Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block

BACKGROUND: The authors conducted a prospective, randomized, double-blind, crossover study comparing the degree of pulpal anesthesia achieved by means of mandibular first molar buccal infiltrations of two anesthetic solutions: 4 percent articaine with 1:100,000 epinephrine and 2 percent lidocaine with 1:100,000 epinephrine after an inferior alveolar nerve (IAN) block with the use of 4 percent articaine with 1:100,000 epinephrine. METHODS: Seventy-three blinded adult subjects randomly received buccal infiltrations at the first molar site with a cartridge of 4 percent articaine with 1:100,000 epinephrine at one appointment and a cartridge of 2 percent lidocaine with 1:100,000 epinephrine at another appointment after receiving a standard IAN block with the use of 4 percent articaine with 1:100,000 epinephrine in a crossover design. After the injections, the authors used an electric pulp tester to test the first molar for anesthesia in three-minute cycles for 60 minutes. They considered anesthesia to be successful when two consecutive 80 readings were obtained within 10 minutes of the IAN block and infiltration injection, and the 80 reading was sustained continuously through the 60th minute. RESULTS: The authors found that with the use of the 4 percent articaine formulation, successful pulpal anesthesia occurred 88 percent of the time for the first molar. With the 2 percent lidocaine formulation, successful pulpal anesthesia occurred 71 percent of the time. The results show a significant difference (P < .05) between the articaine and lidocaine formulations. CONCLUSION AND CLINICAL IMPLICATIONS: For a mandibular buccal infiltration of the first molar after a standard IAN block, 4 percent articaine with 1:100,000 epinephrine resulted in a higher success rate (88 percent) than did 2 percent lidocaine with 1:100,000 epinephrine (71 percent success rate).     

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.     

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.     

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.     

Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study

This randomized crossover double-blind trial compared the efficacy of buccal infiltration with 4% articaine and 2% lidocaine (both with 1:100,000 epinephrine) in securing mandibular first molar pulp anesthesia. Injections were given at least 1 week apart in 31 healthy adult volunteers. Electronic pulp testing was undertaken at baseline and at 2 minute intervals until 30 minutes postinjection. A successful outcome was recorded in the absence of pulp sensation on two consecutive maximal pulp tester stimulations (80 muA). 64.5% of articaine and 38.7% of lidocaine infiltrations were successful (p = 0.008). Articaine infiltration produced significantly more episodes of no response to maximum stimulation in first molars than lidocaine (236 and 129, respectively, p < 0.001). Mandibular buccal infiltration is more effective with 4% articaine with epinephrine compared to 2% lidocaine with epinephrine. Both injections were associated with mild discomfort.     

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.     

A comparison of articaine and lidocaine for inferior alveolar nerve blocks

The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks. Using a crossover design, inferior alveolar nerve blocks were randomly administered, in a double-blind manner, using 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine, at two separate appointments, to 57 subjects. A pulp tester was used to test for anesthesia, in 4-min cycles for 60 min, of the molars, premolars, central, and lateral incisors. Anesthesia was considered successful when two consecutive 80 readings were obtained within 15 min and the 80 reading was continuously sustained for 60 min. Using the articaine solution, successful pulpal anesthesia ranged from 4 to 54% from the central incisor to the second molar. Using the lidocaine solution, successful pulpal anesthesia ranged from 2 to 48%. There was no significant difference (p > 0.05) between the articaine and lidocaine solutions. We concluded that 4% articaine with 1:100,000 epinephrine was similar to 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks.     

A Prospective,Randomized, Double-blind Comparison of 2% Lidocaine With 1:100,000 and 1:50,000 Epinephrine and 3% Mepivacaine for Maxillary Infiltrations

IntroductionThe purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1:100,000 and 1:50,000 epinephrine and 3% mepivacaine in maxillary lateral incisors and first molars.MethodsSixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine at three separate appointments spaced at least 1 week apart. The teeth were pulp tested in 3-minute cycles for a total of 60 minutes.Results and ConclusionsAnesthetic success and the onset of pulpal anesthesia were not significantly different between 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine and 3% mepivacaine for the lateral incisor and first molar. Increasing the epinephrine concentration from 1:100,000 to 1:50,000 in a 2% lidocaine formulation significantly decreased pulpal anesthesia of short duration for the lateral incisor but not the first molar. For both the lateral incisor and first molar, 3% mepivacaine significantly increased pulpal anesthesia of short duration compared with 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine.     

