Department of Endodontics, Dental and Periodontal Research Center, Dental Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Endodontics, Dental Faculty, Tabriz University of Medical Sciences, Tabriz, Iran.
J Endod. 2018 Oct;44(10):1462-1466. doi: 10.1016/j.joen.2018.07.010. Epub 2018 Aug 31.
Previous studies have reported that it is difficult to obtain proper anesthesia in mandibular molars with symptomatic irreversible pulpitis, and supplemental injections are usually unavoidable. The aim of the present study was to determine the anesthetic efficacy of articaine in mandibular first molars with symptomatic irreversible pulpitis with 3 injection methods: an inferior alveolar nerve block (IANB), an IANB with an intraligamentary injection, and an IANB with buccal infiltration before initiating the endodontic treatment.
Ninety-six patients (54 women and 42 men) with a diagnosis of symptomatic irreversible pulpitis in mandibular first molars were selected and randomly assigned into 3 groups (n = 32) according to the injection method as follows: group 1, a conventional IANB injection; group 2, an IANB injection, and after profound lip numbness after the IANB (after 15 minutes), buccal infiltration was administered; and group 3, an IANB injection, and after profound lip numbness after the IANB (after 15 minutes), an intraligamentary injection was performed, and after 20 minutes from the IANB, the endodontic treatment was initiated. The anesthetic solution was articaine 4% with 1:100,000 epinephrine. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation or initial instrumentation. Data were statistically analyzed using the chi-square and Mann-Whitney U tests, and P < .05 was set as significant.
The success rate for IANBs with an intraligamentary injection was 75%, and for IANBs with a buccal injection, it was 65.6%. For IANBs alone, the success rate was 28.1%.
Considering the limitations of the present study, in can be concluded that the success rate of IANBs increased with intraligamentary injections and buccal infiltrations with articaine that were performed before initiating treatment. Also, none of the injection methods showed complete success in anesthesia in all patients.
先前的研究报告指出，对于有症状的不可复性牙髓炎的下颌磨牙，获得适当的麻醉效果较为困难，通常需要辅助注射。本研究的目的是比较在下颌第一磨牙有症状的不可复性牙髓炎的情况下，使用 3 种注射方法（下牙槽神经阻滞麻醉（IANB）、IANB 联合牙周韧带内注射、IANB 联合颊侧浸润麻醉）获得的麻醉效果，然后再开始牙髓治疗。
选择 96 名（54 名女性，42 名男性）诊断为下颌第一磨牙有症状的不可复性牙髓炎的患者，根据注射方法将其随机分为 3 组（每组 32 名患者）：组 1，常规 IANB 注射；组 2，IANB 注射，在 IANB 后（15 分钟后）出现明显的唇麻木后，行颊侧浸润麻醉；组 3，IANB 注射，在 IANB 后（15 分钟后）出现明显的唇麻木后，行牙周韧带内注射，在 IANB 后 20 分钟开始牙髓治疗。麻醉剂为 4%阿替卡因加 1:100000 肾上腺素。根据视觉模拟评分记录，在开髓或初次器械预备时无痛或轻度疼痛定义为成功。使用卡方检验和曼-惠特尼 U 检验进行统计学分析，P<.05 为差异有统计学意义。
IANB 联合牙周韧带内注射的成功率为 75%，IANB 联合颊侧浸润麻醉的成功率为 65.6%，而 IANB 单独使用的成功率为 28.1%。
考虑到本研究的局限性，可以得出结论，在开始治疗前使用阿替卡因行牙周韧带内注射和颊侧浸润麻醉可以提高 IANB 的成功率。此外，没有一种注射方法能在所有患者中达到完全的麻醉效果。
