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Azerbaycan Saytlari

 »  Home  »  Endodontic Articles 8  »  Pulpal anaesthesia for mandibular central incisor teeth: a comparison of infiltration and intraligamentary injections
Pulpal anaesthesia for mandibular central incisor teeth: a comparison of infiltration and intraligamentary injections
Introduction - Materials and methods.



J. G. Meechan & J. I. M. Ledvinka
Department of Oral and Maxillofacial Surgery, Newcastle Dental School, University of Newcastle, Newcastle, UK.

Introduction.
Successful pulpal anaesthesia in mandibular teeth is not always achieved the following regional block anaesthesia (Hinkley et al. 1991, Clark et al. 1999). Soft tissue anaesthesia is not always an indicator of pulpal anaesthesia (Hinkley et al. 1991, Nist et al. 1992, Cohen et al. 1993). Indeed pulpal anaesthesia in the posterior teeth is not an indication of successful anaesthesia in the mandibular anterior teeth (Hinkley et al.1991, Clark et al. 1999). This may be due to many factors including cross-over supply from the contra lateral inferior alveolar nerve (Rood1977). Infiltration anaesthesia and intraligamentary injections may be useful in overcoming collateral supply. The purpose of this study was to compare the efficacy of Infiltration and intraligamentary anaesthesia for mandibular central incisors in adults.

Materials and methods.
Ethical approval was obtained and following written informed consent 12 volunteers aged between 21 and 24years with vital unrestored mandibular central incisors attended on four occasions. At each visit, the volunteer received one of the following methods of anaesthesia.
  1. Labial Infiltration of 1.0 mL in the mucobuccal fold opposite a mandibular central incisor with dummy injection (i.e. needle penetration only) lingually.
  2. Lingual Infiltration of 1.0 mL in the lingual reffected mucosa adjacent to a mandibular central incisor with dummy injection labially.
  3. Labial Infiltration of 0.5 mL plus lingual Infiltration of 0.5 mL.
  4. Intraligamentary injection of 0.18 mL at the mesiobuccal aspect of the mandibular central incisor.
The dummy injections were administered to blind the patient to the method of infiltration used. The Infiltration injections were performed at a rate of 1.0 mL per 30 s and during the dummy injection the needle was inserted for 30 s. A standard aspirating dental cartridge syringe was employed for the Infiltration injections. The intraligamentary injection was carried out over 30 s using a pen-grip design intraligamentary syringe that delivered 0.06 mL of solution per lever depression. As a means of overcoming order effects the sequence of anaesthesia was predetermined, so that each method was received at the first visit in three volunteers, at the second visit in three volunteers, at the third visit in three volunteers and at the final visit in three volunteers; within this design, it was possible to ensure that no two volunteers received exactly the same sequence of injections. Subjects were allocated randomly to a particular anaesthetic rotation. Two percent lidocaine with 1:80 000 adrenaline and 30 gauge needles were used throughout.
Electrical pulp testing was performed with an Analytic Technology Pulp Tester (Analytic Technology, Redmond, Washington, USA), on a mandibular central incisor before injection and every 2 min until the baseline reading was regained or until 30 min after the injection, whichever was the sooner. Readings were taken for at least 10 min after injection even in cases where base-line values were achieved at each recording. Pulpal anaesthesia was considered achieved if the maximum reading of 80 mA on the pulp tester did not produce discomfort.
The discomfort of the injections was recorded after each injection on a 100-mmvisual analogue scale with endpoints ‘no pain’ (0 mm) and ‘unbearable pain’ (100 mm). As the order of injection can affect injection discomfort (Martin et al. 1994), only the data from the first injection at those visits where only one active injection was given were analysed (the dummy injection was always administered second in these cases).
Data were compared with anova, Student’s t-test and w2 tests.