Addition of 2 mg dexamethasone to improve the anesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine administered for inferior alveolar nerve block to patients with symptomatic irreversible pulpitis in the mandibular molars: a randomized double-blind clinical trial
Aggarwal Vivek, Ahmad Tanveer, Singla Mamta, Gupta Alpa, Saatchi Masoud, Hasija Mukesh, Meena Babita, Kumar Umesh,
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( Aggarwal Vivek ) - Jamia Millia Islamia Faculty of Dentistry Department of Conservative Dentistry & Endodontics
( Ahmad Tanveer ) - Jamia Millia Islamia Faculty of Dentistry
( Singla Mamta ) - SGT Dental College Department of Conservative Dentistry & Endodontics
( Gupta Alpa ) - Manav Rachna Dental College Department of Conservative Dentistry and Endodontics
( Saatchi Masoud ) - Isfahan University of Medical Sciences School of Dentistry Department of Endodontics
( Hasija Mukesh ) - Jamia Millia Islamia Faculty of Dentistry Department of Conservative Dentistry & Endodontics
( Meena Babita ) - Jamia Millia Islamia Faculty of Dentistry Department of Conservative Dentistry & Endodontics
( Kumar Umesh ) - Post Graduate Institute of Medical Sciences Division of Conservative Dentistry and Endodontics
Abstract
Introduction: This clinical trial aimed to evaluate the anesthetic effect of the addition of 2 mg (4 mg/ml) of dexamethasone to 2% lidocaine (plain or with 1:80,000 epinephrine). The solutions were injected for a primary inferior alveolar nerve block (IANB) to provide mandibular anesthesia for the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis.
Methods: In a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as ¡°failed¡± anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as ¡°no pain or faint/weak/mild pain¡± during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates.
Results: The 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, ¥ö2 = 9.07, df = 2).
Conclusions: The addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.
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Anesthesia; Dexamethasone; Irreversible Pulpitis; Lidocaine; Mandible
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