Abstract: The purpose of this prospective, randomized study was to compare the degree of pulpal anesthesia 

obtained with the conventional  inferior alveolar, the Gow‐Gates, and the Vazirani‐Akinosi techniques  in vital, 

asymptomatic  teeth. With a  crossover design, 40  subjects  received all 3  techniques  in a  random manner by 

using 3.6 ml of 2%  lidocaine with 1:100,000 epinephrine at 3 separate appointments. An electric pulp  tester 

was used to test for anesthesia in 3‐minute cycles for 60 minutes of the first molars, first premolars, and lateral 

incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 min‐

utes, and the 80 reading was continuously sustained through the 60th minute. The ranges of successful anes‐

thesia were as  follows:  inferior alveolar  technique, 25%– 62%; Gow‐Gates  technique, 16%– 44%; and  for  the 

Vazirani‐ Akinosi technique, 13%–50%. There was no significant difference (P >.05) in success among the 3 tech‐

niques. However, the Gow‐Gates and Vazirani‐Akinosi techniques resulted in a statistically slower onset of pul‐

pal anesthesia than the  inferior alveolar nerve block. We concluded that  in vital, asymptomatic teeth and for 

the subjects who achieved  lip numbness, the conventional  inferior alveolar nerve block  is similar to the Gow‐

Gates and Vazirani‐Akinosi techniques regarding anesthetic success but has a faster onset of pulpal anesthesia. 

(J Endod 2008;34:1306 –1311) 

C O M P A R I S O N O F T H E A N E S T H E T I C E F F I C A C Y O F T H E C O N V E N T I O N A L I N F E R I O R A L V E O L A R , G O W - G A T E S , A N D V A Z I R A N I - A K I N O S I T E C H N I Q U E S Goldberg S, DDS, MS, Reader A, DDS, MS et al

A N E S T H E T I C E F F I C A C Y O F T H E S U P P L E M E N T A L X - T I P I N T R A O S S E O U S I N J E C T I O N I N P A T I E N T S W I T H I R R E V E R S I B L E P U L P I T I S Nusstein J, DDS, MS, Kennedy S, DDS, MS et al

Abstract: The purpose of this study was to determine the anesthetic efficacy of the supplemental intraosseous 

injection, using the X‐tip system in an apical location, in mandibular posterior teeth diagnosed with irreversible 

pulpitis when the conventional inferior alveolar nerve block failed. Thirty‐three emergency patients, diagnosed 

with  irreversible pulpitis of a mandibular posterior  tooth,  received an  inferior alveolar nerve block and had 

moderate to severe pain on endodontic access. The X‐tip system was used to administer 1.8 ml of 2% lidocaine 

with 1:100,000 epinephrine. The X‐tip injection site was 3‐ to 7‐mm apical to the mucogingival junction of the 

affected  tooth. Success of  the X‐tip  intraosseous  injection was defined as none or mild pain on endodontic 

access or  initial  instrumentation. The  results of  this  study demonstrated  that 6 of 33  (18%) X‐tip  injections 

resulted in backflow of anesthetic solution into the oral cavity; none were successful in obtaining anesthesia. 

Twenty‐seven of the remaining 33 X‐tip injections (82%) were successful. We conclude that when the inferior 

alveolar nerve block fails to provide profound pulpal anesthesia, the X‐tip sytem, when used in an apical loca‐

tion and when there was no backflow of the anesthetic solution into the oral cavity, was successful in achiev‐

ing pulpal anesthesia  in mandibular posterior teeth of patients presenting with  irreversible pulpitis. (J Endod 

2003;29(11):724‐729) 

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A P R I L 2 0 1 3 V O L U M E 1 , I S S U E 4

E N D O I N V I V O P A I N M A N A G E M E N T

Abstract: The purpose of this prospective, randomized, double blind study was to compare

the degree of pulpal anesthesia obtained with 0.5% bupivacaine with 1:200,000 epineph-

rine and 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks. Using a

crossover design, inferior alveolar nerve blocks were randomly administered, in a double-

blind manner, using 0.5% bupivacaine with 1:200,000 epinephrine and 2% lidocaine with

