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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 13-15

Comparison of anesthetic efficacy of bupivacaine, lignocaine, articaine, and sterile saline for intrapulpal injections


1 Final Year Post Graduate Student, Department of Pediatrics and Preventive Dentistry, Haldia Institute of Dental Sciences and Reasearch, West Bengal, India
2 Head of the Department, Professor, Department of Pediatrics and Preventive Dentistry, Haldia Institute of Dental Sciences and Research, West Bengal, India
3 Professor, Department of Pediatrics and Preventive Dentistry, Haldia Institute of Dental Sciences and Research, West Bengal, India
4 Associate Professor, Department of Pediatrics and Preventive Dentistry, Haldia Institute of Dental Sciences and Research, 2nd year Post Graduate Student, Department of Pediatrics and Preventive Dentistry, Haldia Institute of Dental Sciences and Research, West Bengal, India

Date of Submission08-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication27-Mar-2021

Correspondence Address:
Dr. Abanti Saha
11, K.B. Basu Road Barasat (m), North 24 Parganas, Barasat - 700 124, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_6_21

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  Abstract 


Background: Effective anesthesia in endodontic treatment in cases of pediatric patients is very important to achieve patients' co-operation. Profound anesthesia is required to access the chamber and extirpate the pulp. If patient discomfort is encountered, intrapulpal injection may be used as a supplement for pulpal anesthesia.
Aims and Objectives: This study aims to analyze the efficacy of different anesthetic solutions and sterile saline for intrapulpal injections in primary vital teeth with irreversible pulpitits.
Materials and Methods: Forty volunteers, patients with irreversible pulpitis whose pain persists after conventional anesthesia during treatment, were selected from Haldia. Patients were divided into four groups to administer intrapulpal solutions (bupivacaine, articaine, and lidocaine) and sterile saline to the respective groups to analyze the efficacy of the solutions in pain relief during pulp extirpation.
Results: Positive back pressure was present in case of all anesthetic solution which was administered on the selected patients.
Conclusion: On the basis of the results, we can conclude that effectiveness of intrapulpal injection is dependent on back pressure.

Keywords: Anesthetic efficacy in primary teeth, anesthetic solutions, articaine, bupivacaine, intrapulpal injections, lignocaine


How to cite this article:
Saha A, Chakraborty A, Dey B, Jana S, Roy N. Comparison of anesthetic efficacy of bupivacaine, lignocaine, articaine, and sterile saline for intrapulpal injections. Int J Prev Clin Dent Res 2021;8:13-5

How to cite this URL:
Saha A, Chakraborty A, Dey B, Jana S, Roy N. Comparison of anesthetic efficacy of bupivacaine, lignocaine, articaine, and sterile saline for intrapulpal injections. Int J Prev Clin Dent Res [serial online] 2021 [cited 2021 Jun 15];8:13-5. Available from: https://www.ijpcdr.org/text.asp?2021/8/1/13/312237




  Introduction Top


During endodontic treatment, effective anesthesia of any vital pulp tissue present in the pulp chamber or root canals is important for patient's cooperation and convenience.[1] Ineffective analgesia might result in a traumatic experience for the kids leading to increased apprehensiveness, reduced pain threshold, and inadequate co-operation.[1] There is a need to identify predictable effective means of achieving pulpal anesthesia for the root canal treatment procedures, when these procedures involve vital pulp tissue,' there is occasionally lack of pulpal anesthesia despite administration by a block, infiltration, or a supplemental technique, such as the periodontal ligament or the intraosseous injection.[2] In about 5%–10% of mandibular posterior teeth with irreversible pulpitis, supplemental injections, even when repeated, do not produce profound anesthesia, pain persists when the pulp is entered. This is an indication for an intrapulpal injection.[3]

The deposition of local anesthetic solution directly into the pulp chamber provides an effective anesthesia for extirpation, instrumentation, and debridement of pulpal tissues. The most significant factor contributing to the success of intrapulpal injection is that its administration must be done under pressure.[1] Birchfield and Rosenberg suggested that the anesthetic effect of the intrapulpal technique is mainly due to the back-pressure of the solution, independent of the type of solution injected.[4]

Whereas, Pashley et al. from their research on pressures created by dental injections proposed a potential mechanism for local anesthesia related to elevated pulp tissue pressure (such as the situation created with the intrapulpal injection). They speculated that direct tissue injury or compression of nerves may be responsible for the anesthesia.[5]

The advantage of the intrapulpal injection is that it works well for profound anesthesia if given under back pressure. Strong back pressure has been shown to be a major factor in producing anesthesia.[3] The pulp must be exposed to permit direct injection, frequently, anesthetic problems occur prior to exposure while still in dentin.[3]

The major drawback of the technique is that needle placement and injection are directly into a vital and very sensitive pulp, the injection may be moderately to severely painful and the duration of technique of intrapulpal anesthesia may be short (15–20 min).[3] Therefore, the bulk of the pulpal tissue must be removed quickly, at the correct working length, to prevent reoccurrence of pain during instrumentation.[3]


  Materials and Methods Top


Fifty-five volunteers with irreversible pulpitis in primary vital teeth were treated in the Pediatrics and Preventive Dentistry at Haldia Institute of Dental Sciences and Research. Volunteers were divided into four groups: lignocaine anesthetic solution group, bupivacaine anesthetic solution group, articaine anesthetic solution group, and sterile saline solution group. These anesthetic solutions were administered intrapulpally to the subjected tooth to the respective groups by three postgraduate trainees. The efficacy of the anesthetic solutions in pain relief during pulp extirpation was measured by the “WONG BAKER'S FACES RATING SCALE.”

