A Comparison of the Efficacy of 4% Articaine with 1:100,000 Epinephrine and 2% Lidocaine with 1:80,000 Epinephrine in Achieving Puipal Anesthesia in Maxillary Teeth with Irreversible Pulpitis

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. (J Endod 2012;38:279-282)