Restorative Dentistry & Endodontics

Research Articles

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis: Amy Kia Cheen Liew, Yi-Chun Yeh, Dalia Abdullah, Yu-Kang Tu; Restor Dent Endod 2021;46(3):e41. Published online July 21, 2021; DOI: https://doi.org/10.5395/rde.2021.46.e41

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Objectives

This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth.

Materials and Methods

Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application.

Results

The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14–3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates.

Conclusions

Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

Citations

Citations to this article as recorded by

Adrenaline in pulp capping treatment of reversible pulpitis
Si-Yun Yang, Jin-Zhu Wang, Hao Fan, Min Chen
World Journal of Clinical Cases.2024; 12(22): 5024. CrossRef
Effect of 810 nm Diode Laser Irradiation on the Time of Initiation and Depth of Anesthesia for Endodontic Treatment of Mandibular First Molars with Symptomatic Irreversible Pulpitis: A Clinical Trial
Elham Khoshbin, Leila Ghasemi, Rooholah Behroozi, Zahra Khosravi, Afsaneh Rahmati, Loghman Rezaeisoufi, Hamed Karkehabadi
Photobiomodulation, Photomedicine, and Laser Surgery.2023; 41(9): 475. CrossRef
The potential of articaine as new generation of local anesthesia in dental clinics: A review
Wen Luo, Kaiyue Zheng, Huifang Kuang, Zhixin Li, Jinrong Wang, Jie Mei
Medicine.2022; 101(48): e32089. CrossRef

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Efficacy of buccal piroxicam infiltration and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial: Saurav Paul, Sridevi Nandamuri, Aakrati Raina, Mukta Bansal; Restor Dent Endod 2021;46(1):e9. Published online January 26, 2021; DOI: https://doi.org/10.5395/rde.2021.46.e9

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Objectives

This randomized clinical trial aimed to assess the effectiveness of buccal infiltration with piroxicam on the anesthetic efficacy of inferior alveolar nerve block (IANB) with buccal infiltration in irreversible pulpitis, with pain assessed using the Heft-Parker visual analogue scale (HP-VAS).

Materials and Methods

This study included 56 patients with irreversible pulpitis in mandibular molars, randomly distributed between 2 groups (n = 28). After evaluating the initial pain score with the HP-VAS, each patient received IANB followed by buccal infiltration of 2% lignocaine with adrenaline (1:80,000). Five minutes later, the patients in groups 1 and 2 were given buccal infiltration with 40 mg/2 mL of piroxicam or normal saline, respectively. An access opening procedure (AOP) was performed 15 minutes post-IANB once the individual showed signs of lip numbness as well as 2 negative responses to electric pulp testing. The HP-VAS was used to grade the patient's pain during caries removal (CR), AOP, and working length measurement (WLM). Successful anesthesia was identified either by the absence of pain or slight pain through CR, AOP, and WLM, with no requirement of a further anesthetic dose. A statistical analysis was done using the Shapiro-Wilk and Mann-Whitney U tests.

Results

The piroxicam group presented a significantly lower (p < 0.05) mean pain score than the saline group during AOP.

Conclusions

Buccal infiltration with piroxicam enhanced the efficacy of anesthesia with IANB and buccal infiltration with lignocaine in patients with irreversible pulpitis.

Citations

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Inferior alveolar nerve block success of 2% mepivacaine versus 4% articaine in patients with symptomatic irreversible pulpitis in mandibular molars: A randomized double‐blind single‐centre clinical trial
Mohammed Fawzy Omar Mohammed Habib, Sovana Tarek, Sara Mohamed Elsayed Teama, Khaled Ezzat, Randa Mohamed El Boghdadi, Abeer Marzouk, Manar Yehia Fouda, Shaimaa Ismail Gawdat, Marwa Mahmoud Bedier, Suzan Abdul Wanees Amin
International Endodontic Journal.2022; 55(11): 1177. CrossRef
Present status and future directions—Mechanisms and management of local anaesthetic failures
Masoud Parirokh, Paul V. Abbott
International Endodontic Journal.2022; 55(S4): 951. CrossRef

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The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain: Masoud Parirokh, Mohammad Hosein Yosefi, Nouzar Nakhaee, Paul V. Abbott, Hamed Manochehrifar; Restor Dent Endod 2015;40(2):155-160. Published online March 16, 2015; DOI: https://doi.org/10.5395/rde.2015.40.2.155

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Objectives

Achieving adequate anesthesia with inferior alveolar nerve blocks (IANB) is of great importance during dental procedures. The aim of the present study was to assess the success rate of two anesthetic agents (bupivacaine and lidocaine) for IANB when treating teeth with irreversible pulpitis.

