Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis: A Prospective,Randomized, Double-blind Clinical Trial

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.

Anesthetic Comparisons of 4% Concentrations of Articaine,Lidocaine, and Prilocaine as Primary Buccal Infiltrations of the Mandibular First Molar: A Prospective Randomized,Double-blind Study

Introduction

Studies have shown the superiority of 4% articaine with 1:100,000 epinephrine over 2% lidocaine with 1:100,000 epinephrine when used as a primary buccal infiltration of the mandibular first molar. A study using other 4% anesthetic formulations may help determine the role of concentration in the increased efficacy of 4% articaine. The authors conducted a prospective randomized, double-blind, crossover study comparing the pulpal anesthesia obtained with 4% concentrations of articaine, lidocaine, and prilocaine formulations as primary buccal infiltrations of the mandibular first molar.

Methods

Sixty asymptomatic adult subjects randomly received a primary mandibular buccal first molar infiltration of 1.8 mL 4% articaine with 1:100,000 epinephrine, 4% lidocaine with 1:100,000 epinephrine, and 4% prilocaine with 1:200,000 epinephrine in 3 separate appointments. An electric pulp tester was used to test the first molar for anesthesia in 3-minute cycles for 60 minutes after the infiltrations. Successful anesthesia was defined as 2 consecutive 80/80 readings.

Results

The success rate for the 4% articaine formulation was 55%, 33% for the 4% lidocaine formulation, and 32% for the 4% prilocaine formulation. There was a significant difference between articaine and both lidocaine (P = .0071) and prilocaine (P = .0187) formulations.

Conclusions

A 4% articaine formulation was statistically better than both 4% lidocaine and 4% prilocaine formulations for buccal infiltration of the mandibular first molar in asymptomatic mandibular first molars. However, the success rate of 55% is not high enough to support its use as a primary buccal infiltration technique in the mandibular first molar.     

Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial

Introduction

The study was designed as a randomized double-blind trial to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in inferior alveolar nerve block (IANB) and infiltration anesthetic techniques to anesthetize mandibular molars with irreversible pulpitis.

Methods

The study was composed of 2 test arms and 1 control arm. Subjects in the test arms received either a standard IANB or a buccal infiltration (B Infil) of 4% articaine with 1:100,000 epinephrine, whereas the subjects in the control arm received a standard IANB of 2% lidocaine with 1:100,000 epinephrine. Subject’s self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anesthetic administration during access preparation and pulp extirpation.

Results

For statistical analysis Pearson χ², Student's paired t test, 1-way analysis of variance, and Friedman tests showed no significant difference in success rates among the 3 arms of the trial.

Conclusions

Although B Infil and IANB of 4% articaine were equally effective, B Infil can be considered a viable alterative in IANB for pulpal anesthesia in mandibular molars with irreversible pulpitis.     

Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial

Introduction

Previous studies have reported that it is difficult to obtain proper anesthesia in mandibular molars with symptomatic irreversible pulpitis, and supplemental injections are usually unavoidable. The aim of the present study was to determine the anesthetic efficacy of articaine in mandibular first molars with symptomatic irreversible pulpitis with 3 injection methods: an inferior alveolar nerve block (IANB), an IANB with an intraligamentary injection, and an IANB with buccal infiltration before initiating the endodontic treatment.

Anesthetic Efficacy of Gow-Gates Nerve Block,Inferior Alveolar Nerve Block,and Their Combination in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective,Randomized Clinical Trial

Introduction

The purpose of this prospective, randomized clinical trial was to evaluate the anesthetic efficacy of the Gow-Gates nerve block (GGNB), the inferior alveolar nerve block (IANB), and their combination for mandibular molars in patients with symptomatic irreversible pulpitis.

Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis

Introduction

The inferior alveolar nerve block (IANB) has a poor success rate in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of ketorolac and dexamethasone infiltration along with standard IANB on the success rate.

Methods

Ninety-four adult volunteers who were actively experiencing pain participated in this prospective, randomized, double-blind study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive any supplemental infiltrations (control). Twenty-four patients received supplemental buccal infiltration of 4% articaine with 1:100,000 ephinephrine, and 24 patients received supplemental buccal infiltration of 1 mL/4 mg of dexamethasone. It was planned to give supplemental buccal infiltration of 1 mL/30 mg of ketorolac tromethamine in 26 patients, but the first 2 patients experienced severe injection pain after ketorlac infiltration and were excluded from the study. In the subsequent patients, 0.9 mL of 4% articaine was infiltrated before injecting ketorolac. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft-Parker visual analog scale. Success was recorded as none or mild pain.

