Anesthetic Efficacy of a Combination of 0.9 M Mannitol Plus 68.8 mg of Lidocaine With 50 μg Epinephrine in Inferior Alveolar Nerve Blocks: A Prospective Randomized, Single Blind Study

Abstract The purpose of this prospective randomized, single blind study was to determine the anesthetic efficacy of 68.8 mg of lidocaine with 50 μg epinephrine compared to 68.8 mg lidocaine with 50 μg epinephrine plus 0.9 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received 2 IAN blocks consisting of a 1.72-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine and a 5-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine (1.72 mL) plus 0.9 M mannitol (3.28 mL) in 2 separate appointments spaced at least 1 week apart. Mandibular anterior and posterior teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings), for each tooth, over the 60 minutes. One hundred percent of the subjects had profound lip numbness with both inferior alveolar nerve blocks. The results demonstrated that the 5 mL-formulation of 68.8 mg lidocaine with 50 μg epinephrine plus 0.9 M mannitol was significantly better than the 1.72-mL formulation of 68.8 mg lidocaine with 50 μg epinephrine for all teeth, except the lateral incisor. We concluded that adding 0.9 M mannitol to a lidocaine with epinephrine formulation was significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol. However, the 0.9 M mannitol/lidocaine formulation would not provide 100% pulpal anesthesia for all the mandibular teeth.

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Anesthetic Efficacy of a Combination of 0.5 M Mannitol Plus 127.2 mg of Lidocaine With 50 μg Epinephrine in Inferior Alveolar Nerve Blocks: A Prospective Randomized, Single-Blind Study

Anesthesia Progress ◽

10.2344/11-00040.1 ◽

2013 ◽

Vol 60 (1) ◽

pp. 3-10 ◽

Cited By ~ 7

Author(s):

Steven Smith ◽

Al Reader ◽

Melissa Drum ◽

John Nusstein ◽

Mike Beck

Keyword(s):

Postoperative Pain ◽

Inferior Alveolar Nerve ◽

Blind Study ◽

Maximum Output ◽

Nerve Blocks ◽

Posterior Teeth ◽

Solution Deposition ◽

The Times ◽

Pulpal Anesthesia ◽

Single Blind

Abstract The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of 127.2 mg lidocaine with 50 μg epinephrine compared to 127.2 mg lidocaine with 50 μg epinephrine plus 0.5 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received 2 IAN blocks consisting of a 3.18 mL formulation of 127.2 mg lidocaine with 50 μg epinephrine and a 5 mL formulation of 127.2 mg lidocaine with 50 μg epinephrine (3.18 mL) plus 0.5 M mannitol (1.82 mL) in 2 separate appointments spaced at least 1 week apart. Mandibular anterior and posterior teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. Pain of solution deposition and postoperative pain were also measured. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings) over the 60 minutes. One hundred percent of the subjects had profound lip numbness with both inferior alveolar nerve blocks. The results demonstrated that a 5 mL formulation of 127.2 mg lidocaine with 50 μg epinephrine plus 0.5 M mannitol was significantly better than the 3.18 mL formulation of 127.2 mg lidocaine with 50 μg epinephrine for all teeth. Solution deposition pain and postoperative pain were not statistically different between the lidocaine/mannitol formulation and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to a lidocaine with epinephrine formulation was significantly more effective in achieving a greater percentage of total pulpal anesthesia than a lidocaine formulation without mannitol.

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Anesthetic Efficacy of Combinations of 0.5 M Mannitol and Lidocaine With Epinephrine in Inferior Alveolar Nerve Blocks: A Prospective Randomized, Single-Blind Study

Anesthesia Progress ◽

10.2344/11-30.1 ◽

2011 ◽

Vol 58 (4) ◽

pp. 157-165 ◽

Cited By ~ 11

Author(s):

Ronald Wolf ◽

Al Reader ◽

Melissa Drum ◽

John Nusstein ◽

Mike Beck

Keyword(s):

