Materials and Method:
- 84 patients with acute irreversible pulpitis in a lower first molar tooth
- Randomly assigned to three groups of 28 patients each: → Group I - IAN block with 1.8 ml of LA soln* → Group II - IAN block with 3.6 ml of LA soln* → Group III - 1.8 ml as an IAN block PLUS 1.8 ml as a buccal infiltration
Materials and Method (Continued):[^9]
- Used Lignocaine 2% + 1:80,000 adrenaline
- Visual analogue scale to rate pain: → Pre-operative - before LA → At 15 minutes after LA injection → During access cavity preparation → During instrumentation of root canals
- Cold pulp sensibility test 15 mins after injn
- Data analyzed by chi-square, ANOVA, Kruskal-Wallis, and Mann-Whitney tests
OS:OM:OP:OR:Endo 2010;109:468–473
Results:[^10]
- Pre-op pain scores - no sig. diff. → Group I - 117.2 ± 29.9 → Group II - 119.2 ± 22.8 → Group III - 112.8 ± 30.4
Overall Success
| Group | Technique | No Pain |
|---|---|---|
| I | 1.8 ml IAN Block | 14.8% |
| II | 3.6 ml IAN Block | 39.3% |
| III | 1.8 ml IAN Block + 1.8 ml Bu Infiltration | 65.4% |
| Sig. Diff | ||
| OS:OM:OP:OR:Endo 2010;109:468–473 |
No. of patients with pain at each stage and overall success[^25]
- Overall 49 (60.5%) pt’s had inadequate anaesthesia
- Only 17 responded to a cold pulp sensibility test 15 minutes after injection
- → More in Group I
- 32 pt’s had pain when access cavity prepared
- → Despite no response to a cold pulp test
- → Group II - more when the pulp chamber was entered
- Only 17 responded to a cold pulp sensibility test 15 minutes after injection
OS:OM:OP:OR:Endo 2010;109:468–473
Discussion:[^11]
- Combining an IAN block with a Buccal infiltration provided more effective LA for acute irreversible pulpitis in lower molars
- Pulp testing after LA is not necessarily an indication of adequate pain control → Dentists need to be aware of the possible need for extra pain control strategies
- Group II better than Group I - but not sig. diff.
→ Greater volume of LA solution helps a little
→ But an alternative injection site was more effective
- Targets different nerves which may be involved in the pain sensation process