Results

Statistical analysis was done by using nonparametric χ² tests. Control IANB gave 39% success rate. Buccal infiltration of articaine and articaine plus ketorolac significantly increased the success rate to 54% and 62%, respectively (P < .05). Supplementary dexamethasone infiltration gave 45% success rate, which was insignificant with control IANB.

Conclusions

Articaine and ketorolac infiltration can increase the success rate of IANB in patients with irreversible pulpitis. None of the tested techniques gave 100% success rate.     

An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars

We compared the anesthetic efficacy of inferior alveolar nerve blocks (IANBs) with that of buccal infiltrations (BIs) in mandibular first molars. Using a crossover design, all subjects received a standard IANB or a BI of 1.7 mL of 4% articaine with 1:100,000 adrenaline (Septanest; Septodont, Saint-Maru-des-Fosses, France) on two appointments separated by at least 1 week. Pulpal anesthesia was determined by using an electric pulp tester. Electric pulp testing was repeated at 5, 8, 11, 15, 20, 25, and 30 minutes after the injections. Anesthesia was considered successful if the subject did not respond to the maximum output of the pulp tester at two or more consecutive time points. Fifty-four percent of the BI and 43% of the IANB were successful; the difference was not significant (p = 0.34). The onset of pulpal anesthesia was significantly faster with BI (p = 0.03). In conclusion, BI with 4% articaine for mandibular first molars can be a useful alternative for clinicians because compared with IANB it has a faster onset and a similar success rate.     

Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block

Aim  To compare mandibular tooth pulpal anaesthesia and reported discomfort following lidocaine inferior alveolar nerve block (IANB) with and without supplementary articaine buccal infiltration.
Methodology  In this prospective randomized double-blind cross-over study, thirty-six healthy adult volunteers received two IANB injections of 2 mL lidocaine 2% with epinephrine 1 : 80 000 over two visits. At one visit, an infiltration of 2 mL of articaine 4% with epinephrine 1 : 100 000 was administered in the mucobuccal fold opposite a mandibular first molar. At the other visit, a dummy injection was performed. Injection discomfort was recorded on 100 mm visual analogue scales. Pulpal anaesthesia of first molar, premolar, and lateral incisor teeth was assessed with an electronic pulp tester until 45 min post-injection. A successful outcome was recorded in the absence of sensation on two or more consecutive maximal pulp tester stimulations. Data were analysed using McNemar and Student's t -tests.
Results  The IANB with supplementary articaine infiltration produced more success than IANB alone in first molars (33 volunteers vs. 20 volunteers respectively, P  < 0.001), premolars (32 volunteers vs. 24 volunteers respectively, P  = 0.021) and lateral incisors (28 volunteers vs. 7 volunteers respectively, P  < 0.001). Buccal infiltration with articaine or dummy injection produced less discomfort than IANB injection ( t  = 4.1, P  < 0.001; t  = 3.0, P  = 0.005 respectively).
Conclusions  The IANB injection supplemented with articaine buccal infiltration was more successful than IANB alone for pulpal anaesthesia in mandibular teeth. Articaine buccal infiltration or dummy buccal infiltration was more comfortable than IANB.     

EFFICACY OF 4% ARTICAINE BUCCAL INFILTRATION VERSUS INFERIOR ALVEOLAR NERVE BLOCK FOR MANDIBULAR MOLARS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objectives:To compare the anesthetic efficacy of buccal infiltration (BI) using 4% articaine vs 4% articaine or 2% lidocaine inferior alveolar nerve block (IANB) for mandibular molars with symptomatic irreversible pulpitis.Methods:PubMed, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov were searched using MESH terms and specific keywords. Included articles were Randomized Clinical Trials (RCTs), which compared 4% articaine BI vs conventional IANB in terms of the efficacy of pulpal anesthesia and success rate. The quality assessment of included studies was done according to the Cochrane risk of bias assessment tool. Studies were quantitatively assessed using fixed or random effect models.Results:Out of 756 articles, 5 RCT studies were included with a total number of 500 patients: 231 in 4% articaine BI group, 150 in 2% lidocaine IANB group, and 119 in 4% articaine IANB group. Our meta-analysis results showed that patients anesthetized with 4% articaine BI had a similar success rate compared to 2% lidocaine IANB [pooled RD: 0.14 (95% CI, -0.01 to 0.29); P = .08]. Similarly, there was non-significant difference when compared to 4% articaine IANB [RD:-0.01 (95% CI, -0.13 to 0.11; P = .86)]. Patients anesthetized with 4% articaine BI presented comparable pain scores compared to IANB (4% articaine or 2% lidocaine) [pooled MD: -0.14 (95% CI, -0.38 to 0.11); P = .27]. Regarding quality assessment, 3 studies were considered to have a low risk of bias, one study has an unclear risk of bias, and one study has a high risk of bias.Conclusion:4% articaine BI showed comparable results in terms of pain relief and success rate in comparison with 2% lidocaine IANB or 4% articaine IANB. However, due to the limited number and small sample size of included studies, these findings should be considered carefully, and further studies are required to confirm our findings.     

