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A Prospective Randomized Trial of Different Supplementary Local Anesthetic Techniques after Failure of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis in Mandibular Teeth

Published:February 06, 2012DOI:https://doi.org/10.1016/j.joen.2011.12.006

      Abstract

      Objective

      The objective of this study was to compare the efficacy of supplementary repeat inferior alveolar nerve block with 2% lidocaine and epinephrine, buccal infiltration with 4% articaine with epinephrine, intraligamentary injection, or intraosseous injection (both with 2% lidocaine with epinephrine) after failed inferior alveolar nerve block (IANB) for securing pain-free treatment in patients experiencing irreversible pulpitis in mandibular permanent teeth.

      Methods

      This randomized clinical trial included 182 patients diagnosed with irreversible pulpitis in mandibular teeth. Patients received 2.0 mL of 2% lidocaine with 1:80,000 epinephrine as an IANB injection. Patients who did not experience pain-free treatment received randomly 1 of 4 supplementary techniques, namely repeat lidocaine IANB (rIANB), articaine buccal infiltration (ABI), lidocaine intraligamentary injection (PDL), or lidocaine intraosseous injection (IO). Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation (80 reading) of the pulp tester, at which time treatment commenced. Treatment was regarded as being successfully completed when it was associated with no pain. Data were analyzed by χ2 and Fisher exact tests.

      Results

      Of the 182 patients, 122 achieved successful pulpal anesthesia within 10 minutes after initial IANB injection; 82 experienced pain-free treatment. ABI and IO allowed more successful (pain-free) treatment (84% and 68%, respectively) than rIANB or PDL supplementary techniques (32% and 48%, respectively); this was statistically significant (P = .001).

      Conclusions

      IANB injection alone does not always allow pain-free treatment for mandibular teeth with irreversible pulpitis. Supplementary buccal infiltration with 4% articaine with epinephrine and intraosseous injection with 2% lidocaine with epinephrine are more likely to allow pain-free treatment than intraligamentary and repeat IANB injections with 2% lidocaine with epinephrine for patients experiencing irreversible pulpitis in mandibular permanent teeth.

      Key Words

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      References

        • Nusstein J.
        • Reader A.
        • Nist R.
        • Beck M.
        • Meyers W.J.
        Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis.
        J Endod. 1998; 24: 487-491
        • Reisman D.
        • Reader A.
        • Nist R.
        • Beck M.
        • Weaver J.
        Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84: 676-682
        • Claffey E.
        • Reader A.
        • Nusstein J.
        • Beck M.
        • Weaver J.
        Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis.
        J Endod. 2004; 30: 568-571
        • Parente S.A.
        • Anderson R.W.
        • Herman W.W.
        • Kimbrough W.F.
        • Weller R.N.
        Anesthetic efficacy of the supplemental intraosseous injection for teeth with irreversible pulpitis.
        J Endod. 1998; 24: 826-828
        • Yonchak T.
        • Reader A.
        • Beck M.
        • Meyers W.J.
        Anesthetic efficacy of unilateral and bilateral inferior alveolar nerve blocks to determine cross innervation in anterior teeth.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001; 92: 132-135
        • Childers M.
        • Reader A.
        • Nist R.
        • Beck M.
        • Meyers W.J.
        Anesthetic efficacy of the periodontal ligament injection after an inferior alveolar nerve block.
        J Endod. 1996; 22: 317-320
        • Nusstein J.
        • Claffey E.
        • Reader A.
        • Beck M.
        • Weaver J.
        Anesthetic effectiveness of the supplemental intraligamentary injection, administered with a computer-controlled local anesthetic delivery system, in patients with irreversible pulpitis.
        J Endod. 2005; 31: 354-358
        • Meechan J.G.
        Supplementary routes to local anaesthesia.
        Int Endod J. 2002; 35: 885-896
        • Rood J.P.
        The analgesia and innervation of mandibular teeth.
        Br Dent J. 1976; 140: 237-239
        • Froum S.J.
        • Froum S.H.
        • Malamed S.F.
        The use of phentolamine mesylate to evaluate mandibular nerve damage following implant placement.
        Contin Educ Dent. 2010; 31: 522-528
        • Smith G.N.
        • Walton R.E.
        Periodontal ligament injection: distribution of injected solutions.
        Oral Surg Oral Med Oral Pathol. 1983; 55: 232-238
        • Smith G.N.
        • Walton R.E.
        • Abbott B.J.
        Clinical evaluation of periodontal ligament anesthesia using a pressure syringe.
        J Am Dent Assoc. 1983; 107: 953-956
        • Gray R.J.
        • Lomax A.M.
        • Rood J.P.
        Periodontal ligament injection: with or without a vasoconstrictor?.
        Br Dent J. 1987; 162: 263-265
        • Schleder J.R.
        • Reader A.
        • Beck M.
        • Meyers W.J.
        The periodontal ligament injection: a comparison of 2% lidocaine, 3% mepivacaine, and 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine in human mandibular premolars.
        J Endod. 1988; 14: 397-404
        • Dreyer W.P.
        • van Heerden J.D.
        • de V Joubert J.J.
        The route of periodontal ligament injection of local anesthetic solution.
        J Endod. 1983; 9: 471-474
        • Simpson M.
        • Drum M.
        • Nusstein J.
        • Reader A.
        • Beck M.
        Effect of combination of preoperative ibuprofen/acetaminophen on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis.
        J Endod. 2011; 37: 593-597
        • Oleson M.
        • Drum M.
        • Reader A.
        • Nusstein M.
        • Beck M.
        Effect of preoperative ibuprofen on the success of the inferior alveolar nerve block in patients with irreversible pulpitis.
        J Endod. 2010; 36: 379-382
        • Tortamano I.P.
        • Siviero M.
        • Costa C.G.
        • Buscariolo I.A.
        • Armonia P.L.
        A comparison of the anesthetic efficacy of articaine and lidocaine in patients with irreversible pulpitis.
        J Endod. 2009; 35: 165-168
        • Quinn C.L.
        Injection techniques to anesthetize the difficult tooth.
        J Calif Dent Assoc. 1998; 26: 665-667
        • Walton R.E.
        • Abbot B.J.
        Periodontal ligament injection: a clinical evaluation.
        J Am Dent Assoc. 1981; 103: 571-575
        • Meechan J.G.
        The use of the mandibular infiltration anesthetic technique in adults.
        J Am Dent Assoc. 2011; 142: 19S-24S
        • Kanaa M.D.
        • Whitworth J.M.
        • Corbett I.P.
        • Meechan J.G.
        Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block.
        Int Endod J. 2009; 42: 238-246
        • Haase A.
        • Reader A.
        • Nusstein J.
        • Beck M.
        • Drum M.
        Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block.
        J Am Dent Assoc. 2008; 139: 1228-1235
        • Aggarwal V.
        • Jain A.
        • Kabi D.
        Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis.
        J Endod. 2009; 35: 925-929
        • Matthews R.
        • Drum M.
        • Reader A.
        • Nusstein J.
        • Beck M.
        Articaine for supplemental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior alveolar nerve block fails.
        J Endod. 2009; 35: 343-346
        • Miller A.
        A clinical evaluation of the Ligmaject periodontal ligament injection syringe.
        Dent Update. 1983; 10: 639-643
      1. Kanaa MD, Whitworth JM, Meechan JG. A comparison of the efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine in achieving pulpal anesthesia in maxillary teeth with irreversible pulpitis. J Endod 2012;38:279–82.