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Title Triazolam Does Not Affect the Success Rate of an Inferior Alveolar Nerve Block (IANB)
Clinical Question In mandibular posterior teeth with symptomatic irreversible pulpitis, does a preemptive dose of triazolam compared to placebo increase the success rate of an inferior alveolar nerve block (IANB)?
Clinical Bottom Line For patients with irreversible pulpitis in a mandibular posterior tooth, a single preemptive dose of triazolam (0.25 mg) does not increase the success of IANB compared to placebo.
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) 18793913Lindemann/200858 patients with irreversible pulpitis (18-65 yrs)Randomized, double-blind, placebo-controlled study
Key resultsApplication of triazolam in a sublingual dose of 0.25 mg (30 minutes before inferior alveolar nerve block) for mandibular posterior teeth did not result in an increase in success of the IAN block in patients with irreversible pulpitis compared to the group receiving placebo. IANB success with triazolam was 43% compared to 57% success for the placebo. There was no significant difference (P=0.43).
Evidence Search Triazolam[Title] AND IANB [All Fields] AND Analgesics
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The Evidence
Validity: This prospective, randomized, double blind clinical trial with a moderate sample size (58) provided a high level of evidence. The groups in the study were similar on the basis of variables such as age, sex, and tooth type. Although the anti-anxiety effect of triazolam has been shown in different studies, this is the only study that evaluated the effect of triazolam on the success of IANB. Inclusion criteria included a vital mandibular posterior tooth (molar or premolar) actively experiencing pain and a prolonged response to cold testing with Endo-Ice. Therefore, each patient had a tooth that fulfilled the criteria for a clinical diagnosis of irreversible pulpitis. Each patient rated his or her initial pain on a Heft-Parker visual analogue scale (VAS). The VAS scale was divided into 4 categories. No pain corresponded to 0 mm. Mild pain was defined as 0 to 54 mm. Mild pain included the descriptors of faint, weak, and mild pain. Moderate pain was defined 54 to 114 mm. Severe pain was defined as equal to or greater than 114 mm. The triazolam /placebo were administered in a blinded manner. At 15 minutes after injection (45 minutes after administration of the triazolam or placebo tablet), the teeth were isolated with a rubber dam, and access was performed. Patients were instructed to definitively rate any pain felt during the endodontic procedure. If the patient felt pain, the treatment was immediately stopped, and the patient rated their discomfort by using the Heft-Parker VAS. The success of the IAN block was defined as the ability to access and instrument the tooth without pain (VAS score of 0) or with mild pain (VAS rating less than or equal to 54 mm). Perspective: Use of triazolam, an anti-anxiety agent, was intended to improve the IAN block efficacy, but the available evidence does not show any statistically significant difference.
Applicability The data is useful to all clinicians performing endodontic therapy on mandibular molars with irreversible pulpitis. Due to the difficulty in anesthetizing these teeth, clinicians should be aware that conscious sedation with triazolam does not increase the IANB success rate. Other modalities that can be used as supplements must be considered.
Specialty/Discipline (Endodontics) (General Dentistry) (Restorative Dentistry)
Keywords triazolam, inferior alveolar nerve block, irreversible pulpitis
ID# 3125
Date of submission: 12/01/2016spacer
E-mail Bayat_movahed@yahoo.com
Author Saeed Bayat Movahed, DDS
Co-author(s) e-mail
Faculty mentor/Co-author Nikita Ruparel, DDS, MS, PhD
Faculty mentor/Co-author e-mail Ruparel@uthscsa.edu
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