Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Anesthetic efficacy of supplemental buccal infiltration versus intraligamentary injection in mandibular first and second molars with irreversible pulpitis: a prospective randomized clinical trial

  • Zargar, Nazanin (Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences) ;
  • Shojaeian, Shiva (Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences) ;
  • Vatankhah, Mohammadreza (Center for Craniofacial Molecular Biology, Herman Ostrow School of Dentistry, University of Southern California) ;
  • Heidaryan, Shirin (Shahid Beheshti University of Medical Sciences) ;
  • Ashraf, Hengameh (Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences) ;
  • Baghban, Alireza Akbarzadeh (Proteomics Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences) ;
  • Dianat, Omid (Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland)
  • Received : 2022.06.22
  • Accepted : 2022.07.29
  • Published : 2022.10.01
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Abstract

Background: To compare the anesthetic efficacy of supplemental buccal infiltration (BI) (1.7 ml) versus intraligamentary (IL) injection containing 0.4 ml of 4% articaine with 1:100.000 epinephrine after an inferior alveolar nerve block (IANB) with 1.7 ml 2% lidocaine in the first and second mandibular molars diagnosed with irreversible pulpitis (IP). Methods: One hundred subjects diagnosed with IP of either the mandibular first (n = 50) or second molars (n = 50) and failed profound anesthesia following an IANB were selected. They randomly received either the IL or BI techniques of anesthesia. Pain scores on a 170 mm Heft-Parker visual analog scale were recorded initially, before, and during supplemental injections. Furthermore, pulse rate was measured before and after each supplemental injection. During the access cavity preparation and initial filing, no or mild pain was assumed to indicate anesthetic success. The chi-square test, Mann-Whitney U test, and independent samples t-test were used for the analyses. Results: The overall success rates were 80% in the IL group and 74% in the BI group, with no significant difference (P = 0.63). In the first molars, there was no significant difference between the two techniques (P = 0.088). In the second molars, IL injection resulted in a significantly higher success rate (P = 0.017) than BI. IL injection was statistically more successful (P = 0.034) in the second molars (92%) than in the first molars (68%). However, BI was significantly more successful (P = 0.047) in the first molars (88%) than in the second molars (64%). The mean pulse rate increase was significantly higher in the IL group than in the BI group (P < 0.001). Conclusions: Both the IL and BI techniques were advantageous when used as supplemental injections. However, more favorable outcomes were observed when the second molars received IL injection and the first molars received BI.

Keywords

Acknowledgement

This project was supported financially by the Vice Dean of Research of the School of Dentistry at Shahid Beheshti University of Medical Science in Tehran, Iran.

