4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: a randomized clinical study

• Published in: International endodontic journal Vol. 48; no. 2; pp. 145 - 152
• Main Authors: Monteiro, M. R. F. P., Groppo, F. C., Haiter-Neto, F., Volpato, M. C., Almeida, J. F. A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-02-2015
• Subjects: Adult; Anesthesia, Dental - methods; Anesthetics, Local - administration & dosage; articaine; Carticaine - administration & dosage; Dentistry; Emergencies; Female; Humans; lidocaine; Lidocaine - administration & dosage; Male; Mandible; Mandibular Nerve; Molar - surgery; Nerve Block - methods; Pain Measurement; Prospective Studies; pulpitis; Pulpitis - surgery; Root Canal Therapy - methods; Treatment Outcome; articaine; pulpitis; lidocaine
• ISSN: 0143-2885; 1365-2591
• DOI: 10.1111/iej.12293

Aim
To compare the anaesthetic efficacy of inferior alveolar nerve blocks (IANB) with 1.8 mL of 2% lidocaine (LI) to a buccal infiltration (BI) with 1.8 mL of 4% articaine (AR), both with 1 : 100 000 epinephrine, in patients with symptomatic irreversible pulpits in a randomized controlled trial.
Methodology
Volunteers presenting at the Emergency Centre (FOP‐UNICAMP) were randomly divided into two groups (30 for AR and 20 for LI). Operator and patient were not blinded. Success was recorded when complete pain‐free treatment was achieved after a single injection (IANB or BI) or when one supplemental injection was needed for emergency endodontic procedures. Success rate of supplemental injection was evaluated between and within groups using Fisher's exact test and chi‐square test.
Results
A higher success rate (P = 0.03/Fisher's exact test) was observed with AR (40%) than with LI (10%). No significant difference was found when a single injection plus one supplemental injection was compared between groups (P = 1.0; AR = 70%; LI = 80%). However, supplemental injection increased the anaesthetic success rates (AR, P = 0.04; LI, P = 0.0001) within groups.
Conclusions
Single anaesthesia techniques (IANB or BI) were not able to achieve pain‐free emergency endodontic treatment. Supplemental anaesthetic techniques should be considered prior to treatment procedures in order to increase success rate (consort: registration number – NCT01912755/Fapesp: #2009/10834‐4).