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Anesthetic efficacy of mental/incisive nerve block compared to inferior alveolar nerve block using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis: a randomized clinical trial

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Abstract

Objectives

The aim of this study was to compare the onset, success rate, injection pain, and post-injection pain of mental/incisive nerve block (MINB) with that of inferior alveolar nerve block (IANB) using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis. The accuracy of electrical pulp test (EPT) in determining pulpal anesthesia was also examined.

Materials and methods

The study was designed as a randomized clinical trial with two study arms—MINB and IANB. Injections were performed using a standardized technique. Root canal treatment was initiated 10 min after the injection. Success was defined as no pain or mild pain during access cavity preparation and instrumentation. Injection pain and post-injection pain (up to 7 days) were recorded. All pain ratings were done using Heft-Parker Visual Analog Scale (HP VAS).

Results

Sixty-four patients were enrolled. The success rate of MINB (93.8%) was higher than IANB (81.2%) but the difference was not significant (p > 0.05). The onset of anesthesia with MINB was significantly quicker, and injection pain was significantly less (p < 0.05), but post-injection pain was significantly higher during the first 4 days (p < 0.001). The accuracy of EPT in determining pulpal anesthesia was 96.88%.

Conclusions

MINB and IANB with 4% articaine had similar efficacy in anesthetizing mandibular premolars with irreversible pulpitis. Post-injection pain with MINB was higher than with IANB.

Clinical relevance

MINB and IANB with 4% articaine can be used interchangeably to anesthetize mandibular premolars with irreversible pulpitis.

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References

  1. Kung J, McDonagh M, Sedgley CM (2015) Does articaine provide an advantage over lidocaine in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. J Endod 41:1784–1794

    Article  Google Scholar 

  2. Kanaa MD, Whitworth JM, Meechan JG (2012) A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod 38:421–425

    Article  Google Scholar 

  3. Kanaa MD, Whitworth JM, Corbett IP, Meechan JG (2009) Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endod J 42:238–246

    Article  Google Scholar 

  4. Nydegger B, Nusstein J, Reader A, Drum M, Beck M (2014) Anesthetic comparisons of 4% concentrations of articaine, lidocaine, and prilocaine as primary buccal infiltrations of the mandibular first molar: a prospective randomized, double-blind study. J Endod 40:1912–1916

    Article  Google Scholar 

  5. Kammerer PW, Schneider D, Palarie V, Schiegnitz E, Daublander M (2017) Comparison of anesthetic efficacy of 2 and 4% articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial. Clin Oral Investig 21:397–403

    Article  Google Scholar 

  6. Skjevik AA, Haug BE, Lygre H, Teigen K (2011) Intramolecular hydrogen bonding in articaine can be related to superior bone tissue penetration: a molecular dynamics study. Biophys Chem 154:18–25

    Article  Google Scholar 

  7. Potocnik I, Tomsic M, Sketelj J, Bajrovic FF (2006) Articaine is more effective than lidocaine or mepivacaine in rat sensory nerve conduction block in vitro. J Dent Res 85:162–166

    Article  Google Scholar 

  8. Aggarwal V, Singla M, Miglani S, Kohli S (2016) Comparative evaluation of mental incisal nerve block, inferior alveolar nerve block, and their combination on the anesthetic success rate in symptomatic mandibular premolars: a randomized double-blind clinical trial. J Endod 42:843–845

    Article  Google Scholar 

  9. Batista da Silva C, Berto LA, Volpato MC, Ramacciato JC, Motta RH, Ranali J et al (2010) Anesthetic efficacy of articaine and lidocaine for incisive/mental nerve block. J Endod 36:438–441

    Article  Google Scholar 

  10. Dressman AS, Nusstein J, Drum M, Reader A (2013) Anesthetic efficacy of a primary articaine infiltration and a repeat articaine infiltration in the incisive/mental nerve region of mandibular premolars: a prospective, randomized, single-blind study. J Endod 39:313–318

    Article  Google Scholar 

  11. Malamed S (2013) Handbook of local anesthesia. 6th ed. Elsevier Mosby, St. Louis

  12. Corbett IP, Kanaa MD, Whitworth JM, Meechan JG (2008) Articaine infiltration for anesthesia of mandibular first molars. J Endod 34:514–518

    Article  Google Scholar 

  13. Torabinejad M, Bahjri K (2005) Essential elements of evidenced-based endodontics: steps involved in conducting clinical research. J Endod 31:563–569

    Article  Google Scholar 

  14. Nekoofar MH, Sheykhrezae MS, Meraji N, Jamee A, Shirvani A, Jamee J et al (2015) Comparison of the effect of root canal preparation by using WaveOne and ProTaper on postoperative pain: a randomized clinical trial. J Endod 41:575–578

    Article  Google Scholar 

  15. Torabinejad M, Nosrat A, Verma P, Udochukwu O (2017) Regenerative endodontic treatment or mineral trioxide aggregate apical plug in teeth with necrotic pulps and open apices: a systematic review and meta-analysis. J Endod 43:1806–1820

    Article  Google Scholar 

  16. Currie CC, Meechan JG, Whitworth JM, Corbett IP (2013) Is mandibular molar buccal infiltration a mental and incisive nerve block? A randomized controlled trial. J Endod 39:439–443

    Article  Google Scholar 

  17. Whitworth JM, Kanaa MD, Corbett IP, Meechan JG (2007) Influence of injection speed on the effectiveness of incisive/mental nerve block: a randomized, controlled, double-blind study in adult volunteers. J Endod 33:1149–1154

