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.

Nazanin Zargar,Alireza Akbarzadeh Baghban,Elnaz Shooshtari,Leila Pourmusavi,Hengameh Ashraf,Ardavan Parhizkar,Jian-Guo Zhou

doi:10.1155/2021/6668738

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.

Highlights

In endodontology, pain management in intra- and postoperative stages of treatment is an important element in gaining success [1]
All patients had a vital mandibular first and/or second molar diagnosed with irreversible pulpitis. e molar teeth had no spontaneous pain; they showed positive response to the electric pulp test (EPT) and exhibited prolonged moderate to severe pain to the cold test with Endo ice (1,1,1,2-tetrafluoroethane; Hygenic Corp, Akron, OH)
Seventy-six patients, with a mandibular first or second molar diagnosed with irreversible pulpitis, showed lip numbness after IANB injection. 10 (13.5%) IANB were successful, 6 with articaine (60%) and 4 with lidocaine (40%)

Summary

Introduction

Pain management in intra- and postoperative stages of treatment is an important element in gaining success [1]. A study reported the success rates of ∼37% and ∼62% for infiltration injection after an ineffective IANB in teeth with irreversible pulpitis using lidocaine and articaine, respectively [27].

Results

Conclusion