Anesthetic Efficacy of Articaine for Inferior Alveolar Nerve Blocks in Patients with Irreversible Pulpitis

Abstract

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.

Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial

“…Conventional inferior alveolar nerve block (IANB) is the most commonly used technique for achieving pulpal anesthesia in posterior mandibular endodontic procedures (1)(2)(3). However, IANB has a high failure rate (1,3) and success rates are even lower when applied for the treatment of mandibular posterior teeth with irreversible pulpitis (1,(3)(4)(5)(6).…”

“…These reports have generally compared local anesthetic solutions to lidocaine (2,(5)(6), which is currently considered the most frequently used anesthetic in dentistry and can be considered as the "gold standard," i.e., the drug to which all local anesthetics are compared (7).…”

“…Articaine was recently introduced to the market and has been extensively studied because of its distinctive molecular characteristics that provide increased liposolubility (8). However, some authors have shown that there is no difference between 2% lidocaine and 4% articaine, both in combination with 1:100,000 epinephrine, in IANB in patients with irreversible pulpitis (2,5). A recent systematic review and meta-analysis concluded that there is a significant advantage when using articaine over lidocaine for supplementary infiltration after mandibular block anesthesia, but no advantage when used for mandibular block anesthesia alone or for maxillary infiltration (9).…”

Comparison of Buccal Infiltration of 4% Articaine With 1 : 100,000 and 1 : 200,000 Epinephrine for Extraction of Maxillary Third Molars With Pericoronitis: A Pilot Study

“…Surgically, the usual treatment is the extraction of the impacted tooth. 1,[11][12][13][14][15] The aim of the present study was to evaluate the differences between articaine hydrochloride with 1 : 100,000 and 1 : 200,000 epinephrine (adrenaline) administered by buccal infiltration alone (without palatal infiltration) for the removal of impacted upper third molar teeth with pericoronitis.…”

Efeitos cardiovasculares da infiltração maxilar da articaína e lidocaína associadas à epinefrina em procedimentos restauradores

“…Em países como a Alemanha e o Canadá, onde existe um rígido controle de qualidade, esta é a formulação anestésica mais utilizada pelos cirurgiões-dentistas (HAAS; LENNON, 1995;WEAVER, 1999) e, recentemente, foi introduzida nos Estados Unidos (MALAMED, 2005;MIKESELL et al, 2005). Por ser um anestésico local de amplo destaque, diversos estudos têm intensificado as comparações de suas propriedades com a precursora lidocaína (BERLIN et al, 2005;CLAFFEY et al, 2004;COSTA et al, 2005c;LEBLANC, 2000;MIKESELL et al, 2005;MOLLER;COVINO, 1994;NUSSTEIN et al, 2004;OLIVEIRA et al, 2004).…”