title: Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis.
abstract: The purpose of this study was to determine the anesthetic efficacy and heart rate effect of 4% articaine with 1:100,000 epinephrine for supplemental intraosseous injection in mandibular posterior teeth diagnosed with irreversible pulpitis. Thirty-seven emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain upon endodontic access. The Stabident system was used to administer 1.8 ml of 4% articaine with 1:100,000 epinephrine. Success of the intraosseous injection was defined as none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was obtained in 86% (32 of 37) of the patients. Maximum mean heart rate was increased 32 beats/minute during the intraosseous injection. We can conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the intraosseous injection of 4% articaine with 1:100,000 epinephrine would be successful 86% of the time in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.
authors.affiliation: Section of Endodontics, College of Dentistry, The Ohio State University, Columbus, Ohio 43218, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Bigby
authors.forename: Al
authors.initials: A
authors.lastname: Reader
authors.forename: John
authors.initials: J
authors.lastname: Nusstein
authors.forename: Mike
authors.initials: M
authors.lastname: Beck
authors.forename: Joel
authors.initials: J
authors.lastname: Weaver
mesh_terms: D000293:Adolescent; D000328:Adult; D000539:Alveolar Process; D000766:Anesthesia, Dental; D000772:Anesthesia, Local; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001641:Bicuspid / Q000294:innervation; D002355:Carticaine / Q000008:administration & dosage*; D003786:Dental Pulp Cavity / Q000294:innervation; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007267:Injections / Q000295:instrumentation / Q000379:methods; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects; D008875:Middle Aged; D008963:Molar / Q000294:innervation; D009407:Nerve Block / Q000379:methods; D010146:Pain / Q000517:prevention & control; D011671:Pulpitis / Q000628:therapy*; D018915:Root Canal Preparation / Q000295:instrumentation; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002355:Carticaine; D004837:Epinephrine