Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial

Area of Science:

• Dentistry
• Anesthesiology
• Endodontics

Background:

• Inferior alveolar nerve block (IANB) demonstrates a high failure rate in managing irreversible pulpitis in mandibular posterior teeth.
• Effective local anesthesia is crucial for successful pulpectomy procedures, particularly in cases of symptomatic irreversible pulpitis.

Purpose of the Study:

• To compare the anesthetic efficacy of 4% articaine, 2% lidocaine, and 2% mepivacaine, all with 1:100,000 epinephrine, for inferior alveolar nerve block (IANB) in patients with irreversible pulpitis of mandibular molars.
• To evaluate pulpal anesthesia and pain control during pulpectomy procedures.

Main Methods:

• A randomized study involving 66 volunteers with irreversible pulpitis in permanent mandibular molars.
• Conventional inferior alveolar nerve block (IANB) with 3.6 mL of either 4% articaine, 2% lidocaine, or 2% mepivacaine (all with 1:100,000 epinephrine).
• Anesthetic efficacy assessed by subjective lip numbness, electric pulp testing, and a verbal analog scale for pain during pulpectomy.

Main Results:

• All patients reported subjective lip numbness.
• Pulpal anesthesia success rates (electric pulp tester) were 68.2% for mepivacaine, 63.6% for articaine, and 63.6% for lidocaine.
• Pain control success rates (no or mild pain) were 72.7% for mepivacaine, 63.6% for articaine, and 54.5% for lidocaine.
• No statistically significant differences were observed in anesthetic efficacy among the three local anesthetics.

Conclusions:

• None of the tested local anesthetics (articaine, lidocaine, mepivacaine) achieved 100% anesthetic success for inferior alveolar nerve block (IANB) in patients with irreversible pulpitis of mandibular molars.
• Further research is needed to improve anesthetic techniques and achieve profound anesthesia in these challenging cases.