Comparing the efficacy of Inferior alveolar nerve block (IANB), IANB along with buccal infiltration and modified intraseptal of Articaine in mandibular molars affected with irreversible pulpitis

The purpose of this prospective, randomized, double-blind clinical study is to compare the efficacy of inferior alveolar nerve block (IANB), IANB with buccal infiltration and modified antraseptal injection of articaine in mandibular molars with irreversible pulpitis. Ninety healthy patients with the diagnosis of symptomatic irreversible pulpitis and normal periapical in mandibular molars will participate in this study and allocate randomly in three groups. The patients are asked to rate their pain on VAS after using cold test (VAS1). The teeth also are tested using electrical pulp tester (EPT1). In first group patient will receive standard IANB injection using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. In the second group they will be administrated standard IANB using 1.8 ml of 2% lidocaine with 1:100,000 epinephrine and buccal infiltration using 1.8 ml of 4% articaine with 1:100,000 epinephrine. In the third group, the patient will receive modified intraseptal using 1.8 ml of 4% articaine with 1:100,000 epinephrine. The injection of 1 ml anesthetic solution in the buccal vestibule and 0.8 ml of anesthetic solution in the mesial and distal dental papilla is considered as modified intraseptal . All injections will be done by a single operator. After 10 minutes, the pulpal anesthesia will be measured by electrical pulp tester (EPT2), then the access cavity will be prepared. If patients do not report lip numbness 10 minutes after IANB injection, they exclude from the study. Patients will be instructed to rate any discomfort during access on the Heft-Parker visual analogue (VAS2) scale. The success of anesthesia are defined as reading EPT ≥80 and the ability to access the tooth with no or mild pain (VAS ≤54).

Shahid Beheshti University of Medical Sciences