Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial.

Carlos E Allegretti,Anna C R T Horliana,Paschoal L Armonia,Rodney G Rocha,Roberta M Sampaio,Isabel Peixoto Tortamano

doi:10.1590/0103-6440201600663

Abstract

Inferior alveolar nerve block has a high failure rate in the treatment of mandibular posterior teeth with irreversible pulpitis. The aim of this study was to compare the anesthetic efficacy of 4% articaine, 2% lidocaine and 2% mepivacaine, all in combination with 1:100,000 epinephrine, in patients with irreversible pulpitis of permanent mandibular molars during a pulpectomy procedure. Sixty-six volunteers from the Emergency Center of the School of Dentistry, University of São Paulo, randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and absence of pain during the pulpectomy procedure were evaluated respectively, by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. All patients reported the subjective signal of lip numbness. Regarding pulpal anesthesia success as measured with the pulp tester, the success rate was respectively 68.2% for mepivacaine, 63.6% for articaine and 63.6% for lidocaine. Regarding patients who reported no pain or mild pain during the pulpectomy, the success rate was, respectively 72.7% for mepivacaine, 63.6% for articaine and 54.5% for lidocaine. These differences were not statistically significant. Neither of the solutions resulted in 100% anesthetic success in patients with irreversible pulpitis of mandibular molars.

Highlights

Conventional inferior alveolar nerve block (IANB) is the most commonly used technique for achieving pulpal anesthesia in posterior mandibular endodontic procedures [1,2,3]
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]
Various clinical studies have attempted to resolve the shortcomings of IANB in patients with irreversible pulpitis

Summary

Introduction

Conventional inferior alveolar nerve block (IANB) is the most commonly used technique for achieving pulpal anesthesia in posterior mandibular endodontic procedures [1,2,3]. Various clinical studies have attempted to resolve the shortcomings of IANB in patients with irreversible pulpitis 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]. Mepivacaine at 3% without a vasoconstrictor in IANB in patients with irreversible pulpitis and mepivacaine proved to be as effective as 2% lidocaine with 1:100,000 epinephrine in achieving pulpal anesthesia of mandibular molars [1]. To the best of authors’ knowledge, no studies have compared mepivacaine and lidocaine at this same concentration (2%), both associated with the same 1:100,000 dose of epinephrine in IANB in patients with irreversible pulpitis. 2% mepivacaine, all in combination with 1:100,000 epinephrine, in the conventional IANB in patients with mandibular molars with irreversible pulpitis. The null hypothesis tested was that there is no difference in the anesthetic efficacy among the three anesthetic solutions

Material and Methods

Findings

Results