CONSORT Randomized Clinical Trial
Anesthetic Efficacy of Supplemental Buccal and Lingual Infiltrations of Articaine and Lidocaine after an Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis

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Abstract

Introduction

The success rate of inferior alveolar nerve block (IANB) decreases in patients with irreversible pulpitis. It was hypothesized that supplemental infiltration of lidocaine and articaine may improve the success rates.

Methods

Eighty-four adult volunteers, actively experiencing pain, participated in this prospective, randomized, double-blinded study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive supplemental infiltrations (control). Thirty patients received supplemental buccal and lingual infiltrations of 2% articaine with 1:200,000 epinephrine, and 30 patients received buccal and lingual infiltrations of 2% lidocaine with 1:200,000 epinephrine at 2 minutes after the IANB. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft Parker visual analog scale. Success was recorded as “none” or “mild” pain.

Results

Statistical analysis using nonparametric McNemer tests showed that supplemental buccal and lingual infiltration of 2% lidocaine with 1:200,000 epinephrine or 4% articaine with 1:200,000 epinephrine improved the success rate from 33% to 47% and 67%, respectively. Also the success rate with 4% articaine with 1:200,000 epinephrine was significantly more than 2% lidocaine with 1:200,000 epinephrine (p < 0.05).

Conclusions

Although supplemental buccal and lingual infiltrations of 4% articaine or 2% lidocaine increased the success rate of the inferior alveolar nerve block in patients with irreversible pulpitis, none of the techniques provided acceptable success rates.

Section snippets

Methods and Materials

Eighty-seven adult volunteer subjects who reported in the dental emergency department participated in this prospective, randomized, double-blinded study. The sample-size calculation consisted of α level type I error of 0.05 for a two-tailed test and β level type II error of 0.20. A power calculation dictated that a sample size of 63 subjects would give 90% power to detect a 15% difference in the success rate of two test groups. We assumed a dropout rate of approximately 10% to 15% and enrolled

Results

Eighty-four adult volunteer subjects, 44 men and 40 women, with an average age of 29 years, ranging from 23 to 37 years, participated in this prospective, randomized, double-blinded study. Of the original 87 patients, three patients, one from each group, did not have profound lip numbness at 15 minutes and were excluded from the study. The age, sex, initial, and 15 minute post injection pain of all the patients are presented in Table 1. The distribution of teeth for control IANB, IANB +

Discussion

Successful management of painful endodontic emergencies is a challenge for a dentist. Local anesthesia using an inferior alveolar nerve block may provide successful anesthesia in 70% of uninflamed pulp, but the success rate drastically decreases to 30% in patients with irreversible pulpitis 2, 3, 5, 6, 7, 8, 9, 10. It has been quoted that patients with irreversible pulpitis have eight times more chances of failure of local anesthesia as compared with normal patients (14). Literature provides

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