Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, England.
J Endod. 2012 Apr;38(4):421-5. doi: 10.1016/j.joen.2011.12.006. Epub 2012 Feb 2.
The objective of this study was to compare the efficacy of supplementary repeat inferior alveolar nerve block with 2% lidocaine and epinephrine, buccal infiltration with 4% articaine with epinephrine, intraligamentary injection, or intraosseous injection (both with 2% lidocaine with epinephrine) after failed inferior alveolar nerve block (IANB) for securing pain-free treatment in patients experiencing irreversible pulpitis in mandibular permanent teeth.
This randomized clinical trial included 182 patients diagnosed with irreversible pulpitis in mandibular teeth. Patients received 2.0 mL of 2% lidocaine with 1:80,000 epinephrine as an IANB injection. Patients who did not experience pain-free treatment received randomly 1 of 4 supplementary techniques, namely repeat lidocaine IANB (rIANB), 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 analyzed by χ(2) and Fisher exact tests.
Of the 182 patients, 122 achieved successful pulpal anesthesia within 10 minutes after initial IANB injection; 82 experienced pain-free treatment. ABI and IO allowed more successful (pain-free) treatment (84% and 68%, respectively) than rIANB or PDL supplementary techniques (32% and 48%, respectively); this was statistically significant (P = .001).
IANB injection alone does not always allow pain-free treatment for mandibular teeth with irreversible pulpitis. Supplementary buccal infiltration with 4% articaine with epinephrine and intraosseous injection with 2% lidocaine with epinephrine are more likely to allow pain-free treatment than intraligamentary and repeat IANB injections with 2% lidocaine with epinephrine for patients experiencing irreversible pulpitis in mandibular permanent teeth.
本研究旨在比较在下颌神经阻滞（IANB）失败后，采用 2%利多卡因加肾上腺素行补充性重复下牙槽神经阻滞、4%阿替卡因加肾上腺素行颊侧浸润、行内连接注射或骨内注射（均用 2%利多卡因加肾上腺素），对治疗下颌恒牙不可逆性牙髓炎患者无痛治疗的效果。
本随机临床试验纳入了 182 例被诊断为下颌牙齿不可逆性牙髓炎的患者。患者接受了 2.0 毫升 2%利多卡因加 1:80000 肾上腺素的 IANB 注射。未接受无痛治疗的患者随机接受了 4 种补充技术中的 1 种，即重复利多卡因 IANB（rIANB）、阿替卡因颊侧浸润（ABI）、利多卡因内连接注射（PDL）或利多卡因骨内注射（IO）。当牙髓测试仪的最大刺激（80 读数）未得到反应时，认为牙髓麻醉成功，此时开始治疗。如果没有疼痛，治疗被认为是成功完成的。采用卡方检验和 Fisher 确切概率法进行数据分析。
在 182 例患者中，有 122 例患者在初次 IANB 注射后 10 分钟内达到了成功的牙髓麻醉；有 82 例患者实现了无痛治疗。ABI 和 IO 辅助技术（分别为 84%和 68%）比 rIANB 或 PDL 辅助技术（分别为 32%和 48%）更能实现（无痛）成功治疗；这具有统计学意义（P =.001）。
IANB 注射单独应用并不总是能为下颌恒牙不可逆性牙髓炎患者实现无痛治疗。对于下颌恒牙不可逆性牙髓炎患者，4%阿替卡因加肾上腺素行颊侧浸润和骨内注射 2%利多卡因加肾上腺素比内连接注射和重复注射 2%利多卡因加肾上腺素更有可能实现无痛治疗。
