Clinical Evaluation of Local Infiltration Technique of Lower Mandibular Teeth

Objective: The objective of this study was to evaluate of local infiltration technique of lower mandibular teeth to provide pulpal anesthesia for pain control in root canal treatment. Methods: The experiments were carried out on 72 first and 35 second mandibular molar teeth in 148 subjects (ages: 18-65 years). All the teeth, the pulp were exposed and diagnosed as irreversible pulpitis and need to have endodontic treatment. The local infiltration technique was performed, firstly 0.5 ml of 2% lidocaine with 0.036 mg adrenaline (Xylesthesin®-A, ESPE, Germany) was injected sub-mucosally on the buccal side. Then 1 ml of the same local anesthetic solution was injected sub-periosteally on the attached gingiva approximately 3 mm from the buccal gingival margin. The teeth were tested with the electric pulp tester (Analytic Technology, Redmond, WA, USA) 5 minutes after anesthetic administration. After negative responded to the pulp tester was obtained, the treatment process of pulp removal was performed. The patients that still responded positively to the electric pulp tester or felt pain during pulp removal, the supplemental injection of 0.8 ml. of anesthetic solution was injected sub-periosteally at the lingual side. The success of this local infiltration technique was defined as the ability to complete treatment without painful sensation. Results: The success rates of the sub-periosteal local infiltration for first and second mandibular molars were 81.9% and 77.1% respectively. The supplementary lingual injection had further success rates of 11.1% and 11.4% respectively. The patients reported inadequate anesthesia for the first molar was 6.9% and 11.4% for the second molar. Conclusion: The success rates of sub-periosteal local infiltration technique of lower mandibular teeth are up to 91%. This technique would be benefit for pain control of the lower mandibular teeth without risk of nerve injury during inferior alveolar nerve block.