Comparative evaluation of supplemental buccal infiltration adjuncts for enhancing inferior alveolar nerve block in...

Achieving profound pulpal anesthesia in mandibular molars with symptomatic irreversible pulpitis remains challenging, with inferior alveolar nerve block (IANB) failure rates up to 80%. This study evaluated the effect of supplemental buccal infiltration using tramadol, dexamethasone, ketorolac, and temperature-modified lidocaine on the efficacy of IANB.

In this randomized, double-blind clinical trial, 120 patients were allocated to six groups (n = 20 each): Control (IANB only), dexamethasone (4 mg/mL), ketorolac (30 mg/mL), tramadol (50 mg/mL), warm lidocaine (40°C), and cold lidocaine (4°C). All received 2% lidocaine with 1:200,000 epinephrine for IANB, followed by 1 mL of the assigned infiltration. Pain intensity was recorded using the Numeric Pain Rating Scale (0-10) during access, chamber, and canal entry. Anesthetic success was defined as a score <3 at canal entry.

Anesthetic success rates were 90% (95% confidence interval [CI], 68%-99%) for tramadol, and 85% (95% CI, 62%-97%) for cold lidocaine, significantly higher than control (40%, P = 0.001 and P = 0.002, respectively). Dexamethasone (55%), ketorolac (50%), and warm lidocaine (60%) showed nonsignificant improvement (P > 0.05). Median pain scores were significantly lower in the tramadol and cold lidocaine groups across all the stages (P < 0.001). No adverse events occurred.

Supplemental buccal infiltration with tramadol or cold lidocaine significantly enhances IANB success in mandibular molars with irreversible pulpitis, offering a simple, safe, and cost-effective approach to improve pulpal anesthesia.