Comparison Of The Success Rates Of Four Anesthetic Solutions For Inferior Alveolar Nerve Block In Patients With Irreversible Pulpitis. A Prospective, Randomized, Double-blind Study

Introduction: This study compared the efficacy of four anesthetic solutions for inferior alveolar nerve block (IANB) in patients with irreversible pulpitis. Material and Methods: This prospective, randomized, double-blind tudy included 60 adult volunteers. The patients were randomly divided into four groups of 15 and received conventional IANB as follows: Group ART - 2 cartridges of 4% articaine with 1:100,000 epinephrine, Group LID - 2 cartridges of 2% lidocaine with 1:100,000 epinephrine, Group PRI - 2 cartridges of 3% prilocaine with 0.03 IU felypressin; and Group MEP - 2 cartridges of 2% mepivacaine with 1:100,000 epinephrine. Access was begun 10 minutes after IANB, and patients were instructed to rate any pain felt during the endodontic procedure. The success of IANB was defined as access and instrumentation of root canals with no pain. If the patient felt any pain, the treatment was discontinued immediately and the anesthetic procedure was classified as unsuccessful. Results: The chi-square test was used to analyze results (α = 5%). There was no significant difference (p > 0.05) in the efficacy of IANB between the ART (53.33%), PRI (46.66%), and MEP (53.33%) groups. However, the success rate in the LID group was statistically lower (20%) than in the other groups (p < 0.05). Conclusion: None of the anesthetic solutions had an acceptable success rate for IANB in patients with irreversible pulpitis. The solution of 2% lidocaine with 1:100,000 epinephrine had the worst rate when compared to the other groups.132226Aggarwal, V., Singla, M., Kabi, D., Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis (2010) Oral Surg Oral Med Oral Pathol Oral Radiol Endod., 109 (2), pp. 303-308Veering, B.T., Complications and local anaesthetic toxicity in regional anaesthesia (2003) Curr Opin Anaesthesiol., 16 (5), pp. 455-459Nusstein, J., Reader, A., Beck, F.M., Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks (2002) Gen Dent., 50 (4), pp. 372-375. , quiz 376-7Potocnik, I., Bajrovic, F., Failure of inferior alveolar nerve block in endodontics (1999) Endod Dent Traumatol., 15, pp. 247-251Levy, T., An assessment of the Gow-Gates mandibular block for third molar surgery (1981) J Am Dent Assoc, 103 (7), pp. 37-41Malamed, S.F., The Gow-Gates mandibular bloc. Evaluation after 4,275 cases. (1981) Oral Surg Oral Med Oral Pathol., 51 (5), pp. 463-467Watson, J.E., Gow-Gates, G.A., A clinical evaluation of the Gow- Gates mandibular block technique (1976) N Z Dent J., 72, pp. 220-223Tortamano, 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 (2009) J Endod., 35 (2), pp. 165-168. , Epub 2008 Dec 12Aggarwal, 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 (2009) J Endod., 35 (7), pp. 925-929Claffey, E., Reader, A., Nusstein, J., Beck, M., Weaver, J., Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis (2004) J Endod., 30 (8), pp. 568-571Kennedy, 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 (2003) J Endod., 29 (10), pp. 630-633Reisman, D., Reader, A., Nist, R., Beck, M., Weaver, J., Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis (1997) Oral Surg Oral Med Oral Pathol Oral Radiol Endod., 84 (6), pp. 676-682Nusstein, 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 (1998) J Endod., 24 (7), pp. 487-491Cohen, H.P., Cha, B.Y., Spångberg, L.S., Endodontic anesthesia in mandibular molars: a clinical study (1993) J Endod., 19 (7), pp. 370-373Hargreaves, K.M., Keiser, K., Local anesthetic failure in