Postoperative Pain ◽

Inferior Alveolar Nerve ◽

Blind Study ◽

Maximum Output ◽

Nerve Blocks ◽

Solution Deposition ◽

The Times ◽

Pulpal Anesthesia ◽

Single Blind ◽

Better Than

Abstract The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of lidocaine with epinephrine compared to lidocaine with epinephrine plus 0.5 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received an IAN block in 3 separate appointments spaced at least 1 week apart using the following formulations: a 1.8 mL solution of 36 mg lidocaine with 18 µg epinephrine (control solution); a 2.84 mL solution of 36 mg lidocaine with 18 µg epinephrine (1.80 mL) plus 0.5 M mannitol (1.04 mL); and a 5 mL solution of 63.6 mg lidocaine with 32 µg epinephrine (3.18 mL) plus 0.5 M mannitol (1.82 mL). Mandibular teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Mean percent total pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings) over the 60 minutes. Pain of solution deposition and postoperative pain were also measured. The results demonstrated that 2.84 mL of lidocaine with epinephrine plus 0.5 M mannitol was significantly better than 1.8 mL of lidocaine with epinephrine for the molars and premolars. The 5 mL of lidocaine with epinephrine plus 0.5 M mannitol was statistically better than 1.8 mL of lidocaine with epinephrine and 2.84 mL of lidocaine with epinephrine plus 0.5 M mannitol for all teeth except the central incisor. Solution deposition pain and postoperative pain were not statistically different among the mannitol formulations and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to lidocaine with epinephrine formulations significantly improved effectiveness in achieving a greater percentage of total pulpal anesthesia compared with a lidocaine formulation without mannitol for IAN block.

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Anesthetic Efficacy of a Combination of 0.5 M Mannitol Plus 36.8 mg of Lidocaine With 18.4 μg Epinephrine in Maxillary Infiltration: A Prospective, Randomized, Single-Blind Study

Anesthesia Progress ◽

10.2344/0003-3006-61.2.63 ◽

2014 ◽

Vol 61 (2) ◽

pp. 63-68 ◽

Cited By ~ 2

Author(s):

Kevin Younkin ◽

Al Reader ◽

Melissa Drum ◽

John Nusstein ◽

Mike Beck

Keyword(s):

Postoperative Pain ◽

Blind Study ◽

Lateral Incisor ◽

Maximum Output ◽

Control Solution ◽

Solution Deposition ◽

Maxillary Lateral Incisor ◽

The Subject ◽

Pulpal Anesthesia ◽

Single Blind

Abstract The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of lidocaine with epinephrine compared to lidocaine with epinephrine plus 0.5 M mannitol in maxillary lateral incisor infiltrations. Forty-one subjects randomly received 2 maxillary lateral infiltrations consisting of a 1.84-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (control solution) and a 2.90-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) in 2 separate appointments spaced at least 1 week apart. The maxillary lateral incisor was blindly electric pulp–tested in 2-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (a reading of 80) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all pulpal anesthesia readings (at output of 80) over the 60-minute test period. Pain during solution deposition and postoperative pain were also measured. The results demonstrated that a 2.90-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) was not statistically significantly superior to a 1.84-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine. The pain of solution deposition was lower with the lidocaine/mannitol formulation. Postoperative pain was not statistically significantly different between the lidocaine/mannitol formulation and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to a lidocaine with epinephrine formulation was not significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol in the maxillary lateral incisor.

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A Prospective, Randomized, Double-Blind Study of the Anesthetic Efficacy of Sodium Bicarbonate Buffered 2% Lidocaine With 1 : 100,000 Epinephrine in Inferior Alveolar Nerve Blocks

Anesthesia Progress ◽

10.2344/0003-3006-57.2.59 ◽

2010 ◽

Vol 57 (2) ◽

pp. 59-66 ◽

Cited By ~ 31

Author(s):

Michael Whitcomb ◽

Melissa Drum ◽

Al Reader ◽

John Nusstein ◽

Mike Beck

Keyword(s):

Sodium Bicarbonate ◽

Inferior Alveolar Nerve ◽

Crossover Design ◽

Blind Study ◽

Double Blind Study ◽

Nerve Blocks ◽

Double Blind ◽

Blind Manner ◽

Pulpal Anesthesia

Abstract The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1 : 100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1 : 100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and lateral and central incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained for 60 minutes. For the buffered 2% lidocaine with 1 : 100,000 epinephrine/sodium bicarbonate formulation, successful pulpal anesthesia ranged from 10–71%. For the unbuffered 2% lidocaine with 1 : 100,000 epinephrine formulation, successful pulpal anesthesia ranged from 10–72%. No significant differences between the 2 anesthetic formulations were noted. The buffered lidocaine formulation did not statistically result in faster onset of pulpal anesthesia or less pain during injection than did the unbuffered lidocaine formulation. We concluded that buffering a 2% lidocaine with 1 : 100,000 epinephrine with sodium bicarbonate, as was formulated in the current study, did not statistically increase anesthetic success, provide faster onset, or result in less pain of injection when compared with unbuffered 2% lidocaine with 1 : 100,000 epinephrine for an IAN block.