Articaine infiltration for anesthesia of mandibular first molars

A randomized, controlled trial of 31 healthy volunteers compared 4% articaine with 1:100,000 epinephrine buccal infiltration to buccal plus lingual infiltration of the same dose of drug in achieving pulpal anesthesia of mandibular first molar teeth. Data were compared with efficacy of an inferior alveolar nerve block using 2% lidocaine 1:80,000 epinephrine in a cohort of 27 of the volunteers. Anesthesia was determined using electronic pulp testing. Buccal and buccal plus lingual infiltrations of articaine with epinephrine did not differ in efficacy in obtaining pulpal anesthesia for mandibular permanent first molars (p = 0.17). Efficacy of 4% articaine with epinephrine infiltrations for first molar pulp anesthesia was similar to that of an IANB using lidocaine with epinephrine over a 30-minute study period (96 and 80 episodes of no response to maximal stimulation respectively, p = 0.097). Subjective tooth numbness was more common after IANB than buccal infiltration (p = 0.005). The discomfort of buccal infiltration with articaine was volume dependent (p = 0.017) and similar to that of an IANB.     

Anesthetic efficacy of 4% Articaine with 1:100,000 epinephrine versus 4% articaine with 1:200,000 epinephrine as a primary buccal infiltration in the mandibular first molar

Introduction

No study has compared 4% articaine with 1:100,000 epinephrine with 4% articaine with 1:200,000 epinephrine in a mandibular buccal infiltration of the first molar. The authors conducted a prospective, randomized, double-blind, crossover study comparing the degree of pulpal anesthesia obtained with 4% articaine with 1:100,000 epinephrine and 4% articaine with 1:200,000 epinephrine as a primary infiltration in the mandibular first molar.

Methods

Eighty-six asymptomatic adult subjects randomly received a primary mandibular buccal first molar infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine and a cartridge of 4% articaine with 1:200,000 epinephrine in 2 separate appointments. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 60 minutes after the injections.

Results

The two 4% articaine formulations showed no statistically significant difference when comparing anesthetic success, onset of anesthesia, or incidence of pulpal anesthesia.

Conclusions

The anesthetic efficacy of 4% articaine with 1:200,000 epinephrine is comparable to 4% articaine with 1:100,000 epinephrine in a primary mandibular buccal infiltration of the first molar.     

A Prospective,Randomized Single-blind Evaluation of Effect of Injection Speed on Anesthetic Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

Introduction

Speed of injection may affect the solution spread in the pterygomandibular space. It was hypothesized that speed of injection will affect the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis.

Methods

Fifty-nine adult volunteers who were actively experiencing pain participated in this prospective, randomized, single-blind study. The patients were divided into 2 groups on a random basis and received either slow or rapid IANB with 3.6 mL of 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated after 15 minutes of the initial IANB. Pain during treatment was recorded by using the Heft-Parker visual analogue scale. The primary outcome measure, and the definition of success, was the ability to undertake pulp access and canal instrumentation with no or mild pain (Heft-Parker visual analog scale score < 55 mm). Secondary outcome measure was the solution deposition pain. Statistical analysis was performed by using Mann-Whitney U test and χ² test.

Results

Slow and rapid injections gave 43% and 51% success rates, respectively. The difference was statistically insignificant. Slow injections produced less solution deposition pain than rapid injections.

Conclusions

Rate of injection has no effect on anesthetic success of IANB, but slow injections were more comfortable than rapid injections.     

Anesthetic Efficacy of 4 % Articaine During Extraction of the Mandibular Posterior Teeth by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques

Introduction

The study was designed to evaluate the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth.

Methods

This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale.

Results

Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94 %, whereas by using IANB with the same anesthetic it was 92 %. No statistical differences were detected in the success rates between the two anesthetic techniques (P = 0.15).

Conclusions

Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.

     

Comparative Evaluation of the Efficacy of 2% Lidocaine Containing 1:200,000 Epinephrine with and without Hyaluronidase (75 IU) in Patients with Irreversible Pulpitis

Introductions

The purpose of this study was to determine the anesthetic efficacy of lidocaine containing epinephrine compared with lidocaine containing epinephrine plus hyaluronidase (75 IU) when performing an inferior alveolar nerve block.

