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Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis.

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.

An evaluation of an electric pulp tester as a measure of analgesia in human vital teeth

The purpose of this study was to evaluate, with theAnalytic Technology electric pulp tester, clinical analgesia in normal, asymptomatic, and symptomatic human vital teeth. Group A consisted of 34 teeth that were classified as normal. Group B consisted of 33 asymptomatic teeth that had restorations, caries, or crown fracture. Group C consisted of 30 teeth with the clinical diagnosis of irreversible pulpitis. Two cartridges (3.6 ml) of 2% lidocaine with 1:100,000 epinephrine were administered by block and/or infiltration. The teeth were tested at various time intervals to determine if they responded to the maximum output (80/80) from the electric pulp tester. If the teeth responded, periodontal ligament injections were given until no response was recorded with the pulp tester. Clinical analgesia was then tested by performing endodontic procedures. The normal and asymptomatic groups had analgesia 100% of the time. In the teeth with irreversible pulpitis, 73% had clinical analgesia.

An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block

The purpose of this study was to evaluate, with the electric pulp tester, the anesthetic efficacy of 1.8 ml of 2% lidocaine with 1:100,000 epinephrine, 3.6 ml of 2% lidocaine with 1:200,000 epinephrine, and 1.8 ml of 4% lidocaine with 1:100,000 epinephrine in human inferior alveolar nerve block. Thirty subjects randomly received each of the solutions at three successive appointments. The first molar, canine, lateral incisor, and contralateral canine were tested with the pulp tester at various time intervals up to 55 min. Complete anesthesia was defined as an 80/80 reading with the pulp tester. No significant differences in anesthetic success or failure were found among the three solutions. Potential anesthetic problems (failure, noncontinuous anesthesia, slow onset, and short duration) occurred in 43 to 57% of the molars, in 43 to 60% of the canines, and in 57 to 80% of the lateral incisors. Complete anesthesia in the mandible is a meaningful clinical problem.

Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis

OBJECTIVE To determine the efficacy of a supplemental intraosseous injection of 3% mepivacaine in mandibular posterior teeth with irreversible pulpitis. Intraosseous injection pain, subjective heart rate increase, and pain ratings during endodontic treatment were also assessed. STUDY DESIGN Forty-eight patients with irreversible pulpitis received conventional inferior alveolar nerve blocks. Electric pulp testing was used to determine pulpal anesthesia. Patients who were positive to the pulp testing, or negative to pulp testing but felt pain during endodontic treatment, received an intraosseous injection of 1.8 ml of 3% mepivacaine. A second intraosseous injection of 3% mepivacaine (1.8 ml) was given if the first injection was unsuccessful. RESULTS Seventy-five percent of patients required an initial intraosseous injection because of failure to gain pulpal anesthesia. The inferior alveolar block was 25% successful; the first intraosseous injection increased success to 80%. A second intraosseous injection further increased success to 98%. These differences were significant (p < 0.05). Eight percent (4/48) of the initial intraosseous injections resulted in solution being expressed into the oral cavity: these were considered technique failures. CONCLUSIONS For mandibular posterior teeth with irreversible pulpitis, a supplemental intraosseous injection of 3% mepivacaine increased anesthetic success. A second intraosseous injection, when necessary, further improved success.

An in vitro comparison of the efficacy of the stepback technique versus a step-back/ultrasonic technique in human mandibular molars

This study compared the effect of the step-back preparation versus a step-back/ultrasound preparation on the tissue removal from the mesial root canals of 60 extracted human mandibular molars. The step-back/ultrasound preparation significantly cleaned isthmuses at both levels and canals at the 1-mm level more effectively than the step-back preparation. Statistical analysis indicated no significant difference, in canal cleanliness at the 3-mm level, between the step-back and the step-back/ ultrasound groups. There were no significant differences demonstrated in isthmus cleaning ability when comparing the step-back group with the control group, at both the 1- and 3-mm levels. At the 1-mm level, operator 1 significantly cleaned canals in the step-back group more effectively than operator 2. However, in the step-back/ultrasound group, no significant differences were demonstrated between operators in their ability to clean canals at this level. In both experimental groups, operator comparisons indicated no significant differences in isthmus cleanliness at the 1-mm level.

