Vali Sichani Armita, Baharian Hossein, Yaraghi Navid, Khosravani Zahra, Sichani Asana Vali
Department of Endodontics, Dental Materials Research Center, School of Dentistry, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Dental Research Center, Dental Students' Research Committee, Department of Endodontics, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Dent Res J (Isfahan). 2024 Nov 21;21:60. doi: 10.4103/drj.drj_324_23. eCollection 2024.
No consensus has been reached on the effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful inferior alveolar nerve (IAN) block. This study aimed to assess the effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful IAN block.
This double-blind randomized controlled clinical trial was conducted on 45 patients with irreversible pulpitis. The patients were randomly assigned to three groups ( = 15) for topical application of 10 mg amitriptyline, 10 mg nortriptyline, and starch (placebo). An IAN block was primarily administered by injection of lidocaine with 1:80,000 epinephrine. Next, the abovementioned medications were topically applied in each group. The pain level of patients was quantified by the McGill Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (FPRS) before the intervention, immediately after injection, and after topical application of materials and compared. Data were analyzed by SPSS version 21 using the Chi-square test, likelihood ratio, one-way ANOVA, repeated-measures ANOVA, and the Kruskal-Wallis test. < 0.05 was considered statistically significant.
All three interventions significantly decreased pain ( < 0.05). Although nortriptyline caused a greater pain relief, the difference among the three groups was not significant regarding the VAS or Wong-Baker FPRS scores ( > 0.05).
Although nortriptyline caused a greater reduction in irreversible pulpitis pain than amitriptyline, the difference between the two medications was not significant. Future studies without a placebo group are recommended.
对于在成功进行下牙槽神经（IAN）阻滞但牙髓麻醉失败的牙齿上局部应用阿米替林和去甲替林对不可逆性牙髓炎疼痛的影响，尚未达成共识。本研究旨在评估在成功进行IAN阻滞但牙髓麻醉失败的牙齿上局部应用阿米替林和去甲替林对不可逆性牙髓炎疼痛的影响。
本双盲随机对照临床试验对45例不可逆性牙髓炎患者进行。患者被随机分为三组（每组n = 15），分别局部应用10毫克阿米替林、10毫克去甲替林和淀粉（安慰剂）。首先通过注射含1:80,000肾上腺素的利多卡因进行IAN阻滞。接下来，在每组中局部应用上述药物。在干预前、注射后即刻以及局部应用材料后，通过麦吉尔视觉模拟量表（VAS）和面部表情疼痛评分量表（FPRS）对患者的疼痛程度进行量化并比较。使用SPSS 21版软件，通过卡方检验、似然比、单因素方差分析、重复测量方差分析和Kruskal-Wallis检验对数据进行分析。P < 0.05被认为具有统计学意义。
所有三种干预措施均显著减轻了疼痛（P < 0.05）。尽管去甲替林带来了更大程度的疼痛缓解，但三组在VAS或面部表情疼痛评分量表（FPRS）得分方面的差异并不显著（P > 0.05）。
尽管去甲替林比阿米替林在减轻不可逆性牙髓炎疼痛方面效果更显著，但两种药物之间的差异并不显著。建议未来开展无安慰剂组的研究。
