Department of Endodontics, Faculty of Dentistry, Ain Shams University in Egypt, Cairo, Egypt.
Department of Endodontics, Faculty of Dentistry, The British University in Egypt, Cairo, Egypt.
Int Endod J. 2022 Mar;55(3):219-230. doi: 10.1111/iej.13667. Epub 2021 Dec 5.
To examine the efficacy rate of four anaesthetic protocols in mandibular first molars with symptomatic irreversible pulpitis (SIP).
One hundred and sixty patients with a diagnosis of SIP were included in this randomized clinical trial. Patients were randomly allocated into four treatment groups (N = 40) according to the administered technique: Group 1 (IANB): standard inferior alveolar nerve block (IANB) injection; Group 2 (IANB + IO): standard IANB followed by a supplemental intraosseous infusion (IO) injection; Group 3 (IANB + PDL): standard IANB followed by a supplemental periodontal ligament (PDL) injection; Group 4 (IANB + BI): standard IANB followed by a supplemental buccal infiltration. Patients rated pain intensity using a verbal rating scale when the root canal treatment procedure was initiated, that is, during caries removal, access preparation and pulpectomy. Heart rate changes were recorded before, during and after each injection. The anaesthetic efficacy rates were analysed using chi-square tests, age differences using one-way anova, gender differences using Fischer Exact tests whilst heart rate changes were analysed using Kruskal-Wallis tests. Statistical significances were set at p < .05 level.
All the included patients were analysed. No differences in the efficacy rate were found in relation to the age or gender of the participants amongst the study groups (p > .05). IANB + IO injections had a significantly higher efficacy rate (92.5%) when compared to other techniques (p < .05), followed by IANB + PDL injections (72.5%), IANB + BI injections (65.0%), with no significant differences between the IANB + PDL or IANB + BI injections (p > .05). IANB injection alone had a significantly lower rate (40%) compared to the other techniques (p < .05). A transient but significant rise in the heart rate was recorded in 60% (24/40) of patients who received the IANB + IO injection compared to other groups (p < .05).
Inferior alveolar nerve block injection alone did not reliably permit pain-free treatment for mandibular molars with SIP. The use of an additional IO supplemental injection provided the most effective anaesthesia for patients requiring emergency root canal treatment for SIP in mandibular posterior teeth.
研究四种麻醉方案对有症状不可复性牙髓炎（SIP）的下颌第一磨牙的疗效。
本随机临床试验纳入了 160 名 SIP 诊断患者。根据所实施的技术，患者被随机分配到四个治疗组（N=40）：组 1（IANB）：标准下牙槽神经阻滞（IANB）注射；组 2（IANB+IO）：标准 IANB 后进行补充骨内注射（IO）；组 3（IANB+PDL）：标准 IANB 后进行补充牙周韧带（PDL）注射；组 4（IANB+BI）：标准 IANB 后进行补充颊侧浸润。当根管治疗程序开始时，即在去龋、制备入口和牙髓切除时，患者使用口头评分量表来评定疼痛强度。在每次注射之前、期间和之后记录心率变化。使用卡方检验分析麻醉效果率，使用单向方差分析分析年龄差异，使用 Fisher 确切检验分析性别差异，使用 Kruskal-Wallis 检验分析心率变化。统计显著性设置为 p<.05 水平。
对所有纳入的患者进行了分析。在研究组中，参与者的年龄或性别与疗效率无差异（p>.05）。与其他技术相比，IANB+IO 注射的疗效率（92.5%）显著更高（p<.05），其次是 IANB+PDL 注射（72.5%）、IANB+BI 注射（65.0%），但 IANB+PDL 或 IANB+BI 注射之间无显著差异（p>.05）。单独使用 IANB 注射的效果率（40%）明显低于其他技术（p<.05）。与其他组相比，接受 IANB+IO 注射的 60%（24/40）患者的心率出现短暂但显著升高（p<.05）。
单独使用下牙槽神经阻滞注射不能可靠地实现 SIP 下颌磨牙无痛治疗。对于需要紧急根管治疗 SIP 的下颌后牙患者，使用补充的 IO 注射可提供最有效的麻醉效果。