    Article  Google Scholar 

  18. Jaber A, Whitworth JM, Corbett IP, Al-Baqshi B, Jauhar S, Meechan JG (2013) Effect of massage on the efficacy of the mental and incisive nerve block. Anesth Prog 60:15–20

    Article  Google Scholar 

  19. Meechan JG, Jaber AA, Corbett IP, Whitworth JM (2011) Buccal versus lingual articaine infiltration for mandibular tooth anaesthesia: a randomized controlled trial. Int Endod J 44:676–681

    Article  Google Scholar 

  20. Modaresi J, Dianat O, Soluti A (2008) Effect of pulp inflammation on nerve impulse quality with or without anesthesia. J Endod 34:438–441

    Article  Google Scholar 

  21. Roy ML, Narahashi T (1992) Differential properties of tetrodotoxin-sensitive and tetrodotoxin-resistant sodium channels in rat dorsal root ganglion neurons. J Neurosci 12:2104–2111

    Article  Google Scholar 

  22. Chaudhary P, Martenson ME, Baumann TK (2001) Vanilloid receptor expression and capsaicin excitation of rat dental primary afferent neurons. J Dent Res 80:1518–1523

    Article  Google Scholar 

  23. Nist RA, Reader A, Beck M, Meyers WJ (1992) An evaluation of the incisive nerve block and combination inferior alveolar and incisive nerve blocks in mandibular anesthesia. J Endod 18:455–459

    Article  Google Scholar 

  24. Mikesell P, Nusstein J, Reader A, Beck M, Weaver J (2005) A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod 31:265–270

    Article  Google Scholar 

  25. Claffey E, Reader A, Nusstein J, Beck M, Weaver J (2004) Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 30:568–571

    Article  Google Scholar 

  26. Kanaa MD, Meechan JG, Corbett IP, Whitworth JM (2006) Speed of injection influences efficacy of inferior alveolar nerve blocks: a double-blind randomized controlled trial in volunteers. J Endod 32:919–923

    Article  Google Scholar 

  27. Aggarwal V, Singla M, Miglani S, Kohli S, Singh S (2012) Comparative evaluation of 1.8 mL and 3.6 mL of 2% lidocaine with 1:200,000 epinephrine for inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, randomized single-blind study. J Endod 38:753–756

    Article  Google Scholar 

  28. Abazarpoor R, Parirokh M, Nakhaee N, Abbott PV (2015) A comparison of different volumes of articaine for inferior alveolar nerve block for molar teeth with symptomatic irreversible pulpitis. J Endod 41:1408–1411

    Article  Google Scholar 

  29. Aggarwal V, Singla M, Miglani S, Kohli S, Irfan M (2012) A prospective, randomized single-blind evaluation of effect of injection speed on anesthetic efficacy of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. J Endod 38:1578–1580

    Article  Google Scholar 

  30. Garisto GA, Gaffen AS, Lawrence HP, Tenenbaum HC, Haas DA (2010) Occurrence of paresthesia after dental local anesthetic administration in the United States. J Am Dent Assoc 141:836–844

    Article  Google Scholar 

  31. Gaffen AS, Haas DA (2009) Retrospective review of voluntary reports of nonsurgical paresthesia in dentistry. J Can Dent Assoc 75:579

    PubMed  Google Scholar 

  32. Nusstein J, Reader A, Nist R, Beck M, Meyers WJ (1998) Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis. J Endod 24:487–491

    Article  Google Scholar 

  33. Dreven LJ, Reader A, Beck M, Meyers WJ, Weaver J (1987) An evaluation of an electric pulp tester as a measure of analgesia in human vital teeth. J Endod 13:233–238

    Article  Google Scholar 

  34. Sampaio RM, Carnaval TG, Lanfredi CB, Horliana AC, Rocha RG, Tortamano IP (2012) Comparison of the anesthetic efficacy between bupivacaine and lidocaine in patients with irreversible pulpitis of mandibular molar. J Endod 38:594–597

    Article  Google Scholar 

  35. Tortamano IP, Siviero M, Costa CG, Buscariolo IA, Armonia PL (2009) A comparison of the anesthetic efficacy of articaine and lidocaine in patients with irreversible pulpitis. J Endod 35:165–168

    Article  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge Dr. Prashant Verma, at University of Maryland School of Dentistry, for the scientific and grammar editing of the manuscript.

Funding

This work was supported by Tehran University of Medical Sciences in Tehran, Iran.

Author information

Author notes

  1. Sholeh Ghabraei and Ashraf Shubbar contributed equally to this work.

Authors and Affiliations

  1. Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran

    Sholeh Ghabraei, Ashraf Shubbar & Mohammad H. Nekoofar

  2. Endodontology Research Group, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK

    Mohammad H. Nekoofar

  3. Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of Dentistry, University of Maryland Baltimore, 650 West Baltimore Street, 4th floor, Baltimore, MD, 21201, USA

    Ali Nosrat

  4. Iranian Center for Endodontic Research, Dental Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Ali Nosrat

Authors
  1. Sholeh Ghabraei
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  2. Ashraf Shubbar
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  3. Mohammad H. Nekoofar
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  4. Ali Nosrat
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Corresponding authors

Correspondence to Mohammad H. Nekoofar or Ali Nosrat.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed involving human participants in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Ghabraei, S., Shubbar, A., Nekoofar, M.H. et al. Anesthetic efficacy of mental/incisive nerve block compared to inferior alveolar nerve block using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis: a randomized clinical trial. Clin Oral Invest 23, 839–845 (2019). https://doi.org/10.1007/s00784-018-2500-4

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  • DOI: https://doi.org/10.1007/s00784-018-2500-4

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