A prospective, randomized, double-blind comparison of bupivacaine and lidocaine for maxillary infiltrations

The purpose of this prospective, randomized, double-blind study was to evaluate the anesthetic efficacy of 1.8 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1.8 mL of 2% lidocaine with 1:100,000 epinephrine in maxillary lateral incisors and first molars. Sixty-five subjects randomly received, in a double-blind manner, two infiltrations at two separate appointments, in a crossover design. The injections consisted of maxillary lateral incisor and first molar infiltrations of 1.8 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1.8 mL 2% lidocaine with 1:100,000 epinephrine. In maxillary lateral incisors, bupivacaine exhibited a significantly lower anesthetic success rate (obtaining two consecutive 80 readings with the pulp tester within 10 minutes) of 78% when compared with a 97% success rate with lidocaine. In maxillary first molars, bupivacaine's onset of pulpal anesthesia (7.7 minutes) was significantly slower than lidocaine (4.3 minutes). Bupivacaine had a lower success rate than lidocaine (64% versus 82%) but there was no significant difference between the two solutions. Neither solution provided pulpal anesthesia for 1 hour.     

Anesthetic efficacy of a combination palatal and buccal infiltration of the maxillary first molar

Introduction

The purpose of this prospective, randomized, single-blind crossover study was to evaluate the anesthetic efficacy of a combination palatal and buccal infiltration of the maxillary first molar.

Materials and Methods

Using a crossover design, 40 subjects received two sets of maxillary first molar infiltrations at two separate appointments spaced at least 1 week apart. The anesthetic used in this study was 2% lidocaine with 1:100,000 epinephrine. One set of infiltrations consisted of a buccal infiltration of 1.8 mL of anesthetic and a palatal infiltration of 0.5 mL of anesthetic. The other set consisted of a buccal infiltration of 1.8 mL of anesthetic and a mock palatal infiltration. The first molar was pulp tested in 4-minute cycles for a total of 60 minutes. Anesthetic success was defined as no subject response to two consecutive 80 readings with an electric pulp tester.

Results and Conclusions

The success rates were 88% for the buccal infiltration and 95% for the buccal plus palatal infiltration. The difference was not statistically significant. The buccal plus palatal infiltration significantly increased the incidence of pulpal anesthesia from 21 minutes through 57 minutes. Although there was an increased incidence of pulpal anesthesia with the combination buccal plus palatal infiltration, anesthesia was not provided for 60 minutes.     

A Prospective,Randomized, Double-blind Comparison of the Anesthetic Efficacy of Two Percent Lidocaine with 1:100,000 and 1:50,000 Epinephrine and Three Percent Mepivacaine in the Intraoral,Infraorbital Nerve Block

IntroductionThe purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine in the intraoral, infraorbital nerve block.MethodsForty subjects randomly received intraoral, infraorbital nerve blocks by using a cartridge of 2% lidocaine with 1:100,000 or 1:50,000 epinephrine and a cartridge of 3% mepivacaine at 3 separate appointments spaced at least 1 week apart. The anteriors, premolars, and first molar were pulp tested in 4-minute cycles for a total of 60 minutes.Results and ConclusionsThe intraoral, infraorbital nerve block was ineffective in providing profound pulpal anesthesia of the maxillary central incisor, lateral incisor, and first molar. Successful pulpal anesthesia of the canine and first and second premolars ranged from 75%–92% by using 2% lidocaine with 1:100,000 and 1:50,000 epinephrine. However, pulpal anesthesia did not last for 60 minutes. The use of 3% mepivacaine provided a shorter duration of anesthesia than the lidocaine formulations with epinephrine in the canines and premolars.     

Anesthetic efficacy of 1.8 mL versus 3.6 mL of 4% articaine with 1:100,000 epinephrine as a primary buccal infiltration of the mandibular first molar

Introduction

No study has compared 1.8 mL and 3.6 mL 4% articaine with 1:100,000 epinephrine in a mandibular buccal infiltration of the first molar. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 1.8 mL and 3.6 mL 4% articaine with 1:100,000 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 1.8 mL or 3.6 mL 4% articaine with 1:100,000 epinephrine in two separate appointments. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 90 minutes after the injections.