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Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial

Brazilian Dental Journal ◽

10.1590/0103-6440201600663 ◽

2016 ◽

Vol 27 (4) ◽

pp. 381-386 ◽

Cited By ~ 16

Author(s):

Carlos E. Allegretti ◽

Roberta M. Sampaio ◽

Anna C. R. T. Horliana ◽

Paschoal L. Armonia ◽

Rodney G. Rocha ◽

...

Keyword(s):

Success Rate ◽

Nerve Block ◽

Inferior Alveolar Nerve ◽

Inferior Alveolar Nerve Block ◽

Posterior Teeth ◽

Mandibular Molars ◽

School Of Dentistry ◽

Mandibular Posterior Teeth ◽

Pulpal Anesthesia ◽

Irreversible Pulpitis

Abstract Inferior alveolar nerve block has a high failure rate in the treatment of mandibular posterior teeth with irreversible pulpitis. The aim of this study was to compare the anesthetic efficacy of 4% articaine, 2% lidocaine and 2% mepivacaine, all in combination with 1:100,000 epinephrine, in patients with irreversible pulpitis of permanent mandibular molars during a pulpectomy procedure. Sixty-six volunteers from the Emergency Center of the School of Dentistry, University of São Paulo, randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and absence of pain during the pulpectomy procedure were evaluated respectively, by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. All patients reported the subjective signal of lip numbness. Regarding pulpal anesthesia success as measured with the pulp tester, the success rate was respectively 68.2% for mepivacaine, 63.6% for articaine and 63.6% for lidocaine. Regarding patients who reported no pain or mild pain during the pulpectomy, the success rate was, respectively 72.7% for mepivacaine, 63.6% for articaine and 54.5% for lidocaine. These differences were not statistically significant. Neither of the solutions resulted in 100% anesthetic success in patients with irreversible pulpitis of mandibular molars.

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Efficacy of Pulpal Anesthesia Using a Needle-less Syringe

Anesthesia Progress ◽

10.2344/anpr-67-02-11 ◽

2020 ◽

Vol 67 (4) ◽

pp. 200-206

Author(s):

Coleman Christensen ◽

Stephen C. Arnason ◽

Ross Oates ◽

Michael Crabtree ◽

John W. Kersey ◽

...

Keyword(s):

Inferior Alveolar Nerve ◽

Contralateral Side ◽

Injection Pain ◽

Injection Technique ◽

Single Tooth ◽

Tooth Type ◽

Vas Scores ◽

The Difference ◽

Mandibular Teeth ◽

Pulpal Anesthesia

The purpose of this study was to investigate the manufacturer's claims regarding a novel needleless intraligamentary local anesthesia injection device (Numbee, BioDent) to provide effective single tooth anesthesia. Investigators compared the Numbee with a traditional inferior alveolar nerve block (IANB) during a restorative procedure on mandibular teeth. A randomized, split-mouth design was conducted with 15 adult subjects receiving an IANB on one side and a Numbee injection on the same tooth type on the contralateral side. Subjects recorded injection pain using the Visual Analog Scale (VAS) and their preferred injection technique. Anesthesia was considered profound with 2 consecutive electric pulp tester readings of 80. If subjects became symptomatic during the restorative procedure, rescue anesthesia was administered. The difference in VAS scores for injection pain between the Numbee and the IANB was not significant (p = .078). For the IANB, the incidence of profound anesthesia was 46%, and required rescue anesthesia was 20%. For the Numbee, the incidence of profound anesthesia was 0%, and required rescue anesthesia was 60%. Subject preference was evenly split (50/50%) between the 2 techniques. The IANB outperformed the Numbee device for achieving profound anesthesia and requiring less rescue anesthesia.

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Deep Semi-Supervised Learning for Automatic Segmentation of Inferior Alveolar Nerve Using a Convolutional Neural Network (Preprint)

10.2196/preprints.32088 ◽

2021 ◽

Author(s):

Ho-Kyung Lim ◽

Seok-Ki Jung ◽

Seung-Hyun Kim ◽

Yongwon Cho ◽

In-Seok Song

Keyword(s):

