Comparison of Success of Buccal Infiltration Versus Intraligamentary Local Anesthetic Techniques in Mandibular First Molar with Irreversible Pulpitis

atients that are suffering from symptomatic irreversible pulpitis have to undergo conventional root canal treatment. This condition is associated with central sensitization and peripheral sensitization which results in a reduction in threshold and an increase in responsiveness of the peripheral ends of nociceptors.1,2 This increased pain response results in difficulty in achieving the cessation of pain, especially when neurogenic inflammatory mediators have produced morphogentic modification in neurons, causing resistance of the nerve fibres to the anaesthetic.1,2,3 This condition poses a challenge for dental health care provider to achieve optimum analgesia during procedure.1 For conventional root canal treatment (RCT) in mandibular teeth, Inferior alveolar nerve block (IANB) is the conventional method for achieving effective localized analgesia. Unfortunately, this technique has poor success rate in irreversible pulpitis. Studies by Fowler et al and Kanna et al reported only 28% and 45.1% success rate after initial IANB using 2% Lidocaine with 1:1,00,000 epinephrine respectively.4,5,6 Recognizing the importance of providing local anesthesia for patients undergoing dental procedures, clinicians use other methods to increase the effectiveness of anesthesia.4,5,8 They often administer local anesthesia (L.A) through supplementary techniques at different sites than primary IANB. These techniques target the nerve endings and nociceptors instead of blocking the inferior alveolar nerve trunk.4 The Buccal Infiltration (B.I) and Intraligamentary injections (I.L) are the most commonly used supplementary local anesthetic techniques due to their immediate onset and easier techniques.4,5 Recent literature reported that B.I with 4 % articaine is significantly superior to other supplementary techniques (P= 0.001). On the other hand, with 2 % Lidocaine intraligamentary injections, a success rate of 50% was reported by Kanna et al and 56% by Nusstein, with using more precised computer controlled administration in 1. FCPS Resident, Department of Operative Dentistry, Fatima Memorial Hospital. 2. Associate Professor, Department of Operative Dentistry, Fatima Memorial Hospital. Corresponding author: “Dr. Muhammad Haris Naeem” < dr.harisqureshi@hotmail.com >