Anaesthetic Efficacy of 4% Articaine in Comparison with 2% Lidocaine as Intraligamentary Injections after an Ineffective Inferior Alveolar Nerve Block in Mandibular Molars with Irreversible Pulpitis: A Prospective Randomised Triple-Blind Clinical Trial

The objective of the current study was to compare the anaesthetic efficacy of supplemental intraligamentary (IL) injection of 4% articaine with that of 2% lidocaine in the mandibular first and second molars with irreversible pulpitis after an ineffective inferior alveolar nerve block injection (IANB) using the same anaesthetic in a randomised triple-blind clinical trial. Seventy-six adult patients, who were diagnosed with irreversible pulpitis in the mandibular first or second molars, were divided into 2 groups and received IANB randomly. In patients with lip numbness, anaesthesia was evaluated with the cold and electrical pulp (EPT) tests, and if the reported number on EPT was below 100, supplemental IL injection was administered using the same anaesthetic. The teeth were retested after 5 minutes. The Heft–Parker visual analogue scale was used to evaluate pain after IANB and IL injections. Statistical analysis was performed using repeated measures ANOVA, chi-square, and independent-sample and paired-sample t-tests. The results showed that there was no significant difference in the success rates of supplemental IL and IANB injections between articaine and lidocaine. Furthermore, there was no significant difference in the success rates of supplemental IL injection with lidocaine between the mandibular first and second molars. However, there was a significant difference in the success rates of supplemental IL injection with articaine between the mandibular first and second molars. Moreover, supplemental IL injections indicated no significant difference in the anaesthetic efficacy between articaine and lidocaine; nevertheless, they were more effective in the mandibular second molars, especially with articaine.

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Effect of Preoperative Pain on Inferior Alveolar Nerve Block

Anesthesia Progress ◽

10.2344/15-00019.1 ◽

2015 ◽

Vol 62 (4) ◽

pp. 135-139 ◽

Cited By ~ 19

Author(s):

Vivek Aggarwal ◽

Mamta Singla ◽

Arunajatesan Subbiya ◽

Paramasivam Vivekanandhan ◽

Vikram Sharma ◽

...

Keyword(s):

Nerve Block ◽

Inferior Alveolar Nerve ◽

Double Blind Study ◽

Inferior Alveolar Nerve Block ◽

Success Rates ◽

Preoperative Pain ◽

Double Blind ◽

Mandibular Molar ◽

Significant Difference ◽

Irreversible Pulpitis

The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. One-hundred seventy-seven adult volunteer subjects, actively experiencing pain in a mandibular molar, participated in this prospective double-blind study carried out at 2 different centers. The patients were classified into 3 groups on the basis of severity of preoperative pain: mild, 1–54 mm on the Heft-Parker visual analog scale (HP VAS); moderate, 55–114 mm; and severe, greater than 114 mm. After IANB with 1.8 mL of 2% lidocaine, endodontic access preparation was initiated. Pain during treatment was recorded using the HP VAS. The primary outcome measure was the ability to undertake pulp access and canal instrumentation with no or mild pain. The success rates were statistically analyzed by multiple logistic regression test. There was a significant difference between the mild and severe preoperative pain group (P = .03). There was a positive correlation between the values of preoperative and intraoperative pain (r = .2 and .4 at 2 centers). The amount of preoperative pain can affect the anesthetic success rates of IANB in patients with symptomatic irreversible pulpitis.

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Comparison of the anaesthetic efficacy of epinephrine concentrations (1 : 80 000 and 1 : 200 000) in 2% lidocaine for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized, double-blind clinical trial

International Endodontic Journal ◽

10.1111/iej.12157 ◽

2013 ◽

Vol 47 (4) ◽

pp. 373-379 ◽

Cited By ~ 13

Author(s):

V. Aggarwal ◽

M. Singla ◽

S. Miglani ◽

S. Kohli

Keyword(s):

Clinical Trial ◽

Nerve Block ◽

Inferior Alveolar Nerve ◽

Inferior Alveolar Nerve Block ◽

Double Blind ◽

Double Blind Clinical Trial ◽

Irreversible Pulpitis

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Anesthetic efficacy of mental/incisive nerve block compared to inferior alveolar nerve block using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis: a randomized clinical trial

Clinical Oral Investigations ◽

10.1007/s00784-018-2500-4 ◽

2018 ◽

Vol 23 (2) ◽

pp. 839-845 ◽

Cited By ~ 5

Author(s):

Sholeh Ghabraei ◽

Ashraf Shubbar ◽

Mohammad H. Nekoofar ◽

Ali Nosrat

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Nerve Block ◽

Inferior Alveolar Nerve ◽

Inferior Alveolar Nerve Block ◽

Irreversible Pulpitis

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Anesthetic efficacy of articaine/epinephrine plus mannitol in comparison with articaine/epinephrine anesthesia for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial

Journal of Dental Research Dental Clinics Dental Prospects ◽

10.15171/joddd.2019.048 ◽

2019 ◽

Vol 13 (4) ◽

pp. 321-326

Author(s):

Sahar Shakoui ◽

mostafa ghodrati ◽

Negin Ghasemi ◽

Tannaz Pourlak ◽

Amir Ardalan Abdollahi

Keyword(s):

Nerve Block ◽

Inferior Alveolar Nerve ◽

Molar Tooth ◽

Controlled Clinical Trial ◽

Inferior Alveolar Nerve Block ◽

Posterior Teeth ◽

Significant Difference ◽

Mandibular Posterior Teeth ◽

Mandibular First Molar ◽

Irreversible Pulpitis

Background. It is difficult to achieve successful pulpal anesthesia in mandibular posterior teeth with symptomatic irreversible pulpitis. The present study aimed to compare the effect of articaine/epinephrine anesthesia with articaine/epinephrine at a combination of 0.5 mol/mL of mannitol for the inferior alveolar nerve block (IANB) in patients presenting with symptomatic irreversible pulpitis in the mandibular first molar tooth. Methods. One hundred patients with symptomatic irreversible pulpitis in the mandibular first molar tooth were selected and randomly divided into two groups based on the injection method. The first group underwent an IANB technique with 1.8 mL of articaine, whereas the second group received 2.9 mL of a formulation, consisting of 1.8 mL of articaine plus 1.1 mL of 0.5 mol/L of mannitol. Fifteen minutes after injections and anesthesia of the lip, the access cavity was prepared. According to the visual analog scale (VAS) criteria, no pain or mild pain for caries removal, pulp exposure and canal instrumentation were regarded as success. Chi-squared test was used for the analysis of data. The level of significance was set at 0.05. Results. The success rate in the group with articaine/epinephrine anesthesia plus mannitol was higher than that in the group with articaine/epinephrine anesthesia, with no significant difference between the two groups (P>0.05). Conclusion. It was concluded, under the limitations of this study, that adding mannitol to articaine/epinephrine anesthesia did not increase the success of IANB in mandibular posterior teeth with symptomatic irreversible pulpitis.

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