Comparative Efficacy Of Pre-Emptive Use Of Enzyme & Anti-Oxidant Based NSAID Over Plain NSAID On Inferior Alveolar Nerve Blockade And Postoperative Pain Control In Endodontic Treatment Of Molars With Symptomatic Pulpitis: A Randomized Controlled Clinical Trial

Pain management during and after endodontic treatment is essential for both clinicians and patients. Thus, effective anesthesia and minimal postoperative pain is always considered to be of utmost importance during an endodontic treatment.

Inferior alveolar nerve block (IANB) is preferred anesthetic technique for endodontic treatment of mandibular molars. However, success rate of IANB is quite low in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars, ranging from 58% to 79%. Anesthetizing tooth with irreversible pulpitis poses a challenge as the voltage-gated sodium channels are resistant to local anesthetic relatively.  Anatomical variations, pulpal inflammation, failure of anesthetic technique and even anxiety caused by preoperative pain can explain anesthetic difficulty.

In postoperative period following an endodontic procedure, approximately 47% of patients report moderate to severe pain, with a higher incidence between 6 and 24 h. The inflammatory process of the pulp involves pro-inflammatory chemical mediators, mainly prostaglandins, which have been shown to cause hyper-algesic effects in addition to inflammatory process. Although periapical inflammation has a significant influence on occurrence of postoperative pain, the presence of excruciating symptoms in preoperative period is one of the factors that can contribute to an increase in pain score.

This study is an attempt to check whether additional factors like Bromelain, Trypsin (ENZYMES) and Rutoside trihydrate (ANTIOXIDANT) provide a synergistic action to the NSAID in pain control which indirectly provides its efficacy over nerve blockade.

In the literature we have many studies proving the potency of various NSAIDs over the IANB success and postoperative pain, but there is a paucity of studies investigating an enzyme and antioxidant based NSAID’s efficacy over IANB success and pain control in endodontically treated molars, which forms the basis of this study research.

The aim of the study is to compare and evaluate the efficacy of the Enzyme and Antioxidant based NSAID (Bromelain 90mg, rutoside trihydrate 100mg, trypsin 48mg, diclofenac sodium 50mg) and plain NSAID (Diclofenac sodium 50mg) as preoperative medication which is given 60 min before initiating the endodontic treatment and to assess its effect on the success of Inferior Alveolar Nerve Block, and to evaluate the influence of these drugs on the intensity of pain during the procedure and postoperative pain at 4 intervals i.e. 6, 12, 24 and 48 hours.