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, Shojaeian Shiva, Vatankhah Mohammadreza, Heidaryan Shirin, Ashraf Hengameh, Baghban Alireza Akbarzadeh, Dianat Omid,
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( Zargar Nazanin ) - Shahid Beheshti University of Medical Sciences School of Dentistry Department of Endodontics
( Shojaeian Shiva ) - Shahid Beheshti University of Medical Sciences School of Dentistry Department of Endodontics
( Vatankhah Mohammadreza ) - University of Southern California Herman Ostrow School of Dentistry Center for Craniofacial Molecular Biology
( Heidaryan Shirin ) - Shahid Beheshti University of Medical Sciences
( Ashraf Hengameh ) - Shahid Beheshti University of Medical Sciences School of Dentistry Department of Endodontics
( Baghban Alireza Akbarzadeh ) - Shahid Beheshti University of Medical Sciences School of Rehabilitation Proteomics Research Center
( Dianat Omid ) - University of Maryland Department of Advanced Oral Sciences and Therapeutics Division of Endodontics
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.
키워드
Articaine; Dental Anesthesia; Infiltration; Intraligamentary Injection; Irreversible Pulpitis; Molar
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