Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis

Objective. Conventional inferior alveolar nerve block (IANB) has a poor success rate in inflamed pulps. Three alternative techniques of providing anesthesia to mandibular molars were evaluated and compared with conventional IANB. Study design. Ninety-seven adult volunteer subjects, actively experiencing pain, participated in this prospective, randomized, double-blinded study. Twenty-five patients received Gow-Gates mandibular conduction block anesthesia, 24 patients received "high" Vazirani-Akinosi inferior alveolar nerve block, 26 received only buccal-plus-lingual infiltrations, and 22 patients ( control) received conventional IANB anesthesia. Endodontic access preparation was initiated after 15 minutes of anesthesia. Pain during treatment was recorded using a Heft-Parker visual analog scale. Success was recorded for "none" or "mild" pain. Results. Statistical analysis using nonparametric McNemer tests showed that Gow-Gates gave a success rate of 52%, which was statistically higher than control IANB (36%) ( P < .05). Vazirani-Akinosi and infiltrations gave 41% and 27% success rates, respectively, with no statistically significant differences from control IANB. Conclusions. Gow-Gates mandibular conduction anesthesia may increase the success rates in patients with irreversible pulpitis compared with conventional IANB. None of the techniques provided acceptable success rates. ( Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 303-308)