Pulpal anesthetic efficacy of a combination of supplementary intraseptal and Buccal Infiltration in young permanent Mandibular Molars with Irreversible Pulpitis: a randomized controlled trial

Abstract

Background: The inferior alveolar nerve block (IANB) alone is not efficient enough to provide profound pulpal anesthesia in mandibular teeth, hence supplemental injection after IANB has been implemented to increase success. The success of intraseptal injection for various dental procedures has recently been reported, but not for deep carious young permanent mandibular molars with irreversible pulpitis. Objectives: To compare the intra-operative pulpal anesthetic efficacy between reference group (IANB supplemented with buccal infiltration alone) and index group (IANB supplemented with a combination of mandibular buccal infiltration (MBI) and intraseptal injection (ISA) in vital deep carious young permanent mandibular molars, diagnosed with irreversible pulpitis.

Materials and methods: This randomized superiority trial included 35 permanent mandibular molars with irreversible pulpitis in patients aged 6 to 18. Both the reference (n=16) and index (n=19) groups received ~2.55 ml of 4% articaine with 1:100,000 epinephrine. Pre-operative pulpal anesthetic success was defined if the tooth responded negative to Endo-Frost® cold test whereas intra-operative success was defined as a patient reporting a pain score from the Wong-Baker FACES Pain Rating Scale ≤ four, requiring no additional injections, and completing of the treatment.

Results: The overall success rate following IANB was 27.3%. The absolute difference between the pre-operative pulpal anesthesia success rates of the index group (89.5%) and of the reference group (68.8%) was 20.7% (95% CI, -5.8- 47.3.p= 0.207). The intra-operative pulpal anesthesia success rates of the index and reference groups were 47.4% and 60.0%, respectively. Their absolute differences in the intra-operative phase were -12.6% (95% CI, -46.1% - 20.8%) for the unadjusted model and-6.3% absolute difference (95% CI, -43.3% - 30.6%) when the model was adjusted with the variable types of vital pulp therapy. Conclusion: Based on the result from this interim analysis, in vital deep carious young permanent mandibular molars diagnosed with ireversible pulpitis, the superiority of the intra-operative pulpal anesthetic efficacy from the IANB supplemented with a combination of MBI and ISA over the IANB supplemented with MBI alone could not be demonstrated. However, a larger sample is required to verify this finding.