Anaesthetic Efficacy of 4% Articaine in Comparison with 2% Lidocaine as Intraligamentary Injections after an Ineffective Inferior Alveolar Nerve Block in Mandibular Molars with Irreversible Pulpitis: A Prospective Randomised Triple-Blind Clinical Trial

Abstract

The objective of the current study was to compare the anaesthetic efficacy of supplemental intraligamentary (IL) injection of 4% articaine with that of 2% lidocaine in the mandibular first and second molars with irreversible pulpitis after an ineffective inferior alveolar nerve block injection (IANB) using the same anaesthetic in a randomised triple-blind clinical trial. Seventy-six adult patients, who were diagnosed with irreversible pulpitis in the mandibular first or second molars, were divided into 2 groups and received IANB randomly. In patients with lip numbness, anaesthesia was evaluated with the cold and electrical pulp (EPT) tests, and if the reported number on EPT was below 100, supplemental IL injection was administered using the same anaesthetic. The teeth were retested after 5 minutes. The Heft–Parker visual analogue scale was used to evaluate pain after IANB and IL injections. Statistical analysis was performed using repeated measures ANOVA, chi-square, and independent-sample and paired-sample t-tests. The results showed that there was no significant difference in the success rates of supplemental IL and IANB injections between articaine and lidocaine. Furthermore, there was no significant difference in the success rates of supplemental IL injection with lidocaine between the mandibular first and second molars. However, there was a significant difference in the success rates of supplemental IL injection with articaine between the mandibular first and second molars. Moreover, supplemental IL injections indicated no significant difference in the anaesthetic efficacy between articaine and lidocaine; nevertheless, they were more effective in the mandibular second molars, especially with articaine.

Anesthetic efficacy of supplemental buccal infiltration versus intraligamentary injection in mandibular first and second molars with irreversible pulpitis: a prospective randomized clinical trial

“…In addition, the chemical structure of articaine with a thiophene ring further improves bone penetration [ 19 ]. Previous studies have shown a higher success rate for BI and IL injection of articaine than for lidocaine [ 20 21 22 ]. Our results showed that the both IL and BI techniques had almost similar success of 80% and 74%, respectively.…”

A Prospective Clinical Study Evaluating the Efficacy of Intra-Ligamentary Anesthetic Solutions in Mandibular Molars Diagnosed as Symptomatic Irreversible Pulpitis with Symptomatic Apical Periodontitis

“…“Heft–Parker Visual Analogue Scale” (HP-VAS) was employed to rank the patient pain and discomfort tendency. The HP-VAS is a 170 mm line split into domains, each describing a certain level of pain [ 14 , 29 ]. After which, based on percussion, palpation, and bite test, a periapical diagnosis was obtained clinically.” Whether the tooth can be restored or not?” was assessed synergistically with bitewing radiographs and clinical findings.…”

“…One of the possible reasons for this could be the failure to locate the lingua [ 8 ]. Furthermore, the literature shows several reports of supplementary injection techniques and solutions in various cases for pain management in irreversible pulpitis patients [ 9 , 10 , 11 , 12 , 13 , 14 ].…”

“…Among the available techniques, intraosseous and intra-ligamentary techniques posed a viable method to increase the success rate of failed IANB [ 19 , 20 ]. The need for specialized devices and their hemodynamic effects on the supplementary intraosseous process made practitioners opt for intra-ligamentary methods to perform painless intraoral procedures [ 9 , 14 ]. Recent studies suggest that supplementary intra-ligament (IL) injection and IANB produced more successful anesthesia.…”

“…Since the level of anesthesia obtained varied from person to person [ 14 , 28 ], the authors took an interest in comparing the efficacy of 2% lidocaine and 4% articaine when used as supplemental intra-ligamentary anesthesia in mandibular molars having symptomatic irreversible pulpitis with symptomatic apical periodontitis. The null hypothesis of the study is that there is no difference in the efficacy of these supplementary intra-ligament injections among patients having symptomatic irreversible pulpitis with apical periodontitis after failed IANB injection in mandibular molars.…”