The effect of pre‐operative submucosal administration of dexamethasone, tramadol, articaine on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: A randomized, double‐blind placebo‐controlled clinical trial

Abstract

Aim: To establish the effects of submucosal tramadol, dexamethasone and articaine on the success of inferior alveolar nerve blocks (IANB) during root canal treatment of mandibular molars with symptomatic irreversible pulpitis (SIP). Methodology:In this randomized double-blind, controlled clinical trial, 120 patients with the diagnosis of SIP in their mandibular first or second molars were included and randomly divided into four groups (n = 30). The control group received normal saline and three experimental groups received a single dose of dexamethasone (8 mg/2 mL), or tramadol (100 mg/2 mL) or articaine (4% / 2 mL). The pre-operative pain levels of the patients were measured with the Heft-Parker visual analogue scale (HP VAS). All patients received standard IANB of 4% articaine with 1:200000 epinephrine. Following the observation of lip numbness, submucosal injections were administered into the mucobuccal fold adjacent to the mandibular molars. After 15 min, standard root canal treatment was initiated, and the pain intensity levels recorded from the access cavity preparation to pulp extirpation were measured with HP VAS. The duration of the anaesthesia was also evaluated. The experimental groups were compared using one-way ANOVA or Kruskal-Wallis H-test. The groups that were significantly different were compared pairwise using the Tukey Multiple Comparison test. The Chi-square test was used to compare the categorical variables. Results:The submucosal administration of articaine significantly increased the success rate to 63% in comparison with the control group that received submucosal saline (p < .05). The success rate of pulpal anaesthesia was 37% in the control group, 57% in the tramadol group and 47% in the dexamethasone group, with no significant difference in the success rate among these groups. In the dexamethasone group, the duration of the anaesthetic effect of IANB was significantly longer than those in the other groups (p < .001). Conclusions:In patients with SIP, pre-operative submucosal administration of articaine increased the success rate of IANB, while administration of dexamethasone | 1983 AKSOY ET AL.

Dexamethasone Increases the Anesthetic Success in Patients with Symptomatic Irreversible Pulpitis: A Meta-Analysis

“…In total, 17 clinical assays were found in both databases ( Figure 1 ), of which 14 obtained a low or medium risk-of-bias result according to the Cochrane Collaboration’s risk-of-bias tool ( Figure 2 ). In this way, 14 clinical trials [ 8 , 9 , 10 , 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ] were used to perform the qualitative analysis, and 11 were used for the quantitative assessment [ 8 , 9 , 11 , 14 , 15 , 16 , 17 , 20 , 21 , 22 , 23 ].…”

“…The anesthetic success was evaluated across eight clinical trials that compared dexamethasone and placebo in patients with SIP [ 8 , 9 , 11 , 14 , 16 , 17 , 20 , 21 ]. The qualitative analysis showed that five clinical investigations presented statistical differences in favor of dexamethasone when compared to placebo [ 8 , 9 , 14 , 20 , 21 ], while three articles found no statistical difference between dexamethasone and placebo [ 11 , 16 , 17 ].…”

“…The anesthetic success was evaluated across eight clinical trials that compared dexamethasone and placebo in patients with SIP [ 8 , 9 , 11 , 14 , 16 , 17 , 20 , 21 ]. The qualitative analysis showed that five clinical investigations presented statistical differences in favor of dexamethasone when compared to placebo [ 8 , 9 , 14 , 20 , 21 ], while three articles found no statistical difference between dexamethasone and placebo [ 11 , 16 , 17 ]. The most used anesthetic agents for IANB were lidocaine (9/14) [ 8 , 9 , 14 , 16 , 17 , 18 , 20 , 22 , 23 ], articaine (2/14) [ 10 , 11 ], mepivacaine (1/14) [ 15 ], while 2/14 clinical trials did not report the anesthetic agent employed [ 19 , 21 ].…”

“…Accordingly, various drugs that interfere with or reduce inflammation and/or pain—such as the supplementary administration of local anesthetics [ 3 ], as well as the systemic administration of nonsteroidal anti-inflammatory drugs (NSAIDs) [ 3 ], corticosteroids [ 7 ], and opioid analgesics [ 8 , 9 , 10 , 11 ]—have been used to relieve pain and reduce inflammation of the pulp tissue, and thus achieve the most adequate dental anesthesia during endodontic treatment [ 3 , 7 , 8 , 9 , 10 , 11 ].…”

“…Some clinical assays have been carried out to determine the effect of dexamethasone on the success of dental anesthesia in patients with SIP, and interesting results have been found [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The main aim of this systematic review and meta-analytical assessment was to evaluate the effects of the systemic and local administration of dexamethasone on the anesthetic success rate, pain intensity, and adverse effects in patients with SIP.…”