{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T06:27:52Z","timestamp":1790922472402,"version":"4.1.0"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Achieving profound pulpal anesthesia in mandibular molars with symptomatic irreversible pulpitis remains challenging, with inferior alveolar nerve block (IANB) failure rates up to 80%. This study evaluated the effect of supplemental buccal infiltration using tramadol, dexamethasone, ketorolac, and temperature-modified lidocaine on the efficacy of IANB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      In this randomized, double-blind clinical trial, 120 patients were allocated to six groups (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 20 each): Control (IANB only), dexamethasone (4 mg\/mL), ketorolac (30 mg\/mL), tramadol (50 mg\/mL), warm lidocaine (40\u00b0C), and cold lidocaine (4\u00b0C). All received 2% lidocaine with 1:200,000 epinephrine for IANB, followed by 1 mL of the assigned infiltration. Pain intensity was recorded using the Numeric Pain Rating Scale (0\u201310) during access, chamber, and canal entry. Anesthetic success was defined as a score &lt;3 at canal entry.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Anesthetic success rates were 90% (95% confidence interval [CI], 68%\u201399%) for tramadol, and 85% (95% CI, 62%\u201397%) for cold lidocaine, significantly higher than control (40%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001 and\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002, respectively). Dexamethasone (55%), ketorolac (50%), and warm lidocaine (60%) showed nonsignificant improvement (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &gt; 0.05). Median pain scores were significantly lower in the tramadol and cold lidocaine groups across all the stages (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001). No adverse events occurred.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Supplemental buccal infiltration with tramadol or cold lidocaine significantly enhances IANB success in mandibular molars with irreversible pulpitis, offering a simple, safe, and cost-effective approach to improve pulpal anesthesia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jcde.jcde_897_25","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T18:00:22Z","timestamp":1768068022000},"page":"72-79","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Comparative evaluation of supplemental buccal infiltration adjuncts for enhancing inferior alveolar nerve block in symptomatic irreversible pulpitis: A randomized double-blind clinical study"],"prefix":"10.4103","volume":"29","author":[{"given":"Aakash","family":"Gupta","sequence":"first","affiliation":[{"name":"Department of Dentistry, Division of Conservative Dentistry and Endodontics, All India Institute of Medical Sciences, Bathinda, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarun Kumar","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Dentistry, Division of Conservative Dentistry and Endodontics, All India Institute of Medical Sciences, Bathinda, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shagun","family":"Gill","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, Gian Sagar Dental College and Hospital, Rajpura, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aditi","family":"Kulshrestha","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry and Endodontics, Manav Rachna 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