Procedural Pain
Conditions
Keywords
Local Anesthesia, Lidocaine, Mandibular molars, Inferior alveolar nerve block, Periodontal ligament injection, supraperiostal injection, Subperiostal injection
Brief summary
This prospective single-arm pilot study evaluated the clinical effectiveness of a combined local anesthetic technique using 2% lidocaine with 1:100,000 epinephrine for dental procedures involving mandibular molars. The technique combined supraperiosteal, subperiosteal, and periodontal ligament injections and was designed to provide adequate local anesthesia without the use of a conventional inferior alveolar nerve block. Participants requiring restorative, endodontic, extraction, or immediate implant procedures involving mandibular molars received the standardized anesthetic protocol. The primary outcome was successful completion of the planned dental procedure without pain requiring additional conventional nerve block anesthesia. The need for repeat administration and the occurrence of complications were also assessed.
Detailed description
This prospective, single-arm pilot study was conducted to evaluate a combined local anesthetic technique for mandibular molar procedures without the use of a conventional inferior alveolar nerve block (IANB). Patients requiring dental treatment involving mandibular molars were enrolled according to predefined eligibility criteria. Local anesthesia was administered using 2% lidocaine with 1:100,000 epinephrine and a 27-gauge short needle. The standardized technique consisted of three components: supraperiosteal, subperiosteal, and periodontal ligament (PDL) injections. Initially, 0.2 mL of anesthetic solution was administered supraperiosteally, followed by 0.2 mL subperiosteally with deeper needle penetration. PDL anesthesia was then administered on both the mesial and distal aspects of the involved tooth, using 0.5 mL of anesthetic solution at each site. Anesthetic effectiveness was clinically assessed before and during the planned dental procedure. If adequate anesthesia was not achieved after the initial administration, the combined anesthetic protocol was repeated once. The need for additional conventional inferior alveolar nerve block anesthesia was recorded. Participants were also followed for 48-72 hours to identify any complications associated with the anesthetic technique. The study included mandibular molars requiring restorative treatment, root canal treatment, extraction, or immediate implant placement. The study was intended to provide preliminary clinical evidence regarding the feasibility and effectiveness of this combined local anesthetic approach and to inform the design of future controlled clinical trials.
Interventions
Local anesthesia was administered using 2% lidocaine with 1:100,000 epinephrine and a 27-gauge short needle. The standardized protocol consisted of 0.2 mL supraperiosteal injection, followed by 0.2 mL subperiosteal injection with deeper needle penetration, and periodontal ligament (PDL) injections of 0.5 mL on the mesial and 0.5 mL on the distal aspect of the mandibular molar. Anesthetic effectiveness was reassessed after 2 minutes. If complete anesthesia was not achieved, the same protocol was repeated once. No inferior alveolar nerve block was administered.
Sponsors
Herat University
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
This is a prospective, single-arm pilot study in which all participants received the same combined local anesthetic technique for mandibular molar dental procedures. No control or comparator arm was included.
Eligibility
Sex/Gender
ALL
Age
16 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Patients aged 16-60 years. * Patients requiring dental treatment involving mandibular molars. * Patients requiring local anesthesia for the planned dental procedure. * Patients able and willing to provide informed consent. * For participants younger than 18 years, informed consent was obtained from a - parent or legal guardian.
Exclusion criteria
* Known allergy or hypersensitivity to lidocaine or epinephrine. * Medical conditions contraindicating the use of lidocaine with epinephrine. * Presence of acute infection or significant swelling at the injection site. * Patients unable to cooperate with the dental procedure or assessment of anesthetic effectiveness. * Patients who declined to participate or provide informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants With Complete Procedural Anesthesia After the First Application | From 2 minutes after completion of the initial anesthetic protocol through completion of the planned dental procedure during the same treatment visit. | Complete procedural anesthesia was defined as adequate procedure-specific pulpal or periodontal anesthesia permitting completion of the planned dental procedure without pain requiring interruption, repetition of the anesthetic protocol, or rescue anesthesia. Anesthetic adequacy was assessed using thermal testing and cautious test cavity preparation for vital teeth, and periodontal probing and initial tooth manipulation for teeth scheduled for extraction. |
| Number of Participants With Successful Anesthesia After Initial Administration | During the planned dental procedure, immediately following administration of local anesthesia | Successful anesthesia was defined as completion of the planned dental procedure without pain requiring additional anesthetic administration or conventional inferior alveolar nerve block (IANB) after the initial application of the combined supraperiosteal, subperiosteal, and periodontal ligament (PDL) injection technique. |
| Successful anesthesia after initial administration | During the planned dental procedure, immediately following administration of local anesthesia. | Successful anesthesia was defined as completion of the planned dental procedure without pain requiring additional anesthetic administration or conventional inferior alveolar nerve block (IANB) after the initial application of the combined supraperiosteal, subperiosteal, and periodontal ligament (PDL) injection technique. |
Countries
Afghanistan
Contacts
PRINCIPAL_INVESTIGATOROzair Erfan, Master of Sience
Stomatology Faculty, Herat University
Outcome results
None listed