Results

Compared with the 1.8-mL volume of 4% articaine with 1:100,000 epinephrine, the 3.6-mL volume showed a statistically higher success rate (70% vs 50%).

Conclusions

The anesthetic efficacy of 3.6 mL 4% articaine with 1:100,000 epinephrine is better than 1.8 mL of the same anesthetic solution in a primary mandibular buccal infiltration of the first molar. However, the success rate of 70% is not high enough to support its use as a primary injection technique in the mandibular first molar.     

A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations

The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in maxillary lateral incisors and first molars. Eighty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of one cartridge of 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine at two separate appointments spaced at least 1 week apart. In maxillary lateral incisors, articaine exhibited a significantly higher anesthetic success rate of 88% when compared with a 62% success rate with lidocaine. In maxillary first molars, articaine had a similar success rate to lidocaine (78% vs 73%), and there was no significant difference between the two solutions. In conclusion, a maxillary infiltration of 4% articaine with 1:100,000 epinephrine statistically improved anesthetic success when compared with 2% lidocaine with 1:100,000 epinephrine in the lateral incisor but not in the first molar.     

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.     

A Comparison of the Anesthetic Efficacy of Articaine and Lidocaine in Patients with Irreversible Pulpitis

The purpose of the present study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine with that of 2% lidocaine with 1:100,000 epinephrine during pulpectomy in patients with irreversible pulpitis in mandibular posterior teeth. Forty volunteers, patients with irreversible pulpitis admitted to the Emergency Center of the School of Dentistry at the University of São Paulo, randomly received a conventional inferior alveolar nerve block containing 3.6 mL of either 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine. During the subsequent pulpectomy, we recorded the patients' subjective assessments of lip anesthesia, the absence/presence of pulpal anesthesia through electric pulp stimulation, and the absence/presence of pain through a verbal analogue scale. All tested patients reported lip anesthesia after the application of either inferior alveolar nerve block. Regarding pulpal anesthesia success as measured with the pulp tester, the lidocaine solution had a higher success rate (70%) than the articaine solution (65%). For patients reporting none or mild pain during pulpectomy, the success rate of the articaine solution (65%) was higher than that of the lidocaine solution (45%). Yet, none of the observed differences between articaine and lidocaine were statistically significant. Apparently, therefore, both local anesthetic solutions had similar effects on the patients with irreversible pulpitis in mandibular posterior teeth. Neither of the solutions, however, resulted in an effective pain control during irreversible pulpitis treatments.     

Anesthetic Efficacy of a Combination of 4% Prilocaine/2% Lidocaine with Epinephrine for the Inferior Alveolar Nerve Block: A Prospective,Randomized, Double-blind Study

Introduction

Prilocaine plain has a high pH and concentration (4%), which could decrease the pain of injection and increase success. The purpose of this study was to compare pain associated with anesthetic solution deposition and the degree of pulpal anesthesia obtained with the combination of prilocaine and lidocaine versus a lidocaine and lidocaine combination when used for inferior alveolar nerve blocks (IANBs).

Articaine for Supplemental Buccal Mandibular Infiltration Anesthesia in Patients with Irreversible Pulpitis When the Inferior Alveolar Nerve Block Fails

The purpose of this prospective study was to determine the anesthetic efficacy of the supplemental buccal infiltration injection of a cartridge of 4% articaine with 1:100,000 epinephrine in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve (IAN) block failed. Fifty-five emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an IAN block and had moderate to severe pain on endodontic access. An infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine was administered buccal to the tooth requiring endodontic treatment. Success of the infiltration injection was defined as no pain or mild pain on endodontic access or instrumentation. The results showed that anesthetic success was obtained in 58% of the mandibular posterior teeth. We can conclude that when the IAN block fails to provide profound pulpal anesthesia, the supplemental buccal infiltration injection of a cartridge of 4% articaine with 1:100,000 epinephrine would be successful 58% of the time for mandibular posterior teeth in patients presenting with irreversible pulpitis. Unfortunately, the modest success rate would not provide predictable pulpal anesthesia for all patients requiring profound anesthesia.     

