(PR115) Current Practices Used to Increase the Success Rate of The Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis

Pain control during endodontic access is important to ensure patient comfort. Achieving adequate anesthesia in an inflamed mandibular molar poses a treatment challenge as the reported failure rate is 30% to 83%. A number of pre-medications, anesthetic techniques and adjuncts have been researched to determine their effect on the anesthetic success of the inferior alveolar nerve block (IANB). The purpose of this research was to describe the current clinical practices used by the members of the American Association of Endodontists (AAE) in anesthetizing mandibular molars (MM) diagnosed with symptomatic irreversible pulpitis (SIP). A cross-sectional observational study design used members of the AAE (n=5736) who were invited to participate in an online survey about the techniques they used to anesthetize MM-SIP. Descriptive statistics and logistic regression analyses were conducted to compare practices of board- certified endodontists, board eligible endodontists, residents and other endodontists. There were 917 responses, and of all the techniques surveyed buccal infiltration with 4% articaine was most likely to be used 100% of the time to increase the success rate of the IANB. The use of a pre-medication before administering the IANB was reported as not likely due to the time considerations of both the patient and provider. Although there are many techniques and adjuncts used to increase the success rate of the IANB in the literature, endodontists in clinical practice had adopted only a few. Additional qualitative research is needed determine reasons for the choices.