Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis: A Prospective, Randomized, Double-blind Clinical Trial
Abstract
Introduction
Profound
pulpal anesthesia is difficult to achieve in mandibular molars with
irreversible pulpitis (IP). However, there are no published randomized
controlled clinical trials comparing the success of supplemental buccal
infiltration (BI) in mandibular first versus second molars with IP. The
purpose of this prospective, randomized, double-blind study was to
compare the efficacy of 4% articaine with 2% lidocaine for supplemental
BIs in mandibular first versus second molars with IP after a failed
inferior alveolar nerve block (IANB). This study's sample was combined
with data from a previous trial.
Methods
One
hundred ninety-nine emergency subjects diagnosed with IP of a
mandibular molar were selected and received an IANB with 4% articaine.
Subjects who failed to achieve profound pulpal anesthesia, determined by
a positive response to cold or pain upon access, randomly received 4%
articaine or 2% lidocaine as a supplemental BI. Endodontic access was
begun 5 minutes after infiltration. Success was defined as less than
mild pain during endodontic access and instrumentation on the
Heft-Parker visual analog scale.
Results
There
was a 25% IANB success rate with 4% articaine. The success rate for
articaine supplemental BI in first molars was 61% versus 63% for
second molars (P > .05). The success of lidocaine in first molars was 66%, but for second molars it was 32% (P = .004).
Conclusions
The
success rate for IANB with 4% articaine was 25%. Articaine and
lidocaine had similar success rates for supplemental infiltration in
first molars, whereas articaine was significantly more successful for
second molars. However, because BI often did not provide profound pulpal
anesthesia, additional techniques including intraosseous anesthesia may
still be required.
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