Anesthetic Efficacy of Articaine and Lidocaine for Incisive/Mental Nerve Block

Abstract 

Introduction

The incisive/mental nerve block (IMNB) could be an alternative to the inferior alveolar nerve block in the mandibular anterior teeth. The effectiveness of articaine has not been tested in IMNB.

Methods

This prospective randomized double-blind crossover study compared the anesthetic efficacy of 0.6 mL 4% articaine and 2% lidocaine, both with 1:100.000 epinephrine administered as IMNB to 40 volunteers in two sessions. Pulpal anesthesia of lateral incisor through premolars was tested with an electric pulp tester. The injection and postoperative pain were evaluated by using visual analog scales. The onset (time from the end of injection to the absence of pulpal response) and duration of pulpal anesthesia (time recorded before two positive responses to the pulp tester) and the anesthesia success (two consecutive readings of 80 without response and onset ≤10 minutes) were measured.

Results

Articaine provided a higher success rate (p < 0.001) of anesthesia than lidocaine for the lateral incisor (32.5%), the canine (55%), and the first (72.5%) and second (80%) premolars and a faster onset (p < 0.05) for canine and increased duration (p < 0.05) of anesthesia for premolars. The median duration of premolars anesthesia was 10 and 20 minutes, respectively, with lidocaine and articaine. There were no differences in pain scores between the solutions (p > 0.05).

Conclusions

Articaine promoted higher anesthesia success and longer duration of anesthesia than lidocaine for most of the teeth after IMNB although anesthesia success could be considered clinically appropriated only for premolars. The volume of local anesthetic used in the present study may not be appropriate for procedures lasting longer than 10 minutes.

Key Words: Articaine, incisive/mental nerve block, lidocaine, local anesthetics