Pulpal anesthesia of maxillary first molars using 4% articaine infiltration in patients with symptomatic irreversible pulpitis: a randomized controlled clinical trial.

Abstract

This study aimed to compare the anesthetic efficacy of 1.8mL (one cartridge) and 3.6mL (two cartridges) buccal infiltration and buccal plus palatal infiltration of 4% articaine in maxillary first molar teeth with symptomatic irreversible pulpitis. This randomized single-blind clinical trial was conducted on 45 patients with symptomatic irreversible pulpitis of maxillary first molars (Trial Registration No: IRCT2015011020238N2_2015). The patients were randomly divided into three groups (n = 15) for buccal infiltration of 1.8mL articaine plus 1:100,000 epinephrine (group 1), buccal infiltration of 3.6mL articaine (group 2), and buccal infiltration of 1.8mL articaine plus palatal infiltration of 0.5mL articaine (group 3). The pain intensity was measured by the Heft-Parker visual analog scale (VAS) during injection and during access cavity preparation. No pain or mild pain during treatment was considered as successful anesthesia. Data were analyzed by the Tukey's post hoc test. The three groups had a significant difference in frequency of the perceived pain during injection (P = 0.01). A higher volume of 4% articaine and injection of articaine in both buccal and palatal sides provided a significantly higher anesthesia success rate (P = 0.049 and P < 0.01, respectively). The highest success rate was recorded in group 3 (93.33%) followed by group 2 (80%) and then group 1 (53.33%). Increasing the administered volume of 4% articaine with 1:100,000 epinephrine and addition of palatal infiltration to buccal infiltration of articaine can significantly increase the success of anesthesia in maxillary first molars with symptomatic irreversible pulpitis. Achieving deep anesthesia in teeth with irreversible pulpitis is a critical parameter in management of patients who are in urgent need of root canal treatments.