Efficacy Of Dental Local Anaesthesia In Mandibular Teeth: Current Views
DDS, MPhil, PhDSpecialty Doctor OMFS: Kettering General Hospital
PhD Clinical Research ProjectNewcastle University, UK
Dr Mohammad Dib KanaaDr Mohammad Dib Kanaa
O M I C SO M I C SDubai 2015Dubai 2015
Support and Sponsorship: Support and Sponsorship: •Kettering General HospitalKettering General Hospital•SASSAS•OMICSOMICS
Introduction ““Anaesthesia is the art or science of Anaesthesia is the art or science of
removing sensation of and reaction removing sensation of and reaction
to a surgical procedure. to a surgical procedure.
Anaesthesia means loss of all forms Anaesthesia means loss of all forms
of sensation whether it is the sense of sensation whether it is the sense
of pain, touch, temperature or of pain, touch, temperature or
position sense”position sense”
(Healy and Pollard, 1999)
O M I C SO M I C SDubai 2015Dubai 2015
IntroductionIntroduction Local anaesthesia is the method of choice for pain control during Local anaesthesia is the method of choice for pain control during
operative dental treatment;operative dental treatment; It was reported that half of the local anaesthetic injections in the It was reported that half of the local anaesthetic injections in the
United States each year were IANB injections;United States each year were IANB injections;
IANB is reported to be successful in 85-95% of casesIANB is reported to be successful in 85-95% of cases (100,000 -(100,000 -300,000 of injections were failure)300,000 of injections were failure); ;
The success rate of mandibular anaesthesia with IANB extremely The success rate of mandibular anaesthesia with IANB extremely varied in the literature, it ranged between 30% to 97%.varied in the literature, it ranged between 30% to 97%.
IANB injection alone does not secure satisfactory pain free IANB injection alone does not secure satisfactory pain free treatment.treatment.
(Montagnese (Montagnese et alet al., 1984; Donkor ., 1984; Donkor et alet al., 1990; Nist ., 1990; Nist et alet al., 1992; Wong & Jacobsen 1992; ., 1992; Wong & Jacobsen 1992; McLean McLean et alet al., 1993; Bou Dagher ., 1993; Bou Dagher et alet al., 1997; Yared and Bou Dagher, 1997; Hannan ., 1997; Yared and Bou Dagher, 1997; Hannan et alet al., ., 1999; Yonchak 1999; Yonchak et alet al., 2001; ., 2001; Kaiser & Hargreaves, 2002; Kanaa et al., 2006; Whitworth et al., Kaiser & Hargreaves, 2002; Kanaa et al., 2006; Whitworth et al., 2007; Corbett et al., 2008; Kanaa et al., 2009; Kanaa et al., 2012., Gazal et al., 2015)2007; Corbett et al., 2008; Kanaa et al., 2009; Kanaa et al., 2012., Gazal et al., 2015)
O M I C SO M I C SDubai 2015Dubai 2015
IntroductionIntroductionRelevant variables of IANB failure:Relevant variables of IANB failure:
Obese; those with large and laterally flaring mandibles; Obese; those with large and laterally flaring mandibles;
Very anxious; Very anxious;
Edentulous patients;Edentulous patients;(Wong and Jacobsen, 1992)(Wong and Jacobsen, 1992)
O M I C SO M I C SDubai 2015Dubai 2015
Causes of LA failure
AnatomicalAnatomical
PathologicalPathological
PharmaceuticalPharmaceutical
PharmacologicalPharmacological
PsychologicalPsychological
TechnicalTechnical
(Haas et al., 1990; Reisman et al., Wong & Jacobsen 1992; 1997; Nusstein et al., 1998; Yonchak et al., 2001; Meechan & Ledvinka, 2002; Kaiser & Hargreaves, 2002 ;Kanaa et al., 2006; Kanaa et al, 2009, Kanaa 2011)
O M I C SO M I C SDubai 2015Dubai 2015
IntroductionIntroduction Injection speedInjection speed
There are conflicting views on the There are conflicting views on the influence of rate of injection on the influence of rate of injection on the distribution of local anaesthetic drugs and distribution of local anaesthetic drugs and its likely effect on securing anaesthesia.its likely effect on securing anaesthesia.
((Rucci Rucci et alet al., 1995; ., 1995; Kaiser & Hargreaves, 2002; Kaiser & Hargreaves, 2002; Oliveira et al., Oliveira et al., 20042004))
O M I C SO M I C SDubai 2015Dubai 2015
IntroductionIntroductionSummarySummary
Therefore an investigation to establish Therefore an investigation to establish if there is an association between if there is an association between speed injection (slow & rapid) and speed injection (slow & rapid) and IANB,IANB, is required. is required.
O M I C SO M I C SDubai 2015Dubai 2015
Materials and MethodsMaterials and Methods Study designStudy design
A double blind randomized A double blind randomized crossover study design was crossover study design was employed employed using healthy volunteers using healthy volunteers aged over 18 yearsaged over 18 years at the at the presentation of this research.presentation of this research.
O M I C SO M I C SDubai 2015Dubai 2015
Official clearances
NHS TrustNHS Trust
MHRAMHRA
LRECLREC
O M I C SO M I C SDubai 2015Dubai 2015
Materials and MethodsMaterials and Methods Power calculationPower calculation
Using 38 volunteers the study would have Using 38 volunteers the study would have 80% power to detect an effect size of 0.9 (a 80% power to detect an effect size of 0.9 (a shift of 0.9 standard deviations) in a shift of 0.9 standard deviations) in a continuous outcome measure assuming a continuous outcome measure assuming a significance level of 5% and a correlation significance level of 5% and a correlation of 0.5 between responses from the same of 0.5 between responses from the same subject.subject.
O M I C SO M I C SDubai 2015Dubai 2015
Materials and MethodsMaterials and Methods Sampling rSampling randomisedandomised procedure procedure
The 38 volunteers were randomly The 38 volunteers were randomly allocated for their first injection using allocated for their first injection using web-based program web-based program (1)(1) to receive slow or to receive slow or rapid injection at the first visit. At the rapid injection at the first visit. At the second visit, the other IANB was second visit, the other IANB was provided. provided.
(1) ((1) (http://department.obg.cuhk.edu.hk/researchsupport/Random_integer.asp ))
O M I C SO M I C SDubai 2015Dubai 2015
Materials and MethodsMaterials and MethodsInclusion criteriaInclusion criteria
Healthy volunteersHealthy volunteers;
Over 18 years;
Standing vital 1st molar, premolar (1st or 2nd) and lateral incisor in at least one side of the mandible;
Volunteers who accept to participate in the trial after reading the information sheet and signed the consent.
O M I C SO M I C SDubai 2015Dubai 2015
Materials and MethodsMaterials and Methods
Application techniquesApplication techniques
The local The local anaestheticanaesthetic needle was inserted midway between needle was inserted midway between the internal oblique ridge and the pterygomandibular raphe the internal oblique ridge and the pterygomandibular raphe and advanced until an adequate bony contact was achieved and advanced until an adequate bony contact was achieved ((direct or Halstead approachdirect or Halstead approach).). Blinded and randomisedBlinded and randomised application with 2mL of 2% lidocaine with 1:80,000 application with 2mL of 2% lidocaine with 1:80,000 epinephrineepinephrine for each for each volunteer was employed on two volunteer was employed on two occasions after an adequate aspiration:occasions after an adequate aspiration:
Rapid Rapid IANBIANB delivery delivery over 15s, the needle remained in place over 15s, the needle remained in place for a further 45s;for a further 45s;
Slow Slow IANBIANB delivery delivery over 60s. over 60s.
O M I C SO M I C SDubai 2015Dubai 2015
Standard electronic pulp tester (1Standard electronic pulp tester (1stst molar, 1 molar, 1stst or 2 or 2ndnd premolar & premolar & lateral incisor pulps); lateral incisor pulps);
((Analytic Technology, Analytic Technology, Washington, USA)Washington, USA)
Unanaesthetised tooth on the other side of the lower jaw had Unanaesthetised tooth on the other side of the lower jaw had
been had pulp sensitivity readings performed twice at base lines been had pulp sensitivity readings performed twice at base lines and once at 10 and 45 minutes post injection;and once at 10 and 45 minutes post injection;
An absence of pulp sensation when stimulated at the maximum An absence of pulp sensation when stimulated at the maximum output (80 reading) was the criterion for pulpal anaesthesia.output (80 reading) was the criterion for pulpal anaesthesia.
Baseline (twice)
Materials and Methods Objective measurement of anaesthetic efficacy
At intervals of 2 minsfor first 10 mins
Then at intervals of 5 mins for 45 mins
O M I C O M I C SSDubai Dubai 20152015
Criterion for success
An absence of pulp sensation An absence of pulp sensation
when stimulated at the maximum when stimulated at the maximum
output (output (8080 reading) ) of tooth pulp of tooth pulp
testingtesting
O M I C SO M I C SDubai 2015Dubai 2015
Materials and MethodsMaterials and MethodsThe statistical analysis of the studyThe statistical analysis of the study
Frequencies;Frequencies; Descriptions;Descriptions; Crosstabulation;Crosstabulation; Pearson Chi-SquarePearson Chi-Square; ; Fisher’s Exact TestFisher’s Exact Test;; McNemar Test; McNemar Test; Paired T test. Paired T test.
O M I C SO M I C SDubai 2015Dubai 2015
Objective assessment of pulpal anaesthesia Objective assessment of pulpal anaesthesia
after after slowslow & & rapidrapid IANB IANB injectioninjection
Results
O M I C SO M I C SDubai 2015Dubai 2015
Slow vs. Rapid IANB in 1Slow vs. Rapid IANB in 1stst molar teeth molar teeth
Results
Percentage of frequency of 80 reading of 1st molar pulp anaesthesia (without sensation) at time intervals after Slow and rapid IANB
0
10
20
30
40
50
60
70
80
90
100
2 4 6 8 10 15 20 25 30 35 40 45
Time after injection (min)
% o
f vo
lun
teer
s ex
per
ien
cin
g n
o
resp
on
se t
o m
axim
al (
80 r
ead
ing
) st
imu
lati
on
Slow IANB
Rapid IANB
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Slow vs. Rapid IANB in premolar teethSlow vs. Rapid IANB in premolar teeth
Results
Percentage of frequency of 80 reading of premolar pulp anaesthesia (without sensation) at time intervals after Slow and rapid IANB
0
10
20
30
40
50
60
70
80
90
100
2 4 6 8 10 15 20 25 30 35 40 45
Time after injection (min)
% o
f vo
lun
teer
s ex
per
ien
cin
g n
o
resp
on
se t
o m
axim
al (
80 r
ead
ing
) st
imu
lati
on
Slow IANB
Rapid IANB
O M I C O M I C SSDubai Dubai 20152015
Slow vs. Rapid IANB in lateral incisorsSlow vs. Rapid IANB in lateral incisors
Results
Percentage of frequency of 80 reading of lateral incisor pulp anaesthesia (without sensation) at time intervals after Slow and rapid IANB
0
10
20
30
40
50
60
70
80
90
100
2 4 6 8 10 15 20 25 30 35 40 45
Time after injection (min)
% o
f vo
lun
teer
s ex
per
ien
cin
g n
o
resp
on
se t
o m
axim
al (
80 r
ead
ing
) st
imu
lati
on
Slow IANB
Rapid IANB
O M I C O M I C SSDubai Dubai 20152015
11stst molar vs. premolar vs. lateral incisor after Slow IANB molar vs. premolar vs. lateral incisor after Slow IANB
Results
Percentage of frequency of 80 reading of 1st molar, premolar and lateral incisor pulp anaesthesia (without sensation) at time intervals after Slow IANB
O M I C O M I C SSDubai Dubai 20152015
010
2030
4050
6070
8090
100
2 4 6 8 10 15 20 25 30 35 40 45
Time after injection (min)
% o
f vol
unte
ers
expe
rien
cing
no
resp
onse
to
max
imal
(80r
eadi
ng) s
tim
ulat
ion
First molar
Premolar
Lateral incisor
11stst molar vs. premolar vs. lateral incisor after Rapid IANB molar vs. premolar vs. lateral incisor after Rapid IANB
Results
Percentage of frequency of 80 reading of 1st molar, premolar and lateral incisor pulp anaesthesia (without sensation) at time intervals after Rapid IANB
O M I C O M I C SSDubai Dubai 20152015
0
10
20
30
40
50
60
70
80
90
100
2 4 6 8 10 15 20 25 30 35 40 45
Time after injection (min)
% o
f vol
unte
ers
expe
rien
cing
no
resp
onse
to
max
imal
(80r
eadi
ng) s
tim
ulat
ion
First molar
Premolar
Lateral incisor
ConclusionConclusion Slow IANB produced more episodes of no sensation on
maximal electronic pulp stimulation in first molars, premolars
and lateral incisors than rapid IANB injection.
Premolars were more likely to have successful pulpal
anaesthesia than first molars and lateral incisors following
IANB (either slowly or rapidly).
O M I C SO M I C SDubai 2015Dubai 2015
The outcomeThe outcome
This study will help to inform: This study will help to inform:
what and how best practice in what and how best practice in
everyday dental procedure everyday dental procedure
should be. should be.
O M I C SO M I C SDubai 2015Dubai 2015
2%4%
1.8ml
Articaine vs. Lidocaine
In
Mandibular buccal plus lingual infiltration(Haas et al., 1990; Yonchak et al., 2001; Meechan & Ledvinka,
2002; Kanaa et al., 2006)
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Aim
To evaluate the efficacy of To evaluate the efficacy of
articaine and lidocaine buccal articaine and lidocaine buccal
plus lingual infiltrations in plus lingual infiltrations in
securing pulp anesthesia in vital securing pulp anesthesia in vital
mandibular first molarsmandibular first molars
O M I C SO M I C SDubai 2015Dubai 2015
Research question (H0)
Articaine
B & LInfiltrations
Lidocaine
O M I C SO M I C SDubai 2015Dubai 2015
Materials and Methods
O M I C SO M I C SDubai 2015Dubai 2015
Study design
Prospective Prospective
Randomized Randomized
Double blind Double blind
CrossoverCrossover
O M I C SO M I C SDubai 2015Dubai 2015
Power calculation
Using 31 subjects would have 90% Using 31 subjects would have 90%
power to detect an effect size of 0.83 (a power to detect an effect size of 0.83 (a
change of 0.83 standard deviations) in a change of 0.83 standard deviations) in a
continuous outcome measure assuming continuous outcome measure assuming
a significance level of 5%a significance level of 5%
O M I C SO M I C SDubai 2015Dubai 2015
Official clearances
NHS TrustNHS Trust
MHRAMHRA
LRECLREC
O M I C SO M I C SDubai 2015Dubai 2015
Inclusion criteria
Healthy adult volunteersHealthy adult volunteers
18 years old and over18 years old and over
Vital mandibular 1st molar
Signed the consent form
O M I C SO M I C SDubai 2015Dubai 2015
Anesthetic DeliveryBuccal & lingual infiltration
2% 2% Lidocaine with Lidocaine with 1:100,0001:100,000 epinephrine epinephrine
4% 4% Articaine with Articaine with
1:100,0001:100,000 epinephrine epinephrine One week
O M I C SO M I C SDubai 2015Dubai 2015
Buccal infiltration
0.9 mL
Lingual infiltration
0.9 mL
O M I C SO M I C SDubai 2015Dubai 2015
Objective measurement
Base-line (twice) At intervals of 2 mins until 30 mins
Mandibular first molarMandibular first molar
Unanesthetised toothUnanesthetised tooth
O M I C SO M I C SDubai 2015Dubai 2015
Criterion for success
An absence of pulp sensation An absence of pulp sensation
when stimulated at the maximum when stimulated at the maximum
output (output (8080 reading) ) on two or more on two or more
consecutive episodes of testingconsecutive episodes of testing
O M I C SO M I C SDubai 2015Dubai 2015
Statistical analysis of the study
McNemar Test McNemar Test
Paired T testPaired T test
O M I C SO M I C SDubai 2015Dubai 2015
Results
O M I C SO M I C SDubai 2015Dubai 2015
Changes from baseline pulp tester reading at first sensation (reading) in lower first molars
Paired T test, t=14, P < 0.001
0
5
10
15
20
25
30
35
40
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Registration point (min after injection)
Ch
ang
es f
rom
bas
elin
e p
ulp
tes
ter
re
adin
g a
t fi
rst
sen
sati
on
(µ
A)
Articaine (B&L)
Lidocaine (B&L)
O M I C SO M I C SDubai 2015Dubai 2015
Episodes of no response to maximal (80 reading) stimulation at time intervals using articaine and lidocaine
Articaine Articaine vs.vs. Lidocaine: Lidocaine: 242242, , 114114 respectively, respectively, McNemar Test,McNemar Test, P < 0.001P < 0.001
0
10
20
30
40
50
60
70
80
90
100
2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Registration point (min after injection)
% o
f vo
lun
teer
s ex
per
ien
cin
g n
o
resp
on
se t
o m
axim
al (
80μ
A)
stim
ula
tio
n
Articaine (B&L)
Lidocaine (B&L)
O M I C SO M I C SDubai 2015Dubai 2015
Articaine
B & LInfiltrations
Lidocaine
Anesthetic success
(P = 0.001)
(21/31)
68%(10/31)
32%
O M I C SO M I C SDubai 2015Dubai 2015
Conclusions
O M I C SO M I C SDubai 2015Dubai 2015
Articaine produced Articaine produced more episodes of no
response to maximal (8080 reading reading) stimulation
at time intervals post injectionpost injection than lidocaine than lidocaine
Articaine wasArticaine was more successful more successful than lidocaine than lidocaine
in producing anaesthesia in lower first in producing anaesthesia in lower first
molars after buccal plus lingual infiltrationsmolars after buccal plus lingual infiltrations
O M I C SO M I C SDubai 2015Dubai 2015
Irreversible Pulpitis Irreversible Pulpitis
in Mandibular Permanent Teethin Mandibular Permanent Teeth
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Objectives
To compare the efficacy of supplementary repeat To compare the efficacy of supplementary repeat
lidocaine IANB, ABI, lidocaine PDL and lidocaine lidocaine IANB, ABI, lidocaine PDL and lidocaine
IO following failed lidocaine IANB for securing IO following failed lidocaine IANB for securing
pain free treatment in patients experiencing pain free treatment in patients experiencing
irreversible pulpitis in mandibular permanent teethirreversible pulpitis in mandibular permanent teeth
O M I C SO M I C SDubai 2015Dubai 2015
Research question (HO)
IANBSupplemented
ABI IO PDL rIANB
Supplemented IANB
Supplemented IANB
O M I C SO M I C SDubai 2015Dubai 2015
Materials and Methods
Study design
A prospective randomized A prospective randomized
clinical trial design was clinical trial design was
employedemployed
O M I C SO M I C SDubai 2015Dubai 2015
Power calculation
Based on outcome data for intraosseous Based on outcome data for intraosseous
anaesthesia, a study with at least 21 subjects in anaesthesia, a study with at least 21 subjects in
each supplementary technique group was each supplementary technique group was
reported to have 90% power to detect a difference reported to have 90% power to detect a difference
in success rate of 82% (8% vs. 90%, Nusstein et in success rate of 82% (8% vs. 90%, Nusstein et
al., 1998) assuming a significance level of 5% and al., 1998) assuming a significance level of 5% and
a correlation of 0.5 between subjects a correlation of 0.5 between subjects
O M I C SO M I C SDubai 2015Dubai 2015
Official clearances
NHS TrustNHS Trust
MHRAMHRA
LRECLREC
O M I C SO M I C SDubai 2015Dubai 2015
Inclusion criteria
182 healthy adult patients182 healthy adult patients
18 years old and over18 years old and over
Irreversible pulpitis mandibular
tooth
Signed the consent form O M I C SO M I C SDubai 2015Dubai 2015
Anaesthetic Delivery
LA solution/ technique Pulp testing Every 2 mins until no sensation or 10 mins
Treatment Pain Supplementary LA Pulp testing at 2 & 5 mins Treatment Pain Other treatments
Mandibular teeth with irreversible pulpitis: 182 patients
I A N B: 2% Lidocaine with epinephrine 1:80,000 (2mL): 182 patients
Success Success
PT-
Randomised supplementary techniques
Failure and withdrawn from trial
Pain
Intraosseous injection of 2% lidocaine with epinephrine 1:80,000 (1 mL)
Treatment
Intraligamentary injection of 2% lidocaine with epinephrine 1:80,000 (0.2 mL)
Repeat IANB of 2% lidocaine with epinephrine 1:80,000 (2 mL)
Buccal infiltration of 4% articaine with epinephrine 1:100,000 (2 mL)
PT+
Treatment
No pain
PT+ PT-
Pain
Treatment
No pain
PT-
Failure and withdrawn from trial
PT+
Treatment
Pain
PT+ PT-
Pain
Treatment
No pain
Positive to pulp test (PT+)
No pain
Negative to pulp test (PT-)
Pain
No pain
O M I C O M I C SSDubai Dubai 20152015
Objective measurement
Base-line (twice)
IANB injectionAt intervals of 2 mins until 10 mins or till 80 reading on pulp test secured
Unanaesthetised toothUnanaesthetised tooth
Tooth with irreversible pulpitis Tooth with irreversible pulpitis
Supplementary TechniquesAt intervals of 2 mins if no 80 reading then at 5 mins
O M I C SO M I C SDubai 2015Dubai 2015
Criterion for LA success
An absence of pulp sensation An absence of pulp sensation
when stimulated at the maximum when stimulated at the maximum
output (output (80 reading80 reading) ) of testingof testing
O M I C SO M I C SDubai 2015Dubai 2015
Criterion treatment success
An absence of any sensation of An absence of any sensation of
pain during the treatment; even pain during the treatment; even
mild painmild pain
O M I C SO M I C SDubai 2015Dubai 2015
Statistical analysis of the study
SPSS software 17.0, SPSS Inc., SPSS software 17.0, SPSS Inc.,
Chicago, USAChicago, USA
Pearson Chi-SquarePearson Chi-Square
Fisher’s Exact TestFisher’s Exact Test
O M I C SO M I C SDubai 2015Dubai 2015
Results
O M I C SO M I C SDubai 2015Dubai 2015
General distributionGeneral distribution
182182 patients with mandibular patients with mandibular irreversible pulpitis teethirreversible pulpitis teeth
133133 males: males: 73.1%73.1%
4949 females: females: 26.9%26.9%
Age range: 18-66 years old (mean Age range: 18-66 years old (mean 31.931.9, , SD SD 10.010.0). ).
O M I C SO M I C SDubai 2015Dubai 2015
LA solution/ technique Pulp testing Every 2 mins until no sensation or 10 mins
Treatment Pain Supplementary LA Pulp testing at 2 & 5 mins Treatment Pain Other treatments
Mandibular teeth with irreversible pulpitis: 182 patients
I A N B: 2% Lidocaine with epinephrine 1:80,000 (2mL): 182 patients
Success Success
PT- :21
Randomised supplementary techniques: 100 patients
Failure and withdrawn from trial
Pain: 40
Intraosseous injection of 2% lidocaine with epinephrine 1:80,000 (1 mL): 25
Treatment: 122
Intraligamentary injection of 2% lidocaine with epinephrine 1:80,000 (0.2 mL): 25
Repeat IANB of 2% lidocaine with epinephrine 1:80,000 (2 mL): 25
Buccal infiltration of 4% articaine with epinephrine 1:100,000 (2 mL): 25
PT+ :4
Treatment: 21
No pain: 17 81%
PT+ :7 PT- :18
Pain: 6
Treatment: 18
No pain: 12 67%
PT- :15
Failure and withdrawn from trial
PT+ : 10
Treatment: 15
Pain: 7
PT+ :2 PT- :23
Pain: 2
Treatment: 23
No pain: 21 91%
Positive to pulp test (PT+): 60
No pain: 8 53%
Negative to pulp test (PT-): 122
Pain: 4
No pain: 82 (45%)
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Premolars vs. MolarsPremolars vs. Molars
Relationship between treatment outcomes in premolars and molars in 77 Relationship between treatment outcomes in premolars and molars in 77 patients with a negative response to pulp testing after supplementary patients with a negative response to pulp testing after supplementary injections.injections. (Chi-Square p = 0.14, Fisher’s Exact Test p = 0.33) (Chi-Square p = 0.14, Fisher’s Exact Test p = 0.33)
Treatmentoutcomes
SuccessN %
FailureN %
TotalN
Premolars 6 100.0 0 0.0 6
Molars 52 73.2 19 26.8 71
Total 58 75.3 19 24.7 77
O M I C O M I C SSDubai Dubai 20152015
Molar tooth & supplementary techniquesMolar tooth & supplementary techniques
Experience of treatment success in 71 mandibular molar teeth after repeat Experience of treatment success in 71 mandibular molar teeth after repeat IANB injection (r IANB), articaine buccal infiltration (ABI), intraligamentary IANB injection (r IANB), articaine buccal infiltration (ABI), intraligamentary (PDL) and intraosseous injection (IO): Pearson Chi-Square p = 0.025, (PDL) and intraosseous injection (IO): Pearson Chi-Square p = 0.025, Likelihood Ratio p = 0.021Likelihood Ratio p = 0.021
Treatmentoutcomesmolars
r IANB
N %
ABI
N %
PDL
N %
IO
N %
Total
N %
Success 7 50.0 21 91.3 9 60.0 15 78.952 73.2
Failure 7 50.0 2 8.7 6 40.0 4 21.1 19 26.8
Total 14 23 15 19 71
O M I C O M I C SSDubai Dubai 20152015
Anesthetic success
rIANB
60%
IANBSupplemented (P = 0.04)
Supplemented IANB
Supplemented IANB
PDL72%
IO
84%
ABI
92%
O M I C SO M I C SDubai 2015Dubai 2015
Treatment success
IANBSupplemented
Supplemented IANB
Supplemented IANB
ABI
91%
IO
81%
PDL67%
(P = 0.04)
rIANB
53%
O M I C SO M I C SDubai 2015Dubai 2015
Conclusions
O M I C SO M I C SDubai 2015Dubai 2015
IANB injection alone does not secure satisfactory IANB injection alone does not secure satisfactory
pain free treatment (pain free treatment (45%45%))
Articaine buccal infiltration and intraosseous Articaine buccal infiltration and intraosseous
injections are better supplementary techniques injections are better supplementary techniques
than intraligamentary and repeat IANB injections than intraligamentary and repeat IANB injections
for patients experiencing irreversible pulpitis in for patients experiencing irreversible pulpitis in
the mandibular permanent teeththe mandibular permanent teeth
O M I C SO M I C SDubai 2015Dubai 2015
J.G. MeechanJ.M. Whitworth
M.D. Kanaa
O M I C SO M I C SDubai 2015Dubai 2015
Special Thanks: Special Thanks: Kettering General HospitalKettering General Hospital
SAS Support and SponsorshipSAS Support and SponsorshipOMICSOMICS
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