Anestesia en la endodoncia de molares y premolares mandibulares con pulpitis aguda irreversile. Recomendaciones clínicas. Hacia una revisión sistimática

Abstract

Aim. The purpose of this paper is to review the state of the dental local anesthesia in patients with acute irreversible pulpitis in mandibular posterior teeth, to find out the most effective methods to achieve anesthesia prior to the endodontic treatment. Materials and methods. A literature review was conducted searching for clinical trials on the efficacy of the mandibular block technique in lower molars and premolars with acute irreversible pulpitis, published from 1987 to 2015. Results. The administration of one cartridge of 1,8 mL standard solution of Lidocaine 2% with Adrenalin 1:100.000 (L-100) or 1:80.000 (L-80) with the mandibular block technique is only effective in 30% of the cases. If administering two cartridges, the effectiveness increases to 45%. One cartridge of 1,8 mL Articaine 4% with Adrenalin 1:100.000 (A-100) is effective in 40% of the cases, increasing to 70% when adding a second cartridge. If prescribing a nonsteroidal anti-inflammatory drug (NSAID) one hour before the treatment and injecting one cartridge of 1,8 mL standard solution L-80 or L-100, the percentage of successfully anesthetized cases reaches 55%. In case of prescribing acetaminophen one hour before treatment, the efficacy is reduced to 50%. If following the mandibular block technique with L-80 or L-100, a buccal reinforcement is made with 1,8 mL A-100, the effectiveness is 65%. If such blockage is made with 1,8 mL of A-100 and the buccal reinforcement with 1,8 mL A-100, the effectiveness is 85%. Conclusion. The recommendations to achieve the highest effectiveness of anesthesia are taking NSAIDs one hour before treatment and performing a mandibular block technique with 3,6 mL of A-100 and buccal reinforcement with 1,8 mL of A100.