endodontics: mechanisms and management (2002) Endod Topics, 1, pp. 26-39Goodis, H.E., Poon, A., Hargreaves, K.M., Tissue pH and temperature regulate pulpal nociceptors (2006) J Dent Res., 85, pp. 1046-1049Stenholm, E., Bongenhielm, U., Ahlquist, M., Fried, K., VRl- and VRL-llike immunoreactivity in normal and injured trigeminal dental primary sensory neurons of the rat (2002) Acta Odontol Scand., 60 (2), pp. 72-79Renton, T., Yiangou, Y., Baecker, P.A., Ford, A.P., Anand, P., Capsaicin receptor VR1 and ATP purinoceptor P2X3 in painful and nonpainful human tooth pulp (2003) J Orofac Pain., 17 (3), pp. 245-250Sherman, M.G., Flax, M., Namerow, K., Murray, P.E., Anesthetic efficacy of the Gow-Gates injection and maxillary infiltration with articaine and lidocaine for irreversible pulpitis (2008) J Endod., 34 (6), pp. 656-659. , Epub 2008 Apr 25Corbett, I.P., Ramacciato, J.C., Groppo, F.C., Meechan, J.G., A survey of local anaesthetic use among general dental practitioners in the UK attending postgraduate courses on pain control (2005) Br Dent J., 199 (12), pp. 784-787. , discussion 778Malamed, S.F., Local anesthetics: dentistry's most important drugs, clinical update 2006 (2006) J Calif Dent Assoc., 34 (12), pp. 971-976Gaffen, A.S., Haas, D.A., Survey of local anesthetic use by Ontario dentists (2009) J Can Dent Assoc., 75 (9), p. 649Nayak, R., Sudha, P., Evaluation of three topical anaesthetic agents against pain: a clinical study (2006) Indian J Dent Res., 17 (4), pp. 155-160Maniglia-Ferreira, C., Almeida-Gomes, F., Carvalho-Sousa, B., Barbosa, A.V., Lins, C.C., Souza, F.D., Clinical evaluation of the use of three anesthetics in endodontics (2009) Acta Odontol Latinoam., 22 (1), pp. 21-26Rosenberg, P.A., Amin, K.G., Zibari, Y., Lin, L.M., Comparison of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine when used as a supplemental anesthetic. (2007) J Endod, 33 (4), pp. 403-405. , Epub 2007 Feb 20, AprCamarda, A.J., Hochman, M.N., Franco, L., Naseri, L., A prospective clinical patient study evaluating the effect of increasing anesthetic volume on inferior alveolar nerve block success rate (2007) Quintessence Int., 38 (8), pp. e521-e526Lai, T.N., Lin, C.P., Kok, S.H., Yang, P.J., Kuo, Y.S., Lan, W.H., Evaluation of mandibular block using a standardized method (2006) Oral Surg Oral Med Oral Pathol Oral Radiol Endod., 102 (4), pp. 462-468. , Epub 2006 Jun 8Aggarwal, V., Singla, M., Kabi, D., Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial (2010) J Endod., 36 (3), pp. 375-378Oleson, M., Drum, M., Reader, A., Nusstein, J., Beck, M., Effect of preoperative ibuprofen on the success of the inferior alveolar nerve block in patients with irreversible pulpitis (2010) J Endod., 36 (3), pp. 379-382Lindemann, M., Reader, A., Nusstein, J., Drum, M., Beck, M., Effect of sublingual triazolam on the success of inferior alveolar nerve block in patients with irreversible pulpitis (2008) J Endod., 34 (10), pp. 1167-1170. , Epub 2008 Aug 23Bigby, J., Reader, A., Nusstein, J., Beck, M., Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis (2007) J Endod., 33 (1), pp. 7-10Corbett, I.P., Kanaa, M.D., Whitworth, J.M., Meechan, J.G., Articaine infiltration for anesthesia of mandibular first molars (2008) J Endod., 34 (5), pp. 514-518Matthews, 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 (2009) J Endod., 35 (3), pp. 343-346Nusstein, J., Clafey, 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 (2005) J Endod., 31, pp. 354-358Bigby, J., Reader, A., Nusstein, J., Beck, M., Weaver, J., Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis. (2006) J Endod, 32 (11), pp. 1044-1047. , Epub 2006 Jul 2