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      Alternative techniques for failure of conventional inferior alveolar nerve block

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          Abstract

          Successful local anesthesia in dental treatment is the most important prerequisite for pain control of patients. However, unlike that in the maxilla, it is difficult to administer local anesthesia in the mandible, and the success rate of conventional inferior alveolar nerve block (IANB) is only 80–85%. It is attributed to various causes such as anatomical variations, extreme anxiety, and technical errors; thus, various alternatives have been devised to improve this. We will analyze the causes of failure in conventional IANB and examine various alternatives that can be applied in these cases.

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          Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis.

          Mike Beck, Joel Weaver, E Claffey … (2004)
          The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.
          Article 0 comments Cited 59 times – based on 0 reviews     Review now
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            Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis.

            R Nist, John Nusstein, W Meyers … (1998)
            The purpose of this study was to determine the anesthetic efficacy of a supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in teeth diagnosed with irreversible pulpitis. Fifty-one patients with symptomatic, vital maxillary, and mandibular posterior teeth diagnosed with irreversible pulpitis received conventional infiltrations or inferior alveolar nerve blocks. Pulp testing was used to determine pulpal anesthesia after "clinically successful" injections. Patients who were positive to the pulp tests, or were negative to the pulp tests but felt pain during endodontic access, received an intraosseous injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The results demonstrated that 42% of the patients who tested negative to the pulp tests reported pain during treatment and required supplemental anesthesia. Eighty-one percent of the mandibular teeth and 12% of maxillary teeth required an intraosseous injection due to failure to gain pulpal anesthesia. Overall, the Stabident intraosseous injection was found to be 88% successful in gaining total pulpal anesthesia for endodontic therapy. We concluded that, for posterior teeth diagnosed with irreversible pulpitis, the supplemental intraosseous injection of 2% lidocaine (1:100,000 epinephrine) was successful when conventional techniques failed.
            Article 0 comments Cited 37 times – based on 0 reviews     Review now
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              A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth.

              Mohammad D. Kanaa, John M Whitworth, John Meechan (2012)
              The objective of this study was to compare the efficacy of supplementary repeat inferior alveolar nerve block with 2% lidocaine and epinephrine, buccal infiltration with 4% articaine with epinephrine, intraligamentary injection, or intraosseous injection (both with 2% lidocaine with epinephrine) after failed inferior alveolar nerve block (IANB) for securing pain-free treatment in patients experiencing irreversible pulpitis in mandibular permanent teeth. This randomized clinical trial included 182 patients diagnosed with irreversible pulpitis in mandibular teeth. Patients received 2.0 mL of 2% lidocaine with 1:80,000 epinephrine as an IANB injection. Patients who did not experience pain-free treatment received randomly 1 of 4 supplementary techniques, namely repeat lidocaine IANB (rIANB), articaine buccal infiltration (ABI), lidocaine intraligamentary injection (PDL), or lidocaine intraosseous injection (IO). Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation (80 reading) of the pulp tester, at which time treatment commenced. Treatment was regarded as being successfully completed when it was associated with no pain. Data were analyzed by χ(2) and Fisher exact tests. Of the 182 patients, 122 achieved successful pulpal anesthesia within 10 minutes after initial IANB injection; 82 experienced pain-free treatment. ABI and IO allowed more successful (pain-free) treatment (84% and 68%, respectively) than rIANB or PDL supplementary techniques (32% and 48%, respectively); this was statistically significant (P = .001). IANB injection alone does not always allow pain-free treatment for mandibular teeth with irreversible pulpitis. Supplementary buccal infiltration with 4% articaine with epinephrine and intraosseous injection with 2% lidocaine with epinephrine are more likely to allow pain-free treatment than intraligamentary and repeat IANB injections with 2% lidocaine with epinephrine for patients experiencing irreversible pulpitis in mandibular permanent teeth. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Dent Anesth Pain Med
                Journal ID (iso-abbrev): J Dent Anesth Pain Med
                Journal ID (publisher-id): JDAPM
                Title: Journal of Dental Anesthesia and Pain Medicine
                Publisher: The Korean Dental Society of Anesthsiology
                ISSN (Print): 2383-9309
                ISSN (Electronic): 2383-9317
                Publication date (Print): June 2019
                Publication date (Electronic): 30 June 2019
                Volume: 19
                Issue: 3
                Pages: 125-134
                Affiliations
                [1 ]Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Korea.
                [2 ]Orthognathic Surgery Center, Seoul National University Dental Hospital, Korea.
                Author notes
                Corresponding Author: Hoon Joo Yang. Orthognathic Surgery Center, Seoul National University Dental Hospital, 101 Daehakro, Jongno-gu, Seoul 03080, Korea. Tel: +82-2-2072-4827, Fax: +82-2-766-4948, didgnswn@ 123456hanmail.net
                Author information
                https://orcid.org/0000-0002-7861-8439
                https://orcid.org/0000-0002-4652-7305
                Article
                DOI: 10.17245/jdapm.2019.19.3.125
                PMC ID: 6620537
                PubMed ID: 31338418
                SO-VID: 4462967d-2370-49a0-bf3e-7ba56e4509ec
                Copyright © Copyright © 2019 Journal of Dental Anesthesia and Pain Medicine
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 May 2019
                Date revision received : 24 June 2019
                Date accepted : 26 June 2019
                Categories
                Subject: Review Article

                Keywords: anatomical factor,anesthetic technique,inferior alveolar nerve block,patient factor,technical factor
                Data availability:
                Keywords: anatomical factor, anesthetic technique, inferior alveolar nerve block, patient factor, technical factor

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