Comparison of the anaesthetic efficacy of and heart rate changes after periodontal ligament or intraosseous X‐Tip injection in mandibular molars: a randomized controlled clinical trial

Zarei M, Ghoddusi J, Sharifi E, Forghani M, Afkhami F, Marouzi P. Comparison of the anaesthetic efficacy of and heart rate changes after periodontal ligament or intraosseous X-Tip injection in mandibular molars: a randomized controlled clinical trial. International Endodontic Journal, 45, 921–926, 2012. Abstract Aim  To compare the efficacy of supplemental anaesthesia using periodontal ligament injections (PDL) and intraosseous injections with the X-Tip system in terms of the measured heart rate and patient reported pain level. Methodology  In this single-blind randomized clinical trial, 40 patients (22 women, 18 men) with irreversible pulpitis who had experienced unsuccessful pain management by inferior alveolar nerve block with 2% lidocaine and 1 : 100 000 epinephrine were selected. Patients were divided equally and randomly into two groups. Supplementary anaesthesia was provided through intraosseous injection with the X-Tip system (X-Tip group) or by PDL injection (PDL group). After each step of injection, pain severity was assessed using a visual analogue scale. Patient heart rate was recorded with a pulse oximeter. Data were coded and analysed using Mann–Whitney U-test with SPSS (version 16) software. Results  Anaesthetic success was obtained in 100% of X-Tip and 70% of PDL group patients after the first supplemental injection. Compared with the first PDL injection, the first intraosseous injection resulted in a significant increase in heart rate (P = 0.001); however, this increase was short-lived (mean increase: 9–10 beats per min). No significant difference in heart rate or anaesthesia success was observed between men and women. Conclusion  Intraosseous injection using the X-Tip system was more effective than PDL injection as a supplementary anaesthetic for pulpectomy in mandibular molars or second premolars. However, the former resulted in a transient increase in heart rate.