1:100,000 epinephrine, at two separate appointments, to 39 subjects. A pulp tester was

used to test for anesthesia until two consecutive readings of less than 80 were recorded on

at least three of the five experimental teeth. Anesthesia was considered successful when

two consecutive 80 readings were obtained within 15 min and the 80 reading was continu-

ously sustained for 60 min. Anesthetic success was significantly improved for all teeth ex-

cept the first molar with the lidocaine solution. Pulpal anesthesia averaged 4 hr for bupiva-

caine versus 2 hr and 24 min for lidocaine. for lidocaine. (J Endod July 2005:31(7):499-

504)

A P R O S P E C T I V E , R A N D O M I Z E D , D O U B L E - B L I N D C O M P A R I S O N O F B U P I V A C A I N E A N D L I D O C A I N E F O R I N F E R I O R A L V E O L A R N E R V E B L O C K S Fernandez C, DDS, MS, Reader A, DDS, MS, et al

T H E E F F E C T O F P R E O P E R A T I V E A C E T A M I N O P H E N O R A C O M B I N A T I O N O F A C E T A M I N O P H E N A N D I B U P R O F E N O N T H E S U C C E S S O F I N F E R I O R A L V E O L A R N E R V E B L O C K F O R T E E T H W I T H I R R E V E R S I B L E P U L P I T I S

Ianiro SR, DDS, Jeansonne, BG, DDS PhD, et al

Abstract: This study compared preoperative administration of acetaminophen or a combi-

nation of acetaminophen and ibuprofen versus placebo for potential increased effective-

ness of inferior alveolar nerve (IAN) block anesthesia. There were 40 patients with irreversi-

ble pulpitis randomly assigned to a drug or placebo group. Thirty minutes after ingestion of

medication, an IAN block was administered. A cold test was done 15 minutes after the

block, and if the patients had no sensitivity, endodontic therapy was initiated. If the patient

had no pain on access, the IAN was recorded as successful. If the patient had sensitivity to

cold or to the access procedure, it was recorded as a failure. Overall success was 60% for

all three groups. Success was 71.4% for the acetaminophen group, 75.9% for the aceta-

minophen and ibuprofen group, and 46.2% for the placebo group. There was no significant

difference between the groups; however, there was a trend toward higher success in the

medication groups. (J Endod 2007;33:11–14)

Page 2 E N D O I N V I V O

Abstract: A randomized, controlled trial of 31 healthy volunteers compared 4% articaine

with 1:100,000 epinephrine buccal infiltration to buccal plus lingual infiltration of the same

dose of drug in achieving pulpal anesthesia of mandibular first molar teeth. Data were com-

pared with efficacy of an inferior alveolar nerve block using 2% lidocaine 1:80,000 epineph-

rine in a cohort of 27 of the volunteers. Anesthesia was determined using electronic pulp

testing. Buccal and buccal plus lingual infiltrations of articaine with epinephrine did not dif-

fer in efficacy in obtaining pulpal anesthesia for mandibular permanent first molars

(p=0.17). Efficacy of 4% articaine with epinephrine infiltrations for first molar pulp anesthe-

sia was similar to that of an IANB using lidocaine with epinephrine over a 30-minute study

period (96 and 80 episodes of no response to maximal stimulation respectively, p=0.097).

Subjective tooth numbness was more common after IANB than buccal infiltration (p=0.005).

The discomfort of buccal infiltration with articaine was volume dependent (p=0.017) and

similar to that of an IANB. (J Endod 2008;34:514 –518)

A R T I C A I N E I N F I L T R A T I O N F O R A N E S T H E S I A O F M A N D I B U L A R F I R S T M O L A R

Corbett IP, PhD, Kanaa Mohammad M Phil, et al

C O N T R O L L E D L O C A L A N E S T H E T I C D E L I V E R Y S Y S T E M , I N P A T I E N T S W I T H I R R E V E R S I B L E P U L P I T I S

Nusstein J, DDS, MS, Claffey E, DDS, MS et al

Abstract: The purpose of this study was to determine the anesthetic effectiveness of the supplemental intraligamentary injec-

tion, administered with a computer-controlled local anesthetic delivery system, in mandibular posterior teeth diagnosed with

irreversible pulpitis when the conventional inferior alveolar nerve block failed. Fiftyfour emergency patients, diagnosed with

irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate to severe pain

upon endodontic access. A computer-controlled local anesthetic delivery system was then used to administer intraligamentary

injections of 1.4 ml of 2% lidocaine with 1:100,000 epinephrine. Success of the intraligamentary injection was defined as

none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was

obtained in 56% (30 of 54) of the patients. We concluded that when the inferior alveolar nerve block failed to provide profound

pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis, the intraligamentary injection

