Comparative evaluation of anesthetic efficacy of 4% articaine and 2% lidocaine for buccal infiltration in adult patients with irreversible pulpitis of maxillary first molar: A prospective randomized study

Buccal versus buccal palatal infiltration for pulpal anesthesia using 2% lidocaine and 4% articaine: A randomized controlled trial

Background

The inability in achieving complete pulpal anesthesia with standard buccal infiltration especially in cases with SIP used for maxillary teeth. The study aimed to compare the anesthetic efficacy of buccal and buccal plus palatal infiltration technique using 2% lidocaine and 4% articaine in permanent maxillary first molars with the diagnosis of symptomatic irreversible pulpitis (SIP).

Material and method

One hundred and twenty-three patients with clinical diagnosis of SIP, aged 18-50 years were randomly allocated to three treatment groups (N = 41). Group 1(BIL): Buccal infiltration technique using 2% lidocaine with 1:80,000 adrenaline. Group 2(BPIL): combination of buccal plus palatal infiltration using 2% Lidocaine with 1:80,000 adrenaline. Group 3(BIA): Buccal infiltration using 4% articaine with 1:100,000 adrenaline. Pain intensity of patients were recorded before and after the administration of local anesthesia during endodontic procedure that is during caries removal, access preparation and pulp removal using Heft-Parker Visual Analog Scale (HP-VAS). Success was defined by "no pain (0 mm)" or "mild pain (0-54 mm)" during endodontic procedure. The anesthetic efficacy rates were analyzed using chi-square tests, age differences using one-way ANOVA.

Results

The final analysis included total of 117 patients. Higher success was observed in group II (85%) in comparison to group I (69%) and group III (74%), but the difference was statistically nonsignificant (p > 0.05). Our results demonstrated a nonsignificant difference between genders in all three groups (p > 0.05).

Conclusion

The use of buccal plus palatal infiltration and 4% articaine can provide effective anesthesia as standard buccal infiltration and 2% lidocaine for patients with SIP in maxillary first molars.

Success of Pulpal Anesthesia Following Buccal Infiltration of the Maxillary First Molar With 1.8 mL and 3.6 mL of 4% Articaine With 1:100,000 Epinephrine: A Prospective, Randomized Crossover Study

OBJECTIVE

The purpose of this prospective, randomized crossover study was to compare the peak incidence of success, onset, and incidence over time of pulpal anesthesia in maxillary first molars following a buccal infiltration of 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine.

METHODS

A total of 118 adults received 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine via buccal infiltration of the maxillary first molar at 2 separate appointments. Electric pulp testing (EPT) of the maxillary first molar was performed over 68 minutes.

RESULTS

There was no significant difference in the peak incidence of anesthetic success (85% and 92%, respectively) in the maxillary first molar between 1.8 mL and 3.6 mL. The difference in onset times (4.5 min for 1.8 mL vs 4.4 min for 3.6 mL) was not statistically significant. However, the 3.6-mL volume did produce a significantly higher incidence of pulpal anesthesia from minutes 48 to 68 compared with the 1.8-mL volume.

CONCLUSION

There was no significant difference in peak incidence or onset of pulpal anesthesia in the maxillary first molar between 1.8 mL and 3.6 mL of articaine with epinephrine. The incidence of pulpal anesthesia was significantly higher with 3.6 mL of articaine at 48 minutes and beyond, but neither volume provided complete pulpal anesthesia for all subjects that lasted at least 60 minutes.

Pulpal anesthesia of maxillary first molars using 4% articaine infiltration in patients with symptomatic irreversible pulpitis: a randomized controlled clinical trial

OBJECTIVES

This study aimed to compare the anesthetic efficacy of 1.8 mL (one cartridge) and 3.6 mL (two cartridges) buccal infiltration and buccal plus palatal infiltration of 4% articaine in maxillary first molar teeth with symptomatic irreversible pulpitis.

MATERIALS AND METHODS

This randomized single-blind clinical trial was conducted on 45 patients with symptomatic irreversible pulpitis of maxillary first molars (Trial Registration No: IRCT2015011020238N2_2015). The patients were randomly divided into three groups (n = 15) for buccal infiltration of 1.8 mL articaine plus 1:100,000 epinephrine (group 1), buccal infiltration of 3.6 mL articaine (group 2), and buccal infiltration of 1.8 mL articaine plus palatal infiltration of 0.5 mL articaine (group 3). The pain intensity was measured by the Heft-Parker visual analog scale (VAS) during injection and during access cavity preparation. No pain or mild pain during treatment was considered as successful anesthesia. Data were analyzed by the Tukey's post hoc test.

RESULTS

The three groups had a significant difference in frequency of the perceived pain during injection (P = 0.01). A higher volume of 4% articaine and injection of articaine in both buccal and palatal sides provided a significantly higher anesthesia success rate (P = 0.049 and P < 0.01, respectively). The highest success rate was recorded in group 3 (93.33%) followed by group 2 (80%) and then group 1 (53.33%).

CONCLUSIONS

Increasing the administered volume of 4% articaine with 1:100,000 epinephrine and addition of palatal infiltration to buccal infiltration of articaine can significantly increase the success of anesthesia in maxillary first molars with symptomatic irreversible pulpitis.

CLINICAL RELEVANCE

Achieving deep anesthesia in teeth with irreversible pulpitis is a critical parameter in management of patients who are in urgent need of root canal treatments.