title: Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis.
abstract: BACKGROUND
  The inferior alveolar nerve block (IANB) has a poor success rate in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of ketorolac and dexamethasone infiltration along with standard IANB on the success rate.
  
  
  METHODS
  Ninety-four adult volunteers who were actively experiencing pain participated in this prospective, randomized, double-blind study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive any supplemental infiltrations (control). Twenty-four patients received supplemental buccal infiltration of 4% articaine with 1:100,000 ephinephrine, and 24 patients received supplemental buccal infiltration of 1 mL/4 mg of dexamethasone. It was planned to give supplemental buccal infiltration of 1 mL/30 mg of ketorolac tromethamine in 26 patients, but the first 2 patients experienced severe injection pain after ketorlac infiltration and were excluded from the study. In the subsequent patients, 0.9 mL of 4% articaine was infiltrated before injecting ketorolac. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft-Parker visual analog scale. Success was recorded as none or mild pain.
  
  
  RESULTS
  Statistical analysis was done by using nonparametric χ(2) tests. Control IANB gave 39% success rate. Buccal infiltration of articaine and articaine plus ketorolac significantly increased the success rate to 54% and 62%, respectively (P < .05). Supplementary dexamethasone infiltration gave 45% success rate, which was insignificant with control IANB.
  
  
  CONCLUSIONS
  Articaine and ketorolac infiltration can increase the success rate of IANB in patients with irreversible pulpitis. None of the tested techniques gave 100% success rate.
authors.affiliation: Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India. drvivekaggarwal@gmail.com
authors.forename: Vivek
authors.initials: V
authors.lastname: Aggarwal
authors.forename: Mamta
authors.initials: M
authors.lastname: Singla
authors.forename: Abbas
authors.initials: A
authors.lastname: Rizvi
authors.forename: Sanjay
authors.initials: S
authors.lastname: Miglani
mesh_terms: D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D002355:Carticaine / Q000008:administration & dosage*; D003907:Dexamethasone / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007267:Injections; D020911:Ketorolac Tromethamine / Q000008:administration & dosage / Q000627:therapeutic use*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010486:Periapical Tissue; D011446:Prospective Studies; D011671:Pulpitis / Q000628:therapy; D018915:Root Canal Preparation; D012390:Root Canal Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D014662:Vasoconstrictor Agents; D020911:Ketorolac Tromethamine; D003907:Dexamethasone; D008012:Lidocaine; D002355:Carticaine; D004837:Epinephrine