Sensitivity, Specificity, Predictive Values, and Accuracy of Three Diagnostic Tests to Predict Inferior Alveolar Nerve Blockade Failure in Symptomatic Irreversible Pulpitis

Abstract

Introduction The inferior alveolar nerve block (IANB) is the most common anesthetic technique used on mandibular teeth during root canal treatment. Its success in the presence of preoperative inflammation is still controversial. The aim of this study was to evaluate the sensitivity, specificity, predictive values, and accuracy of three diagnostic tests used to predict IANB failure in symptomatic irreversible pulpitis (SIP). Methodology A cross-sectional study was carried out on the mandibular molars of 53 patients with SIP. All patients received a single cartridge of mepivacaine 2% with 1 : 100000 epinephrine using the IANB technique. Three diagnostic clinical tests were performed to detect anesthetic failure. Anesthetic failure was defined as a positive painful response to any of the three tests. Sensitivity, specificity, predictive values, accuracy, and ROC curves were calculated and compared and significant differences were analyzed. Results IANB failure was determined in 71.7% of the patients. The sensitivity scores for the three tests (lip numbness, the cold stimuli test, and responsiveness during endodontic access) were 0.03, 0.35, and 0.55, respectively, and the specificity score was determined as 1 for all of the tests. Clinically, none of the evaluated tests demonstrated a high enough accuracy (0.30, 0.53, and 0.68 for lip numbness, the cold stimuli test, and responsiveness during endodontic access, resp.). A comparison of the areas under the curve in the ROC analyses showed statistically significant differences between the three tests (p < 0.05). Conclusion None of the analyzed tests demonstrated a high enough accuracy to be considered a reliable diagnostic tool for the prediction of anesthetic failure.

Is mepivacaine as effective as lidocaine during inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis? A systematic review and meta‐analysis

“…, Chavarría‐Bolaños et al . , Corbella et al . ) and avoids diluting the drug (due to the local vasoconstriction that maintains the drug concentration).…”

“…Regarding the time taken to inject the anaesthetic agent, it has been reported that a slow injection promotes deeper diffusion (Kanaa et al 2006, Chavarr ıa-Bolaños et al 2017, Corbella et al 2017) and avoids diluting the drug (due to the local vasoconstriction that maintains the drug concentration). In the Vieira et al Anaesthesia in endodontics International Endodontic Journal, 51, 1104-1117, 2018 present review, three studies (Cunha et al 2011, Allegretti et al 2016, Visconti et al 2016) used a slow injection of the anaesthetic agentnearly 120 s for every 1.8 mL.…”

A comparison of a new diagnostic test of the human Brucellosis, the Brucella Coombs Gel Test, with other methods

“…The sensitivity and specificity are equal to TP/ (TP+FN), and TN/(TN+FP), respectively. Accuracy was calculated as the proportion of the true results (both true positives and true negatives) among the total number of cases examined [13]. All obtained data were analyzed by using the Statistical Package for the Social Sciences (SPSS) version 22.0 software (SPSS Inc., Chicago, IL, USA).…”

Postanesthetic Cold Sensibility Test as an Indicator for the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis of Mandibular Molars

“…e sample size was determined based on the statistical formula stated by Chavarría-Bolaños et al [4]. e following formula is described as follows:…”