***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This study compared preoperative administration of acetaminophen or a combination of acetaminophen and ibuprofen versus placebo for potential increased effectiveness of inferior alveolar nerve ( IAN ) block anesthesia . There were 40 patients with irreversible pulpitis r and omly assigned to a drug or placebo group . Thirty minutes after ingestion of medication , an IAN block was administered . A cold test was done 15 minutes after the block , and if the patients had no sensitivity , endodontic therapy was initiated . If the patient had no pain on access , the IAN was recorded as successful . If the patient had sensitivity to cold or to the access procedure , it was recorded as a failure . Overall success was 60 % for all three groups . Success was 71.4 % for the acetaminophen group , 75.9 % for the acetaminophen and ibuprofen group , and 46.2 % for the placebo group . There was no significant difference between the groups ; however , there was a trend toward higher success in the medication groups Objectives : This study was done to compare the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine with that of 2 % lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in m and ibular posterior teeth . Material and Methods : Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics , K.D. Dental College , r and omly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4 % articaine with 1:100,000 epinephrine or 2 % lidocaine with 1:80,000 epinephrine . After the patient ’s subjective assessment of lip anesthesia , the  absence/presence of pulpal anesthesia through electric pulp stimulation  was recorded and the absence/presence of pain was recorded through visual analogue scale . Results : The pulpal anesthesia success for articaine ( 76 % ) was slightly more than with lidocaine ( 58 % ) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine ( 88 % ) was slightly more than that of lidocaine ( 82 % ) although the difference between the two solutions was not statistically significant . Conclusions : Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block . Key words : Anesthesia , articaine , lignocaine , pulpitis AIM This r and omized double-blinded controlled trial was performed to compare the efficacy of inferior alveolar nerve block ( IANB ) injection for m and ibular first molar teeth with irreversible pulpitis with or without supplementary buccal infiltration and intraligamentary injection . METHODOLOGY Eighty-two patients with asymptomatic irreversible pulpitis received either a combination of intraligamentary injection + buccal infiltration+ IANB or with traditional IANB injection in m and ibular first molar teeth with irreversible pulpitis . Each patient recorded their pain score on a Heft-Parker visual analogue scale before commencing treatment , in response to a cold test 15 min after the design ated anaesthetic injection , during access cavity preparation and during root canal instrumentation . No or mild pain at any stage was considered a success . Data were analysed by chi-square test . RESULTS At the final stage of treatment , 69 of the 82 patients were eligible to be included in the study . No significant difference was found between age ( P = 0.569 ) and gender ( P = 0.570 ) amongst the patients in the two groups . The success rate of anaesthesia in the IANB and the combination groups were 22 % and 58 % , respectively . The success rate of anaesthesia in the combination group was significantly higher than the traditional IANB injection ( P = 0.003 ) . CONCLUSION A combination of anaesthetic techniques can improve the success rate of anaesthesia for m and ibular first molar teeth with irreversible pulpitis AIM To compare the anaesthetic efficacy of inferior alveolar nerve blocks ( IANB ) with 1.8 mL of 2 % lidocaine ( LI ) to a buccal infiltration ( BI ) with 1.8 mL of 4 % articaine ( AR ) , both with 1 : 100 000 epinephrine , in patients with symptomatic irreversible pulpits in a r and omized controlled trial . METHODOLOGY Volunteers presenting at the Emergency Centre ( FOP-UNICAMP ) were r and omly divided into two groups ( 30 for AR and 20 for LI ) . Operator and patient were not blinded . Success was recorded when complete pain-free treatment was achieved after a single injection ( IANB or BI ) or when one supplemental injection was needed for emergency endodontic procedures . Success rate of supplemental injection was evaluated between and within groups using Fisher 's exact test and chi-square test . RESULTS A higher success rate ( P = 0.03/Fisher 's exact test ) was observed with AR ( 40 % ) than with LI ( 10 % ) . No significant difference was found when a single injection plus one supplemental injection was compared between groups ( P = 1.0 ; AR = 70 % ; LI = 80 % ) . However , supplemental injection increased the anaesthetic success rates ( AR , P = 0.04 ; LI , P = 0.0001 ) within groups . CONCLUSIONS Single anaesthesia techniques ( IANB or BI ) were not able to achieve pain-free emergency endodontic treatment .  Supplemental anaesthetic techniques should be considered prior to treatment procedures in order to increase success rate ( consort : registration number - NCT01912755/Fapesp : # 2009/10834 - 4 ) INTRODUCTION Achieving anesthesia in m and ibular molar teeth with irreversible pulpitis is very difficult . The aim of this study was to compare the efficacy of 1.8 mL and 3.6 mL articaine for an inferior alveolar nerve  block ( IANB ) when treating molars with symptomatic irreversible pulpitis . METHODS In a r and omized , double-blind clinical trial , 82 first m and ibular molar teeth with symptomatic irreversible pulpitis r and omly received conventional IANB injection either with 1 ( 1.8 mL ) or 2 cartridges ( 3.6 mL ) of 4 % articaine with 1:100,000 epinephrine . The patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft-Parker visual analog scale . No or mild pain was considered as successful anesthesia . Data were analyzed by t and chi-square tests . RESULTS Eighty patients were eligible to participate in this study , which showed that 3.6 mL articaine provided a significantly higher success rate ( 77.5 % ) of IANBs compared with 1.8 mL of the same anesthetic solution ( 27.5 % ) although neither group had 100 % successful