Effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful inferior alveolar nerve block: A randomized clinical trial.

Background: No consensus has been reached on the effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful inferior alveolar nerve (IAN) block. This study aimed to assess the effect of topical application of amitriptyline and nortriptyline on irreversible pulpitis pain in teeth with failed pulpal anesthesia after a successful IAN block.

Materials and methods: This double-blind randomized controlled clinical trial was conducted on 45 patients with irreversible pulpitis. The patients were randomly assigned to three groups (n = 15) for topical application of 10 mg amitriptyline, 10 mg nortriptyline, and starch (placebo). An IAN block was primarily administered by injection of lidocaine with 1:80,000 epinephrine. Next, the abovementioned medications were topically applied in each group. The pain level of patients was quantified by the McGill Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (FPRS) before the intervention, immediately after injection, and after topical application of materials and compared. Data were analyzed by SPSS version 21 using the Chi-square test, likelihood ratio, one-way ANOVA, repeated-measures ANOVA, and the Kruskal-Wallis test. P < 0.05 was considered statistically significant.

Results: All three interventions significantly decreased pain (P < 0.05). Although nortriptyline caused a greater pain relief, the difference among the three groups was not significant regarding the VAS or Wong-Baker FPRS scores (P > 0.05).

Conclusion: Although nortriptyline caused a greater reduction in irreversible pulpitis pain than amitriptyline, the difference between the two medications was not significant. Future studies without a placebo group are recommended.