The Anesthetic Efficacy of Articaine and Lidocaine in Equivalent Doses as Buccal and Non-Palatal Infiltration for Maxillary Molar Extraction: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trial

Abstract

The purpose of the present study was to evaluate the anesthetic adequacy of 4% articaine 1.8mL versus 2% lidocaine 3.6mL without palatal injection compared with the standard technique for the extraction of maxillary molar teeth. This randomized, double-blinded, placebo-controlled clinical trial included patients requiring extraction of 1 maxillary molar under local anesthesia. Patients were randomly distributed into 1 of 3 groups: group A received 4% articaine 1.8mL as a buccal injection and 0.2mL as a palatal injection, group B received 4% articaine 1.8mL plus normal saline 0.2mL as a palatal injection, and group C received 2% lidocaine 3.6mL plus normal saline 0.2mL as a palatal injection. Pain was measured during injection, 8minutes afterward, and during extraction using a visual analog scale. Initial palatal anesthesia and patients' satisfaction were measured using a 5-score verbal rating scale. Statistical analyses included descriptive statistics, analysis of variance, and Pearson χ2 test. Differences with a P value less than .05 were considered significant. Eighty-four patients were included in the study. The average pain of injection was comparable among all study groups (P=.933). Pain during extraction in the articaine group was significantly less than that experienced in the placebo groups (P<.001), although the differences between placebo groups were insignificant. Satisfaction scores were significantly higher in the articaine group compared with the placebo groups (P<.001), with comparable results between placebo groups. Although the anesthetic effects of single placebo-controlled buccal injections of 4% articaine and 2% lidocaine were comparable, the level of anesthetic adequacy was statistically less than that achieved by 4% articaine given by the standard technique. These results do not justify the buccal and non-palatal infiltration of articaine or lidocaine as an effective alternative to the standard technique in the extraction of maxillary molar teeth.