Materials and Methods

Sixty volunteer male and female patients who required root canal treatment of a mandibular molar due to caries participated in the present study. The inclusion criteria included prolonged pain to thermal stimulus but no spontaneous pain. The patients were randomly allocated to receive either 2% lidocaine with 1:80,000 epinephrine or 0.5% bupivacaine with 1:200,000 epinephrine as an IANB injection. The sensitivity of the teeth to a cold test as well as the amount of pain during access cavity preparation and root canal instrumentation were recorded. Results were statistically analyzed with the Chi-Square and Fischer's exact tests.

Results

At the final step, fifty-nine patients were included in the study. The success rate for bupivacaine and lidocaine groups were 20.0% and 24.1%, respectively. There was no significant difference between the two groups at any stage of the treatment procedure.

Conclusions

There was no difference in success rates of anesthesia when bupivacaine and lidocaine were used for IANB injections to treat mandibular molar teeth with irreversible pulpitis. Neither agent was able to completely anesthetize the teeth effectively. Therefore, practitioners should be prepared to administer supplemental anesthesia to overcome pain during root canal treatment.

Citations

Citations to this article as recorded by

A Morphometric Study of the Mandibular Foramen, Lingula, and the Incidence of Accessory Mandibular Foramina in Dry Mandibles
Yashaswi Singh, Pratibha Shakya, Noor Us Saba, Heena Singh, Navneet Kumar
Cureus.2025;[Epub] CrossRef
Effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful inferior alveolar nerve block: A randomized clinical trial
Armita Vali Sichani, Hossein Baharian, Navid Yaraghi, Zahra Khosravani, Asana Vali Sichani
Dental Research Journal.2024;[Epub] CrossRef
The Effect of the Anatomic Variables on the Success Rate of Anesthesia in Maxillary Molars with Irreversible Pulpitis
Masoud Parirokh, Sina Kakooei, Nouzar Nakhaee, Hamed Manochehrifar, Paul Abbott
Journal of Endodontics.2022; 48(6): 707. CrossRef
Present status and future directions—Mechanisms and management of local anaesthetic failures
Masoud Parirokh, Paul V. Abbott
International Endodontic Journal.2022; 55(S4): 951. CrossRef
Local anesthesia in oral and maxillofacial surgery: A review of current opinion
Yu-Hao Wang, Dian-Ri Wang, Ji-Yuan Liu, Jian Pan
Journal of Dental Sciences.2021; 16(4): 1055. CrossRef
ANATOMICAL STUDY OF MANDIBULAR FORAMEN IN DRY ADULT HUMAN MANDIBLES IN BIHAR STATE REGION
Vijay Kumar Singh, Md. Zahid Hussain, Subodh Kumar
GLOBAL JOURNAL FOR RESEARCH ANALYSIS.2021; : 34. CrossRef
Efficacy of buccal piroxicam infiltration and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial
Saurav Paul, Sridevi Nandamuri, Aakrati Raina, Mukta Bansal
Restorative Dentistry & Endodontics.2021;[Epub] CrossRef
Different anesthetics on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis
Juliana Larocca de Geus, Jane Kenya Nogueira da Costa, Letícia Maíra Wambier, Bianca Medeiros Maran, Alessandro Dourado Loguercio, Alessandra Reis
The Journal of the American Dental Association.2020; 151(2): 87. CrossRef
Efficacy of local anaesthetic solutions on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a systematic review and network meta‐analysis of randomized clinical trials
V. Nagendrababu, S. J. Pulikkotil, A. Suresh, S. K. Veettil, S. Bhatia, F. C. Setzer
International Endodontic Journal.2019; 52(6): 779. CrossRef
The Effect of Sphenopalatine Block on the Postoperative Pain of Endoscopic Sinus Surgery: A Meta‐analysis
Do Hyun Kim, Haram Kang, Se Hwan Hwang
Otolaryngology–Head and Neck Surgery.2019; 160(2): 223. CrossRef
