Local Dexamethasone Administration in Symptomatic Irreversible Pulpitis

Symptomatic irreversible pulpitis is associated with a high incidence of failure of inferior alveolar nerve block anesthesia, particularly in mandibular molars, resulting in pain during endodontic treatment and the frequent need for supplemental anesthesia. Corticosteroids have been investigated as adjunctive agents because of their anti-inflammatory properties and their potential to improve anesthetic success and reduce postoperative pain. However, limited evidence is available regarding the influence of different local administration techniques on these outcomes.

This prospective, randomized, controlled, single-blind clinical trial aims to compare the effects of submucosal and intraligamentary administration of dexamethasone on anesthetic success and postoperative pain following inferior alveolar nerve block in patients with symptomatic irreversible pulpitis of mandibular first or second molars.

Eighty-four participants will be randomly allocated into three parallel groups (28 participants per group):

Group 1 (Control): Inferior alveolar nerve block followed by submucosal injection of normal saline (placebo).

Group 2: Inferior alveolar nerve block followed by submucosal injection of dexamethasone.

Group 3: Inferior alveolar nerve block followed by intraligamentary injection of dexamethasone.

The primary outcome is anesthetic success, assessed using the Heft-Parker Visual Analog Scale (HP-VAS) during access cavity preparation and pulp extirpation. Secondary outcomes include postoperative pain intensity assessed using the HP-VAS at 6, 12, 24, 48, and 72 hours after treatment, as well as the need for postoperative analgesic medication. The findings of this study may help identify the most effective local administration technique for dexamethasone to improve anesthetic success and postoperative pain management in patients with symptomatic irreversible pulpitis.

Inclusion criteria

• Patients aged 18 to 65 years.
• ASA I or ASA II systemic health status.
• Symptomatic irreversible pulpitis in a mandibular molar tooth.
• Positive response to pulp sensibility tests.
• Preoperative pain score greater than 54 mm on the Heft-Parker Visual Analog Scale (HP-VAS).
• Ability to understand the study procedures and provide written informed consent.

Exclusion criteria

• Pregnancy or lactation.
• Allergy or contraindication to articaine, dexamethasone, or study-related medications.
• Use of analgesics, anti-inflammatory drugs, or antibiotics within the previous 12 hours.
• Presence of periapical radiolucency or diagnosis of pulpal necrosis.
• Significant systemic disease (ASA III or higher).
• Inability to complete pain assessment forms or follow study procedures.