title: Description and evaluation of an intraoral cervical plexus anesthetic technique.
abstract: Unsuccessful anesthesia of the inferior alveolar nerve (IAN) may be due to supplementary innervations of mandibular molars from other branches, namely the cervical plexus (CP). The purpose of this prospective, randomized, double-blind, controlled trial was to determine the effectiveness of an intraoral cervical plexus anesthetic technique (ICPAT) in mandibular molars with symptomatic irreversible pulpitis (SIR) when the IAN and lingual nerve (LN) blocks failed, and to provide a description of the technique. Forty patients diagnosed with SIR received IAN and LN block anesthesia prior to treatment. After clinical signs of anesthesia, patients were subjected to an electrical pulp test (EPT) at 2-min cycles for 10 min post-injection. The anesthesia was considered unsuccessful if there was a positive EPT response ten minutes following profound lip numbness. The experimental group (n = 20) were administered 2% Lidocaine with 1:100,000 epinephrine using the ICPAT. The control group (n = 20) were administered 0.9% sterile saline using the ICPAT. Success was defined as no response on two consecutive readings from an EPT. In the experimental group, 60% of subjects showed successful anesthesia, whereas none of the subjects in the control group had successful anesthesia. A multiple logistic regression analysis showed that the anesthesia success rate using the ICPAT method was significantly higher (P < 0.05) than in the control group, irrespective of molar tooth type. The ICPAT method may be useful as a supplementary anesthetic technique for mandibular molars with SIR in subjects whom the IAN and LN blocks do not provide adequate anesthesia.
authors: Department of Endodontology, Temple University Kornberg School of Dentistry, Philadelphia, Pennsylvania.
authors: Daniel P
authors: DP
authors: Bitner
authors: Department of Endodontology, Temple University Kornberg School of Dentistry, Philadelphia, Pennsylvania.
authors: Daniel
authors: D
authors: Uzbelger Feldman
authors: Department of Endodontology, Temple University Kornberg School of Dentistry, Philadelphia, Pennsylvania.
authors: Kevin
authors: K
authors: Axx
authors: Department of Periodontology and Oral Implantology, Director, Periodontal Diagnostics Research Laboratory, Temple University Kornberg School of Dentistry, Philadelphia, Pennsylvania.
authors: Jasim M
authors: JM
authors: Albandar
mesh_terms: D000293:Adolescent; D000328:Adult; D066008:Cervical Plexus Block / Q000379:methods*; D003791:Dental Pulp Test; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects*; D008875:Middle Aged; D008963:Molar / Q000294:innervation; D011446:Prospective Studies; D011671:Pulpitis / Q000175:diagnosis; D055815:Young Adult
keywords: accessory innervation; anesthetic failure; anesthetic technique; cervical plexus; greater auricular nerve; inferior alveolar nerve; lingual nerve; local anesthesia; randomized controlled trial; transverse cervical nerve