Efficacy of buccal piroxicam infiltration and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial

다국어 초록 (Multilingual Abstract)

Objectives: This randomized clinical trial aimed to assess the effectiveness of buccal infiltration with piroxicam on the anesthetic efficacy of inferior alveolar nerve block (IANB) with buccal infiltration in irreversible pulpitis, with pain assessed using the Heft-Parker visual analogue scale (HP-VAS).
Materials and Methods: This study included 56 patients with irreversible pulpitis in mandibular molars, randomly distributed between 2 groups (n = 28). After evaluating the initial pain score with the HP-VAS, each patient received IANB followed by buccal infiltration of 2% lignocaine with adrenaline (1:80,000). Five minutes later, the patients in groups 1 and 2 were given buccal infiltration with 40 mg/2 mL of piroxicam or normal saline, respectively. An access opening procedure (AOP) was performed 15 minutes post-IANB once the individual showed signs of lip numbness as well as 2 negative responses to electric pulp testing. The HP-VAS was used to grade the patient's pain during caries removal (CR), AOP, and working length measurement (WLM). Successful anesthesia was identified either by the absence of pain or slight pain through CR, AOP, and WLM, with no requirement of a further anesthetic dose. A statistical analysis was done using the Shapiro-Wilk and Mann-Whitney U tests.
Results: The piroxicam group presented a significantly lower (p < 0.05) mean pain score than the saline group during AOP.
Conclusions: Buccal infiltration with piroxicam enhanced the efficacy of anesthesia with IANB and buccal infiltration with lignocaine in patients with irreversible pulpitis.

참고문헌 (Reference)

1 Masoud Parirokh, "The success rate of bupivacaine and lidocaine as anesthetic agents in inferior alveolar nerve block in teeth with irreversible pulpitis without spontaneous pain" 대한치과보존학회 40 (40): 155-160, 2015

2 Prasanna N, "The efficacy of pre-operative oral medication of lornoxicam and diclofenac potassium on the success of inferior alveolar nerve block in patients with irreversible pulpitis:a double-blind, randomised controlled clinical trial" 44 : 330-336, 2011

3 Kaviani N, "The effect of orally administered ketamine on requirement for anesthetics and postoperative pain in mandibular molar teeth with irreversible pulpitis" 53 : 461-465, 2011

4 Goddard G, "Reproducibility of visual analog scale (VAS) pain scores to mechanical pressure" 22 : 250-256, 2004

5 Ali SG, "Pulpitis: a review" 14 : 92-97, 2015

6 Atbaei A, "Prophylactic intraligamentary injection of piroxicam (feldene) for the management of post-endodontic pain in molar teeth with irreversible pulpitis" 38 : 31-35, 2012

7 Brogden RN, "Piroxicam: a review of its pharmacological properties and therapeutic efficacy" 22 : 165-187, 1981

8 Shanbagh TV, "Pharmacology for dental students" Elsevier 2010

9 Hargreaves KM, "Local anesthetic failure in endodontics: mechanisms and management" 1 : 26-39, 2002

10 Vadivelu N, "Ketorolac tromethamine - routes and clinical implications" 15 : 175-193, 2015

11 Wiseman RL, "Intramuscular piroxicam, a new dosage form, in the treatment of acute musculoskeletal disorders" 13 : 255-262, 1985

12 Handysides RA, "Ingle's endodontics" BC Decker Inc 2008

13 Cohen HP, "Endodontic anesthesia in mandibular molars: a clinical study" 19 : 370-373, 1993

14 Akhlaghi NM, "Efficacy of ketorolac buccal infiltrations and inferior alveolar nerve blocks in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial" 42 : 691-695, 2016

15 Parirokh M, "Efficacy of combining a buccal infiltration with an inferior alveolar nerve block for mandibular molars with irreversible pulpitis" 109 : 468-473, 2010

16 Rogers BS, "Efficacy of articaine versus lidocaine as a supplemental buccal infiltration in mandibular molars with irreversible pulpitis: a prospective, randomized, double-blind study" 40 : 753-758, 2014

17 Jena A, "Effect of preoperative medications on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: a placebo-controlled clinical study" 16 : 171-174, 2013

18 Smith WL, "Cyclooxygenases: structural, cellular, and molecular biology" 69 : 145-182, 2000

19 Subhan Z, "Comparison of prophylactic intraligamentary injection of piroxicam and lignocaine for management of postoperative endodontic pain" 36 : 480-483, 2016

20 Joshi N, "Comparative evaluation of the efficacy of two modes of delivery of Piroxicam (Dolonex®) for the management of postendodontic pain: a randomized control trial" 19 : 301-305, 2016

21 Aggarwal V, "Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis" 37 : 445-449, 2011

22 Aggarwal V, "Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial" 36 : 375-378, 2010

23 Averbuch M, "Assessment of visual analog versus categorical scale for measurement of osteoarthritis pain" 44 : 368-372, 2004

24 Yadav S, "Anesthetic success of supplemental infiltration in mandibular molars with irreversible pulpitis: a systematic review" 18 : 182-186, 2015

25 Verma PK, "Anesthetic efficacy of X-tip intraosseous injection using 2%lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: a clinical study" 16 : 162-166, 2013