Effectiveness of intraosseous anaesthesia in irreversible pulpitis Systematic integrative review

Abstract

INTRODUCTION: In patients with irreversible pulpitis, pain management is a challenge due to the higher failure rate that occurs in healthy patients. Conventional techniques are sometimes not sufficient and other anaesthesia systems could be needed. Intraosseous anaesthesia (IOA) is a more efficient technique that delivers the anaesthetic solution into the cancellous bone directly in contact with the apex of the tooth. OBJECTIVES: Primary is to evaluate the efficacy of IOA in root canal treatment of teeth with irreversible pulpitis. Secondary are: - To evaluate the precautions and the contraindications of IOA. - To compare the side effects with conventional systems. MATERIALS AND METHODS: A bibliographic search was conducted in PubMed from 2012 to 2022 of articles in English using the following keywords: "Anesthesia”; “Intraosseous”; “Dental”; “Irreversible Pulpitis”; “mandibular molar”. RESULTS: 14 articles were selected. Of the 14 articles, 6 evaluated the efficacy of IOA as a first injection, and 4 as a secondary injection. The remaining 4 articles evaluated other variables. DISCUSSION: In the first injection, depending on the study, the effectiveness of IOA is either equal or superior to conventional techniques. In the reinforcement anaesthesia, IOA was more effective than conventional. Side effects were observed, the main one being an increase in heart rate. Other side effects are rare, and most can be avoided with precautions. In terms of comfort, IOA was preferred by patients. CONCLUSION: IOA as supplementary anaesthesia is a good alternative to conventional anaesthesia in patients with IP. It is recommended for patient’s comfort.