Anesthetic Effectiveness of the Supplemental Intraligamentary Injection, Administered with a Computer-Controlled Local Anesthetic Delivery System, in Patients with Irreversible Pulpitis

Abstract

The purpose of this study was to determine the anesthetic effectiveness of the supplemental intraligamentary injection, administered with a computer-controlled local anesthetic delivery system, in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve block failed. Fifty-four emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate to severe pain upon endodontic access. A computer-controlled local anesthetic delivery system was then used to administer intraligamentary injections of 1.4 ml of 2% lidocaine with 1:100,000 epinephrine. Success of the intraligamentary injection was defined as none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was obtained in 56% (30 of 54) of the patients. We concluded that when the inferior alveolar nerve block failed to provide profound pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis, the intraligamentary injection administered with a computer-controlled local anesthetic delivery system was successful approximately 56% of the time.

Articaine: a review of the literature

“…69 The articaine IANB and PDL injection success rate (83%) was higher than lignocaine (56%) when used in a similar setting. 70 Articaine in an intraosseous injection (IO) supplemental to IANB and LB in mandibular posterior teeth with IP had a success rate of 86% when delivered with the Stabident system (Fairfax Dental Inc., Miami, FL, USA), 71 which were comparable to success rates of lignocaine Stabident injections supplemental to IANB in mandibular posterior teeth with IP of 90 and 91% 72,73 and with lignocaine X-tip (X-tip Technologies, Lakewood, NJ, USA) IO injections of 82%. 74 In general, the evidence indicates little benefit in using articaine for IP (Table 2).…”

Articaine for Supplemental Buccal Mandibular Infiltration Anesthesia in Patients with Irreversible Pulpitis When the Inferior Alveolar Nerve Block Fails

“…Reinjection increased success to 96%. Nusstein et al (22) administered supplemental intraligamentary injections with a computer-controlled anesthetic delivery system in mandibular posterior teeth and achieved a 56% success rate. No reinjection was performed in the study by Nusstein et al (22).…”

The Use of Intraosseous Anesthesia among Endodontists: Results of a Questionnaire

“…Anesthetic is forced through the periodontal ligament and into the medullary bone in small amounts. Reported success rates for the PDL injection vary from 42% to 86% (7,8) when used as a primary form of anesthesia and as high as 95% when combined with IANB (2,9). Disadvantages to the PDL injection include postoperative discomfort (up to 98%) (2), short duration of anesthesia (4 -20 minutes) (2,8), and, at times, technical difficulty administering the injection.…”