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.
Key Words
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Article info
Publication history
Published online: February 04, 2018
Identification
Copyright
© 2018 American Association of Endodontists.