anesthesia ( P < .001 ) . CONCLUSIONS Increasing the volume of articaine provided a significantly higher success rate of IANBs in m and ibular first molar teeth with symptomatic irreversible pulpitis , but it did not result in 100 % anesthetic success The purpose of the present study was to compare the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine with that of 2 % lidocaine with 1:100,000 epinephrine during pulpectomy in patients with irreversible pulpitis in m and ibular posterior teeth . Forty volunteers , patients with irreversible pulpitis admitted to the Emergency Center of the School of Dentistry at the University of São Paulo , r and omly received a conventional inferior alveolar nerve block containing 3.6 mL of either 4 % articaine with 1:100,000 epinephrine or 2 % lidocaine with 1:100,000 epinephrine . During the subsequent pulpectomy , we recorded the patients ' subjective assessment s of  lip anesthesia  , the  absence/presence of pulpal anesthesia through electric pulp stimulation  , and the  absence/presence of pain through a verbal analogue scale . All tested patients reported lip anesthesia after the application of either inferior alveolar nerve block . Regarding pulpal anesthesia success as measured with the pulp tester , the lidocaine solution had a higher success rate ( 70 % ) than the articaine solution ( 65 % ) . For patients reporting none or mild pain during pulpectomy , the success rate of the articaine solution ( 65 % ) was higher than that of the lidocaine solution ( 45 % ) . Yet , none of the observed differences between articaine and lidocaine were statistically significant . Apparently , therefore , both local anesthetic solutions had similar effects on the patients with irreversible pulpitis in m and ibular posterior teeth . Neither of the solutions , however , result ed in an effective pain control during irreversible pulpitis treatments INTRODUCTION Profound pulpal anesthesia in posterior m and ibular teeth with irreversible pulpitis usually requires administering an inferior alveolar nerve block ( IANB ) plus other supplemental injections . The purpose of this prospect i ve , r and omized , double-blind study was to compare the anesthetic success rate of buccal infiltration injections of articaine and lidocaine when supplemented with an IANB . METHODS One hundred twenty-five emergency patients who had their first or second m and ibular molar diagnosed with irreversible pulpitis participated in the study and received the IANB by using either 2 % lidocaine with 1:100,000 epinephrine or 4 % articaine with 1:100,000 epinephrine . One hundred two of the patients reported moderate-to-severe pain upon initiation of their endodontic treatment or through filing of their tooth canals and received supplemental buccal infiltration injections by using the same anesthetic that the IANB had been performed . After the block or the supplemental buccal infiltration injections , success was achieved with no or mild pain during instrumentation of the tooth canals . RESULTS The success rate after the administration of the infiltration injections after an incomplete IANB by using lidocaine was 29 % , whereas by using articaine it was 71 % ( P < .001 ) . No statistical differences were detected in the success rates between the 2 anesthetics after the block injections . CONCLUSIONS Supplementing an incomplete articaine IANB with articaine infiltration raises the anesthetic success more effectively compared with lidocaine in m and ibular molars with irreversible pulpitis The purpose of this prospect i ve , r and omized , double-blind , placebo-controlled study was to determine the effect of preoperative oral administration of ibuprofen or dexamethasone on the success rate of  inferior alveolar nerve block  ( IANB ) in patients with symptomatic irreversible pulpitis . Seventy-eight patients with irreversible pulpitis were r and omly divided into 3 groups ( 26 per group ) and given one of the following at 1 hr prior to performing local anesthesia : a placebo ; 400 mg ibuprofen ; or 4 mg dexamethasone . Each patient recorded their pain level on a visual analog scale before taking the medication or placebo , at 15 min after completion of IANB , and during treatment if pain occurred . The success of the anesthesia was defined as no or mild pain at any stage during the endodontic procedure . The success rate of the IANB was 38.5 , 73.1 , and 80.8 % with the placebo , ibuprofen , and dexamethasone , respectively . Both ibuprofen and dexamethasone were significantly more effective than the placebo . No significant difference was observed , however , between the two experimental medications in terms of effectiveness . The results of the present study suggest that premedication with ibuprofen or dexamethasone increases the success rate of an IANB in patients with symptomatic irreversible pulpitis in the m and ibular molars PURPOSE To evaluate the efficacy of local anesthesia using tramadol hydrochloride ( HCl ) with versus without adrenaline in the extraction of upper molar teeth . PATIENTS AND METHODS This was a double-blinded study that included 100 patients who required extraction of 1 upper molar by the conventional method and were allocated r and omly into 1 of 2 groups : in group A ( n = 50 ) , each patient received an initial dose of drug A ( tramadol HCl 50 mg and adrenalin 0.0225 mg diluted to 1.8 mL by distilled water ) ; in group B ( n = 50 ) , each patient received an initial dose of drug B ( tramadol HCl 50 mg diluted to 1.8 mL by distilled water ) . Degree of pain during tooth extraction , duration of surgery , and total number of cartridges used were recorded intraoperatively . Postoperatively , patients were instructed to record any adverse effects , such as nausea or vomiting , on the first day of the operation . RESULTS There were significant differences in the number of cartridges used and the degree of intraoperative pain . However , there was no significant difference in duration of surgery or side effects . CONCLUSIONS The results of this study suggest that tramadol HCl in combination with adrenaline can be used as an alternative local anesthetic in 
    Output:
    
It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of m and ibular anesthetic effect in irreversible pulpitis .