Department of Conservative Dentistry & Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India.
Department of Conservative Dentistry & Endodontics, SGT Dental College, Gurgaon, Haryana, India.
J Endod. 2024 Aug;50(8):1037-1043. doi: 10.1016/j.joen.2024.05.005. Epub 2024 May 19.
The present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis.
One-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance.
The initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them.
Patients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.
本研究评估了两种不同的基于背压的补充麻醉对接受下颌磨牙有症状不可复性牙髓炎根管治疗的患者术后疼痛的影响。
135 名患有下颌第一或第二磨牙有症状不可复性牙髓炎的成年患者，接受 2%利多卡因加 1:80000 肾上腺素的下牙槽神经阻滞（IANB）注射。注射后 10 分钟开始进行窝洞预备。所有患者均必须出现唇部麻木。 Heft-Parker 视觉模拟量表（HP-VAS）用于测量根管治疗过程中的疼痛。初步注射成功的定义为在窝洞预备过程中无疼痛或轻度疼痛（HP-VAS 小于 55mm）。初始麻醉成功的患者作为对照组，接受根管治疗。95 名初步麻醉不成功的患者随机接受 2%利多卡因加 1:80000 肾上腺素的牙周膜内注射或类似麻醉溶液的牙髓内注射。重新开始根管治疗，在大量冲洗下将根管器械插入工作长度。根管内放置氢氧化钙药物，牙齿进行临时修复。术后疼痛分别在 2 小时、4 小时、6 小时、24 小时和 3 天进行测量。采用 Pearson 卡方检验、单因素方差分析和单向重复测量方差分析对数据进行分析。
初始下牙槽神经阻滞在 40 例（135 例）中成功。牙周膜内注射 33 例（47 例）成功（70%），牙髓内注射全部成功（45/45）。接受牙周膜内注射的患者在所有时间点直至 24 小时的疼痛评分均显著较高。3 天后，所有组的疼痛均显著减轻，但组间无显著差异。
接受补充牙周膜内注射的患者在根管治疗后 24 小时内可能会经历更高的术后疼痛。3 天后，疼痛评分降至对照组水平。