Anesthetic Efficacy of the Intraosseous Injection after an Inferior Alveolar Nerve Block

The purpose of this study was to determine the contribution of the intraosseous (IO) injection to the inferior alveolar nerve (IAN) block in human first molars. Using a repeated-measures design, 40 subjects randomly received either a combination IAN block + IO injection (on the distal of the first molar) using 2% lidocaine with 1:100,000 epinephrine or an IAN block+mock IO injection (gingival penetration only) at two successive appointments. The first molar and adjacent teeth, and contralateral canine (+/-controls) were blindly tested with an Analytic Technology pulp tester at 2-min cycles for 60 min. An 80 reading was used as the criterion for pulpal anesthesia. One hundred percent of the subjects had lip numbness with the IAN block. For the first molar, anesthetic success, defined as achieving an 80 reading within 15 min and keeping this reading for 60 min, was 42% with the IAN and 90% with the IAN + IO. Anesthetic failure defined as never achieving two 80 readings during the 60 min was 32% with the IAN and 0% with the IAN + IO. The onset of anesthesia was immediate with the IO injection. Eighty percent of the subjects sampled had a subjective increase in heart rate with the IO injection. The IO injection and postinjection questionnaire recorded low pain ratings.

An evaluation of 4% prilocaine and 3% mepivacaine compared with 2% lidocaine (1:100,000 epinephrine) for inferior alveolar nerve block

The purpose of this study was to measure the degree of anesthesia obtained with 4% prilocaine and 3% mepivacaine compared with 2% lidocaine (1:100,000 epinephrine) for inferior alveolar nerve block. Using a repeated measures design, 30 subjects randomly received an inferior alveolar injection using masked cartridges of each solution at three successive appointments. The first molar, first premolar, lateral incisor, and contralateral canine (control) were blindly tested with an Analytic Technology pulp tester at 3-min cycles for 50 min. Anesthetic success was defined as no subject response to the maximum output of the pulp tester (80 reading) within 16 min and maintenance of this reading for 50 min. Although subjects felt numb subjectively, anesthetic success as defined here occurred in 43 to 63% of the molars, in 53 to 67% of the premolars, and in 30 to 37% of the lateral incisors. No statistically significant differences in onset, success, or failure were found among the solutions. We conclude that the three preparations are equivalent for an inferior alveolar nerve block of 50-min duration.

Articaine for Supplemental Buccal Mandibular Infiltration Anesthesia in Patients with Irreversible Pulpitis When the Inferior Alveolar Nerve Block Fails

The purpose of this prospective study was to determine the anesthetic efficacy of the supplemental buccal infiltration injection of a cartridge of 4% articaine with 1:100,000 epinephrine in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve (IAN) block failed. Fifty-five emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an IAN block and had moderate to severe pain on endodontic access. An infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine was administered buccal to the tooth requiring endodontic treatment. Success of the infiltration injection was defined as no pain or mild pain on endodontic access or instrumentation. The results showed that anesthetic success was obtained in 58% of the mandibular posterior teeth. We can conclude that when the IAN block fails to provide profound pulpal anesthesia, the supplemental buccal infiltration injection of a cartridge of 4% articaine with 1:100,000 epinephrine would be successful 58% of the time for mandibular posterior teeth in patients presenting with irreversible pulpitis. Unfortunately, the modest success rate would not provide predictable pulpal anesthesia for all patients requiring profound anesthesia.

A radioimmunoassay determination of the concentrations of prostaglandins E2 and F2α in painful and asymptomatic human dental pulps

The purpose of this study was to determine the concentrations of prostaglandin E 2 and prostaglandin F 2α in painful and asymptomatic human dental pulps. Pulps were obtained from three groups of teeth: uninflamed pulps, asymptomatic teeth with caries and/or large restorations, and symptomatic teeth with the clinical diagnosis of irreversible pulpitis. Pulps were dissected from the teeth and stored in liquid nitrogen. They were homogenized in 40% ethanol and a lipid solvent extraction was performed. Prostaglandin levels were measured using radioimmunoassay. The pulps which were likely to demonstrate inflammation had significantly higher mean concentrations of prostaglandin E 2 than did the uninflamed pulps (p 2 and prostaglandin F 2α than the asymptomatic pulps (p

Anesthetic efficacy of the periodontal ligament injection after an inferior alveolar nerve block

The purpose of this study was to determine the contribution of the periodontal ligament injection (PDL) to the inferior aveolar nerve (IAN) block in human first molars. Using a repeated-measures design, 40 subjects randomly received a combination IAN block and PDL injections of the first molar using 2% lidocaine with 1:100,000 epinephrine and a combination IAN block and mock PDL injections (needle penetration only) at two successive appointments. The first molar and adjacent teeth, and contralateral canine (positive and negative controls) were blindly tested with an Analytic Technology pulp tester at 2-min cycles for 60 min. Profound anesthesia was defined as no subject response at an 80 reading. One hundred percent of the subjects had lip numbness with the IAN block. When the combination IAN/PDL injections were compared with the IAN block, the incidence of successful pulpal anesthesia (80 reading) was significantly greater for the combination injections through the first 23 min of pulp testing. However, after 23 min, there was no increase in anesthetic success by adding the PDL to the IAN injection. We concluded that adding the PDL injection to an IAN block increased the incidence of pulpal anesthesia for the first 23 min in the first molar.