Department of Stomatology, São Paulo University, São Paulo, SP, Brazil.
Postgraduate Program in Biophotonics Applied to Health Sciences, Nove de Julho University, São Paulo, SP, Brazil.
PLoS One. 2019 Jul 31;14(7):e0219536. doi: 10.1371/journal.pone.0219536. eCollection 2019.
The aim of this study was to compare the anesthetic efficacy of two volumes of articaine in conventional inferior alveolar nerve block (IANB) of mandibular molars with irreversible pulpitis, and in cases of anesthetic failure, its complementation with periodontal ligament injection (PDL).
Ninety patients with irreversible pulpitis in mandibular molars received conventional IANB with 1.8 mL or 3.6 mL of 4% articaine with 1:100,000 epinephrine. In cases of IANB failure, the same volumes were administered in the PDL. Presence of pulpal anesthesia and absence/presence of pain during pulpectomy were evaluated by electric pulp stimulation and verbal analogue scale, respectively. Relative risks (RR) with corresponding 95% confidence intervals (95% CI) were calculated for each outcome.
27% and 42% of the patients achieved pulpal anesthesia following IANB with 1.8 mL and 3.6 mL, respectively (RR = 0.63, CI 95% 0.35 to 1.14, p = 0.12). Analgesia during pulpectomy was present in 64% and 73% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.87, CI 95% 0.66 to 1.16, p = 0.36). In cases of IANB failure, 75% and 42% of the patients that received 1.8 mL and 3.6 mL of PDL injection, respectively, achieved pulpal anesthesia (RR = 1.80, CI 95% 0.87 to 3.72, p = 0.11). During a new attempt at the pulpectomy procedure, analgesia was present in 69% and 75% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.91, CI 95% 0.57 to 1.45, p = 0.71).
Increasing the volume from 1.8 mL to 3.6 mL of the 4% articaine with 1:100,000 epinephrine in the IANB and in the PDL, did not significantly increase the success rate of pulpal anesthesia and clinical analgesia during the pulpectomy procedure. Therefore, both volumes presented a similar efficacy, though neither resulted in effective pain control during irreversible pulpitis treatment.
ClinicalTrials.gov NCT02422823.
本研究旨在比较两种体积的 4%阿替卡因（含 1:100000 肾上腺素）在患有不可复性牙髓炎的下颌磨牙常规下齿槽神经阻滞（IANB）中的麻醉效果，并在麻醉失败时，通过牙周膜注射（PDL）进行补充。
90 例患有不可复性牙髓炎的下颌磨牙患者接受了 1.8 毫升或 3.6 毫升的 4%阿替卡因（含 1:100000 肾上腺素）进行常规 IANB。IANB 失败时，在 PDL 中给予相同体积的药物。通过电牙髓刺激和口头模拟量表评估牙髓麻醉的存在以及牙髓切除术中是否存在疼痛。对于每种结果，计算相应的相对风险（RR）及其 95%置信区间（95%CI）。
IANB 中使用 1.8 毫升和 3.6 毫升时，分别有 27%和 42%的患者达到牙髓麻醉（RR=0.63，95%CI 0.35 至 1.14，p=0.12）。在牙髓切除术中，分别有 64%和 73%的患者出现镇痛，对于 1.8 毫升和 3.6 毫升（RR=0.87，95%CI 0.66 至 1.16，p=0.36）。IANB 失败时，分别接受 1.8 毫升和 3.6 毫升 PDL 注射的患者中，分别有 75%和 42%的患者达到牙髓麻醉（RR=1.80，95%CI 0.87 至 3.72，p=0.11）。在重新进行牙髓切除术时，分别有 69%和 75%的患者在 1.8 毫升和 3.6 毫升时出现镇痛（RR=0.91，95%CI 0.57 至 1.45，p=0.71）。
IANB 和 PDL 中 4%阿替卡因（含 1:100000 肾上腺素）的体积从 1.8 毫升增加到 3.6 毫升，并未显著提高牙髓麻醉和牙髓切除术中临床镇痛的成功率。因此，两种体积的效果相似，尽管都无法在不可逆性牙髓炎治疗期间有效控制疼痛。
ClinicalTrials.gov NCT02422823。
