title: Comparison of the anaesthetic efficacy of and heart rate changes after periodontal ligament or intraosseous X-Tip injection in mandibular molars: a randomized controlled clinical trial.
abstract: OBJECTIVE
  To compare the efficacy of supplemental anaesthesia using periodontal ligament injections (PDL) and intraosseous injections with the X-Tip system in terms of the measured heart rate and patient reported pain level.
  
  
  METHODS
  In this single-blind randomized clinical trial, 40 patients (22 women, 18 men) with irreversible pulpitis who had experienced unsuccessful pain management by inferior alveolar nerve block with 2% lidocaine and 1 : 100 000 epinephrine were selected. Patients were divided equally and randomly into two groups. Supplementary anaesthesia was provided through intraosseous injection with the X-Tip system (X-Tip group) or by PDL injection (PDL group). After each step of injection, pain severity was assessed using a visual analogue scale. Patient heart rate was recorded with a pulse oximeter. Data were coded and analysed using Mann-Whitney U-test with SPSS (version 16) software.
  
  
  RESULTS
  Anaesthetic success was obtained in 100% of X-Tip and 70% of PDL group patients after the first supplemental injection. Compared with the first PDL injection, the first intraosseous injection resulted in a significant increase in heart rate (P = 0.001); however, this increase was short-lived (mean increase: 9-10 beats per min). No significant difference in heart rate or anaesthesia success was observed between men and women.
  
  
  CONCLUSIONS
  Intraosseous injection using the X-Tip system was more effective than PDL injection as a supplementary anaesthetic for pulpectomy in mandibular molars or second premolars. However, the former resulted in a transient increase in heart rate.
authors.affiliation: Dental Research Center, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Zarei
authors.forename: J
authors.initials: J
authors.lastname: Ghoddusi
authors.forename: E
authors.initials: E
authors.lastname: Sharifi
authors.forename: M
authors.initials: M
authors.lastname: Forghani
authors.forename: F
authors.initials: F
authors.lastname: Afkhami
authors.forename: Parviz
authors.initials: P
authors.lastname: Marouzi
mesh_terms: D000293:Adolescent; D000328:Adult; D000766:Anesthesia, Dental / Q000295:instrumentation*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001842:Bone and Bones; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D017148:Infusions, Intraosseous / Q000295:instrumentation*; D007267:Injections / Q000295:instrumentation*; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008334:Mandible; D008340:Mandibular Nerve; D008875:Middle Aged; D008963:Molar; D009407:Nerve Block / Q000295:instrumentation*; D010147:Pain Measurement; D010513:Periodontal Ligament; D011670:Pulpectomy; D011671:Pulpitis / Q000601:surgery; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine