Dataset Information

Comparing the Efficacy of Twin Mix and Lidocaine for Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis.

ABSTRACT: This randomized, active-controlled, double-blind, prospective clinical trial evaluated the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine versus an admixture of 2% lidocaine with 1:200,000 epinephrine and 1 mL of 4 mg dexamethasone (Twin mix) for inferior alveolar nerve blocks (IANBs) in patients with symptomatic irreversible pulpitis (SIP) of the mandibular molars. Seventy-eight patients with SIP of mandibular molars were randomly allocated to the 2 groups of 39 subjects. All patients were required to have profound lip numbness within 10 minutes of local anesthetic deposition. The efficacy of pulpal anesthesia was confirmed by absence of pain or mild pain (Heft-Parker visual analogue scale ≤54 mm) during access cavity preparation and placement of glide path files. The collected data were subjected to independent t test, chi-square test, and Fisher exact test using SPSS software version 20.0 at a significance level of 0.05. IANB success rates for the lidocaine group and the Twin mix group was 66% and 68% respectively, which was not a statistically significant difference (p > .05). This study demonstrated that the anesthetic efficacy of Twin mix was equivalent to 2% lidocaine for IANBs in teeth with SIP.

SUBMITTER: Kaushik M

PROVIDER: S-EPMC7780253 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Comparing the Efficacy of Twin Mix and Lidocaine for Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis.

Kaushik Mamta M Mehra Neha N Sharma Roshni R Moturi Kishore K Podugu Uday Kumar UK George Alvin A

Anesthesia progress 20201201 4

This randomized, active-controlled, double-blind, prospective clinical trial evaluated the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine versus an admixture of 2% lidocaine with 1:200,000 epinephrine and 1 mL of 4 mg dexamethasone (Twin mix) for inferior alveolar nerve blocks (IANBs) in patients with symptomatic irreversible pulpitis (SIP) of the mandibular molars. Seventy-eight patients with SIP of mandibular molars were randomly allocated to the 2 groups of 39 subjects. All pa ...[more]

PMID: 33393600

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Project description:Background and Objectives: Lidocaine Hydrochloride has been the standard choice for local anesthesia in dentistry and Articaine's unique structure and growing popularity make it a viable alternative. Due to contradictory results in prior research and a scarcity of trials conducted in the Pakistani population, this study aims to compare the anesthetic efficacy of Lidocaine with Articaine for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. Materials and Methods: This double-blinded, randomized controlled trial included 152 patients who were selected by consecutive non-probability sampling. The participants included patients who presented with symptomatic irreversible pulpitis in mandibular posterior teeth (molars and premolars) and depicted normal apical tissue radiographically. The patients were equally and randomly divided into two groups. The control group received 2% Lidocaine Hydrochloride injections, and the experiment group received 4% Articaine Hydrochloride injections. Participants scored their pain on the HP-VAS both before and after the administration of anesthesia. A value of 54 mm or less on the scale indicated effective anesthesia. The data obtained were analyzed using SPSS. Chi-square test was applied to analyze data for statistical significance. Results: There was no statistically significant difference in the efficacy of the two anesthetic agents. During access cavity preparation, Lidocaine demonstrated a success rate of 93%, whereas Articaine exhibited a slightly higher success rate of 97%. During initial instrumentation, the success rates for Lidocaine and Articaine were 72% and 71%, respectively. This suggests that both Lidocaine and Articaine were effective in achieving anesthesia during the dental procedure in patients with symptomatic irreversible pulpitis, with Articaine showing a slightly better success rate, although the difference was not statistically significant. Conclusions: The anesthetic efficacy of Articaine is similar to that of lidocaine in subjects with symptomatic irreversible pulpitis. Hence, Articaine can serve as an alternative to Lidocaine for local anesthesia administration in dentistry.

Project description:Background and Objectives: Symptomatic irreversible pulpitis in permanent mature teeth is a common indication for nonsurgical root canal treatment (NSRCT), but contemporary studies have reported on vital pulp therapy (VPT) applied in such teeth as a less invasive treatment. This systematic review assessed the outcomes of VPT, including partial and full pulpotomy performed with hydraulic calcium silicate cements (HCSCs) in permanent mature posterior teeth diagnosed with symptomatic irreversible pulpitis. Materials and Methods: The PRISMA guidelines were followed. The search strategy included PubMed®, EMBASE, Cochrane library and grey literature electronic databases. The quality assessment of the identified studies followed the Cochrane Collaboration Risk of Bias, ROBINS-I and Newcastle-Ottawa Scale tools. Results: The search of primary databases identified 142 articles, of which 9 randomized controlled trials and 3 prospective cohort studies were selected for review. The risk-of-bias was assessed as 'high' or 'serious', 'fair', and 'low' for three, seven and two articles, respectively. One to five years after VPT using HCSCs, the success rates mostly ranged from 78 to 90%. Based on two articles, the outcomes of the VPT and NSRCT were comparable at one and five years. Despite the necessity for the intra-operative pulp assessment in VPT procedures, the majority of the studies did not fully report on this step or on the time needed to achieve hemostasis. Small sample sizes, of under 23 teeth, were reported in three studies. Conclusions: The reviewed 12 articles reported favorable outcomes of the VPT performed with HCSCs in permanent mature posterior teeth with symptomatic irreversible pulpitis, with radiographic success in the range of 81 to 90%. Two articles suggested comparable outcomes of the VPT and root canal treatment. Universal case selection and outcome criteria needs to be established for VPT when considered as an alternative to NSRCT. This evidence supports the need for further research comparing longer-term outcomes of both of the treatment modalities.

Project description:BackgroundSymptomatic irreversible pulpitis (SIP) or symptomatic apical periodontitis (SAP) are two painful conditions often warranting emergency treatment. The most common emergency treatments supported by evidence are pulpotomy and pulpectomy and are normally performed under time-constrained circumstances. However, there is no strong evidence of which treatment suggested in literature a clinician can use to reduce endodontic pain effectively. Therefore, the aim of this systematic review is to investigate the present knowledge on postoperative pain related to the two types of emergency treatments available for treating SIP and SAP.MethodsRandomized controlled trials investigating postoperative pain after emergency treatments (pulpotomy and/or pulpectomy) on permanent dentition with signs and symptoms of SIP and/or SAP were searched in three major databases from 1978 until 2022. Risk of bias was assessed with Cochrane's tool.ResultsOnly five studies fulfilled the inclusion criteria. The included studies indicated that pulpotomy and pulpectomy are both suitable treatment options for SAP and SIP, as they provide sufficient alleviation of pain in permanent dentition. However, inconsistent results were found between the included trials on which emergency treatment is more effective in reducing pain. Cochrane's tool revealed that the studies had a low risk of bias. Limitations found in the design of the included randomized control trials decreased the level of evidence. None of the included studies accounted for essential confounding variables, such as factors affecting pain (including the psychological aspects). Moreover, possible non-odontogenic pain was not assessed, and therefore, it was not excluded; hence, affecting the internal validity of the studies.ConclusionThere are controversies within the available randomized control trials on which treatment is most effective in reducing emergency pain. This could be due to some weaknesses in the design of the clinical trials. Thus, further well-designed studies are warranted to draw conclusions on which emergency treatment is more effective in reducing pain.Systematic review registrationPROSPERO (CRD42023422282).

Dataset Information

Comparing the Efficacy of Twin Mix and Lidocaine for Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis.

Publications

Comparing the Efficacy of Twin Mix and Lidocaine for Inferior Alveolar Nerve Blocks in Patients With Symptomatic Irreversible Pulpitis.

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