Endodontic anesthesia in mandibular molars: a clinical study

Area of Science:

• Dentistry
• Anesthesiology
• Endodontics

Background:

• Inferior alveolar nerve block (IANB) is a common dental anesthesia technique.
• Assessing pulpal anesthesia effectiveness is crucial for successful endodontic therapy.
• Lidocaine with epinephrine and mepivacaine without vasoconstrictor are frequently used local anesthetics.

Purpose of the Study:

• To compare the efficacy of 3% mepivacaine without a vasoconstrictor against 2% lidocaine with 1:100,000 epinephrine for pulpal anesthesia in mandibular molars.
• To evaluate the reliability of lip anesthesia as an indicator of pulpal anesthesia.
• To determine the effectiveness of dichlorodifluormethane (DDM) in assessing pulpal anesthesia.

Main Methods:

• Sixty-one patients requiring endodontic therapy for mandibular molars were enrolled.
• Subjects received either IANB with 2% lidocaine/epinephrine or 3% mepivacaine.
• Pulpal anesthesia was assessed using dichlorodifluormethane (DDM); supplemental PDL injections were administered as needed.

Main Results:

• 3% mepivacaine without a vasoconstrictor was found to be as effective as 2% lidocaine with epinephrine in achieving pulpal anesthesia via IANB.
• Lip anesthesia was not a reliable predictor of pulpal anesthesia, with 23 of 61 subjects requiring additional injections.
• DDM testing proved to be a reliable method for confirming pulpal anesthesia.

Conclusions:

• 3% mepivacaine without a vasoconstrictor provides effective pulpal anesthesia for mandibular molars, comparable to lidocaine with epinephrine.
• Clinicians should not rely on lip anesthesia alone to confirm pulpal anesthesia.
• DDM is a dependable tool for verifying pulpal anesthesia in endodontic procedures.