"An Evaluation of the Gow-Gates and Vazirani-Akinosi Injections in Patients with Symptomatic Irreversible Pulpitis"
Year: 2013
Type: article
Abstract: The purpose of this study was to evaluate the degree of pulpal anesthesia obtained with the Gow-Gates and Vazirani-Akinosi techniques using 3.6 mL of 2% lidocaine with 1:100,000 epinephrine, in patients presenting with symptomatic irreversible pulpitis.One hundred and twenty emergency patients (diagnosed with symptomatic irreversible pulpitis of a mandibular posterior tooth) received either a Gow-Gates or Vazirani-Akinosi injection to block the inferior alveolar nerve before endodontic access.Block success of the injection was defined as subjective lip numbness.Pulpal anesthetic success of the injection was defined as no pain or mild pain upon endodontic access or instrumentation as measured on a 170 mm visual analog scale.The results showed that block success was obtained in 92% of subjects receiving the Gow-Gates injection and 63% of subjects receiving the Vazirani-Akinosi injection.Among the Gow-Gates subjects, successful pulpal anesthesia was obtained 35% of the time.Among Vazirani-Akinosi subjects, successful pulpal anesthesia was obtained 16% of the time.Neither the Gow-Gates or Vazirani-Akinosi injections provided adequate pulpal anesthetic success rates.Both injections would require supplemental anesthesia.We would not recommend the Vazirani-Akinosi injection for routine endodontic treatment.iii DEDICATION To my dad, who taught me that all doctors are scientists.To my mom, whose brains, beauty, and strength inspire.To my teachers who taught me to write well and think big.To my husband Ben whose unending love, support, and boundless energy sustain my curiosity and courage.In memory of Gpa and Děde, both scientists, who I know are so proud of me.Yared and Dagher's study examined varied epinephrine concentrations (1:50,000, 1:80,000, and 1:100,000) in 1.8 mL of 2% lidocaine and supported Vreeland's findings.No significant difference in anesthetic success and failure were found in their test span of 50 minutes among the mandibular first molar, first premolar and lateral tooth (5).This indicates that a higher concentration of epinephrine does not affect the incidence of pulpal anesthesia utilizing the inferior alveolar nerve block.In contrast to Nusstein's study, Yared and Dagher evaluated 3.6 mL versus 1.8 mL of 2% lidocaine with either 1:50,000, 1:80,000, or 1:100,000 epinephrine concentrations and found that among thirty adult subjects, the volume of solution did influence the degree of anesthesia in that the incidence of anesthesia was greater when the solutions were doubled in volume (5).The same group of subjects studied in their evaluation of 1.8 mL of 2% lidocaine with varied epinephrine concentrations, were included in this study.The average age of the subjects was 32 years.Subjects were in good health and were not taking any medications that would alter their perception of pain.Mandibular right and left sides were tested in equal number utilizing the first molar, first premolar, and lateral incisor as test teeth.The contralateral canine was used as the control to ensure proper function of the pulp tester and adequate response of the subject during the experiment.Clinical examination of the dentition ensured all teeth to be tested were free of caries, large restorations, periodontal disease, history of trauma, or sensitivity.A repeated measures design was utilized such that each subject randomly received each anesthetic solution on three successive appointments at least one week apart.Baseline pulp testing was performed on all four test teeth, after which the inferior alveolar block was administered as described by Malamed (6).All of the pre-injection and post-injection
Author: Vivian V. Click
Institution: The Ohio State University
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2339361434