title: Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: a randomized controlled trial.
abstract: OBJECTIVE
  This randomized double-blinded controlled trial was performed to compare the efficacy of inferior alveolar nerve block (IANB) injection for mandibular first molar teeth with irreversible pulpitis with or without supplementary buccal infiltration and intraligamentary injection.
  
  
  METHODS
  Eighty-two patients with asymptomatic irreversible pulpitis received either a combination of intraligamentary injection + buccal infiltration+ IANB or with traditional IANB injection in mandibular first molar teeth with irreversible pulpitis. Each patient recorded their pain score on a Heft-Parker visual analogue scale before commencing treatment, in response to a cold test 15 min after the designated anaesthetic injection, during access cavity preparation and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analysed by chi-square test.
  
  
  RESULTS
  At the final stage of treatment, 69 of the 82 patients were eligible to be included in the study. No significant difference was found between age (P = 0.569) and gender (P = 0.570) amongst the patients in the two groups. The success rate of anaesthesia in the IANB and the combination groups were 22% and 58%, respectively. The success rate of anaesthesia in the combination group was significantly higher than the traditional IANB injection (P = 0.003).
  
  
  CONCLUSIONS
  A combination of anaesthetic techniques can improve the success rate of anaesthesia for mandibular first molar teeth with irreversible pulpitis.
authors.affiliation: Oral and Dental Diseases Research Center, Kerman University of Medical Sciences, Kerman, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Parirokh
authors.forename: S
authors.initials: S
authors.lastname: Sadr
authors.forename: N
authors.initials: N
authors.lastname: Nakhaee
authors.forename: P V
authors.initials: PV
authors.lastname: Abbott
authors.forename: S
authors.initials: S
authors.lastname: Askarifard
mesh_terms: D002610:Cheek; D004311:Double-Blind Method; D006801:Humans; D008334:Mandible; D008340:Mandibular Nerve / Q000187:drug effects*; D008963:Molar / Q000294:innervation*; D009407:Nerve Block / Q000379:methods*; D011671:Pulpitis / Q000188:drug therapy*
keywords: anaesthesia; buccal infiltration; inferior alveolar nerve block; intraligamentary injection; irreversible pulpitis; supplemental anaesthesia