Syftet med denna randomiserade kliniska studie var att jämföra anestesieffekten mellan 2 % lidocain med 1:200,000 adrenalin och 3 % prilocain med 0,03 i.u./ml felypressin vid en blockad av Nervus alveolaris inferior för behandling av patienter med symtomatisk pulpit i en underkäksmolar eller –premolar.Materialet utgjordes av 5 patienter som uppsökt Tandvårdshögskolans jourmottagning för akuta besvär. Patienterna fick upp till 3,6 ml av antingen 2% lidocain (n=4) eller 3% prilocain (n=1). Det valda medlet var okänt för både patient och behandlare under hela behandlingen. Behandling (pulpotomi) påbörjades först när patienten erhållit bedövad läpp. Information om smärta före och under behandling, intag av analgetika och oro inför behandling noterades. Lyckad anestesi ansågs vara ingen eller endast mild smärta under behandling (<54 mm av 170 mm på en visuell analog skala).Lyckandefrekvensen för lidocain var 50 % och för prilocain 100 %. Det insamlade materialet var för litet för möjliggöra statistisk analys.De patienter som inkluderades i denna pilotstudie var för få för att visa eventuella skillnader i anestesieffekt mellan lidocain och prilocain vid en blockad av Nervus alveolaris inferior för behandling av patienter med symtomatisk pulpit i en underkäksmolar eller –premolar. Ett större underlag krävs för att kunna dra slutsatser om något av de testade bedövningsmedlen är överlägset. Ett stickprov på 57 deltagare i varje grupp krävs för att upptäcka en skillnad i lyckandefrekvens på 25 % (power 80 %). Protokollet har nu testats och visat sig vara lämpligt att använda i en större studie. / The aim of this randomized clinical trial was to compare the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine and 3% prilocaine with 0,03 i.u./ml felypressin used for the inferior alveolar nerve block (IANB) in endodontic treatment of adult patients with symptomatic pulpitis in posterior mandibular teeth.5 patients visiting the emergency clinic of the Faculty of Odontology, Malmö University participated in the study. They randomly received, in a double-blind manner, up to 3,6 ml of either 2% lidocaine (n=4) or 3% prilocaine (n=1) in a conventional IANB. Treatment (pulpotomy) was only initiated after profound lip numbness was obtained. Pre- and perioperative pain, intake of analgesics and anxiety was recorded. Anesthetic success was defined as no or only mild pain (a rating of <54mm on a 170mm Visual Analogue Scale) during treatment.The success rate for IANB using lidocaine was 50% and for prilocaine 100%. The material size was insufficient to enable statistical analysis.The few patients selected for this pilot study were insufficient to assess any difference in anesthetic efficacy between lidocaine and prilocaine for IANB in endodontic treatment of adult patients with symptomatic pulpitis in a posterior mandibular tooth. Further data collection is needed to make conclusions about possible superiority of any of the tested substances. A sample size of 57 test subjects in each group would give a power of 80% to detect a difference of 25% in success rate. The protocol appears to be suitable for use in a larger-scale study.

Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: Profound pulpal anesthesia is not always adequate in mandibular teeth after the administration of local anesthesia, especially in the presence of irreversible pulpitis. Failure to achieve anesthesia has been seen in 30–80% of patients in teeth with a diagnosis of irreversible pulpitis. Onpharma™ developed an FDA-approved device that uses sodium bicarbonate to buffer a standard local anesthetic (LA) solution so that its pH may become closer to its pKa. Claims have been made that buffering a local anesthetic increases the anesthetic’s effect. Previous studies on the anesthetic efficacy of Onpharma’s Onset buffering system were inconclusive and may be dependent on the techniques used. Objectives: The aim of this study is to determine whether a buffered local anesthetic can lead to more profound and faster pulpal anesthesia in mandibular molars diagnosed with symptomatic irreversible pulpitis as compared to a standard, unbuffered local anesthetic. Materials and Methods: 40 total subjects completed the study. Screened and eligible subjects with a mandibular molar diagnosed with symptomatic irreversible pulpitis were randomly allocated into 2 groups so 1 group received a total of 3 cartridges of a standard, unbuffered 2% lidocaine with 1:100,000 epinephrine via inferior alveolar nerve block (IANB) followed by supplemental buccal and lingual infiltrations, while the other received the equivalent yet buffered formulation. An electronic pulp tester (EPT) was used to objectively determine baseline pulpal status of the affected tooth, followed by 2-minute interval testing following the administration of all local anesthesia. The onset of pulpal anesthesia was defined by the first of 2 consecutive EPT=80 readings, and the endodontic treatment could begin. Profound pulpal anesthesia was ultimately determined if the patient reported a comfortable pulpotomy as reflected on the Wong-Baker FACES Visual Analog Scale. Null Hypothesis 1: Subjects possessing mandibular molars diagnosed with symptomatic irreversible pulpitis will not achieve pulpal anesthesia more profoundly using buffered 2% lidocaine w/ 1:100,000 epinephrine in comparison to the standard, unbuffered anesthetic formulation. Null hypothesis 2: Subjects possessing mandibular molars diagnosed with symptomatic irreversible pulpitis will not achieve pulpal anesthesia faster using buffered 2% lidocaine w/ 1:100,000 epinephrine in comparison to the standard, unbuffered anesthetic formulation. Results: We observed a local anesthetic success rate of 45% in the buffered group, 70% in the unbuffered group, and ultimately 57.5% between both groups. The findings further indicate that the VAS scores after pulpotomy is significantly different between the 2 groups (p=0.019), with the unbuffered group having a more profound mean VAS score of 1.2 (as opposed to a buffered mean of 3.1). Regarding the time of onset for pulpal anesthesia, there was no statistically significant difference noted between the buffered and unbuffered groups. Conclusion: Based on the findings of this study, the null hypothesis 1 cannot be rejected since unbuffered 2% lidocaine with 1:100,000 epinephrine had a statistically significant increase in profound pulpal anesthesia compared to the buffered equivalent. The null hypothesis 2 cannot be rejected since there was no evidence of a significant difference in the time to pulpal anesthesia between the buffered and unbuffered groups.