A Comparison of the Efficacy of 4% Articaine with 1:100,000
Epinephrine and 2% Lidocaine with 1:80,000 Epinephrine
in Achieving Pulpal Anesthesia in Maxillary Teeth Abstract Introduction To assess the efficacy of buccal infiltrations of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine in achieving anesthesia in maxillary teeth with irreversible pulpitis. Methods This randomized double-blind clinical trial included 100 patients diagnosed with irreversible pulpitis in maxillary teeth. Patients received 2.0 mL 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:80,000 epinephrine in the buccal sulcus adjacent to the tooth with pulpitis. Before and every 2 minutes up to a maximum of 10 minutes after injection, the response of the test tooth was assessed using an electronic pulp tester. Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation (80 reading) of the pulp tester during the test period, at which time treatment commenced. Treatment was regarded as being successfully completed when it was associated with no pain. The time to onset of successful pulp anesthesia was recorded for each test tooth. Injection discomfort was recorded on standard 100-mm visual analog scales (VASs). Data were analyzed by the Chi-square and Student t tests. Results Fifty patients received articaine and 50 received lidocaine. Seventy-three of the 100 patients achieved pulpal anesthesia within 10 minutes of injection: 38 after articaine and 35 after lidocaine (P = .5). The onset of pulpal anesthesia after articaine and lidocaine buccal infiltrations was similar (mean and standard deviations: 4.9 2.7 minutes vs 5.1 2.4 minutes, respectively; t = 0.2; P = .82). Pain-free treatment was completed in 33 patients after articaine and 29 after lidocaine buccal infiltrations (P = .63). Although articaine buccal injection was significantly more comfortable than lidocaine buccal injection (t = 2.3, P = .026), both were associated with mild discomfort on VAS (means standard deviation: 10.8 mm 11.7 mm vs 17.5 mm 17.6 mm, respectively). Conclusions There was no significant difference in efficacy between 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine in achieving anesthesia in maxillary teeth with irreversible pulpitis after buccal infiltration.
References 1. Haase, A., Reader, A., Nusstein, J., Beck, M., and Drum, M. Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block.J Am Dent Assoc. 2008; 139: 12281235 2. Jaber, A., Whitworth, J.M., Corbett, I.P., Al-Baqshi, B., Kanaa, M.D., and Meechan, J.G. The efficacy of infiltration anaesthesia for adult mandibular incisors: a randomised double-blind cross-over trial comparing articaine and lidocaine buccal and buccal plus lingual infiltrations. Br Dent J. 2010; 209: E16 3. Robertson, D., Nusstein, J., Reader, A., Beck, M., and McCartney, M. The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc. 2007; 138: 11041112 4. Kanaa, M.D., Whitworth, J.M., Corbett, I.P., and Meechan, J.G. Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomised double-blind cross-over study. J Endod. 2006; 32: 296298 5. Evans, G., Nusstein, J., Drum, M., Reader, A., and Beck, M. A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations. J Endod. 2008; 34: 389393 6. Nusstein, J., Reader, A., Nist, R., Beck, M., and Meyers, W.J. Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis. J Endod. 1998; 24: 487491 7. Srinivasan, N., Kavitha, M., Loganathan, C.S., and Padmini, G. Comparison of anesthetic efficacy of 4% articaine and 2% lidocaine for maxillary buccal infiltration in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009; 107: 133136 8. Costa, C.G., Tortamano, I.P., Rocha, R.G., Francischone, C.E., and Tortamano, N. Onset and duration periods of articaine and lidocaine on maxillary infiltration. Quintessence Int. 2005; 36: 197201 9. Uckan, S., Dayangac, E., and Araz, K. Is permanent maxillary tooth removal without palatal injection possible?.Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 102: 733735 10. Claffey, E., Reader, A., Nusstein, J., Beck, M., and Weaver, J. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod. 2004; 30: 568571 11. Mikesell, P., Nusstein, J., Reader, A., Beck, M., and Weaver, J. A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod. 2005; 31: 265270 12. Sierra Rebolledo, A., Delgado Molina, E., Berini Aytis, L., and Gay Escoda, C. Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars. Med Oral Patol Oral Cir Bucal. 2007; 12: E139E144 13. Tortamano, I.P., Siviero, M., Costa, C.G., Buscariolo, I.A., and Armonia, P.L. A comparison of the anesthetic efficacy of articaine and lidocaine in patients with irreversible pulpitis. J Endod. 2009; 35: 165168 14. Oliveira, P.C., Volpato, M.C., Ramacciato, J.C., and Ranali, J. Articaine and lignocaine efficiency in infiltration anaesthesia: a pilot study. Br Dent J. 2004; 197: 4546 15. McEntire, M., Nusstein, J., Drum, M., Reader, A., and Beck, M. Anesthetic efficacy of 4% articaine with 1:100,000 epinephrine versus 4% articaine with 1:200,000 epinephrine as a primary buccal infiltration in the mandibular first molar. J Endod. 2011; 37: 450454 16. Kaufman, E., Galili, D., and Garfunkel, A. Intraligamental anaesthesia; a clinical study. J Prosth Dent. 1983; 49: 337339 17. Miller, A. A clinical evaluation of the Ligmaject periodontal ligament injection syringe. Dent Update. 1983; 10: 639643 18. Aggarwal, V., Singla, M., and Kabi, D. Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2010; 109: 303308 19. Vahatalo, K., Antila, H., and Lehtinen, R. Articaine and lidocaine for maxillary infiltration anesthesia. Anesth Prog.1993; 40: 114116 20. Collins, S.L., Moore, R.A., and McQuay, H.J. The visual analogue pain intensity scale: what is moderate pain in millimetres?. Pain. 1997; 72: 9597