 |
| Title |
Secondary PDL and Intraosseous Injections Are Both Effective at Anesthetizing Difficult-to-Anesthetize Mandibular Molars |
| Clinical Question |
In patients with a mandibular molar that has irreversible pulpitis and inadequate anesthesia following an inferior alveolar injection, are secondary intraosseous injections more effective at achieving successful anesthesia and reducing side effects than periodontal ligament (PDL) injections? |
| Clinical Bottom Line |
Both secondary intraosseous and PDL injections can provide anesthesia for mandibular molars that have irreversible pulpitis, but intraosseous injections have a slightly higher effectiveness rate. |
| 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 diagnosed with irreversible pulpitis in mandibular teeth | Randomized Controlled Trial | | Key results | Following a failed inferior alveolar nerve block injection on a mandibular molar that has irreversible pulpitis, intraosseous injection with 2% lidocaine with epinephrine has a higher likelihood (68%) of achieving pain-free treatment compared to a PDL injection with 2% lidocaine with epinephrine (48%). | | #2) 21881057 | Moore/2011 | Mandibular teeth | Editorial and Opinions | | Key results | To manage failed mandibular anesthesia, PDL injections and intraosseous injections are excellent alternatives. | | #3) 8217423 | Cannell/1983 | Healthy adults | Randomized Controlled Trial | | Key results | PDL injections are unlikely to have unwanted systemic effects in healthy adults.
| |
| Evidence Search |
("periodontal ligament"[MeSH Terms] OR ("periodontal"[All Fields] AND "ligament"[All Fields]) OR "periodontal ligament"[All Fields]) AND ("injections"[MeSH Terms] OR "injections"[All Fields] OR "injection"[All Fields]) AND intraosseous[All Fields] AND ("injections"[MeSH Terms] OR "injections"[All Fields])
|
Comments on
The Evidence |
Validity: The evidence from the first study gains validity from its large population and randomized control trial study design. To remove patient error that may manifest itself in differences of pain tolerance, pulp testing was performed to standardize the process. The investigators also tested teeth on the opposite side of the arch to ensure proper anesthesia. To further strengthen the validity, the same operator performed all of the injections. The second study is a review that has recommendations for both types of injections from the American Dental Association. The third article shows that there aren’t systemic effects after use of PDL injections.
Perspective: There were no studies of PDL injections using articaine; thus, further research should be done to compare the effectiveness of articaine to lidocaine. The results may be similar but it would be helpful to confirm. Before clinicians make treatment decisions, cost of both the armamentarium and maintenance of that equipment should be considered. Cost wasn’t reviewed in these studies. Since both intraosseous and PDL injections are effective at providing supplementary anesthesia on mandibular molars that have irreversible pulpitis, the cost of the armamentarium could be a major factor in selecting treatment. |
| Applicability |
These results help guide clinicians to get quicker and more successful anesthesia on mandibular molars that have irreversible pulpitis. These findings also help make the clinician aware of the lack of side effects for the supplementary injection techniques. |
| Specialty/Discipline |
(Endodontics) (General Dentistry) (Oral Surgery) |
| Keywords |
Periodontal ligament injection, intraosseous injections
|
| ID# |
3020 |
| Date of submission: |
04/26/2016 |
| E-mail |
crabtreec@livemail.uthscsa.edu |
| Author |
Colby Crabtree |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Gregory Spackman, DDS, MBA |
| Faculty mentor/Co-author e-mail |
Spackman@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 | |
|
|
