Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of Endo-Ice followed by intrapulpal ice application as an adjunct to inferior alveolar nerve block in patients with symptomatic irreversible pulpitis—a randomized controlled trial

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objective

The purpose of the present study was to evaluate the effect of Endo-Ice followed by intrapulpal ice application for reducing pain during pulp extirpation in mandibular molars with symptomatic irreversible pulpitis.

Materials and methods

Sixty patients diagnosed with symptomatic irreversible pulpitis participated in the present study. Subjects were randomly allocated to any one of the following groups: control group—inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000), articaine group—inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + Buccal infiltration with articaine (4%) with adrenaline (1:100000); or cold group—inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + cold application. The outcome assessor measured the level of pain during access opening and pulp extirpation using the visual analogue scale. The anxiety level of the patient was also measured.

Results

During access opening, there was a significant difference in the pain reduction in the articaine group when compared to cold and control group (p value = 0.02). During pulp extirpation, cold group and articaine group showed a significant reduction in pain levels as compared to the control group (p value = 0.001). There was no difference in the pain level during pulp extirpation among the two test arms (articaine and cold) (p value = 0.99). Further, cold significantly reduced the level of anxiety when compared to the articaine or control group (p value = 0.001).

Conclusion

Hence, cold is a simple, supplementary technique in reducing pain during pulp extirpation.

Clinical relevance

Application of cold may help in minimizing the fear of additional injection in managing pain during endodontic treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Matthews R, Drum M, Reader A, Nusstein J, Beck M (2009) Articaine for supplemental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior alveolar nerve block fails. J Endod 35:343–346. https://doi.org/10.1016/j.joen.2008.11.025

    Article  PubMed  Google Scholar 

  2. Bigby J, Reader A, Nusstein J, Beck M (2007) Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 33:7–10. https://doi.org/10.1016/j.joen.2006.09.006

    Article  PubMed  Google Scholar 

  3. Vreeland DL, Reader A, Beck M, Meyers W, Weaver J (1989) An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endod 15:6–12. https://doi.org/10.1016/S0099-2399(89)80091-3

    Article  PubMed  Google Scholar 

  4. Mellor AC, Dorman ML, Girdler NM (2005) The use of an intra-oral injection of ketorolac in the treatment of irreversible pulpitis. Int Endod J 38:789–792. https://doi.org/10.1111/j.1365-2591.2005.01015_1.x

    Article  PubMed  Google Scholar 

  5. Wong M, Lytle WR (1991) A comparison of anxiety levels associated with root canal therapy and oral surgery treatment. J Endod 17:461–465. https://doi.org/10.1016/S0099-2399(07)80138-5

    Article  PubMed  Google Scholar 

  6. Shantiaee Y, Javaheri S, Movahhedian A, Eslami S, Dianat O (2017) Efficacy of preoperative ibuprofen and meloxicam on the success rate of inferior alveolar nerve block for teeth with irreversible pulpitis. Int Dent J 67:85–90. https://doi.org/10.1111/idj.12272

    Article  PubMed  Google Scholar 

  7. Singla M, Subbiya A, Aggarwal V, Vivekanandhan P, Yadav S, Venkatesh H, Geethapriya N, Sharma V (2015) Comparison of the anaesthetic efficacy of different volumes of 4% articaine (1.8 and 3.6 mL) as supplemental buccal infiltration after failed inferior alveolar nerve block. Int Endod J 48:103–108. https://doi.org/10.1111/iej.12283

    Article  PubMed  Google Scholar 

  8. Akhlaghi NM, Hormozi B, Abbott PV, Khalilak Z (2016) Efficacy of ketorolac buccal infiltrations and inferior alveolar nerve block in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial. J Endod 42:691–695. https://doi.org/10.1016/j.joen.2016.02.003

    Article  PubMed  Google Scholar 

  9. De Pedro-Muñoz A, Mena-Álvarez J (2017) The effect of preoperative submucosal administration of tramadol on the success rate of inferior alveolar nerve block on mandibular molars with symptomatic irreversible pulpitis: a randomized, double-blind placebo-controlled clinical trial. Int Endod J 50:1134–1142. https://doi.org/10.1111/iej.12755

    Article  PubMed  Google Scholar 

  10. Shetty KP, Satish SV, Kilaru KR, Sardar P, Luke AM (2015) Comparison of anesthetic efficacy between lidocaine with and without magnesium sulfate USP 50% for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. J Endod 41:431–433. https://doi.org/10.1016/j.joen.2015.01.003

    Article  PubMed  Google Scholar 

  11. Talati A, Bidar M, Sadeghi G, Nezami H (2006) A comparative study of lidocaine and lidocaine mannitol in anesthetizing human teeth with inflamed pulps. Iran Endod J 1:19–23. https://doi.org/10.22037/iej.v1i1.155

