Abstract
Introduction
Profound pulpal anesthesia in mandibular molars with irreversible pulpitis (IP) is
often difficult to obtain and often requires supplemental injections after an ineffective
inferior alveolar nerve block (IANB). The purpose of this prospective, randomized,
double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for
supplemental buccal infiltrations (BIs) after an ineffective IANB in mandibular molars
with IP. In addition, the use of articaine for IANB and intraosseous injections was
investigated.
Methods
One hundred emergency patients diagnosed with IP of a mandibular molar were selected
and received an IANB with 4% articaine. All injections were 1.7 mL with 1:100,000
epinephrine. All patients reported profound lip numbness after IANB. Patients with
ineffective IANB (positive pulpal response to cold or pain on access) randomly received
4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was initiated
5 minutes after deposition of the infiltration solution. Success was defined as no
pain or no more than mild pain during endodontic access and instrumentation as measured
on a visual analogue scale.
Results
Seventy-four patients failed to achieve pulpal anesthesia after IANB with 4% articaine,
resulting in IANB success rate of 26%. Success rates for supplemental BIs were 62%
for articaine and 37% for lidocaine (P < .05). This effect was most pronounced in second molars (P < .05).
Conclusions
Supplemental BI with articaine was significantly more effective than lidocaine. The
IANB success rate of 4% articaine confirmed published data.
Key Words
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Article info
Publication history
Published online: February 10, 2014
Identification
Copyright
© 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.
