Title 4% Articaine Infiltration Is as Effective as 2% Lidocaine Nerve Block When Treating Primary Mandibular Molars
Clinical Question When treating primary mandibular molars, is 4% Articaine infiltration as effective as 2% Lidocaine nerve block?
Clinical Bottom Line In mandibular primary molars where pulpotomy or extraction is required due to deep carious lesions, 4% Articaine infiltration is just as effective as 2% Lidocaine nerve block when analyzed behaviorally and clinically. This is supported by two randomized controlled trials that showed no significant difference in outcome between 4% Articaine infiltration and 2% Lidocaine nerve block on mandibular primary molars. 4% Articaine infiltration may be a valid replacement for 2% Lidocaine nerve block as a local anesthetic technique.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
29573375Alzahrani/2018N= 98 children (5-9 years old) Randomized parallel-group controlled study
Key resultsAll participants in this randomized, controlled equivalency study were ASA I or II and required mandibular primary molar extraction or pulpotomy with no history of abscess or apical pathosis. The success of the procedures was measured by assessing the child’s behavior during the procedure with the Visual Analogue Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (W-BFSR). The results suggested equivalence in success rates for both anesthetic techniques during treatment. Absolute differences in success rates between the two techniques were 0.06 for the VAS (95% CI: -0.11 to 0.23).
30087759Ghadimi/2018N=23 children (5-8 years old)Randomized cross-over clinical trial
Key resultsAll participants in this study needed pulpotomy treatment in both mandibular primary second molars with no evidence of soft tissue infection/inflammation near the area of injection. The Wong-Baker Faces Pain Rating Scale (WBFPRS) was used for the assessment of pain during injection. The modified behavioral pain scale (MBPS) was used for evaluating children’s behavior during the procedure. Patients’ feeling during injection and post-treatment complications did not significantly differ between two groups (p>0.05). Patients’ behavior during pulpotomy was significantly better in the Articaine group (p=0.004).
Evidence Search Publication Type: clinical trial MeSH Terms: carticaine; clinical trials as topic; tooth, deciduous
Comments on
The Evidence
Validity: Both studies utilized measurement tools for pain and behavior that have already been tested and validated. Both randomized controlled trials showed high validity with patient groups being similar at start and completion. In Alzahrani/2018 the principal investigator (PI) was blinded to the assignment before enrollment. However, the blinding of the operator (PI) was lost during local anesthetic administration. In Ghadimi/2018 groups were treated the same, a double-blind technique was used, recall bias was unlikely and there were no competing interests.
Applicability This evidence shows that 4% Articaine infiltration is indicated for anesthesia on primary mandibular molar pulpotomies and extraction on par with 2% Lidocaine nerve block in children 5-9 yrs. old.
Specialty (Endodontics) (General Dentistry) (Pediatric Dentistry)
Keywords Primary Molars, Articaine, Lidocaine
ID# 3395
Date of submission 10/31/2019
E-mail munizlopez@livemail.uthscsa.edu
Author Miriam Muniz, DDS
Co-author(s) Abrefi Asare, DDS MS
Co-author(s) e-mail Asare@livemail.uthscsa.edu
Faculty mentor Dr. Elva Jordan
Faculty mentor e-mail JORDANEV@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available