    Article  PubMed  PubMed Central  Google Scholar 

  12. Stentz D, Drum M, Reader A, Nusstein J, Fowler S, Beck M (2018) Effect of a combination of intranasal ketorolac and nitrous oxide on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a prospective, randomized, double-blind study. J Endod 44:9–13. https://doi.org/10.1016/j.joen.2017.09.011

    Article  PubMed  Google Scholar 

  13. Parente SA, Anderson RW, Herman WW, Kimbrough WF, Weller RN (1998) Anesthetic efficacy of the supplemental intraosseous injection for teeth with irreversible pulpitis. J Endod 24:826–828. https://doi.org/10.1016/S0099-2399(98)80011-3

    Article  PubMed  Google Scholar 

  14. Nusstein J, Claffey E, Reader A, Beck M, Weaver J (2005) Anesthetic effectiveness of the supplemental intraligamentary injection, administered with computer controlled local anesthetic delivery system, in patients with irreversible pulpitis. J Endod 31:354–358. https://doi.org/10.1097/01.DON.0000140565.88940.60

    Article  PubMed  Google Scholar 

  15. Birchfield J, Rosenberg PA (1975) Role of the anesthetic solution in intrapulpal anesthesia. J Endod 1:26–27. https://doi.org/10.1016/S0099-2399(75)80246-9

    Article  PubMed  Google Scholar 

  16. Aggarwal V, Jain A, Kabi D (2009) Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis. J Endod 35:925–929. https://doi.org/10.1016/j.joen.2009.04.012

    Article  PubMed  Google Scholar 

  17. Ashraf H, Kazem M, Dianat O, Noghrehkar F (2013) Efficacy of articaine versus lidocaine in block and infiltration anesthesia administered in teeth with irreversible pulpitis: a prospective, randomized, double-blind study. J Endod 39:6–10. https://doi.org/10.1016/j.joen.2012.10.012

    Article  PubMed  Google Scholar 

  18. Poorni S, Veniashok B, Senthilkumar AD, Indira R, Ramachandran S (2011) Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial. J Endod 37:1603–1607. https://doi.org/10.1016/j.joen.2011.09.009

    Article  PubMed  Google Scholar 

  19. Shapiro MR, McDonald NJ, Gardner RJ, Peters MC, Botero TM (2018) Efficacy of articaine versus lidocaine in supplemental infiltration for mandibular first versus second molars with irreversible pulpitis: a prospective, randomized, double-blind clinical trial. J Endod 44:523–528. https://doi.org/10.1016/j.joen.2017.10.003

    Article  PubMed  Google Scholar 

  20. Cook O, Nusstein J, Drum M, Fowler S, Reader A, Draper J (2018) Anesthetic efficacy of a combination of 4% prilocaine/2% lidocaine with epinephrine for the inferior alveolar nerve block: a prospective, randomized, double-blind study. J Endod 44:683–688.Article In Press. https://doi.org/10.1016/j.joen.2018.01.004

    Article  PubMed  Google Scholar 

  21. Majstorovic M, Veerkamp JS (2004) Relationship between needle phobia and dental anxiety. J Dent Child (Chic) 71:201–205

    Google Scholar 

  22. Maiwand MO, Makey AR (1981) Cryoanalgesia for relief of pain after thoracotomy. Br Med J (Clin Res Ed) 282:1749–1750

    Article  Google Scholar 

  23. Evans PJ, Lloyd JW, Jack TM (1981) Cryoanalgesia for intractable perineal pain. J R Soc Med 74(11):804–809

    Article  PubMed  PubMed Central  Google Scholar 

  24. Harbert H (1989) Topical ice: a precursor to palatal injections. J Endod 15:27–28. https://doi.org/10.1016/S0099-2399(89)80094-9

    Article  PubMed  Google Scholar 

  25. Vera J, Ochoa-Rivera J, Vazquez-Carcano M et al (2015) Effect of intracanal cryotherapy on reducing root surface temperature. J Endod 41:1884–1887. https://doi.org/10.1016/j.joen.2015.08.009

    Article  PubMed  Google Scholar 

  26. Vera J, Ochoa-Rivera J, Romero M et al (2018) Intracanal cryotherapy reduces postoperative pain in teeth with symptomatic apical periodontitis: a randomized multicenter clinical trial. J Endod 44:4–8. https://doi.org/10.1016/j.joen.2017.08.038

    Article  PubMed  Google Scholar 

  27. Hargreaves KM (2001) Neurochemical factors in injury and inflammation in orofacial tissues. In: Lavigne G, Lund J, Sessle B, Dubner R (eds) Orofacial pain: basic sciences to clinical management. Quintessence Publications, Chicago

    Google Scholar 

  28. Suda H, Ikeda H (2002) The circulation of the pulp. In: Hargreaves K, Goodis H (eds) Seltzer and Bender’s Dental Pulp. Quintessence Publications, Chicago

