University of California, San Francisco, USA;
| | | | - Abbasali Khademi
- Dental Research Center, Department of Endodontics, Dental School, Isfahan University of MedicalSciences, Isfahan, Iran
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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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Sharifi R, Godiny M, Mozaffari HR, Safaei M, Hatam R, Veisi M. Effect of Topical Application of Dentol Drop on the Success of Inferior Alveolar Nerve Block for Teeth with Irreversible Pulpitis: A Double-blind Randomized Clinical Trial. IRANIAN ENDODONTIC JOURNAL 2019; 14:96-103. [PMID: 36855449 PMCID: PMC9968381 DOI: 10.22037/iej.v14i2.22531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/06/2019] [Accepted: 02/23/2019] [Indexed: 03/02/2023]
Abstract
Introduction The failure rate of inferior alveolar nerve (IAN) block is high for mandibular molars with irreversible pulpitis. This double-blind, randomized, clinical trial aimed to assess the effect of topical application of Dentol drop on the rate of successful anaesthesia of mandibular molars with irreversible pulpitis due to deep carious lesions. Methods and Materials Seventy-two patients with mandibular first and second molars with irreversible pulpitis and deep cavitated carious lesions participated in this study. The patients were randomly assigned to the test and control groups (n=36). In the test group, a cotton pellet, dipped in Dentol drop, was placed in the cavity for 10 min. A placebo was used _in the same manner_ in the control group. Level of pain was measured before the intervention, 15 min after anaesthesia (when patients reported numbness at the corner of the mouth), during access cavity preparation, upon pulp exposure and after introduction of the initial file into the root canal; using a Heft-Parker "Visual Analog Scale" (VAS). Data were analysed using ANCOVA. Results Levels of pain were recorded during access cavity preparation (P<0.001), pulp exposure (P<0.001) and file introduction into the canal (P=0.018). In the test (Dentol) group, the obtained levels of pain were significantly lower than those of the corresponding values in the control group. Conclusion Topical application of Dentol drop increased the success rate of IAN block for root canal treatment of mandibular molars with irreversible pulpitis.
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Affiliation(s)
- Roohollah Sharifi
- Department of Endodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran;
| | - Mostafa Godiny
- Department of Endodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran; ,Corresponding author: Mostafa Godiny, Department of Endodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran. E-mail:
| | - Hamid Reza Mozaffari
- Department of Oral and Maxillofacial Medicine, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran; , Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran;
| | - Mohsen Safaei
- Oral and Dental Sciences Research Laboratory, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran;
| | - Reza Hatam
- Department of Endodontics, School of Dentistry, Kermanshah University of Medical Sciences, Kermanshah, Iran;
| | - Mahta Veisi
- Student Research Committee, Dental School, Kermanshah University of Medical Sciences, Kermanshah, Iran
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