Comparative evaluation of anesthetic efficacy of 1.8 mL and 3.6 mL of articaine in irreversible pulpitis of the mandibular molar: A randomized clinical trial

Abstract

Objective The aim of this study was to compare the anesthetic efficacy of two volumes of articaine in conventional inferior alveolar nerve block (IANB) of mandibular molars with irreversible pulpitis, and in cases of anesthetic failure, its complementation with periodontal ligament injection (PDL). Methods Ninety patients with irreversible pulpitis in mandibular molars received conventional IANB with 1.8 mL or 3.6 mL of 4% articaine with 1:100,000 epinephrine. In cases of IANB failure, the same volumes were administered in the PDL. Presence of pulpal anesthesia and absence/presence of pain during pulpectomy were evaluated by electric pulp stimulation and verbal analogue scale, respectively. Relative risks (RR) with corresponding 95% confidence intervals (95% CI) were calculated for each outcome. Results 27% and 42% of the patients achieved pulpal anesthesia following IANB with 1.8 mL and 3.6 mL, respectively (RR = 0.63, CI 95% 0.35 to 1.14, p = 0.12). Analgesia during pulpectomy was present in 64% and 73% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.87, CI 95% 0.66 to 1.16, p = 0.36). In cases of IANB failure, 75% and 42% of the patients that received 1.8 mL and 3.6 mL of PDL injection, respectively, achieved pulpal anesthesia (RR = 1.80, CI 95% 0.87 to 3.72, p = 0.11). During a new attempt at the pulpectomy procedure, analgesia was present in 69% and 75% of the patients, respectively, for 1.8 mL and 3.6 mL (RR = 0.91, CI 95% 0.57 to 1.45, p = 0.71). Conclusion Increasing the volume from 1.8 mL to 3.6 mL of the 4% articaine with 1:100,000 epinephrine in the IANB and in the PDL, did not significantly increase the success rate of pulpal anesthesia and clinical analgesia during the pulpectomy procedure. Therefore, both volumes presented a similar efficacy, though neither resulted in effective pain control during irreversible pulpitis treatment. Trial registration ClinicalTrials.gov NCT02422823 .

Comparing the anaesthetic efficacy of 1.8 mL and 3.6 mL of anaesthetic solution for inferior alveolar nerve blocks for teeth with irreversible pulpitis: a systematic review and meta‐analysis with trial sequential analysis

“…2015), whereas one used a verbal analogue scale (Silva et al . 2019). Among the four trials, two were conducted in Iran (Parirokh et al .…”

“…2012) and another in Brazil (Silva et al . 2019). All trials were published between 2010 and 2019 and all included only mandibular molars.…”

“…2015, Silva et al . 2019). The assessment of risk of bias of the included trials is shown in Table 2.…”

“…2015, Silva et al . 2019), whereas one was categorized as having ‘some concerns’ in regard to risk of bias (Aggarwal et al . 2012) because of bias in the randomization process.…”

“…Conversely, one randomized clinical trial (Silva et al . 2019) and one retrospective study (Fowler & Reader 2013) reported no significant difference in success rates of IANBs when the volume of local anaesthetic solution was increased while treating teeth with irreversible pulpitis. Two systematic reviews concluded that increasing the volume of local anaesthetic solution increased the success rate of IANBs when treating mandibular molars with irreversible pulpitis (Tupyota et al .…”