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Anesthetic effect with repeated intraosseous injection
INQUIRY Anesthesiology Anesthetic effect with repeated intraosseous injection Background.—Use of the primary intraosseous injection technique has proved highly successful for mandibular first molar and maxillary lateral incisor procedures. The onset of anesthesia is immediate, then the profound pulpal anesthesia steadily diminishes over 60 minutes. Adding more anesthetic solution through the original intraosseous perforation site should increase the duration of pulpal anesthesia. Understanding the effect of adding a repeated intraosseous injection 30 minutes after a primary injection was the aim of a prospective, randomized, single-blinded investigation. Methods.—Fifty-five subjects participated in a crossover design study. All received a primary intraosseous injection of 1.4 mL of 2% lidocaine with epinephrine using the Wand Plus, which was activated at a slow rate (1.4 mL/4 minutes 45 seconds). This was achieved by partially depressing the foot pedal for 8 seconds. When the foot pedal was released, the Wand Plus automatically activated cruise
control, with 1 drop of anesthetic solution delivered every other second. Thirty minutes later the subjects were given either a repeat intraosseous injection or a mock injection. The second intraosseous injection was carried out as previously except the subject was blindfolded and a saliva ejector was placed. The mock injection was given as previously except that the anesthetic solution was delivered to the orifice of the saliva ejector, located in the subject’s buccal vestibule. At the beginning of each appointment and before injections, two pulp tests of the experimental teeth and the control contralateral canine were carried out. Two minutes after the first intraosseous injection was delivered, the first and second primary molars were tested. The second premolar and contralateral control canine were tested at 3 minutes. Every 6 minutes the contralateral canine was tested using a pulp tester without batteries to determine the subject’s reliability. The testing cycle was repeated every 2 minutes for 30 minutes, then the repeat intraosseous or mock injection was delivered. The pulp tests of the first molar and
Fig 1.—The incidence of second molar anesthesia as determined by the lack of response to electrical pulp testing at the maximum setting (percentage of 80/80 seconds) at each postinjection time interval for the two sets of injections. Significant differences (p < 0.05) between the intraosseous (IO) plus IO versus the IO plus mock IO were shown from minute 36 to minute 82. (Courtesy of Jensen J, Nusstein J, Drum M, et al: Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 34:126-130, 2008.)
Fig 2.—The incidence of first molar anesthesia as determined by the lack of response to electrical pulp testing at the maximum setting (percentage of 80/80 seconds) at each postinjection time interval for the two sets of injections. Significant differences (p < 0.05) between the IO plus IO versus the IO plus mock IO were shown from minute 36 to minute 84. (Courtesy of Jensen J, Nusstein J, Drum M, et al: Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 34:126-130, 2008.)
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Dental Abstracts
Fig 3.—The incidence of second premolar anesthesia as determined by the lack of response to electrical pulp testing at the maximum setting (percentage of 80/80 seconds) at each postinjection time interval for the two sets of injections. Significant differences (p < 0.05) between the IO plus IO versus the IO plus mock IO were shown from minute 37 to minute 73). (Courtesy of Jensen J, Nusstein J, Drum M, et al: Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 34:126-130, 2008.)
adjacent teeth were carried out after 36 minutes and every 2 minutes thereafter for 120 minutes. Having the subject not respond at a maximum output reading of 80 twice within 10 minutes was deemed success. Results.—For the primary intraosseous injections, pulpal anesthesia ranged from 82% of cases for the second molar to 100% of cases for the second premolar. These values were not statistically significantly different. The repeated intraosseous injections improved the duration of pulpal anesthesia (Figs 1 to 3) an additional 15 minutes.
Discussion.—Pulpal anesthesia, demonstrated as no patient response in vital asymptomatic teeth to an 80 reading, was achieved with the initial intraosseous injection in 82% to 100% of the patients. Adding a second intraosseous injection increased the time of anesthesia by 15 minutes. Compared to two previous studies of inferior alveolar nerve block using articaine or lidocaine, this study achieved even higher success rates for the first molar and second premolar. In those studies the rates were 81% to 83% for the first molar and 73% to 80% for the second premolar. The second molar success rate was 94% to 96% in this study, whereas it was 91% to 93% with the inferior alveolar nerve block. The use of intraosseous anesthesia provided a quicker onset than was seen with the inferior alveolar nerve block. Pulpal anesthesia declined steadily in this study, but the effect was sustained for an average of 2 hours 24 minutes for the inferior alveolar nerve block using 1.8 mL of 2% lidocaine with 1:100,000 epinephrine.
Clinical Significance.—Reported here are more rapid onset time and comparable effectiveness for intraosseous versus block injection local anesthesia. Wait-time before beginning a procedure is shortened and duration can be extended with subsequent reinjections.
Jensen J, Nusstein J, Drum M, et al: Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 34:126-130, 2008 Reprints available from M Drum, Dept of Endodontics, College of Dentistry, The Ohio State Univ, 305 W 12th Ave, Columbus, OH 43210; e-mail: [email protected]
Caries Research Sealants to prevent root dentin demineralization Background.—As people age, their gingival tissues recede, exposing root surfaces to the oral environment and increasing their risk for dental caries and dentin hypersensitivity. Fluorides applied topically can prevent dentin sensitivity but do not eliminate root caries. Various dentin bonding agents have demonstrated a caries-protective effect as they build the acid-resistant hybrid layer on human root dentin. This layer is acid resistant and seals the underlying dentin. Two dentin bonding agents and a desensitizing agent were compared for their effect on the initial demineralization of human root dentin in situ.
