Intraligamentary vs Inferior Alveolar Nerve Block for Pulpitis: A Randomized Clinical Trial

Aula Dental Avanzada52 enrolled

Overview

This multicenter randomized trial compares the clinical effectiveness of intraligamentary injection versus inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis in mandibular molars. The goal is to determine which technique provides better pain control during endodontic treatment.

Symptomatic irreversible pulpitis in mandibular molars presents a clinical challenge due to the difficulty in achieving profound anesthesia. This prospective, randomized, controlled clinical trial evaluates two anesthetic techniques-intraligamentary injection (ILA) versus inferior alveolar nerve block (IANB)-to compare their efficacy in eliminating pain during endodontic access. Patients will be enrolled from multiple dental centers following standardized inclusion and exclusion criteria. Pain will be assessed using validated scales. Statistical analysis will be conducted to determine significant differences in anesthetic success between groups.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Symptomatic Irreversible Pulpitis (SIP)Dental Pain Inferior Alveolar Nerve Block Failure

Interventions

Intraligamentary InjectionPROCEDURE

Intraligamentary local anesthesia will be administered using a standard dental syringe with 2% lidocaine and 1:100,000 epinephrine.

Inferior Alveolar Nerve BlockPROCEDURE

Inferior alveolar nerve block will be performed with 2% lidocaine and 1:100,000 epinephrine using the conventional technique.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Adults aged 18 years or older * Presenting with symptomatic irreversible pulpitis in a mandibular molar * Vital response to cold testing * Ability to understand and provide informed consent * Available for follow-up and data collection Exclusion Criteria: * Known allergy to lidocaine or epinephrine * Pregnancy or breastfeeding * Use of analgesics or anti-inflammatory drugs in the previous 6 hours * Non-vital or previously treated teeth * Significant systemic disease (ASA III or above) * History of psychiatric or neurological disorders affecting pain perception

Outcomes

Primary Outcomes

Pain during endodontic access

Pain intensity experienced by the patient during endodontic access after the assigned anesthetic technique.

Time frame: Immediately after access cavity preparation (within 30 minutes of anesthesia)

Secondary Outcomes

Need for supplementary anesthesia

Whether the initial anesthesia technique was sufficient or required additional anesthetic injection to complete the procedure pain-free.

Time frame: During access or initial root canal instrumentation (within first 45 minutes)

Patient satisfaction immediately after treatment

Patient-reported satisfaction immediately after treatment will be measured using a 5-point Likert scale. The scale ranges from 1 (very dissatisfied) to 5 (very satisfied). Higher scores indicate better satisfaction.

Time frame: End of visit (within 1 hour)

Postoperative pain at 7 days

Pain intensity reported by the patient at day 7 after treatment will be assessed using a 4-point ordinal scale: 1 (none), 2 (mild), 3 (moderate), 4 (severe). Higher scores indicate worse pain.

Time frame: Day 7 post-treatment

Patient satisfaction at 7 days

Patient-reported satisfaction one week after treatment will be measured using a 5-point Likert scale. The scale ranges from 1 (very dissatisfied) to 5 (very satisfied). Higher scores indicate better satisfaction.