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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) 22414822Kanaa/2012182 patients diagnosed with irreversible pulpitis in mandibular teethRandomized Controlled Trial
Key resultsFollowing 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) 21881057Moore/2011Mandibular teethEditorial and Opinions
Key resultsTo manage failed mandibular anesthesia, PDL injections and intraosseous injections are excellent alternatives.
#3) 8217423Cannell/1983Healthy adultsRandomized Controlled Trial
Key resultsPDL 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: 04/26/2016spacer
E-mail crabtreec@livemail.uthscsa.edu
Author Colby Crabtree
Co-author(s) e-mail
Faculty mentor/Co-author Gregory Spackman, DDS, MBA
Faculty mentor/Co-author e-mail Spackman@uthscsa.edu
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