title: Evaluation of the Gow-Gates and Vazirani-Akinosi techniques in patients with symptomatic irreversible pulpitis: a prospective randomized study.
abstract: BACKGROUND
  Few studies have evaluated the effectiveness of the Gow-Gates and Vazirani-Akinosi techniques in patients presenting with symptomatic irreversible pulpitis. Therefore, the purpose of this prospective, randomized study was to evaluate the anesthetic efficacy of the Gow-Gates and Vazirani-Akinosi techniques using 3.6 mL 2% lidocaine with 1:100,000 epinephrine in mandibular posterior teeth in patients presenting with symptomatic irreversible pulpitis.
  
  
  METHODS
  One hundred twenty-five emergency patients diagnosed with symptomatic irreversible pulpitis randomly received either a Gow-Gates or Vazirani-Akinosi injection using 3.6 mL 2% lidocaine with 1:100,000 epinephrine to block the inferior alveolar nerve before endodontic access. Subjective lip numbness was recorded. Pulpal anesthetic success of the injection was defined as no pain or mild pain upon endodontic access and instrumentation as measured on a visual analog scale.
  
  
  RESULTS
  Subjective lip numbness was obtained 92% of the time with the Gow-Gates technique and 63% of the time with the Vazirani-Akinosi technique. The difference was statistically significant (P = .0001). For the patients achieving lip numbness, successful pulpal anesthesia was obtained 35% of the time with the Gow-Gates technique and 16% of the time with the Vazirani-Akinosi technique. The difference was statistically significant (P = .0381).
  
  
  CONCLUSIONS
  We concluded that for patients who achieved lip numbness neither the Gow-Gates technique nor the Vazirani-Akinosi technique provided adequate pulpal anesthesia for mandibular posterior teeth in patients presenting with symptomatic irreversible pulpitis. Both injections would require supplemental anesthesia.
authors.affiliation: Private Practice of Endodontics, Honolulu, Hawaii.
authors.forename: Vivian
authors.initials: V
authors.lastname: Click
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: Melissa
authors.initials: M
authors.lastname: Drum
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio. Electronic address: reader.2@osu.edu.
authors.forename: Al
authors.initials: A
authors.lastname: Reader
authors.affiliation: Division of Endodontics, The Ohio State University, Columbus, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Nusstein
authors.affiliation: Division of Oral Biology, The Ohio State University, Columbus, Ohio.
authors.forename: Mike
authors.initials: M
authors.lastname: Beck
mesh_terms: D000293:Adolescent; D000328:Adult; D000766:Anesthesia, Dental / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage; D003782:Dental Pulp / Q000473:pathology; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008046:Lip / Q000187:drug effects; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects; D008875:Middle Aged; D008963:Molar; D009407:Nerve Block / Q000379:methods*; D011446:Prospective Studies; D011671:Pulpitis / Q000473:pathology / Q000628:therapy*; D018915:Root Canal Preparation / Q000379:methods*; D012390:Root Canal Therapy / Q000379:methods; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine
keywords: Gow-Gates technique; Vazirani-Akinosi technique; symptomatic irreversible pulpitis