Symptomatic irreversible pulpitis in mandibular molars, particularly in patients requiring profound pulpal anesthesia, remains associated with high inferior alveolar nerve block (IANB) failure rates despite the availability of supplemental anesthetic techniques. To address this challenge, a study evaluated the efficacy of supplemental buccal infiltration using tramadol, dexamethasone, ketorolac, and temperature-modified lidocaine in enhancing IANB success among 120 patients with symptomatic irreversible pulpitis. The study found that anesthetic success rates were highest with supplemental tramadol (90%) and cold lidocaine (85%) buccal infiltration, both demonstrating significantly greater efficacy compared with the control group (40%).
In contrast, dexamethasone (55%), ketorolac (50%), and warm lidocaine (60%) showed nonsignificant improvements in IANB success rates. Additionally,…
