Efficacy of Articaine Versus Lidocaine, as a Buccal Infiltration Combined With Intraligamentary Injection, in Mandibular Molars With Irreversible Pulpitis- A Clinical Trial Study

Abstract

BACKGROUND Pain should be controlled before dental procedure, which is an essential step in reducing anxiety and fear. Local anaesthesia plays an important role in pain control before any endodontic treatment. Most common technique used to anaesthetize mandibular molar teeth during endodontic procedure is inferior alveolar nerve block (IANB) technique with 2% lidocaine. 1 METHODS 60 patients diagnosed with irreversible pulpitis of mandibular molar were selected, and were given buccal infiltration combined with intraligamentary injection by either 4% articaine (1:100000 epinephrine) or 2% lidocaine (1:80000 epinephrine) with 30 patients in each group. Endodontic access will be initiated 5 mintues after the deposition of infiltration and intraligamentary injection technique. Success will be defined as no pain or no more than mild pain before treatment, during endodontic access and instrumentation which will be measured on visual analogue scale. The Mann Whitney test was used to compare anaesthesia success between the groups.

Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis

“…VAS was used to assess the outcome in all studies except that the verbal analogue scale was applied by Allegretti et al (2016) and the study by Tortamano et al (2013) calculated the onset of pulpal anaesthesia in minutes. Overall, post-intervention results showed improvements in the intervention groups based on the outcome parameters (Gao & Meng, 2020;Kumar et al, 2020;Ghazalgoo et al, 2018;Lokhande et al, 2019;Martínez-Martínez, Freyle-Granados & Senior-Carmona, 2018;Shapiro et al, 2018;Aggarwal, Singla & Miglani, 2017;Umesh, 2017;Hosseini et al, 2016;Saraf et al, 2016;Zain et al, 2016;Monteiro et al, 2015;Rajput et al, 2015;Ahmad et al, 2014;Nabeel, Ahmed & Sikander, 2014;Rogers et al, 2014;Sood, Hans & Shetty, 2014;Ashraf et al, 2013;Tortamano et al, 2013;Kanaa, Whitworth & Meechan, 2012a;Kanaa, Whitworth & Meechan, 2012b;Aggarwal et al, 2011;Poorni et al, 2011).…”

“…All included studies were unicentric trials published between 2011 and 2020. Of the 26 studies, 10 studies (Kumar et al, 2020;Aggarwal et al, 2019;Lokhande et al, 2019;Aggarwal, Singla & Miglani, 2017;Umesh, 2017;Saraf et al, 2016;Sood, Hans & Shetty, 2014;Subbiya et al, 2011;Aggarwal et al, 2011;Poorni et al, 2011) were conducted in different parts of India, 3 in Iran (Ghazalgoo et al, 2018;Hosseini et al, 2016;Ashraf et al, 2013), Pakistan (Zain et al, 2016;Rajput et al, 2015;Nabeel, Ahmed & Sikander, 2014) and Brazil (Allegretti et al, 2016;Monteiro et al, 2015;Tortamano et al, 2013), 2 in the USA (Shapiro et al, 2018;Rogers et al, 2014), 2 in the UK (Kanaa, Whitworth & Meechan, 2012a;Kanaa, Whitworth & Meechan, 2012b) and one each in China (Gao & Meng, 2020), Colombia (Martínez-Martínez, Freyle-Granados & Senior-Carmona, 2018 and Saudi Arabia (Ahmad et al, 2014). The study design of 24 studies (Gao & Meng, 2020;Kumar et al, 2020;Aggarwal et al, 2019;Ghazalgoo et al, 2018;Martínez-Martínez, Freyle-Granados & Senior-Carmona, 2018;Shapiro et al, 2018; 2017; Umesh, 2017;Allegretti et al, 2016;Hosseini et al, 2016;Saraf et al, 2016;Zain et al, 2016;…”

“…The age of the participants was 15-65 years. The ethical clearance and informed consent were obtained in all except 2 studies (Lokhande et al, 2019;Subbiya et al, 2011). A total of 1,824 teeth with completely formed root apex, diagnosed with symptomatic IP and anaesthetised with either articaine or lidocaine were included in the review, 1,578 mandibular teeth from 22 studies (Gao & Meng, 2020;Kumar et al, 2020;Aggarwal et al, 2019;Ghazalgoo et al, 2018;Martínez-Martínez, Freyle-Granados & Senior-Carmona, 2018;Shapiro et al, 2018;Aggarwal, Singla & Miglani, 2017;Umesh, 2017;Allegretti et al, 2016;Zain et al, 2016;Monteiro et al, 2015;Rajput et al, 2015;Ahmad et al, 2014;Rogers et al, 2014;Sood, Hans & Shetty, 2014;Ashraf et al, 2013;Tortamano et al, 2013;Kanaa, Whitworth & Meechan, 2012b;Subbiya et al, 2011;Aggarwal et al, 2011;Poorni et al, 2011) and 246 maxillary teeth from 4 studies comprised the present meta-analysis (Hosseini et al, 2016;Saraf et al, 2016;Nabeel, Ahmed & Sikander, 2014;Kanaa, Whitworth & Meechan, 2012a) (Table 2).…”

“…In nineteen studies, both the anaesthetic solutions were administered by the same dentist. (Gao & Meng, 2020;Kumar et al, 2020;Ghazalgoo et al, 2018;Lokhande et al, 2019;Martínez-Martínez, Freyle-Granados & Senior-Carmona, 2018;Shapiro et al, 2018;Aggarwal, Singla & Miglani, 2017;Umesh, 2017;Allegretti et al, 2016;Zain et al, 2016;Ahmad et al, 2014;Rogers et al, 2014;Sood, Hans & Shetty, 2014;Ashraf et al, 2013;Kanaa, Whitworth & Meechan, 2012a;Kanaa, Whitworth & Meechan, 2012b;Aggarwal et al, 2011;Poorni et al, 2011) (Table 2).…”

“…The onset of anaesthesia was assessed from the time lapse between the end of NB and the onset of symptoms of subjective anaesthesia, such as the feeling of heaviness at the site of injection and lip numbness, or by electric pulp testing, cold testing, pulp evaluation and canal preparation using a standard digital stop clock. For the mandibular region, 19 studies assessed the success rate of anaesthesia (Gao & Meng, 2020;Kumar et al, 2020;Aggarwal et al, 2019;Ghazalgoo et al, 2018;Lokhande et al, 2019;Martínez-Martínez, Freyle-Granados & Senior-Carmona, 2018;Shapiro et al, 2018;Aggarwal, Singla & Miglani, 2017;Allegretti et al, 2016;Zain et al, 2016;Monteiro et al, 2015;Rajput et al, 2015;Ahmad et al, 2014;Rogers et al, 2014;Sood, Hans & Shetty, 2014;Ashraf et al, 2013;Kanaa, Whitworth & Meechan, 2012b;Subbiya et al, 2011;Aggarwal et al, 2011;Poorni et al, 2011), 4 studies evaluated the postoperative pain (Umesh, 2017;Zain et al, 2016;Rogers et al, 2014;Aggarwal et al, 2011) and 1 study evaluated the mean onset time of anaesthesia (Tortamano et al, 2013). For the maxillary region, the success rate of anaesthesia was reported by 3 studies (Hosseini et al, 2016;Nabeel, Ahmed & Sikander, 2014;Kanaa, Whitworth & Meechan, 2012a), 1 study (Saraf et al, 2016) reported postoperative pain and 2 studies reported (Saraf et al, 2016;Kanaa, Whitworth & Meechan, 2012a) the mean onset time of anaesthesia.…”