Endodontology
Efficacy of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system

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Objective

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of the intraligamentary injection of 4% articaine with 1:100,000 epinephrine and of 2% lidocaine with 1:100,000 epinephrine, administered with computer-controlled local anesthetic delivery system, in mandibular posterior teeth.

Study design

Using a crossover design, intraligamentary injections of 1.4 mL of 4% articaine with 1:100,000 epinephrine and of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine were randomly administered with a computer-controlled local anesthetic delivery system, in a double-blind manner on the mesial and distal aspects of a mandibular first molar, at 2 separate appointments to 51 subjects. A pulp tester was used to test for anesthesia, in 2-minute cycles for 60 minutes, of the mandibular first and second molars and second premolar. Anesthesia was considered successful when 2 consecutive 80 readings (highest output) were obtained within 20 minutes.

Results

Successful pulpal anesthesia was obtained 86% of the time for the first molar using the articaine solution and 74% of the time using the lidocaine solution. There were no significant differences (P > .05) between the articaine and lidocaine solutions. The mean onset times of pulpal anesthesia for the first molar were 1.3 minutes with articaine solution and 2.2 minutes with lidocaine solution. Duration of pulpal anesthesia for the first molar was 34 minutes for the articaine solution and 31 minutes for the lidocaine solution.

Conclusion

The efficacy of 4% articaine with 1:100,000 epinephrine was similar to the efficacy of 2% lidocaine with 1:100,000 epinephrine for intraligamentary injections.

Section snippets

Material and methods

Fifty-one adult subjects participated in this study. All subjects were in good health and were not taking any medication that would alter pain perception, as determined by a written health history and oral questioning. The Ohio State University Human Subjects Review Committee approved the study, and written informed consent was obtained from each subject.

Subjects randomly received intraligamentary injections of articaine and lidocaine solutions at 2 separate appointments spaced at least 1 week

Results

Fifty-one adult subjects, 25 men and 26 women from age 20 to 53 years with an average age of 26 years, participated.

Anesthetic success of the intraligamentary injection is presented in Table I. There were no significant differences between the articaine and lidocaine solutions. Incidence of pulpal anesthesia (80 readings) for the 2 anesthetic solutions are presented in Fig 1, Fig 2, Fig 3.

The onset of pulpal anesthesia is presented in Table II. There was a significant difference between the

Discussion

The use of no response to the 80 reading (maximum output of the pulp tester) as a criterion for pulpal anesthesia was based on the clinical studies of Dreven et al40 and Certosimo and Archer.41 These studies40, 41 showed that no response at the 80 reading ensured pulpal anesthesia in vital asymptomatic teeth. Additionally, Certosimo and Archer41 demonstrated that electric pulp testing readings less than 80 resulted in pain during restorative procedures.

The 4% articaine with 1:100,000

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    This article was adapted from a thesis submitted by Dr Berlin in partial fulfillment of the requirements for the MS degree at The Ohio State University. A portion of this article was presented at the 2003 Annual Session of the American Association of Endodontists, Tampa, Fla. This study was supported by research funding from the Graduate Student Research Fund, Graduate Endodontics, The Ohio State University.

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