Active Learning ◽

Automatic Segmentation ◽

Inferior Alveolar Nerve ◽

Dice Similarity Coefficient ◽

Clinical Tool ◽

Lower Lip ◽

Precise Position ◽

Visual Scoring ◽

Mandibular Teeth ◽

The Times

BACKGROUND The inferior alveolar nerve (IAN) innervates and regulates the sensation of the mandibular teeth and lower lip. The position of the IAN should be monitored during surgery to prevent damage. Therefore, a study using artificial intelligence (AI) was planned to image and track the position of the IAN automatically for a quicker and safer surgery. OBJECTIVE In this study, we segmented the precise position of the IAN using AI. The accuracy of this technique was evaluated by comparing the position with the position manually specified by a specialist, and segmentation accuracy and annotation efficiency were found to be improved with learning. METHODS A total of 138 cone-beam computed tomography datasets (Internal: 98, External: 40) collected from multiple centers (three hospitals) were used in the study. A customized 3D nnU-Net was used for image segmentation. Active learning, which consists of three steps, was carried out in iterations for 83 datasets with cumulative additions after each step. Subsequently, the accuracy of the model for IAN segmentation was evaluated using the residual dataset. We compared the accuracy by deriving the dice similarity coefficient (DSC) value and the segmentation time for each learning step. In addition, visual scoring was considered to comparatively evaluate the manual and automatic segmentation. RESULTS After learning, the DSC gradually increased to 0.48 ± 0.11 to 0.50 ± 0.11, and 0.58 ± 0.08. The DSC for the external dataset was 0.49 ± 0.12. The times required for segmentation were 124.8, 143.4, and 86.4 s, showing a large decrease at the final stage. In visual scoring, the accuracy of manual segmentation was found to be higher than that of automatic segmentation. CONCLUSIONS The deep active learning framework can serve as a fast, accurate, and robust clinical tool for demarcating IAN location.

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An Evaluation of Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Pulpal Anesthesia for Mandibular First Molars

Journal of Endodontics ◽

10.1016/j.joen.2007.09.006 ◽

2008 ◽

Vol 34 (1) ◽

pp. 11-13 ◽

Cited By ~ 57

Author(s):

Il-Young Jung ◽

Jun-Hyung Kim ◽

Eui-Seong Kim ◽

Chan-Young Lee ◽

Seung Jong Lee

Keyword(s):

Inferior Alveolar Nerve ◽

Nerve Blocks ◽

Pulpal Anesthesia

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Comparison of speed of action and injection discomfort of 4% articaine and 2% mepivacaine for pulpal anesthesia in mandibular teeth: A randomized, double-blind cross-over trial

European Journal of Dentistry ◽

10.4103/1305-7456.156811 ◽

2015 ◽

Vol 09 (02) ◽

pp. 201-206 ◽

Cited By ~ 3

Author(s):

Giath Gazal

Keyword(s):

Inferior Alveolar Nerve ◽

T Test ◽

Injection Pain ◽

Double Blind Study ◽

Double Blind ◽

Pain Scores ◽

Molar Teeth ◽

Mandibular Teeth ◽

Pulpal Anesthesia ◽

Mandibular First Molar

ABSTRACT Objective: To compare the injection pain and speed of local anesthetic effect induced by tissue infiltration of mepivacaine 2% with epinephrine 1:100,000 versus articaine 4% with epinephrine 1:100,000 in securing mandibular first molar pulp anesthesia. Materials and Methods: Totally, 25 patients were recruited in a crossover, randomized, double-blind study. Each subject received injections of mepivacaine 2% with epinephrine 1:100,000 as inferior alveolar nerve block (IANB) supplemented with either articaine 4% with epinephrine 1:100,000 (septocaine) or mepivacaine 2% buccal infiltration (BI) injection on two visits. The time of first numbness to associated lip, tongue and tooth was recorded by asking the participant directly and using electrical pulp tester. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation. The patients rated the pain of infiltration using a 100 mm visual analog scale immediately after receiving each injection. The pain scores were compared using the paired t-test. Results: There were significant differences in the meantime of first numbness to associated lip and tooth of volunteers between mepivacaine and articaine BI groups P = 0.03 and 0.002. Volunteers in articaine group recorded earlier lip and teeth numbness than those in mepivacaine group. There were significant differences between the mean pain scores for volunteers in the post IANB and postbuccal injection groups (t-test: P <0.001). Mepivacaine IANB injection was significantly more painful than articaine/mepivacaine buccal injection. Conclusions: About 4% articaine was faster than 2% mepivacaine (both with 1:100,000 adrenaline) in anesthetizing the pulps of lower molar teeth after BIs. Earlier lip and teeth numbness were recorded in articaine group. Articaine and mepivacaine BIs were more comfortable than mepivacaine IANB injections.

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