The clinicians reported intrapulpal anesthesia to be either successful or unsuccessful. The findings were later matched with the solution used when the code was broken. Data were compiled and analyzed to determine the role of back-pressure plus anesthetic solution as compared with back-pressure plus saline solution. The comparison was the number of successfully anesthetized patients in the anesthetic group versus the number of successfully anesthetized patients in the saline solution group.


  Results Top


Overall the intrapulpal injection was quite successful with no difference between anesthetic and saline solution.

The mean Wong Baker's faces rating scale of the patients with saline was significantly lowest of all and that of the patients with Articaine was significantly highest of all (P < 0.01). However, there was no significant difference in mean Wong Baker's faces rating scale of the patients with bupivacaine and lignocaine (P > 0.05) [Figure 1] and [Table 1].
Figure 1: Faces pain scale-revised

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Table 1: Comparison of mean Wong Baker's Faces Rating Scale of the patients of the four groups

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According to [Table 2], for all anesthetic solution, positive back pressure was found in all patients (100.0%). Thus, there was no significant difference in the proportion of patients with positive back pressure induced by different anesthetic solution (Z = 0.01; P = 0.99).{Figure 2}


  Discussion Top


Pain was subjective and depended on an individual's experience. Earlier studies suggested that back-pressure is the factor responsible for anesthesia with the intra-pulpal injection. This study also supports the same finding.

Dentists strive hard to perform pulp therapy in pediatric patients, for effective anesthesia to avoiding interventional and expensive management techniques such as conscious sedation, general anesthesia, and other behavioral management methods.[1] Intrapulpal anesthesia is an indication in this case.

Monheim has suggested that prolonged pressure may lead to degeneration of nerve fibers in many instances leading to profound anesthesia for long endodontic treatment procedures, as in cases of pediatric patients.[6]

If anesthetic solution is not a factor in efficacy, the action of the vasoconstrictor could be considered as a reason.[7] As there was no significant difference between efficacy of saline solution and anesthetic solutions when injected under pressure.

The intrapulpal injection is not an appropriate supplement if back-pressure cannot be achieved or if the pulp tissue is inaccessible to the effects of the back-pressure (such as the case with tissue located deep within a very narrow or curved canal).[2]

It should also be noted that the periodontal ligament injection is usually considered the preferred supplemental technique to obtain profound pulpal anesthesia if the standard block or infiltration injection is not effective.[8],[9] The intrapulpal injection is considered an additional option if the periodontal ligament injection does not affect profound pulpal anesthesia.[2]

There are various aids for achieving back-pressure with the intrapulpal injection if the opening into the chamber is too large to wedge the needle. Sometimes, a larger size needle can be used. It is necessary to place the pieces of rubber, wax, or cotton pellets over or around the needle to form a stopper.[8]

In case of relatively narrow or curved canal where the pulp tissue located deep within the canal, intrapulpal injection may not be successful in that situation. An effective injection is more likely by changing to a smaller size syringe needle, although some canals may be smaller than even a 30G needle.

The intrapulpal injection is an effective and useful injection when used properly and under appropriate circumstances. For intrapulpal injections, proper case selection is mandatory to achieve its benefits.


  Conclusion Top


This study considered that the effectiveness of intrapulpal injection is dependent on back pressure and is independent of the saline solution and anesthetic solution.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Balasubramanian SK, Natanasabapathy V, Vinayachandran D. Cilinical considerations of intrapulpal anesthesia in pediatric dentistry. Anesth Essays Res 2017;11:1-2.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Vangheluwe J, Walton R, Colo D, Intrapulpal injection Factors related to effectiveness, Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:38-40.   Back to cited text no. 2
    
3.
Intrapulpal injection, Endontics: Colleagues for excellence, Winter 2009 Bonus Material G.   Back to cited text no. 3
    
4.
Birchfield J, Rosenberg PA. Role of the anesthetic solution in intrapulpal anesthesia. J Endod 1975;1:26-7.  Back to cited text no. 4
    
5.
Pashley EL, Nelson R, Pashley DH. Pressures created by dental injections. J Dent Res 1981;60:1742-8.  Back to cited text no. 5
    
6.
Monheim LM. Local Anesthesia and Pain Control in Dental Practice. 3rd ed. St. Louis: CV Mosby Co.; 1965. p. 136-8.  Back to cited text no. 6
    
7.
Olgart L, Gazelius B. Effects of adrenaline and felypressin (octapressin) on blood flow and sensory nerve activity in the tooth. Acta Odontol Scand 1977;35:69-75.  Back to cited text no. 7
    
8.
Walton RE, Torabinejad M. Managing local anesthesia problems in the endodontic patient. J Am Dent Assoc 1992;123:97-102.  Back to cited text no. 8
    
9.
Ingle JI, Walton RE, Goerig AC, Preparation for end-odontic therapy. In: Ingle JI, Bakland LK, editors. Endodontics. 4th ed. Baltimore: Williams & Wilkins, 1994. p. 79.  Back to cited text no. 9
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

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