Matthews Rachel, Drum Melissa, Reader Al, Nusstein John, Beck Mike
Division of Endodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA.
J Endod. 2009 Mar;35(3):343-6. doi: 10.1016/j.joen.2008.11.025.
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.
本前瞻性研究的目的是确定，当传统的下牙槽神经（IAN）阻滞麻醉失败时，对诊断为不可逆性牙髓炎的下颌后牙补充颊侧浸润注射一针含1:100,000肾上腺素的4%阿替卡因的麻醉效果。55例诊断为下颌后牙不可逆性牙髓炎的急诊患者接受了IAN阻滞麻醉，但在进行牙髓治疗时仍有中度至重度疼痛。对需要进行牙髓治疗的牙齿颊侧注射一针含1:100,000肾上腺素的4%阿替卡因。浸润注射成功的定义为在进行牙髓治疗或器械操作时无疼痛或轻度疼痛。结果显示，58%的下颌后牙获得了麻醉成功。我们可以得出结论，当IAN阻滞麻醉未能提供有效的牙髓麻醉时，对诊断为不可逆性牙髓炎的患者，补充颊侧浸润注射一针含1:100,000肾上腺素的4%阿替卡因，58%的情况下对下颌后牙麻醉会成功。不幸的是，这一适度的成功率并不能为所有需要深度麻醉的患者提供可预测的牙髓麻醉效果。
