ANESTHETIC EFFICACY OF THE SUPPLEMENTAL INTRAOSSEOUS INJECTION OF 3-PERCENT MEPIVACAINE IN IRREVERSIBLE PULPITIS

Objective, To determine the efficacy of a supplemental intraosseous in jection of 3% mepivacaine in mandibular posterior teeth with irreversi ble pulpitis. Intraosseous injection pain, subjective heart rate incre ase, and pain ratings during endodontic treatment were also assessed. Study Design, Forty-eight patients with irreversible pulpitis received conventional inferior alveolar nerve blocks. Electric pulp testing wa s used to determine pulpal anesthesia. Patients who were positive to t he pulp testing, or negative to pulp testing but felt pain during endo dontic treatment, received an intraosseous injection of 1.8 ml of 3% m epivacaine. A second intraosseous injection of 3% mepivacaine (1.8 mi) was given if the first injection was unsuccessful. Results, Seventy-f ive percent of patients required an initial intraosseous injection bec ause of Failure to gain pulpal anesthesia. The inferior alveolar block was 25% successful; the first intraosseous injection increased succes s to 80%. A second intraosseous injection further increased success to 98%. These differences were significant (p < 0.05). Eight percent (4/ 48) of the initial intraosseous injections resulted in solution being expressed into the oral cavity; these were considered technique failur es. Conclusions, For mandibular posterior teeth with irreversible pulp itis, a supplemental intraosseous injection of 3% mepivacaine increase d anesthetic success. A second intraosseous injection, when necessary, further improved success.