Pre‐operative ketorolac efficacy with different anesthetics, irrigants during single visit root canal treatment of mandibular molars with acute irreversible pulpitis

Abstract

Mandibular molar teeth with acute irreversible pulpitis pose challenges in single visit root canal treatment – (i) success of local anaesthesia and (ii) post‐operative pain. One hundred and twenty‐six patients with pain associated with carious mandibular molar teeth were enrolled. All patients were administered 10 mg of ketorolac tromethamine prior to local anaesthesia. Local anesthetics used were 2% lignocaine with 1:80 000 adrenaline and 4% articaine with 1:100 000 adrenaline. Three irrigation solutions were used – saline, 3% sodium hypochlorite and dexamethasone. Mean intra‐operative pain scores for the lignocaine and articaine groups were 4.33 (±2.58) and 4.22 (±2.88), respectively. There was a statistically significant difference (P = 0.000) in post‐operative pain incidence between the lignocaine and articaine groups with 16.7% (10 patients) and 49.2% (29 patients), respectively. Pre‐operative ketorolac tromethamine was not effective in reducing the intra‐operative pain incidence. However, it was effective in controlling post‐operative pain with lignocaine anesthetic group.

Effect of laser assisted local anesthesia in single-visit root canal treatment for mandibular molar teeth with acute irreversible pulpitis

“…An earlier report from the authors’ department concluded that pre-operative ketorolac tromethamine was not effective in reducing the intra-operative pain for mandibular molar teeth with acute irreversible pulpitis and apical periodontitis when using inferior alveolar nerve blocks (IANB) with both lignocaine and articaine anesthetic agents. However, it was effective in reducing post-operative pain after using lignocaine which was in agreement with a meta-analysis (3, 4). Mean intra-operative pain scores for both anesthetic agents were 4.33 and 4.22, respectively, and 27 (21.4%) patients required supplemental anaesthesia to control their intra-operative pain in the aforementioned study (3).…”

“…However, it was effective in reducing post-operative pain after using lignocaine which was in agreement with a meta-analysis (3, 4). Mean intra-operative pain scores for both anesthetic agents were 4.33 and 4.22, respectively, and 27 (21.4%) patients required supplemental anaesthesia to control their intra-operative pain in the aforementioned study (3). In another clinical study in the authors’ department where an inferior alveolar nerve block was used plus buccal nerve infiltration and intra-ligamentary injection with both anesthetic agents for single-visit root canal treatment in mandibular molar teeth with acute irreversible pulpitis, the mean intra-operative pain scores were 2.43 and 3.19 for the two anesthetic agents, respectively, and 12 (9.4%) patients required supplemental anesthesia (5).…”

“…The primary aim of this study was to evaluate the efficacy of laser activation in reducing the intra-operative pain intensity and thereby indirectly reducing the need for supplemental anaesthesia. Only mandibular molar teeth exhibiting acute irreversible pulpitis were considered, as these teeth are the most difficult teeth to anesthetize with a single IANB injection (3). The result of the present study highlights the efficacy of a laser to reduce both the intra-operative pain intensity and the need for supplemental anesthesia.…”

“…The patients (or where appropriate, parents or guardian) were informed about the nature of the treatment and the study, and they were asked to sign an informed consent form. The methodology adopted for this study was similar to clinical experiments conducted earlier in the authors’ department (3).…”

“…In another clinical study in the authors’ department where an inferior alveolar nerve block was used plus buccal nerve infiltration and intra-ligamentary injection with both anesthetic agents for single-visit root canal treatment in mandibular molar teeth with acute irreversible pulpitis, the mean intra-operative pain scores were 2.43 and 3.19 for the two anesthetic agents, respectively, and 12 (9.4%) patients required supplemental anesthesia (5). Supplemental anaesthesia requirements were far more reduced in the above-cited clinical trial when patients were given multiple injections prior to commencement of the root canal treatment (5).…”