Ishwarya Gurucharan1, Mahalaxmi Sekar2, Saravanakarthikeyan Balasubramanian3, Srinivasan Narasimhan4. 1. RNS Dental Clinic, Coimbatore, 641 011, Tamil Nadu, India. 2. Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, SRM Institute of Science and Technology, Bharathi Salai, Ramapuram, Chennai, 600 089, Tamil Nadu, India. 3. Department of Conservative Dentistry and Endodontics, SRM Dental College, Ramapuram, SRM Institute of Science and Technology, Bharathi Salai, Ramapuram, Chennai, 600 089, Tamil Nadu, India. skmdc2006@gmail.com. 4. Hamad Dental Centre, Hamad Medical Corporation, Doha, Qatar.
Abstract
OBJECTIVE: This randomized controlled clinical trial assessed the analgesic and anesthetic effects of precooling the injection site and administration of refrigerated 2% lignocaine HCl with 1:100,000 epinephrine (LE) in maxillary molars with symptomatic irreversible pulpitis (SIP). MATERIALS AND METHODS: Sixty patients diagnosed with SIP (preoperative pain score ≥ 85 mm) in maxillary first molars were randomly allocated to two groups. In group I (control), topical gel was applied for a minute followed by conventional LE infiltration, whereas in group II (experimental), topical ice application for 15 s and refrigerated (4-6 °C) LE administration was done prior to endodontic treatment. The primary outcome measure was anesthetic efficacy that was defined as none to weak pain (≤ 36 mm) as measured on Heft Parker visual analog scale (HP-VAS) following access cavity preparation. Pain on injection and onset constituted the secondary outcome measures. The pain on injection was measured using HP-VAS, whereas the onset of anesthesia was assessed using an electric pulp tester (EPT) which was applied on the experimental tooth every minute until no response was elicited. Mann-Whitney U test was performed to analyze the data (p < 0.01). RESULTS: Experimental group reported a success rate of 86.6% when compared to control group (26.6%) and a statistically significant reduction on injection pain (20.0 mm vs 54.5 mm) (p < 0.01). The onset of anesthesia for experimental group was 2.4 min which was also significantly lower than control group (4.5 min) (p < 0.01). CONCLUSIONS: Cryotherapy can serve as an effective alternative to conventional anesthesia for achieving success, reduced pain, and faster onset during endodontic treatment of maxillary molars with SIP. CLINICAL RELEVANCE: Precooling the injection site and cold LE administration can result in effective pulpal anesthesia during endodontic management of maxillary molars in SIP patients.
OBJECTIVE: This randomized controlled clinical trial assessed the analgesic and anesthetic effects of precooling the injection site and administration of refrigerated 2% lignocaine HCl with 1:100,000 epinephrine (LE) in maxillary molars with symptomatic irreversible pulpitis (SIP). MATERIALS AND METHODS: Sixty patients diagnosed with SIP (preoperative pain score ≥ 85 mm) in maxillary first molars were randomly allocated to two groups. In group I (control), topical gel was applied for a minute followed by conventional LE infiltration, whereas in group II (experimental), topical ice application for 15 s and refrigerated (4-6 °C) LE administration was done prior to endodontic treatment. The primary outcome measure was anesthetic efficacy that was defined as none to weak pain (≤ 36 mm) as measured on Heft Parker visual analog scale (HP-VAS) following access cavity preparation. Pain on injection and onset constituted the secondary outcome measures. The pain on injection was measured using HP-VAS, whereas the onset of anesthesia was assessed using an electric pulp tester (EPT) which was applied on the experimental tooth every minute until no response was elicited. Mann-Whitney U test was performed to analyze the data (p < 0.01). RESULTS: Experimental group reported a success rate of 86.6% when compared to control group (26.6%) and a statistically significant reduction on injection pain (20.0 mm vs 54.5 mm) (p < 0.01). The onset of anesthesia for experimental group was 2.4 min which was also significantly lower than control group (4.5 min) (p < 0.01). CONCLUSIONS: Cryotherapy can serve as an effective alternative to conventional anesthesia for achieving success, reduced pain, and faster onset during endodontic treatment of maxillary molars with SIP. CLINICAL RELEVANCE: Precooling the injection site and cold LE administration can result in effective pulpal anesthesia during endodontic management of maxillary molars in SIP patients.
Authors: Harry J Gould; John D England; R Denis Soignier; Porter Nolan; Lerna D Minor; Z P Liu; S Rock Levinson; Dennis Paul Journal: J Pain Date: 2004-06 Impact factor: 5.820