Effect of four local anesthetics (tetracaine, proparacaine, lidocaine, and bupivacaine) on intraocular pressure in dogs
Ali Asghar Sarchahi, Mehdi Eskandari
International Ophthalmology.2019; 39(7): 1467. CrossRef
Strategies for managing pain during endodontic treatment
Paul V. Abbott, Masoud Parirokh
Australian Endodontic Journal.2018; 44(2): 99. CrossRef
Is mepivacaine as effective as lidocaine during inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis? A systematic review and meta‐analysis
W. A. Vieira, L. R. Paranhos, G. O. Cericato, A. Franco, M. A. G. Ribeiro
International Endodontic Journal.2018; 51(10): 1104. CrossRef
Injectable local anaesthetic agents for dental anaesthesia
Geoffrey St George, Alyn Morgan, John Meechan, David R Moles, Ian Needleman, Yuan-Ling Ng, Aviva Petrie
Cochrane Database of Systematic Reviews.2018;[Epub] CrossRef
Successful pulpal anesthesia for symptomatic irreversible pulpitis
Melissa Drum, Al Reader, John Nusstein, Sara Fowler
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The Effect of Photobiomodulation on the Depth of Anesthesia During Endodontic Treatment of Teeth With Symptomatic Irreversible Pulpitis (Double Blind Randomized Clinical Trial)
Sholeh Ghabraei, Nasim Chiniforush, Behnam Bolhari, Mohsen Aminsobhani, Abbas Khosarvi
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Morphometric study on mandibular foramen and incidence of accessory mandibular foramen in mandibles of south Indian population and its clinical implications in inferior alveolar nerve block
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The Effect of Maxillary First Molar Root Length on the Success Rate of Buccal Infiltration Anesthesia
Ehsan Moradi Askari, Masoud Parirokh, Nouzar Nakhaee, Hamid Reza Hosseini, Paul V. Abbott
Journal of Endodontics.2016; 42(10): 1462. CrossRef
Efficacy of Ketorolac Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis: A Prospective, Double-blind, Randomized Clinical Trial
Nahid Mohammadzadeh Akhlaghi, Behnoush Hormozi, Paul V. Abbott, Zohreh Khalilak
Journal of Endodontics.2016; 42(5): 691. CrossRef

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Case Report

Hypoesthesia after IAN block anesthesia with lidocaine: management of mild to moderate nerve injury: Sungjoo Moon, Seung-Jong Lee, Euiseong Kim, Chan-Young Lee; Restor Dent Endod 2012;37(4):232-235. Published online November 21, 2012; DOI: https://doi.org/10.5395/rde.2012.37.4.232

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Hypoesthesia after an inferior alveolar nerve (IAN) block does not commonly occur, but some cases are reported. The causes of hypoesthesia include a needle injury or toxicity of local anesthetic agents, and the incidence itself can cause stress to both dentists and patients. This case presents a hypoesthesia on mental nerve area followed by IAN block anesthesia with 2% lidocaine. Prescription of steroids for a week was performed and periodic follow up was done. After 1 wk, the symptoms got much better and after 4 mon, hypoesthesia completely disappeared. During this healing period, only early steroid medication was prescribed. In most cases, hypoesthesia is resolved within 6 mon, but being aware of etiology and the treatment options of hypoesthesia is important. Because the hypoesthesia caused by IAN block anesthesia is a mild to moderate nerve injury, early detection of symptom and prescription of steroids could be helpful for improvement of the hypoesthesia.

Citations

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İMPLANT CERRAHİSİ SONRASI HİPOESTEZİ-6 AYLIK TAKİP: VAKA SERİSİ
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