References

  1. Attar S, Bowles WR, Baisden MK, Hodges JS, McClanahan SB. Evaluation of pretreatment analgesia and endodontic treatment for postoperative endodontic pain. J Endod 2008; 34: 652-5. https://doi.org/10.1016/j.joen.2008.02.017
  2. 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: 568-71. https://doi.org/10.1097/01.DON.0000125317.21892.8F
  3. Cohen S, Burns R. Pathway of the pulp. 8th edition. St. Louis, Mosby. 2001.
  4. Kennedy S, Reader A, Nusstein J, Beck M, Weaver J. The significance of needle deflection in success of the inferior alveolar nerve block in patients with irreversible pulpitis. J Endod 2003; 29: 630-3. https://doi.org/10.1097/00004770-200310000-00004
  5. Meechan JG. Supplementary routes to local anaesthesia. Int Endod J 2002; 35: 885-96. https://doi.org/10.1046/j.1365-2591.2002.00592.x
  6. Gallatin J, Nusstein J, Reader A, Beck M, Weaver J. A comparison of injection pain and postoperative pain of two intraosseous anesthetic techniques. Anesth Prog 2003; 50: 111-20.
  7. Kanaa MD, Whitworth JM, Meechan JG. 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. J Endod 2012; 38: 421-5. https://doi.org/10.1016/j.joen.2011.12.006
  8. 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: 1228-35. https://doi.org/10.14219/jada.archive.2008.0338
  9. Fowler S, Drum M, Reader A, Beck M. Anesthetic success of an inferior alveolar nerve block and supplemental articaine buccal infiltration for molars and premolars in patients with symptomatic irreversible pulpitis. J Endod 2016; 42: 390-2. https://doi.org/10.1016/j.joen.2015.12.025
  10. Robertson D, Nusstein J, Reader A, Beck M, McCartney M. The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc 2007; 138: 1104-12. https://doi.org/10.14219/jada.archive.2007.0324
  11. Shapiro MR, McDonald NJ, Gardner RJ, Peters MC, Botero TM. Efficacy of articaine versus lidocaine in supplemental infiltration for mandibular first versus second molars with irreversible pulpitis: a prospective, randomized, double-blind clinical trial. J Endod 2018; 44: 523-8. https://doi.org/10.1016/j.joen.2017.10.003
  12. Rogers BS, Botero TM, McDonald NJ, Gardner RJ, Peters MC. Efficacy of articaine versus lidocaine as a supplemental buccal infiltration in mandibular molars with irreversible pulpitis: a prospective, randomized, double-blind study. J Endod 2014; 40: 753-8. https://doi.org/10.1016/j.joen.2013.12.022
  13. Smith GN, Walton RE, Abbott BJ. Clinical evaluation of periodontal ligament anesthesia using a pressure syringe. J Am Dent Assoc 1983; 107: 953-6. https://doi.org/10.14219/jada.archive.1983.0357
  14. Walton RE, Abbott BJ. Periodontal ligament injection: a clinical evaluation. J Am Dent Assoc 1981; 103: 571-5. https://doi.org/10.14219/jada.archive.1981.0307
  15. 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: 354-8. https://doi.org/10.1097/01.DON.0000140565.88940.60
  16. Shahi S, Rahimi S, Yavari HR, Ghasemi N, Ahmadi F. Success rate of 3 injection methods with articaine for mandibular first molars with symptomatic irreversible pulpitis: a consort randomized double-blind clinical trial. J Endod 2018; 44: 1462-6. https://doi.org/10.1016/j.joen.2018.07.010
  17. Nusstein J, Reader A, Beck FM. Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks. Gen Dent 2002; 50: 372-5.
  18. Kanaa MD, Meechan JG, Corbett IP, Whitworth JM. Speed of injection influences efficacy of inferior alveolar nerve blocks: a double-blind randomized controlled trial in volunteers. J Endod 2006; 32: 919-23. https://doi.org/10.1016/j.joen.2006.04.004
  19. Oertel R, Rahn R, Kirch W. Clinical pharmacokinetics of articaine. Clin Pharmacokinet 1997; 33: 417-25. https://doi.org/10.2165/00003088-199733060-00002
  20. Berlin J, Nusstein J, Reader A, Beck M, Weaver J. Efficacy of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99: 361-6. https://doi.org/10.1016/j.tripleo.2004.11.009
  21. 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: 925-9. https://doi.org/10.1016/j.joen.2009.04.012
  22. Zargar N, Shooshtari E, Pourmusavi L, Akbarzadeh Baghban A, Ashraaf H, Parhizkar A. 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. Pain Res Manag 2021; 2021: 6668738.
  23. Fan S, Chen WL, Pan CB, Huang ZQ, Xian MQ, Yang ZH, et al. Anesthetic efficacy of inferior alveolar nerve block plus buccal infiltration or periodontal ligament injections with articaine in patients with irreversible pulpitis in the mandibular first molar. Oral Surg Oral Med Oral Pathol Oral Radiol 2009; 108: e89-93. https://doi.org/10.1016/j.tripleo.2009.06.012
  24. Aggarwal V, Singla M, Saatchi M, Hasija M. Anaesthetic efficacy of 2% lidocaine with different concentrations of epinephrine (1:80,000 and 1:200,000) in intraligamentary injection after a failed primary inferior alveolar nerve block: a randomized double-blind study. Acta Odontol Scand 2020; 78: 275-80. https://doi.org/10.1080/00016357.2019.1700302
  25. Kung J, McDonagh M, Sedgley CM. Does articaine provide an advantage over lidocaine in patients with symptomatic irreversible pulpitis? a systematic review and meta-analysis. J Endod 2015; 41: 1784-94. https://doi.org/10.1016/j.joen.2015.07.001
  26. 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: 343-6. https://doi.org/10.1016/j.joen.2008.11.025
  27. Corbett IP, Kanaa MD, Whitworth JM, Meechan JG. Articaine infiltration for anesthesia of mandibular first molars. J Endod 2008; 34: 514-8. https://doi.org/10.1016/j.joen.2008.02.042
  28. Frankle KT, Seibel W, Dumsha TC. Anatomical study of the position of the mesial roots of mandibular molars. J Endod 1990; 16: 480-5. https://doi.org/10.1016/S0099-2399(07)80177-4
  29. Ashraf H, Kazem M, Dianat O, Noghrehkar F. Efficacy of articaine versus lidocaine in block and infiltration anesthesia administered in teeth with irreversible pulpitis: a prospective, randomized, double-blind study. J Endod 2013; 39: 6-10. https://doi.org/10.1016/j.joen.2012.10.012
  30. Gupta A, Wadhwa J, Aggarwal V, Mehta N, Abraham D, Aneja K, et al. Anesthetic efficacy of supplemental intraligamentary injection in human mandibular teeth with irreversible pulpitis: a systematic review and meta-analysis. Journal of dental anesthesia and pain medicine 2022; 22: 1-10. https://doi.org/10.17245/jdapm.2022.22.1.1
  31. Dreyer WP, van Heerden JD, de V Joubert JJ. The route of periodontal ligament injection of local anesthetic solution. J Endod 1983; 9: 471-4. https://doi.org/10.1016/S0099-2399(83)80161-7
  32. Tagger M, Tagger E, Sarnat H. Periodontal ligament injection: spread of the solution in the dog. J Endod 1994; 20: 283-7. https://doi.org/10.1016/S0099-2399(06)80817-4
  33. Wood M, Reader A, Nusstein J, Beck M, Padgett D, Weaver J. Comparison of intraosseous and infiltration injections for venous lidocaine blood concentrations and heart rate changes after injection of 2% lidocaine with 1:100,000 epinephrine. J Endod 2005; 31: 435-8. https://doi.org/10.1097/01.don.0000148146.10314.1a