Efficacy Of Local Anesthesia In Mandibular Irreversible Pulpitis Teeth

Methods: This randomized clinical trial included 182 patients diagnosed with irreversible pulpitis in mandibular teeth. Patients received 2.0 mL of IANB injection using 2% lidocaine with 1:80,000 epinephrine. Patients did not experience pain free treatment, received randomly one of four supplementary techniques namely, repeat lidocaine IANB (r IANB), articaine buccal infiltration (ABI), lidocaine intraligamentary injection (PDL) or lidocaine intraosseous injection (IO). Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation (80 reading) of the pulp tester, at which time treatment commenced. Treatment was regarded as being successfully completed when it was associated with no pain. Data were analysed by X2 tests.

Results: Of the 182 patients, 122 achieved successful pulpal anaesthesia within 10 minutes following IANB injection; 82 experienced pain free treatment. In the remaining 100 patients who received one of the four supplementary techniques, pulpal anaesthesia was significantly better following ABI and IO injections (23/25: 92% & 21/25: 84%, respectively) than after r IANB and PDL (15/25: 60% & 18/25: 72%, respectively) injections (p=0.040). Pain free treatment was also higher after ABI and IO injections (21/23: 91.3% & 17/21: 81%, respectively) than after r IANB and PDL (8/15: 53.3% & 12/18: 66.7%, respectively) injections (p=0.043).

Conclusions: IANB injection alone does not secure satisfactory pain free treatment (82/182: 45.1%). Articaine buccal infiltration and intraosseous injections are better supplementary techniques than intraligamentary and repeat IANB injections for patients experiencing irreversible pulpitis in the mandibular permanent teeth.