title: Anesthetic efficacy of X-tip intraosseous injection using 2% lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: A clinical study.
abstract: BACKGROUND
  The inferior alveolar nerve block (IAN) is the most frequently used mandibular injection technique for achieving local anesthesia in endodontics. Supplemental injections are essential to overcome failure of IAN block in patients with irreversible pulpitis.
  
  
  OBJECTIVE
  To evaluate the anesthetic efficacy of X-tip intraosseous injection (2% lidocaine with 1:80,000 epinephrine) in patients with irreversible pulpitis in mandibular posterior teeth when conventional IAN block failed.
  
  
  METHODS
  Thirty emergency patients diagnosed with irreversible pulpitis in a mandibular posterior tooth received an IAN block and experienced moderate to severe pain on endodontic access or initial instrumentation. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:80,000 epinephrine. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analogue scale ratings < 54 mm) on endodontic access or initial instrumentation.
  
  
  RESULTS
  Ninety-three percent of X-tip injections were successful and 7% were unsuccessful. Discomfort rating for X-tip perforation: 96.66% patients reported none or mild pain, whereas 3.34% reported moderate to severe pain. For discomfort rating during solution deposition, 74.99% patients reported none or mild pain and 24.92% reported moderate to severe pain. Ninety-six percent of the patients had subjective/objective increase in heart rate.
  
  
  CONCLUSIONS
  Supplemental X-tip intraosseous injection using 2% lignocaine with 1:80,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.
authors.affiliation: Department of Conservative Dentistry and Endodontics, Faculty of Dental Sciences, I.M.S, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
authors.forename: Pushpendra Kumar
authors.initials: PK
authors.lastname: Verma
authors.forename: Ruchi
authors.initials: R
authors.lastname: Srivastava
authors.forename: Kumar M
authors.initials: KM
authors.lastname: Ramesh
keywords: Anesthetic failure; X-tip system; heft-Parker “visual analogue scale” pain scale; intraosseous anesthesia; irreversible pulpitis; technical failure