Methods.—The two bonding agents were Syntac Classic and Xeno III; the desensitizer was Hyposen. Twenty-eight freshly extracted human molars underwent thorough root cleaning to remove the cementum. Four root dentin specimens were prepared from each tooth and distributed to four experimental groups (Table 1): a control group (C) that was left untreated; a Syntac Classic (S) group that had Syntac primer applied, was air dried, then Syntac Adhesive applied, dried, and light cured; a Xeno III (X) group that had adhesive applied and air dried, then light cured; and a Hyposen (H) group that had Hyposen Desensitizer solution
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Issue 6
2008
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control, with 1 drop of anesthetic solution delivered every other second. Thirty minutes later the subjects were given either a repeat intraosseous injection or a mock injection. The second intraosseous injection was carried out as previously except the subject was blindfolded and a saliva ejector was placed. The mock injection was given as previously except that the anesthetic solution was delivered to the orifice of the saliva ejector, located in the subject’s buccal vestibule. At the beginning of each appointment and before injections, two pulp tests of the experimental teeth and the control contralateral canine were carried out. Two minutes after the first intraosseous injection was delivered, the first and second primary molars were tested. The second premolar and contralateral control canine were tested at 3 minutes. Every 6 minutes the contralateral canine was tested using a pulp tester without batteries to determine the subject’s reliability. The testing cycle was repeated every 2 minutes for 30 minutes, then the repeat intraosseous or mock injection was delivered. The pulp tests of the first molar and
Fig 1.—The incidence of second molar anesthesia as determined by the lack of response to electrical pulp testing at the maximum setting (percentage of 80/80 seconds) at each postinjection time interval for the two sets of injections. Significant differences (p < 0.05) between the intraosseous (IO) plus IO versus the IO plus mock IO were shown from minute 36 to minute 82. (Courtesy of Jensen J, Nusstein J, Drum M, et al: Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 34:126-130, 2008.)
Fig 2.—The incidence of first molar anesthesia as determined by the lack of response to electrical pulp testing at the maximum setting (percentage of 80/80 seconds) at each postinjection time interval for the two sets of injections. Significant differences (p < 0.05) between the IO plus IO versus the IO plus mock IO were shown from minute 36 to minute 84. (Courtesy of Jensen J, Nusstein J, Drum M, et al: Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 34:126-130, 2008.)
306
Dental Abstracts
Fig 3.—The incidence of second premolar anesthesia as determined by the lack of response to electrical pulp testing at the maximum setting (percentage of 80/80 seconds) at each postinjection time interval for the two sets of injections. Significant differences (p < 0.05) between the IO plus IO versus the IO plus mock IO were shown from minute 37 to minute 73). (Courtesy of Jensen J, Nusstein J, Drum M, et al: Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 34:126-130, 2008.)
adjacent teeth were carried out after 36 minutes and every 2 minutes thereafter for 120 minutes. Having the subject not respond at a maximum output reading of 80 twice within 10 minutes was deemed success. Results.—For the primary intraosseous injections, pulpal anesthesia ranged from 82% of cases for the second molar to 100% of cases for the second premolar. These values were not statistically significantly different. The repeated intraosseous injections improved the duration of pulpal anesthesia (Figs 1 to 3) an additional 15 minutes.
Discussion.—Pulpal anesthesia, demonstrated as no patient response in vital asymptomatic teeth to an 80 reading, was achieved with the initial intraosseous injection in 82% to 100% of the patients. Adding a second intraosseous injection increased the time of anesthesia by 15 minutes. Compared to two previous studies of inferior alveolar nerve block using articaine or lidocaine, this study achieved even higher success rates for the first molar and second premolar. In those studies the rates were 81% to 83% for the first molar and 73% to 80% for the second premolar. The second molar success rate was 94% to 96% in this study, whereas it was 91% to 93% with the inferior alveolar nerve block. The use of intraosseous anesthesia provided a quicker onset than was seen with the inferior alveolar nerve block. Pulpal anesthesia declined steadily in this study, but the effect was sustained for an average of 2 hours 24 minutes for the inferior alveolar nerve block using 1.8 mL of 2% lidocaine with 1:100,000 epinephrine.
Clinical Significance.—Reported here are more rapid onset time and comparable effectiveness for intraosseous versus block injection local anesthesia. Wait-time before beginning a procedure is shortened and duration can be extended with subsequent reinjections.
Jensen J, Nusstein J, Drum M, et al: Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 34:126-130, 2008 Reprints available from M Drum, Dept of Endodontics, College of Dentistry, The Ohio State Univ, 305 W 12th Ave, Columbus, OH 43210; e-mail: [email protected]
Caries Research Sealants to prevent root dentin demineralization Background.—As people age, their gingival tissues recede, exposing root surfaces to the oral environment and increasing their risk for dental caries and dentin hypersensitivity. Fluorides applied topically can prevent dentin sensitivity but do not eliminate root caries. Various dentin bonding agents have demonstrated a caries-protective effect as they build the acid-resistant hybrid layer on human root dentin. This layer is acid resistant and seals the underlying dentin. Two dentin bonding agents and a desensitizing agent were compared for their effect on the initial demineralization of human root dentin in situ.
Methods.—The two bonding agents were Syntac Classic and Xeno III; the desensitizer was Hyposen. Twenty-eight freshly extracted human molars underwent thorough root cleaning to remove the cementum. Four root dentin specimens were prepared from each tooth and distributed to four experimental groups (Table 1): a control group (C) that was left untreated; a Syntac Classic (S) group that had Syntac primer applied, was air dried, then Syntac Adhesive applied, dried, and light cured; a Xeno III (X) group that had adhesive applied and air dried, then light cured; and a Hyposen (H) group that had Hyposen Desensitizer solution
Volume 53
Issue 6
2008
307