Influence of needle gauge on pain perception and use of obturators in achieving profound pulpal anesthesia – A double-blinded in vivo study

Abstract

Introduction: Achieving profound pupal anesthesia and pain management is key in endodontic practice. However, inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia, during symptomatic irreversible pulpitis and has a high failure rate between 35% and 45%. Intrapulpal (IP) injection has been found to have increased efficiency and pain. The study aims to find the pain perception of 26G and 31G and the use of obturators in improving the efficacy of IP anesthesia. Materials and Methods: Eighty patients with symptomatic irreversible pulpitis after the failure of IANB were recruited and divided into four groups to receive IP with Group I A: 26G with obturators, Group I B: 26G without obturators, Group IIA: 31G with obturators, and Group IIB: 31G without obturators. The pain was measured using the visual analog scale and the effectivity of anesthetic injection by the duration of action. Results: A 31G needle produced the least pain perception compared to the 26G needle during IP injection. A 31G with an obturator was the most efficient, acting in less than a minute and 26G without an obturator showed the least. Conclusion: Within the limitation of this trial, it can be concluded that lesser gauge needles reduce pain perception during IP, and obturators achieve adequate back pressure.