Anesthetic Comparisons of 4% Concentrations of Articaine, Lidocaine, and Prilocaine as Primary Buccal Infiltrations of the Mandibular First Molar: A Prospective Randomized, Double-blind Study

• Published in: Journal of endodontics Vol. 40; no. 12; pp. 1912 - 1916
• Main Authors: Nydegger, Brett, DDS, MS, Nusstein, John, DDS, MS, Reader, Al, DDS, MS, Drum, Melissa, DDS, MS, Beck, Mike, DDS, MA
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2014
• Subjects: Adult; Anesthesia, Dental - methods; Anesthetics, Local - administration & dosage; Articaine; Carticaine - administration & dosage; Cross-Over Studies; Dental Pulp - drug effects; Dentistry; Double-Blind Method; Endocrinology & Metabolism; Epinephrine - administration & dosage; Female; Humans; infiltration; Injections - adverse effects; Injections - instrumentation; lidocaine; Lidocaine - administration & dosage; Male; Mandible - drug effects; mandibular; Molar - drug effects; Needles - adverse effects; Pain - etiology; Pain Measurement - methods; Pain, Postoperative - etiology; prilocaine; Prilocaine - administration & dosage; Prospective Studies; Vasoconstrictor Agents - administration & dosage; Young Adult; Articaine; prilocaine; infiltration; lidocaine; mandibular
• ISSN: 0099-2399; 1878-3554
• DOI: 10.1016/j.joen.2014.08.001

Abstract Introduction Studies have shown the superiority of 4% articaine with 1:100,000 epinephrine over 2% lidocaine with 1:100,000 epinephrine when used as a primary buccal infiltration of the mandibular first molar. A study using other 4% anesthetic formulations may help determine the role of concentration in the increased efficacy of 4% articaine. The authors conducted a prospective randomized, double-blind, crossover study comparing the pulpal anesthesia obtained with 4% concentrations of articaine, lidocaine, and prilocaine formulations as primary buccal infiltrations of the mandibular first molar. Methods Sixty asymptomatic adult subjects randomly received a primary mandibular buccal first molar infiltration of 1.8 mL 4% articaine with 1:100,000 epinephrine, 4% lidocaine with 1:100,000 epinephrine, and 4% prilocaine with 1:200,000 epinephrine in 3 separate appointments. An electric pulp tester was used to test the first molar for anesthesia in 3-minute cycles for 60 minutes after the infiltrations. Successful anesthesia was defined as 2 consecutive 80/80 readings. Results The success rate for the 4% articaine formulation was 55%, 33% for the 4% lidocaine formulation, and 32% for the 4% prilocaine formulation. There was a significant difference between articaine and both lidocaine ( P  = .0071) and prilocaine ( P  = .0187) formulations. Conclusions A 4% articaine formulation was statistically better than both 4% lidocaine and 4% prilocaine formulations for buccal infiltration of the mandibular first molar in asymptomatic mandibular first molars. However, the success rate of 55% is not high enough to support its use as a primary buccal infiltration technique in the mandibular first molar.