title: Articaine for supplemental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior alveolar nerve block fails.
abstract: The purpose of this prospective study was to determine the anesthetic efficacy of the supplemental buccal infiltration injection of a cartridge of 4% articaine with 1:100,000 epinephrine in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve (IAN) block failed. Fifty-five emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an IAN block and had moderate to severe pain on endodontic access. An infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine was administered buccal to the tooth requiring endodontic treatment. Success of the infiltration injection was defined as no pain or mild pain on endodontic access or instrumentation. The results showed that anesthetic success was obtained in 58% of the mandibular posterior teeth. We can conclude that when the IAN block fails to provide profound pulpal anesthesia, the supplemental buccal infiltration injection of a cartridge of 4% articaine with 1:100,000 epinephrine would be successful 58% of the time for mandibular posterior teeth in patients presenting with irreversible pulpitis. Unfortunately, the modest success rate would not provide predictable pulpal anesthesia for all patients requiring profound anesthesia.
authors.affiliation: Division of Endodontics, College of Dentistry, The Ohio State University, Columbus, OH 43210, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Matthews
authors.forename: Melissa
authors.initials: M
authors.lastname: Drum
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
mesh_terms: D000278:Administration, Buccal; D000293:Adolescent; D000328:Adult; D000368:Aged; D000766:Anesthesia, Dental / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002355:Carticaine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible; D008340:Mandibular Nerve; D008875:Middle Aged; D009407:Nerve Block; D011446:Prospective Studies; D011671:Pulpitis / Q000628:therapy*; D012390:Root Canal Therapy; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D002355:Carticaine