Methods

Patients complaining of pain in the mandibular posterior teeth were selected. Based on their chief complaint, proper clinical and radiographic examinations were performed. Among them, 40 subjects diagnosed with irreversible pulpitis were selected. The inferior alveolar nerve block was induced using 3 mL 2% lidocaine with epinephrine. Hyaluronidase (75 IU) or a placebo was injected 30 minutes after the beginning of pulpal anesthesia (randomized and double-blind trial). The duration of the effect in the pulpal and gingival tissues was evaluated by the response to painful electrical stimuli applied to the adjacent premolar and by mechanical stimuli (pinprick) to the buccal gingiva, respectively.

Results

In both pulpal and gingival tissues, the duration of the anesthetic effects with hyaluronidase was longer than with placebo.

Conclusions

Hyaluronidase increased the duration of the effects of lidocaine in inferior alveolar nerve blocks.     

Effect of a Combination of Nitrous Oxide and Intraligamentary Injection on the Success of the Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

IntroductionThe purpose of this prospective study was to determine the effect of a combination of nitrous oxide/oxygen and 1 set of supplemental intraligamentary/periodontal ligament (PDL) injections followed by a second set of PDL injections on anesthetic success in patients with symptomatic irreversible pulpitis (SIP).MethodsNinety-four patients with a mandibular posterior tooth diagnosed with SIP received nitrous oxide/oxygen and an inferior alveolar nerve block (IANB) with 2% lidocaine with 1:100,000 epinephrine. Patients rated the pain of PDL injections and endodontic access on a visual analog scale. If moderate to severe pain was felt during treatment, the operator administered 1 set of supplemental PDL injections with 4% articaine with 1:100,000 epinephrine. If moderate to severe pain was felt again during treatment, the operator administered a second set of supplemental PDL injections. Anesthetic success was defined as having no to mild pain during endodontic treatment.ResultsThe success of the IANB with nitrous oxide was 44% (95% confidence interval [CI], 34%–54%). The overall anesthetic success rate (IANB with PDL injections) was increased from 69% (95% CI, 60%–78%) with 1 set of PDL injections to 80% (95% CI, 72%–88%) with a second set of PDL injections.ConclusionsAlthough the second set of PDL injections increased anesthetic success, it was not sufficient to ensure complete pulpal anesthesia.     

Anesthetic Efficacy of Supine and Upright Positions for the Inferior Alveolar Nerve Block: A Prospective,Randomized Study

Introduction

It has been recommended to place patients in an upright position after administration of an inferior alveolar nerve block (IANB), theoretically allowing the anesthetic to diffuse in an inferior direction and resulting in better pulpal anesthesia. The purpose of this study was to compare an upright versus a supine position on the success of pulpal anesthesia when an IANB was administered in asymptomatic teeth.

Anesthetic Efficacy of Supplemental Buccal and Lingual Infiltrations of Articaine and Lidocaine after an Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis

IntroductionThe success rate of inferior alveolar nerve block (IANB) decreases in patients with irreversible pulpitis. It was hypothesized that supplemental infiltration of lidocaine and articaine may improve the success rates.MethodsEighty-four adult volunteers, actively experiencing pain, participated in this prospective, randomized, double-blinded study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive supplemental infiltrations (control). Thirty patients received supplemental buccal and lingual infiltrations of 2% articaine with 1:200,000 epinephrine, and 30 patients received buccal and lingual infiltrations of 2% lidocaine with 1:200,000 epinephrine at 2 minutes after the IANB. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft Parker visual analog scale. Success was recorded as “none” or “mild” pain.ResultsStatistical analysis using nonparametric McNemer tests showed that supplemental buccal and lingual infiltration of 2% lidocaine with 1:200,000 epinephrine or 4% articaine with 1:200,000 epinephrine improved the success rate from 33% to 47% and 67%, respectively. Also the success rate with 4% articaine with 1:200,000 epinephrine was significantly more than 2% lidocaine with 1:200,000 epinephrine (p < 0.05).ConclusionsAlthough supplemental buccal and lingual infiltrations of 4% articaine or 2% lidocaine increased the success rate of the inferior alveolar nerve block in patients with irreversible pulpitis, none of the techniques provided acceptable success rates.     

Effects of Epinephrine on Lidocaine Pharmacokinetics and Blood Volume in the Dental Pulp

Introduction

Epinephrine potentiates and prolongs the efficacy of local anesthetics by reducing blood flow. We investigated the effect of epinephrine on the pharmacokinetics of lidocaine and the pulpal blood volume after maxillary infiltration anesthesia in rats.

Methods

We measured the ¹⁴C-radioactivity and ¹⁴C-distribution in the maxilla and the dental pulp after the injection of 2% ¹⁴C-lidocaine with or without 10 μg/mL epinephrine (n = 7) into the palatine mucosa proximal to the first molar. The blood volume in the pulp was measured using ^99mTc-pertechnetate (n = 5).

Results

When lidocaine was injected together with epinephrine, the lidocaine became widely distributed throughout the maxilla and was observed mainly in the first molar pulp. The lidocaine amount in the dental pulp at 10–60 minutes was more than 2 times higher than that after the injection of lidocaine alone. The relative pulpal blood volume after 20 minutes decreased to 63.1% of the value after the injection of lidocaine alone.

Conclusions

We found that lidocaine had infiltrated into the molar pulp after infiltration anesthesia. Furthermore, our results suggested that epinephrine augmented the retention of lidocaine in the pulp.     

Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis

IntroductionSeveral strategies have been investigated for achieving successful pulpal anesthesia during endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. However, comprehensive evaluation and identification of the most efficacious and safe intervention are lacking. We aimed to determine this using network meta-analysis.MethodsMEDLINE, Embase, Cochrane Central, CINAHL, and Scopus databases were searched. Study selection and data extraction were performed in duplicate. Eligible randomized controlled trials were meta-analyzed to estimate the treatment effects (odd ratios [ORs]; 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. CINeMA software (University of Bern, Bern, Switzerland) was used to assess the quality of results.ResultsThirty-seven interventions from 46 studies were identified. Compared with the common practice of an inferior alveolar nerve block with 2% lidocaine, a supplemental intraosseous injection was ranked the most efficacious with very low to moderate confidence (2% lidocaine + preoperative nonsteroidal anti-inflammatory drugs [NSAIDs] + acetaminophen [OR = 74; 95% CrI, 15–470; SUCRA = 97%], 2% lidocaine + preoperative NSAIDs [OR = 46; 95% CrI, 8–420; SUCRA = 94%], 2% lidocaine [OR = 33; 95% CrI, 14–80; SUCRA = 93%], 2% lidocaine + preoperative opioids + acetaminophen [OR = 20; 95% CrI, 4.4–98; SUCRA = 86%], and 4% articaine [OR = 20; 95% CrI, 6.3–96; SUCRA = 87%]) followed by supplemental buccal and lingual infiltrations using 4% articaine + preoperative NSAIDs (OR = 18; 95% CrI, 6–56; SUCRA = 86%; very low confidence). No major safety concerns were reported.ConclusionsVery low- to moderate-quality evidence suggests intraosseous injection using 2% lidocaine with 1:100,000 epinephrine or 4% articaine with 1:100,000 epinephrine or buccal and lingual infiltrations of 4% articaine with 1:100,000 epinephrine are superior strategies to achieve pulpal anesthesia during endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Preoperative NSAIDs or opioids with or without acetaminophen may increase the efficacy of these injections.     

Efficacy of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system

OBJECTIVE: The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of the intraligamentary injection of 4% articaine with 1:100,000 epinephrine and of 2% lidocaine with 1:100,000 epinephrine, administered with computer-controlled local anesthetic delivery system, in mandibular posterior teeth. STUDY DESIGN: Using a crossover design, intraligamentary injections of 1.4 mL of 4% articaine with 1:100,000 epinephrine and of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine were randomly administered with a computer-controlled local anesthetic delivery system, in a double-blind manner on the mesial and distal aspects of a mandibular first molar, at 2 separate appointments to 51 subjects. A pulp tester was used to test for anesthesia, in 2-minute cycles for 60 minutes, of the mandibular first and second molars and second premolar. Anesthesia was considered successful when 2 consecutive 80 readings (highest output) were obtained within 20 minutes. RESULTS: Successful pulpal anesthesia was obtained 86% of the time for the first molar using the articaine solution and 74% of the time using the lidocaine solution. There were no significant differences (P > .05) between the articaine and lidocaine solutions. The mean onset times of pulpal anesthesia for the first molar were 1.3 minutes with articaine solution and 2.2 minutes with lidocaine solution. Duration of pulpal anesthesia for the first molar was 34 minutes for the articaine solution and 31 minutes for the lidocaine solution. CONCLUSION: The efficacy of 4% articaine with 1:100,000 epinephrine was similar to the efficacy of 2% lidocaine with 1:100,000 epinephrine for intraligamentary injections.