The purpose of this study was to determine the
anesthetic efficacy of the supplemental intraosseous injection, using the X-tip system in an apical location, in mandibular posterior teeth diagnosed with irreversible
pulpitis when the conventional inferior alveolar nerve block failed. Thirty-three emergency patients, diagnosed with irreversible
pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe
pain on endodontic access. The X-tip system was used to administer 1.8 ml of 2%
lidocaine with 1:100,000
epinephrine. The X-tip injection site was 3- to 7-mm apical to the mucogingival junction of the affected tooth. Success of the X-tip intraosseous injection was defined as none or mild
pain on endodontic access or initial instrumentation. The results of this study demonstrated that 6 of 33 (18%) X-tip
injections resulted in backflow of
anesthetic solution into the oral cavity; none were successful in obtaining
anesthesia. Twenty-seven of the remaining 33 X-tip
injections (82%) were successful. We conclude that when the inferior alveolar nerve block fails to provide profound pulpal
anesthesia, the X-tip system, when used in an apical location and when there was no backflow of the
anesthetic solution into the oral cavity, was successful in achieving pulpal
anesthesia in mandibular posterior teeth of patients presenting with irreversible
pulpitis.