 |
| Title |
Supplemental Intraosseous Anesthesia Improves the Success Rate of Inferior Alveolar Nerve Blocks in Molars with Irreversible Pulpitis. |
| Clinical Question |
In patients receiving treatment for irreversible pulpitis of mandibular molars, does the supplemental intraosseous anesthesia provide a superior clinical success rate compared to an inferior alveolar nerve block alone? |
| Clinical Bottom Line |
In cases with patients being treated for irreversible pulpitis, a supplemental delivery of local anesthetic by means of intraosseous injection following an initial inferior alveolar nerve block aids in achieving successful pain free treatment. |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 22414822 | Kanaa/2012 | 182 patients (73.1% male, 26.9% female) with average age of 31.9 with cases of irreversible pulpitis. | Randomized Controlled Trial | | Key results | A significant difference was found in the success of treatment of mandibular molars diagnosed with irreversible pulpitis after 4 supplementary injection techniques: repeated inferior alveolar nerve block (rIANB), articaine buccal infiltration (ABI), intraligamentary injection (PDL), or intraosseous injection (IO); (χ2, P=.001). Success rates were greater with the use of ABI (84%) & IO (68%) compared to PDL injections (48%) or rIANB (32%). | | #2) 22506833 | Zarei/2012 | 40 patients (22 female, 18 male) with irreversible pulpitis | Randomized Controlled Trial | | Key results | Forty patients who experienced a failed inferior alveolar nerve block were divided into 2 groups to receive supplemental anesthesia with an intraossesous or intraligamentary (PDL) injection. Pain levels using the VAS score were recorded before and after supplemental anesthesia was given. After the first injections, the use of the X-tip intraosseous injection (IO) provided 100% (n=20) success in pulpal anesthesia compared to the use of a PDL injection, which recorded a 70% (n=14) success rate. These findings were statistically significant (Mann-Whitney U-test, p=0.02). | | #3) 14651278 | Nusstein/2003 | 33 adult patients (16 male, 17 female) with irreversible pulpitis of mandibular posterior teeth. | Case Series | | Key results | Patients who received a supplemental intraosseous injection after a failed inferior alveolar nerve block were found to have an anesthetic success rate of 82% (27 of 33, 95% confidence interval = 65-93%). Pain levels were recorded using Heft-Parker VAS scores prior to supplemental injection and throughout the procedure. A successful treatment was defined with a VAS score of less than or equal to 54. VAS score of zero correlates to no pain, where mild pain is defined by a VAS score less than or equal to 54. No statistics for significance were reported. | | #4) 22414822 | Verma/2013 | 30 patients (16 male, 14 female) diagnosed with irreversible pulpitis of mandibular posterior teeth. | Case Series | | Key results | Patients who received an inferior alveolar nerve block and experienced moderate to severe pain during endodontic treatment were given supplemental intraosseous (IO) anesthesia. A success rate of 93% was recorded for patients receiving supplemental IO anesthesia (n=28, 95% confidence interval = 77-98%, Z value = 4.55, P<0.001). “Z test for single proportion was used for anesthetic success and failure and confidence interval was calculated by the Wilson method.” | |
| Evidence Search |
intraosseous[All Fields] AND ("anaesthesia"[All Fields] OR "anesthesia"[MeSH Terms] OR "anesthesia"[All Fields]) ; supplemental[All Fields] AND intraosseous[All Fields] AND ("anaesthesia"[All Fields] OR "anesthesia"[MeSH Terms] OR "anesthesia"[All Fields]) |
Comments on
The Evidence |
Validity: The sample sizes of the listed studies were relatively small, but each study was well-designed. The studies had a greater than 80% completion rate. Patients were enrolled in the study following a strict inclusion criteria that included diagnosis of irreversible pulpitis. The dichotomous outcome for successful anesthesia (yes or no) was recorded blinded to the treatment provided when applicable.
Perspective:
Intraosseous inject of local anesthetics should be considered as a supplemental anesthesia for patients being endodontically treated for irreversible pulpitis in a mandibular molar. Research has proven that supplemental intraosseous anesthesia provides a successful means to achieve pulpal anesthesia when inferior alveolar nerve blocks fail. However, the health care provider must be trained and familiarized with technique since damage to the bone and surrounding structures could happen if the correct technique is not used.
|
| Applicability |
This information is greatly beneficial to practitioners performing endodontic procedures and reviewing different anesthetic techniques in cases involving molars with irreversible pulpitis. |
| Specialty/Discipline |
(Endodontics) (General Dentistry) |
| Keywords |
Intraosseous; inferior alveolar nerve; anesthesia; molars; irreversible pulpitis
|
| ID# |
2689 |
| Date of submission: |
03/24/2014 |
| E-mail |
thayer@livemail.uthscsa.edu |
| Author |
Scott Thayer |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Anibal Diogenes, DDS, MS, PhD |
| Faculty mentor/Co-author e-mail |
diogenes@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
|
Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
|
|
