Comparing the Efficacy of Local Intraligamentary Injection of Dexamethasone and Piroxicam on Postoperative Pain in Mandibular Molars with Symptomatic Irreversible Pulpitis
Authors: Goyal Sameer , Chaudhary Ritika , Reddy Anuradha , Kadir Abdul , Bhatt Yamini , Anjaneyulu Korrapolu Venkata 
Published: March 2024

Abstract

Background:
Endodontic therapy may cause the expulsion of inflammatory agents into the nearby periapical tissues, directly stimulating or sensitizing pain fibers. With the help of glucocorticoids pharmacotherapeutic agents and nonsteroidal anti-inflammatory drugs, the majority of pain following an endodontic therapy is typically successfully controlled. The intraligamentary shot is thought to make it possible to apply localized anti-inflammatory medications precisely to the periapical area. Hence, the aim of the study was to evaluate the impact of piroxicam intraligamentary injection, dexamethasone intraligamentary injection, and local anesthetic agent intraligamentary injection on pain following endodontic therapy in teeth having symptomatic irrevocable pulpitis.

Materials and Methods:
To create the random order, 84 patients were separated into three comparable categories of 28 patients. Dexamethasone, piroxicam, and mepivacaine were the three interventions that received letters A, B, and C, respectively. On the Numeric Pain Rating Scale pain record form, patients who participated were requested to indicate their degree of preoperative pain. For the typical mandibular inferior alveolar nerve block injections, every individual got 1.8 mL of 2% mepivacaine plus 1:20,000 levonordefrin. When the procedure began, the operator blinding was being performed, the support worker loaded a vacant cartridge with 0.4 mL of either dexamethasone pharmaceutical agent (8 mg/2 mL) or 0.4 mL of piroxicam pharmaceutical agent (20 mg/mL) from the drug vial to the cartridges utilizing an insulin syringe. The study’s main finding was the degree of pain following a root canal therapy, which was assessed employing an eleven-point Numeric Rating Score (NRS) with the limits of no pain and severe pain as endpoints.

Results:
The postoperative pain was maximum in the mepivacaine category, while it was minimum in the piroxicam category at 4 and 12 h follow-up. Similar trends were observed when there was analysis at 24 h follow-up and 48 h follow up where the postoperative pain was maximum in the mepivacaine category while it was minimum in the piroxicam category. Mann–Whitney pairwise comparison at all postoperatively follow-up time intervals revealed no statistically significant variance in pain decrease after the therapy between the dexamethasone category and piroxicam category (P > 0.05). At every postoperative follow-up, the decrease in pain was demonstrated to be statistically vital among the piroxicam subcategory and the mepivacaine category (P < 0.05).

Conclusion:
Within the constraints of the present investigation, it could be determined that preventative intraligamentary injections of dexamethasone and piroxicam were significantly more effective than mepivacaine at decreasing postendodontic pain, however, there wasn’t statistical variance between the use of either drug.