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Title Articaine (4%) Does Not Improve Inferior Alveolar Nerve Block Success Compared to Lidocaine (2%) for Mandibular Molars with Irreversible Pulpitis
Clinical Question For patients with irreversible pulpitis in mandibular molars, is 4% articaine superior to 2% lidocaine in achieving successful anesthesia when administered as an inferior alveolar nerve block?
Clinical Bottom Line Administration of 4% articaine as an inferior alveolar nerve (IAN) block does not result in greater anesthesia success compared to 2% lidocaine when providing endodontic treatment to mandibular molars diagnosed with irreversible pulpitis.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 23228249Ashraf/2013125 patients with irreversible pulpitis of a mandibular molar.Randomized Controlled Trial
Key resultsThere was no significant difference between articaine and lidocaine for a successful inferior alveolar nerve block. The success rate for IAN block was 14% (17/125), 8 patients with articaine and 9 with lidocaine. Six patients did not experience lip numbness after either IAN block, and 51 patients in each group received supplemental infiltration anesthesia of the same solution. Successful anesthesia achieved after supplemental infiltration was 80% (41/51) for articaine and 33% (17/51) for lidocaine.
#2) 22099890Poorni/201190 men and 66 women between 18-30 with moderate to severe pain > 54 (HP VAS) in a mandibular molar.Randomized Controlled Trial
Key resultsSuccess rate was 75% for IAN block with 4% articaine and 69.2% for IAN block with 2% lidocaine during endodontic access preparation (P=.755). During pulp extirpation, success rate was 69.2% for 4% articaine and 65.4% for 2% lidocaine (P=.891). Researchers did not find the differences between each group statistically significant.
#3) 15273637Claffey/200472 patients with irreversible pulpitis of a mandibular molar.Randomized Controlled Trial
Key resultsSuccess rate was 24% (9/37) for IAN block using 4% articaine and 23% (8/35) for IAN block using 2% lidocaine. There is no statistically significant difference between the two solutions in achieving successful anesthesia required to comfortably provide endodontic treatment (P=.88).
Evidence Search ("Carticaine"[Mesh] AND "Lidocaine"[Mesh]) AND "Pulpitis"[Mesh]
Comments on
The Evidence
Validity: All three studies provided high level of evidence (they are double-blind, randomized controlled studies with good sample size). However, success rates varied widely across the three studies. The results reported by Ashraf et al. were somewhat misleading. The researchers’ table showed percentages of successful IAN blocks for articaine and lidocaine as over the total number of successful blocks (17) instead of over the number of patients who received each anesthetic. The total number of patients who received anesthesia with either articaine or lidocaine were not clear. The rate of successful anesthesia after supplemental infiltration for each group was extrapolated from the table. No systematic review has been done on the topic as yet. Perspective: The use of articaine is associated with an increased risk of temporary or permanent paresthesia (Garisto et al, 2010). In addition, it is not superior to lidocaine in providing successful anesthesia as an IAN block. Thus, lidocaine should be considered the first line of anesthetic agent to be administered as an IAN block in cases of mandibular molars diagnosed with irreversible pulpitis.
Applicability Applicable for otherwise healthy patients undergoing endodontic treatment for a mandibular molar with irreversible pulpitis. Other factors should be considered when choosing between articaine and lidocaine for an inferior nerve block. The clinical bottom line does not apply to IAN blocks with supplemental infiltrations, where results may be significant (as shown by Ashraf et al.) Supplemental anesthesia given as infiltrations, intraligamentary or intraosseous may be required since the success rate for anesthesia with IAN block for mandibular molars with irreversible pulpitis is poor, making it unpredictable for managing intraoperative pain.
Specialty/Discipline (Endodontics) (General Dentistry) (Oral Surgery) (Periodontics) (Dental Hygiene)
Keywords Inferior alveolar nerve block, articaine, lidocaine, pulpitis, mandibular molar
ID# 2658
Date of submission: 04/04/2014spacer
E-mail tranlv@livemail.uthscsa.edu
Author Loc V. Tran
Co-author(s) e-mail
Faculty mentor/Co-author Anibal Diogenes, DDS, MS, PhD
Faculty mentor/Co-author e-mail diogenes@uthscsa.edu
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