Efficacy of infiltrative anesthesia for extraction of endodontically treated mandibular molars: A randomized controlled trial
Infiltration can be used for mandibular molars
Keywords:
Local infiltration anesthesia, Inferior alveolar block, tooth ExtractionAbstract
Background/Aim: In most dental curricula, it has been taught that infiltrative anesthesia (IA) is not sufficient for the extraction of lower molars and that an inferior alveolar nerve block (IANB) is required instead. This study compared the effectiveness of IANB and IA for the extraction of mandibular molars that had previously undergone root canal treatment.
Methods: Patients older than 18 years who had a mandibular molar with previously completed root canal treatment were included. Patients who were allergic to local anesthetics, those with severely mobile teeth, those with severe pain due to acute infection, and those using psychotropic drugs were excluded. Sixty subjects were randomly divided into the study (n=30) and control (n=30) groups. An anesthetic solution containing 20 mg/mL lidocaine and 0.0125 mg/mL epinephrine was used. In the study group, only vestibular and lingual IA were used. In the control group, IANB was performed. The teeth were extracted following the standard procedure. The pain experienced during extraction was compared between the study and control groups.
Results: There was no significant difference in extraction pain between the two anesthesia techniques (P=0.836). The gender of the patient and whether the tooth to be extracted was a first or second molar did not affect pain (P=0.953 and P=0.900, respectively).
Conclusion: Buccal and lingual IA can be used to extract the mandibular molars in certain cases. Teaching dental students that IA can be used instead of IANB in some mandibular molar extractions may provide them with comfort and confidence in clinical practice.
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References
Malamed SF. Handbook of Local Anesthesia. 6th ed. St. Louis: Elsevier Health Sciences; 2004.
Wong MK, Jacobsen PL. Reasons for local anesthesia failures. J Am Dent Assoc. 1992;123:69-73. DOI: https://doi.org/10.14219/jada.archive.1992.0004
Chevalier V, Arbab-Chirani R, Tea SH, Roux M. Facial palsy after inferior alveolar nerve block: case report and review of the literature. Int J Oral Maxillofac Surg. 2010;39:1139-42. DOI: https://doi.org/10.1016/j.ijom.2010.04.049
Shabazfar N, Daubländer M, Al-Nawas B, Kämmerer PW. Periodontal intraligament injection as alternative to inferior alveolar nerve block—meta-analysis of the literature from 1979 to 2012. Clin Oral Investig. 2014;18:351-8. DOI: https://doi.org/10.1007/s00784-013-1113-1
Göçmen G, Özkan Y. Comparison of the efficacy of local infiltration and mandibular block anesthesia with articaine for harvesting ramus grafts. J Oral Maxillofac Surg. 2016;74:2143-50. DOI: https://doi.org/10.1016/j.joms.2016.05.008
Johnson TM, Badovinac R, Shaefer J. Teaching alternatives to the standard inferior alveolar nerve block in dental education: outcomes in clinical practice. J Dent Educ. 2007;71:1145-52. DOI: https://doi.org/10.1002/j.0022-0337.2007.71.9.tb04378.x
AlHindi M, Rashed B, AlOtaibi N. Failure rate of inferior alveolar nerve block among dental students and interns. Saudi Med J. 2016;37:84-9. DOI: https://doi.org/10.15537/smj.2016.1.13278
Torrente-Castells E, Gargallo-Albiol J, Rodríguez-Baeza A, Berini-Aytés L, Gay-Escoda C. Necrosis of the skin of the chin: a possible complication of inferior alveolar nerve block injection. J Am Dent Assoc. 2008;139:1625-30. DOI: https://doi.org/10.14219/jada.archive.2008.0104
Choi EH, Seo JY, Jung BY, Park W. Diplopia after inferior alveolar nerve block anesthesia: report of 2 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009;107:e21-4. DOI: https://doi.org/10.1016/j.tripleo.2009.02.009
Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study. J Endod. 2006;32:296-8. DOI: https://doi.org/10.1016/j.joen.2005.09.016
Palti DG, Almeida CM, Rodrigues AC, Andreo JC, Lima JEO. Anesthetic technique for inferior alveolar nerve block: a new approach. J Appl Oral Sci. 2011;19:11-5. DOI: https://doi.org/10.1590/S1678-77572011000100004
Jung IY, Kim JH, Kim ES, Lee CY, Lee SJ. An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod. 2008;34:11-3. DOI: https://doi.org/10.1016/j.joen.2007.09.006
Robertson D, Nusstein J, Reader A, Beck M, McCartney M. The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc. 2007;138:1104-12. DOI: https://doi.org/10.14219/jada.archive.2007.0324
Bataineh AB, Alwarafi MA. Patient’s pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block. Clin Oral Investig. 2016;20:2241-50. DOI: https://doi.org/10.1007/s00784-016-1712-8
Corbett IP, Kanaa MD, Whitworth JM, Meechan JG. Articaine infiltration for anesthesia of mandibular first molars. J Endod. 2008;34:514-8. DOI: https://doi.org/10.1016/j.joen.2008.02.042
Gaffen AS, Haas DA. Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry. J Can Dent Assoc. 2009;75:579.
Wilson AW, Deacock S, Downie IP, Zaki G. Allergy to local anaesthetic: the importance of thorough investigation. Br Dent J. 2000;188:120-2. DOI: https://doi.org/10.1038/sj.bdj.4800408a
Alghaithy RA, Qualtrough AJE. Pulp sensibility and vitality tests for diagnosing pulpal health in permanent teeth: a critical review. Int Endod J. 2017;50:135-42. DOI: https://doi.org/10.1111/iej.12611
Nusstein JM, Beck M. Comparison of preoperative pain and medication use in emergency patients presenting with irreversible pulpitis or teeth with necrotic pulps. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96:207-14. DOI: https://doi.org/10.1016/S1079-2104(02)91732-4
Vallerand AH, Polomano RC. The relationship of gender to pain. Pain Manag Nurs. 2000;1:8-15. DOI: https://doi.org/10.1053/jpmn.2000.9759
Gallatin J, Nusstein J, Reader A, Beck M, Weaver J. A comparison of injection pain and postoperative pain of two intraosseous anesthetic techniques. Anesth Prog. 2003;50:111-20.
Tófoli GR, Ramacciato JC, Volpato MC, Meechan JG, Ranali J, Groppo FC. Anesthetic efficacy and pain induced by dental anesthesia: the influence of gender and menstrual cycle. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2007;103:e34-8. DOI: https://doi.org/10.1016/j.tripleo.2006.08.024
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