Comparison of anesthetic efficacy of 2 and 4% articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial.

Abstract

The purpose of this clinical prospective, randomized, double-blind trial was to compare the anesthetic efficacy of 2% articaine and 4% articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth. In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2% articaine (group I) and, in 52 cases, 4% articaine (group II) was administered. The primary objective was to analyze the differences of anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min)), as well as in length of soft tissue anesthesia (min), were evaluated. Additionally, the need of a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analyzed. Anesthesia was sufficient for dental extractions in both groups without significant differences (p=0.201). The onset of anesthesia did not differ significantly (p=0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9 vs. 4h; p<0.001). There was no significant difference in the need for a second injection (p=0.359), in injection pain (p=0.386), as well as in pain during (p=0.287) or after treatment (p=0.121). In both groups, no complications were seen. The local anesthetic effect of the 4% articaine solution is not significantly better when compared to 2% articaine. For mandibular tooth extraction, articaine 2% may be used as alternative as well.