الفهرس 
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Abstract
The purpose of this prospective, randomized, double-blind, placebo-controlled study was to elucidate whether premedication therapy with ibuprofen or combination of ibuprofen and acetaminophen affect anesthesia efficacy of inferior alveolar nerve block in patient with irreversible pulpits.
Sixty subjects presenting for emergency endodontic treatment with mandibular posterior teeth diagnosed with symptomatic irreversible pulpitis participated in the study.
Patients are divided into 6 groups. Each group consisted of 10 patients. The first 30 patients of the first 3 groups received ibuprofen 800 mg (2 capsules of ibuprofen 400 mg), ibuprofen 800 mg with acetaminophen 1000 mg (2 capsules of ibuprofen 400 mg with acetaminophen 500 mg) or 2 capsules of sugar placebo one hour before anesthesia. The second 30 patients received one capsule 3 times daily for two days before anesthesia of ibuprofen 400 mg, ibuprofen 400 mg with acetaminophen 500 mg or placebo. The capsules were identical and given in a double-blind manner.
Before taking the medications patients were asked to rate their current pain on the following 4-point scale: 0, no pain; 1, mild pain; 2, moderate pain; 3, severe pain. Then Cold test using ice stick was done to the patients to ensure vitality of the tooth and the electrical pulp tester EPT is used to record the base line readings before application of anesthesia.
After 1 hour of oral administration of the capsules or after the two days therapy with the capsules, all patients received standard IANB injections by using 1.8 mL of 2% lidocaine with 1:200,000 epinephrine. After 15 minutes of the initial IANB, EPT readings were again recorded. Patients were again asked to rate their pain on pain scale. A conventional access opening was initiated and patients were asked to rate the pain on the scale of pain. The stage at which pain occur was recorded as within dentin, within pulpal space, and instrumentation of canals. Success was defined as no pain or mild pain during endodontic access preparation and instrumentation.
There were no statistically significant differences between the six groups with regard to gender, age, initial pain, mean EPT scores before and after anesthesia, tooth type and the stage at which pain occur. There was also non-statistically significant decrease in mean EPT scores after anesthesia in (Placebo 1h), (Placebo 2d) and (Ibuprofen 400 mg + Acetaminophen 500 mg 2d) groups.
There was a statistically significant decrease in mean EPT scores after anesthesia in (Ibuprofen 800 mg 1h), (Ibuprofen 400 mg 2d) and (Ibuprofen 800 mg + Acetaminophen 1000 mg 1h) groups.
Success in the six groups was (Ibuprofen 800 mg 1h) 60%, (Ibuprofen 400 mg 2d) 50%, (Placebo 1h) 40%, (Placebo 2d) 30%, (Ibuprofen 800 mg + Acetaminophen 1000 mg 1h) 50%, (Ibuprofen 400 mg + Acetaminophen 500 mg 2d) 60%. There is a trend toward higher success in the medication groups but there was no statistically significant difference among the groups (P = 0.74).
In conclusion, this study confirmed that mandibular anesthesia in symptomatic teeth is difficult to attain with an inferior alveolar nerve block alone, and administering ibuprofen or combination of ibuprofen with acetaminophen either 1hour or 2 days prior to treatment did not improve success. Further research is needed to determine more effective means of providing anesthesia of mandibular posterior teeth in patients with irreversible pulpitis.
Recommendations
After finishing the current study, we have some recommendations to authors trying to search in a similar issue of the current study:
1. Try to test the effect of lornoxicam and dexamethasone as a premedication therapy before anesthesia as some outhers found them significantly increase the success of IAN block of mandibular posterior teeth with irreversible pulpitis.
2. The use of VAS pain scale is better than the use of four point pain scale. VAS is more descriptive of pain. Results by VAS are easily analyzed by statistics and easily compared with other similar studies.
3. Do not use the two days premedication therapy again. We found that most patients complain were exaggerated when coming the second visit after the two days therapy. By this way we depend on patient in the two days and he may take other medication without telling us.
4. Increasing number of patients may useful for better analysis of the results.