title: Comparative evaluation of effect of preoperative alprazolam and diclofenac potassium on the success of inferior alveolar, Vazirani-Akinosi, and Gow-Gates techniques for teeth with irreversible pulpitis: Randomized controlled trial.
abstract: BACKGROUND
  In teeth with irreversible pulpitis, successful local anesthesia is hard to achieve irrespective of the amount of local anesthesia and technique used. Such cases can be managed by concoction of pre-medications like anxiolytics, analgesics and effective local anesthesia. This double-blind, placebo-controlled study was planned to evaluate the effect of oral administration of alprazolam and diclofenac potassium on the success rate of inferior alveolar nerve block (IANB), Gow-Gates (GG) and Vazirani-Akinosi (VA) techniques for the root canal treatment of mandibular molars with irreversible pulpitis.
  
  
  METHODS
  198 emergency patients with symptomatic irreversible pulpitis were randomly divided into three groups as - A, B and C receiving IANB, GG or V-A respectively using 2% lidocaine with 1: 100,000 epinephrine. These groups were sub-divided into sub-groups I and II as control and pre-medication groups. Patients who did not react to the stimulus made by an explorer between the canine and first premolar and showing subjective lip and tongue numbness were included in the study.
  
  
  RESULTS
  All sub-groups showed statistically significant reduction in VAS score. However sub-groups V and VI (that is GG with and without pre-medication respectively) showed best improvement in initial severe pain in mandibular molars with irreversible pulpitis. Moreover, all pre-medication sub-groups showed better pain control compared to respective control groups.
  
  
  CONCLUSIONS
  It was concluded that use of pre-medications in the form of combination of anxiolytics and analgesics improves the success rate of local anesthesia in teeth with irreversible pulpitis. Use of anxiolytics eases the patient in endodontic emergencies. Also use of GG along with pre-medication is the best method for effective pain management of acute pain in irreversible pulpitis.
authors.affiliation: Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India.
authors.forename: Pratibha
authors.initials: P
authors.lastname: Shetkar
authors.affiliation: Department of Conservative Dentistry and Endodontics, Sinhgad Dental College and Hospital, Pune, Maharashtra, India.
authors.forename: Ganesh Ranganath
authors.initials: GR
authors.lastname: Jadhav
authors.affiliation: Department of Conservative Dentistry and Endodontics, Centre for Dental Education and Research, New Delhi, India.
authors.forename: Priya
authors.initials: P
authors.lastname: Mittal
authors.affiliation: Department of Conservative Dentistry and Endodontics, Rural Dental College, Pravaranagar, Loni, Maharashtra, India.
authors.forename: Saikalyan
authors.initials: S
authors.lastname: Surapaneni
authors.affiliation: Department of Public Health Dentistry, Sinhgad Dental College and Hospital, Pune, Maharashtra, India.
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Kalra
authors.affiliation: Department of Conservative Dentistry and Endodontics, KIMS Dental College and Hospital, Amalapuram, Andhra Pradesh, India.
authors.forename: Mohan
authors.initials: M
authors.lastname: Sakri
authors.affiliation: Department of Preventive and Pediatric Dentistry, Al-Badar Dental College, Davangere, Karnataka, India.
authors.forename: A
authors.initials: A
authors.lastname: Basavaprabhu
keywords: Analgesics; Gow-Gates technique; Vazirani-Akinosi technique; anxiolytics; inferior alveolar nerve block; irreversible pulpitis