A comparison of two anesthesia methods for the surgical removal of maxillary third molars: PSA nerve block technique vs. local infiltration technique

Anesthetic Efficacy of Endo-Ice and Intrapulpal Ice Sticks After Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomized Controlled Study

BACKGROUND

There is a dearth of studies to assess the effectiveness of cryotherapy as a possible adjuvant in anesthesia. Therefore, this study aimed to compare the impact of pretreatment intraoral ice packs, application of Endo-ice, and a combination of Endo-ice and intrapulpal ice sticks use on the effectiveness of pulpal anesthesia as an adjunct in the management of pain and dental anxiety in mandibular second molars with symptomatic irreversible pulpitis (SIP) against traditional inferior alveolar nerve block (IANB) technique.

MATERIALS AND METHODS

The randomized controlled double-blind clinical study comprised of 200 subjects within the age group of 20-45 years with SIP involving mandibular second molars and divided into four groups of 50 each. Conventional IANB was administered in group 1. Intraoral compact ice packs, Endo-ice, and combined use of Endo-ice and intrapulpal ice sticks were employed following conventional IANB in groups 2, 3, and 4, respectively. The intensity of pain and anxiety before and after the intervention was documented using Heft-Parker visual analog scale (HP-VAS) and Corah's Dental Anxiety Scale-Revised (DAS-R).

RESULTS

The average age of the overall study sample was 30.8±2.08 years, and the differences in age and gender distribution were found to be statistically insignificant. The mean HP-VAS scores on access opening and pulpectomy, using ANOVA paired with Tukey's post hoc multiple comparison tests were evaluated to be statistically highly significant (p<0.001). The greatest reduction in HP-VAS score was observed in group 4 receiving combined use of both Endo-ice and intrapulpal ice sticks. While the pretreatment DAS-R score was determined to be statistically insignificant between groups, group 1 subjects had the highest DAS-R score postoperatively (p<0.001). The effectiveness of pulpal anesthesia was found to be 84%, 96%, 92%, and 98% for groups 1 through 4, respectively, and demonstrated a statistically significant difference.

CONCLUSION

The combined use of Endo-ice and intrapulpal ice sticks used as an adjuvant to local anesthesia (LA) was found to be significantly effective in lowering pain compared to the control groups in molars with SIP. Cold administration before and during the procedure was more effective than conventional LA in lowering intraoperative anxiety. Furthermore, the use of Endo-ice and intrapulpal cold after IANB significantly improves the effectiveness of pulpal anesthesia in mandibular second molars with SIP.

Comparative Assessment of Pain during Infiltration by a Two-stage Infiltration Technique: A Double-blind Clinical Trial

AIM

The aim of this study was to assess and compare the pain during infiltration by a modified two-stage local anesthetic infiltration technique under topical anesthesia (TA).

MATERIALS AND METHODS

In this cross-over double-blind study, 30 volunteers participated, where two groups were given single-stage infiltration and the other two had two-stage infiltrations. Depending upon the infiltration technique (one- or two-stage) and the use of TA, the patients were randomly divided into four groups. Local anesthesia (LA) was administered by infiltration into the mucobuccal fold of the maxillary central incisor, and the pain perceived during the infiltration in each group was recorded. The volunteers were recalled after 24 hours to assess the tenderness at the injection site. The volunteers were recalled 2 weeks after infiltration for the subsequent groups to assess the pain for this cross-over study.

RESULTS

A statistically significant difference was observed in the pain perceived when TA was used and when the infiltration was done in two stages. Regarding the pain at the site of injection after 24 hours, no significant difference was observed among the volunteers.

CONCLUSION

Topical anesthesia was effective in reducing the pain of injection when compared to placebo. The pain of injection is further reduced with a two-stage infiltration technique after TA application.

CLINICAL SIGNIFICANCE

Topical anesthesia can be used routinely before infiltration, and LA infiltration injections are less painful if administered in two stages.

Comparison of the Efficacy of Dexamethasone and Methylprednisolone in Infiltration Injection for Postendodontic Pain in Patients with Necrotic Pulp: A Randomized Controlled Clinical Trial

Purpose. Postendodontic pain is one of the problems of root canal therapy. This clinical study aimed to evaluate the effect of infiltration injection of dexamethasone and methylprednisolone on postendodontic pain in patients with necrotic pulp. Methods. A total of 80 volunteers with necrotic pulp teeth were included and assigned to two groups (n = 40). After the administration of local anesthesia and before root canal therapy, in group 1, an infiltration injection of 1 ml of dexamethasone was done and in group 2, an infiltration injection of 1 ml of methylprednisolone was done in the buccal vestibule of each tooth. Patients’ pain was reported using a visual analogue scale at pretreatment and 6, 12, 24, and 48 hours after treatment. Results. There was no significant difference between the two groups receiving dexamethasone and methylprednisolone at pretreatment and 6, 12, 24, and 48 hours after endodontic treatment. Conclusions. Infiltration injection of dexamethasone and methylprednisolone had a significant effect in reducing pain after the endodontic treatment in necrotic pulp teeth, but between 6 and 12 hours, methylprednisolone had significantly more effect on pain relief than dexamethasone. Overall, the use of any of these drugs to reduce postendodontic pain is recommended.

Effect of Intrapapillary Local Anesthetic on Postoperative Pain Following Dental Treatment Under General Anesthesia in Pediatric Patients

OBJECTIVE

This randomized, prospective, blinded study compared pain in children following dental treatment under general anesthesia (GA) using 1 of 2 established analgesia methods.

METHODS

Patients age 4 to 7 years were randomly assigned to a control group (intravenous [IV] analgesics) or experimental group (IV analgesics and intrapapillary local anesthetic infiltrations) between July 2017 and February 2018. During recovery from surgery, Faces, Legs, Activity, Cry, and Consolability (FLACC) scores were recorded upon regaining consciousness and reassessed every 15 minutes until discharge. Overall pain occurrence (FLACC ≥1) and moderate/severe pain occurrence (FLACC ≥4) were analyzed using mixed effects logistic regression (N = 88).

RESULTS

The experimental group had a 17% lower overall pain occurrence than the control group (16 vs 33%; p = .02). Moderate/severe pain occurrence between the groups was not significant (9 vs 22%; p = .23). The dental treatment subjects received (number of completed stainless steel crowns, extractions, and/or pulpotomies) did not significantly affect pain occurrence.

CONCLUSION

Local anesthesia intrapapillary infiltrations around stainless steel crowns decrease overall pain occurrence but not moderate/severe pain occurrence following dental treatment under GA in pediatric patients.

Comparing the Efficiencies of Third Molar Surgeries With and Without a Dentist Anesthesiologist

Two different anesthesia models were compared in terms of surgical duration, safer outcomes, and economic implications. Third molar surgeries performed with and without a separate dentist anesthesiologist were evaluated by a retrospective data analysis of the surgical operative times. For more difficult surgeries, substantially shorter operative times were observed with the dentist anesthesiologist model, leading to a more favorable surgical outcome. An example calculation is presented to demonstrate economic advantages of scheduling the participation of a dentist anesthesiologist for more difficult surgeries.