How Effective are Inferior Alveolar Nerve Block and Supplemental Intraligamentary Injections in Pediatric Patients with Deep Carious Permanent Mandibular Molars?

Purpose: The purpose of this study was to assess, within the deep carious permanent mandibular molars of pediatric patients: (1) pre-operative pulpal anesthesia following an inferior alveolar nerve block (IANB); (2) preoperative pulpal anesthesia following a supplemental intraligamentary injection (SII); and (3) intraoperative pulpal anesthesia. Methods: Vital permanent mandibular molars with deep caries were first anesthetized with IANB. Preoperative pulpal anesthesia was assessed, and success was defined when the tooth had no response to the sensibility tests. In cases with failed preoperative pulpal anesthesia, an SII was administered and pulpal anesthesia was reassessed. A maximum of three SIIs was allowed. Intraoperatively, pulpal anesthesia was determined when the Wong-Baker FACES Pain Rating Scale reported by the patients was no more than four. Results: Sixty molars of patients aged 10.9±2.9 years old were included. The success of preoperative pulpal anesthesia following IANB was 26.7 percent. In cases with failed IANB, SIIs were administered. The overall cumulative success rate of preoperative pulpal anesthesia was 80 percent. Intraoperatively, the success of pulpal anesthesia was 72.9 percent. Conclusions: The success of pulpal anesthesia by inferior alveolar nerve block in young permanent teeth with deep caries was low. A supplemental intraligamentary injection can greatly enhance preoperative pulpal anesthesia; however, 27.1 percent of patients still experienced pain during treatment.