A comparison of the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block

BackgroundThe efficacy of the extraoral infraorbital nerve block has not been studied sufficiently to ensure its appropriate clinical use. To compare the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block, the authors conducted a prospective, randomized crossover study.MethodsForty adult participants randomly received extraoral infraorbital nerve blocks of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine at one appointment and intraoral infraorbital nerve blocks of 1.8 mL of 2 percent lidocaine with 1:100,000 epinephrine at another appointment in a crossover design. After administering the injections, the authors used an electric pulp tester to assess the maxillary central and lateral incisors, canine, premolars and first molar for pulpal anesthesia in four-minute cycles for 60 minutes. They considered anesthesia to be successful when the participant had no response to two consecutive 80 readings (the maximum output) with the electric pulp tester.ConclusionsThe authors found that the extraoral and intraoral infraorbital nerve blocks were ineffective in providing profound pulpal anesthesia of the maxillary central incisor (15 percent success rate) and lateral incisor (22 percent success rate). The pulpal anesthesia success rate was 92 percent for the canine for both types of nerve blocks, 80 to 90 percent for first and second premolars and 65 to 70 percent for the first molar, with no significant differences (P < .05) between the two nerve blocks. Pulpal anesthesia did not last for an hour in any of the teeth. Needle insertion pain and postoperative sequelae were more common after the extraoral infraorbital nerve block was administered.Clinical ImplicationsBoth nerve blocks would be ineffective in the central and lateral incisors. Both nerve blocks would be somewhat successful in the canine and premolars but not in the first molar.     

Onset and duration periods of articaine and lidocaine on maxillary infiltration.

OBJECTIVES: The aim of this study was to compare the onset and duration of pulpal anesthesia by maxillary infiltration using 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. METHOD AND MATERIALS: Twenty healthy patients randomly received 1.8 mL of one of the three local anesthetics during operative dentistry procedures of low complexity on three maxillary posterior teeth. Onset and duration were determined using an electric pulp tester. RESULTS: The mean values for pulpal onset were 2.8, 1.6, and 1.4 minutes and for pulpal duration were 39.2, 56.7, and 66.3 minutes, respectively, for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. Statistical analysis by the Kruskal-Wallis nonparametric test showed significant differences with better results (shorter onset and longer duration periods) for both articaine solutions compared with the lidocaine solution. Although 4% articaine with 1:100,000 epinephrine clinically presented the shortest onset and the longest duration periods, there was no statistically significant difference between the articaine solutions. CONCLUSION: Both articaine solutions produced shorter onset and longer duration of pulpal anesthesia by maxillary infiltration than the lidocaine solution did. Statistical analysis did not confirm better clinical results of 4% articaine with 1:100,000 epinephrine than with 4% articaine with 1:200,000 epinephrine.     

Anesthetic efficacy of the palatal-anterior superior alveolar injection

BACKGROUND: A single palatal-anterior superior alveolar, or P-ASA, injection has been reported to provide pulpal anesthesia of the four maxillary incisors and usually the canines. The authors conducted a prospective, randomized, double-blind study to compare the anesthetic efficacy of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine using a computer-assisted injection system to administer the P-ASA injection. MATERIALS AND METHODS: In a double-blind manner, the authors used a crossover design to administer randomly P-ASA injections of 1.4 milliliters of the lidocaine solution and 1.4 mL of the mepivacaine solution using the computer-assisted injection system at two appointments to 40 subjects. They used a pulp tester to test for anesthesia of the central incisors, lateral incisors and canines in four-minute cycles for 72 minutes. Anesthesia was considered successful when two consecutive maximum readings (80 readings) with the pulp tester were obtained. RESULTS: For the lidocaine solution, successful pulpal anesthesia ranged from 32 to 58 percent for the six anterior teeth. For the mepivacaine solution, successful pulpal anesthesia ranged from 22 to 38 percent. Except for the left canine, the lidocaine solution was significantly more likely to result in pulpal anesthesia than the use of the mepivacaine solution. The duration of pulpal anesthesia, for both solutions, declined steadily over 72 minutes. CONCLUSIONS AND CLINICAL IMPLICATIONS: Using the computer-assisted injection system for the P-ASA injection, we concluded that the rather modest-to-low success rates of the lidocaine and mepivacaine solutions would not ensure predictable pulpal anesthesia of the four maxillary incisors and the canines.