    Google Scholar 

  29. Byers MR, Taylor PE, Khayat BG, Kimberly CL (1990) Effects of injury and inflammation on pulpal and periapical nerves. J Endod 16:78–84. https://doi.org/10.1016/S0099-2399(06)81568-2

    Article  PubMed  Google Scholar 

  30. Goodis HE, Winthrop V, White JM (2000) Pulpal responses to cooling tooth temperatures. J Endod 26:263–267. https://doi.org/10.1097/00004770-200005000-00001

    Article  PubMed  Google Scholar 

  31. Seymour RA, Simpson JM, Charlton JE, Phillips ME (1985) An evaluation of length and end phrase of visual analogue scales in dental pain. Pain 21:177–185

    Article  PubMed  Google Scholar 

  32. Bleakley CM, Hopkins JT (2010) Is it possible to achieve optimal levels of tissue cooling in cryotherapy? Phys Ther Rev 15:344–350. https://doi.org/10.1179/174328810X12786297204873

    Article  Google Scholar 

  33. de Morais CA, Bernardineli N, Lima WM, Cupertino RR, Guerisoli DM (2008) Evaluation of the temperature of different refrigerant sprays used as a pulpal test. Aust Endod J 34:86–88. https://doi.org/10.1111/j.1747-4477.2007.00077.x

    Article  PubMed  Google Scholar 

  34. Rickoff B, Trowbridge H, Baker J, Fuss Z, Bender IB (1988) Effects of thermal vitality tests on human dental pulp. J Endod 14:482–485. https://doi.org/10.1016/S0099-2399(88)80104-3

    Article  PubMed  Google Scholar 

  35. Shrestha A, Messer HH, Asundi A, Kishen A (2010) Effect of hydration on the strain gradients in dental hard tissues after heat and cold application. J Endod 36:1643–1647. https://doi.org/10.1016/j.joen.2010.06.027

    Article  PubMed  Google Scholar 

  36. Barnard D (1980) The effects of extreme cold on sensory nerves. Ann R Coll Surg Engl 62:180–187

    PubMed  PubMed Central  Google Scholar 

  37. Capps SG, Mayberry B (2009) Cryotherapy and intermittent pneumatic compression for soft tissue trauma. Athletic Therapy Today 14:2–4

    Article  Google Scholar 

  38. Goodis HE, Poon A, Hargreaves KM (2006) Tissue pH and temperature regulate pulpal nociceptors. J Dent Res 85:1046–1049. https://doi.org/10.1177/154405910608501114

    Article  PubMed  Google Scholar 

  39. Babes A, Amuzescu B, Krause U, Scholz A, Flonta ML, Reid G (2002) Cooling inhibits capsaicin-induced currents in cultured rat dorsal root ganglion neurons. Neurosci Lett 317:131–134

    Article  PubMed  Google Scholar 

  40. Rogers BS, Botero TM, McDonald NJ, Gardner RJ, Peters MC (2014) Efficacy of articaine versus lidocaine as a supplemental buccal infiltration in mandibular molars with irreversible pulpitis: a prospective, randomized, double-blind study. J Endod 40:753–758

    Article  PubMed  Google Scholar 

  41. Malamed SF, Gagnon S, Leblanc D (2000) Efficacy of articaine: a new amide local anesthetic. J Am Dent Assoc 131:635–642. https://doi.org/10.14219/jada.archive.2000.0237

    Article  PubMed  Google Scholar 

  42. Appukuttan D, Datchnamurthy M, Deborah SP, Hirudayaraj GJ, Tadepalli A, Victor DJ (2012) Reliability and validity of the Tamil version of modified dental anxiety scale. J Oral Sci 54:313–320. https://doi.org/10.1016/j.joen.2013.12.022

    Article  PubMed  Google Scholar 

Download references

Funding

The work was supported by the Department of Conservative dentistry and Endodontics, Meenakshi Ammal Dental College, Maduravoyal, Chennai 95.

Author information

Authors and Affiliations

  1. Department of Conservative Dentistry and Endodontics, Meenakshi Academy of Higher Education and Research (MAHER), Faculty of Dentistry, Maduravoyal, Chennai, 600095, India

    Vishnupriya Koteeswaran, Suma Ballal, Velmurugan Natanasabapathy & Dinesh Kowsky

Authors
  1. Vishnupriya Koteeswaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Suma Ballal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Velmurugan Natanasabapathy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dinesh Kowsky
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Velmurugan Natanasabapathy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koteeswaran, V., Ballal, S., Natanasabapathy, V. et al. Efficacy of Endo-Ice followed by intrapulpal ice application as an adjunct to inferior alveolar nerve block in patients with symptomatic irreversible pulpitis—a randomized controlled trial. Clin Oral Invest 23, 3501–3507 (2019). https://doi.org/10.1007/s00784-018-2768-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-018-2768-4

Keywords

Search

Navigation