Page 3

A N E V A L U A T I O N O F B U C C A L I N F I L T R A T I O N S A N D I N F E R I O R A L V E O L A R N E R V E B L O C K S I N P U L P A L A N E S T H E S I A F O R M A N D I B U L A R F I R S T M O L A R S

Jung IY, DDS< MSc, PhD, Kim JH, DDS, et al

Abstract: We compared the anesthetic efficacy of inferior alveolar nerve blocks (IANBs) with that of buccal infiltrations (BIs) in

mandibular first molars. Using a crossover design, all subjects received a standard IANB or a BI of 1.7 ml. of 4% articaine with

1:100,000 adrenaline (Septanest, Septodont, Saint-Maru-des-Fosses, France) on two appointments separated by at least 1

week. Pulpal anesthesia was determined by using an electric pulp tester. Electric pulp testing was repeated at 5, 8, 11, 15,

20, 25, and 30 minutes after injections. Anesthesia was considered successful if the subject did not respond to the maximum

output of the pulp tester at two or more consecutive time points. Fifty-four percent of the BI and 43% of the IANB were suc-

cessful; the difference was not significant (P=0.34). The onset of pulpal anesthesia was significantly fastger with BI (p=0.03).

In conclusion, BI with 4%$ articaine for mandibular first molars can be a useful alternative for clinicians because compared

with IANB, it has faster onset and a similar success rate. (J Endod 2008:34:11-13)

C O N T R O L L E D L O C A L A N E S T H E T I C D E L I V E R Y S Y S T E M , I N P A T I E N T S W I T H I R R E V E R S I B L E P U L P I T I S

Nusstein J, DDS, MS, Claffey E, DDS, MS et al

4310 Sherwoodtowne Blvd.,

Suite 300

Mississauga, ON

L4Z4C4

Phone - 905.270.3357

Fax - 905.270.4172

Email - kendo@endosolns.com

E N D O D O N T I C S O L U T I O N S W W W . E N D O S O L N S . C O M

Abstract: A randomized, double-blind trial was conducted to compare the efficacy of 4% articaine with 1:100,000 epineph-

rine and 2% lidocaine with 1:100,000 epinephrine when used as a supplemental anesthetic. Forty-eight patients with irreversi-

ble pulpitis requiring supplemental buccal infiltration for endodontic therapy were given either 4% articaine with 1:100,000

epinephrineor 2% lidocaine with 1:100,000 epinephrine in a double-blind manner. A standard VAS pain scale was used to

evaluate the patient’s response to pain after a supplemental injection. The mean VAS score after supplemental anesthesia

was 15.28 for 4% articaine with 1:100,000 epinephrine and 19.70 for 2% lidocaine with1:100,000 epinephrine. The mean

percentage change in VAS score was 70.5 and 62.2% for articaine and lidocaine, respectively. There was no statistically signifi-

cant difference in the VAS pain score between 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epi-

nephrine as a supplemental anesthetic. (J Endod 2007;33:403– 405)

C O M P A R I S O N O F 4 % A R T I C A I N E W I T H 1 : 1 0 0 , 0 0 0 E P I N E P H R I N E A N D 2 % L I D O C A I N E W I T H 1 : 1 0 0 , 0 0 0 E P I N E P H R I N E W H E N U S E D A S S U P P L E M E N T A L A N E S T H E T I C

Roenberg PA, DDS, Amin KG, et al

P A T I E N C E , P E R S I S T E N C E , P E R S E V E R A N C E

Future newsletters will address the

transition from legacy shapes as

evidenced in the 1.5 of the image to

the extreme left and the change to

anatomical based shaping in the 1.4

and 2.5—with the abundance of NiTi

instruments in the marketplace and

with the capacity to visualize anat-

omy with axial orientation provided

by small FOV cone beam tomogra-

phy, the future of endodontics will

lead to enhanced restorative inter-

facing...more to come