title: Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study.
abstract: BACKGROUND
  The achievement of successful local anesthesia is a continual challenge in dentistry. Adjunctive local anesthetic techniques and their armamentaria, such as intraosseous injection (the Stabident system and the X-tip system) have been proposed to be advantageous in cases where the conventional local anesthetic techniques have failed.
  
  
  OBJECTIVE
  A clinical study was undertaken using intraosseous injection system by name X-tip to evaluate its effectiveness in cases where inferior alveolar nerve block has failed to provide pulpal anesthesia.
  
  
  METHODS
  Sixty adult patients selected were to undergo endodontic treatment for a mandibular molar tooth. Inferior alveolar nerve block was given using 4% articaine with 1:100,000 epinephrine. Twenty-four patients (40%) had pain even after administration of IAN block; intraosseous injection was administered using 4% articaine containing 1:100,000 epinephrine, using the X-tip system. The success of X-tip intraosseous injection was defined as none or mild pain (Heft-Parker visual analog scale ratings ≤ 54 mm) on endodontic access or initial instrumentation.
  
  
  RESULTS
  Intraosseous injection technique was successful in 21 out of 24 patients (87.5%), except three patients who had pain even after supplemental X-tip injection.
  
  
  CONCLUSIONS
  Within the limits of this study, we can conclude that supplemental intraosseous injection using 4% articaine with 1:100,000 epinephrine has a statistically significant influence in achieving pulpal anesthesia in patients with irreversible pulpitis.
authors.affiliation: Department of Conservative Dentistry and Endodontics, Rajarajeswari Dental College and Hospital, Bangalore, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Idris
authors.affiliation: Department of Endodontist, Department of Dentistry, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala, India.
authors.forename: Nasil
authors.initials: N
authors.lastname: Sakkir
authors.affiliation: Department of Conservative Dentistry and Endodontics, Nehru Smaraka Vidya Kendra Sri Venkateshwara Dental College and Hospital, Bangalore, Karnataka, India.
authors.forename: Kishore Gopalakrishna
authors.initials: KG
authors.lastname: Naik
authors.affiliation: Department of Conservative Dentistry and Endodontics, Rajarajeswari Dental College and Hospital, Bangalore, India.
authors.forename: Nandakishore Kunijal
authors.initials: NK
authors.lastname: Jayaram
keywords: Heft-Parker “visual analogue scale” pain scale; Inferior alveolar nerve block; X-Tip; intraosseous anesthesia; stabident