Efficacy of preoperative ibuprofen on the success of inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: a randomized clinical trial

By Noguera-Gonzalez D, Cerda-Cristerna BI, Chavarria-Bolaños D, Flores-Reyes H, Pozos-Guillen A.

Date: 01/2013
Journal: IEJ


  • To evaluate the effect of preoperative oral ibuprofen (IBU) on the success of inferior alveolar nerve blocks (IANBs) with mepivacaine containing 1 : 100 000 epinephrine for patients with symptomatic irreversible pulpitis (SIP).


  • N= 50 (2 groups)
  • Exclusion criteria: Pregnant patients, allergy to NSAIDs or mepivacaine, altered sensation syndromes or history of previous sensation alteration, ingestion of food 1 h before the study, poor tooth integrity for rehabilitation and illegal drug ingestion.
  • Inclusion criteria: >18 years, good health, no intake of medicaments for 12 h prior to treatment, SIP of mand posterior tooth. Prolonged moderated to severe pain (>10 s) according to Heft-Parker scale.
  • Positive/negative control: Gelatin administration
  • Control & Design: Double blind RCT. Patients assigned sequential numbers in order of enrollment and assigned according to randomization table. Patients received identical capsules w/either 600mg ibuprofen or gelatin 1 hour prior to administration of IANB w/2% Mepivacaine w/1:100k Epi. After 15 minutes, three-step exam done to evaluate lip numbness, cold testing, and discomfort during endo access. One blinded administrator conducted diagnosis/injection. Another independent investigator evaluated effects of treatment.
  • Criteria of evaluation: Absence of pain during exam and procedure


  • After IANB, all patient reported lip numbness
  • IANB success rates for Ibuprofen group were 72%, for the placebo group 36%
  • At 24 hrs, 4 patients reported moderate-severe pain (1 IBU, 3 PLA)
  • At 48 hrs, no patients reported pain.

Clinical Significance:

Preoperative oral administration of IBU 1 hour prior could improve the efficacy of mepivacaine IANB in patients with symptomatic irreversible pulpitis.