Efficacy of anesthetic solutions and different clinical approaches for the management of lower molars with irreversible pulpitis: a systematize review of the literature
DOI:
https://doi.org/10.22456/2177-0018.128114Keywords:
Endodontics, Anesthesia, Mandibular nerve , Preanesthetic medicationAbstract
Aim: Anesthetic difficulties may arise from scenarios of infection and inflammation, as in cases of irreversible pulpitis. Therefore, the purpose of this systematized review was to help the clinician to achieve deep anesthesia during emergency endodontic treatment of mandibular molars with irreversible pulpitis. Materials and methods: Randomized clinical trials performed with patients with irreversible pulpitis in mandibular molars seeking emergency care were selected via PubMed. These should assess anesthetic success by reporting pain during coronary opening and/or instrumentation of root canals. Two distinct primary outcomes were the target of this study (anesthetic solutions and alternative approaches). For anesthetic solutions, 18 studies were included, and for alternative conducts, 10 studies. Literature review: Several strategies have been investigated to increase the percentage of anesthetic success, such as the use of complementary techniques to inferior alveolar nerve block (IANB), increasing the volume of anesthetic or vasoconstrictor, tamponade of solutions and alternative approaches. Discussion: It was found that there is no difference in the success rate for the IANB and for complementary anesthetic techniques for the different anesthetic agents. In addition, higher adrenaline concentration, increased volume of solution used, substances capable of buffering the anesthetic solution, administration or injection of anti-inflammatories, cryotherapy and nitrous oxide also seem to improve anesthetic success rates. Conclusion: Several alternative methods seem promising to potentiate deep anesthesia, and should be better investigated for the adoption of parameters in favor of its definitive use.
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Copyright (c) 2022 Lucas Nunes Cechin, Israel Bangel Carlotto, Guilherme Pauletto, Sidnei Flores de Pellegrin, Carlos Alexandre Sousa Bier
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