How Successful is Supplemental Intraseptal and Buccal Infiltration Anaesthesia in the Mandibular Molars of Patients Undergoing Root Canal Treatment or Tooth Extraction?

Abstract

Objectives:To investigate the success rate of supplemental intraseptal and buccal infiltration anaesthesia in mandibular molars undergoing endodontic therapy/extraction when the inferior alveolar nerve block has failed. Material and Methods: A prospective clinical trial including 200 patients undergoing lower molar root canal treatment/teeth extraction was conducted. Only 80 patients of the participants who had profound lower lip anaesthesia after the administration of inferior alveolar nerve block (IANB) were in pain within treatment. Patients experiencing moderate to severe pain upon using elevators, forceps, bur, or endodontic file were randomly allocated to the 2% lidocaine intraseptal injection and 4% articaine buccal infiltration groups. Level of pain was assessed every 2 to 10 min on standard 100 mm visual analogue scales. Results: Overall, 55 (69%) of patients who were given either intraseptal injection of 2% lidocaine or buccal infiltration of 4% articaine had successful anaesthesia of lower molar teeth within 10 min. However, 25 (31%) of participating patients in the buccal infiltration and the intraseptal groups had failed anaesthesia within the study duration (10 min), and they received additional local anaesthetic. IANBs were more painful than buccal and intraseptal injections. However, buccal articaine injections were significantly more comfortable than intraseptal lidocaine injections (P > 0.001). Conclusions: Supplemental intraseptal injection of 2% lidocaine and buccal infiltration of 4% articaine achieved profound pulpal anaesthesia in 69% of patients when the inferior alveolar nerve block failed. Recommendations can be given to dental practitioners to use infiltration of 4% articaine in conjunction with intraseptal injection of 2% lidocaine to anaesthetize the lower molar teeth when inferior alveolar nerve block fails.

Rules of selection for a safe local anesthetic in dentistry

“…For example, chloroprocaine is an ester class local anaesthetic, indicated for patients with allergies to amide group and is considered the safest local anesthetic for pedodontics. 1 , 2 , 3 , 4 Amide group anaesthetics are the second type of widely used local dental anesthetics 1 , 4 It has a remarkably long time of action, metabolized in the liver and their toxicity is almost non-existent. 1 , 5 …”

“…1 , 2 As a general rule, all local anaesthetic drugs cause vasodilation, except for cocaine. 2 , 3 , 4 , 5 Vasodilating property leads to the rapid absorption of the anesthetic solution into the blood, which in turn causes an increase in toxicity and a decrease in the time of action. 2 , 3 , 4 , 5 Therefore the safest anesthetic drug is the one that has the least vasodilation property.…”

“…The rest of the drug, 85–90%, is metabolized in the blood and transformed into articaine acid, considered ineffective and non-toxic. 1 , 4 , 6 On the other hand, lidocaine and mepivacaine are primarily metabolized in the liver. 1 Only a small amount of mepivacaine is excreted by the kidneys unchanged.…”

“… 2 , 3 , 9 Intraligamentary and intraosseous injecting with adrenaline containing anaesthesia is not recommended for patients with cardiovascular disease because drug easily enters the blood circulation with these techniques. 1 , 3 , 4 , 8 In elderly patients, the amount of local anesthetics should be reduced due to the decline in the functional capacity of both the liver and kidneys. 1 , 2 , 8 Majority of elderly patients suffer from heart diseases, so limiting the amount of local anaesthetic with adrenaline is recommended.…”

“…1 , 2 , 8 Majority of elderly patients suffer from heart diseases, so limiting the amount of local anaesthetic with adrenaline is recommended. 1 , 4 , 6 , 7 …”