Comparative evaluation of supplemental buccal infiltration adjuncts for enhancing inferior alveolar nerve block in symptomatic irreversible pulpitis: A randomized double-blind clinical study
Year: 2026
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Background: 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. Materials and Methods: = 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. Results: < 0.001). No adverse events occurred. Conclusion: 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.
Language: English
Subfield: Oral Surgery
Field: Dentistry
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7121686002