CURRENT LITERATURE

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

Brett Nydegger, DDS, MS , John Nusstein, DDS, MS , Al Reader, DDS, M, Melissa Drum, DDS, MS , Mike Beck, DDS, MA

Obtaining profound anesthesia is one of the basic tenents of good endodontic practise. Ask any patient and they will absolutely confirm this. Nydegger et al wrote in the December 2014 issue of The Journal of Endodontics, “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.” To help determine the role of concentration in the increased efficacy of 4% articaine the authors compared “the pulpal anesthesia obtained with 4% concentrations of articaine, lidocaine, and prilocaine formulations as primary buccal infiltrations of the mandibular first molar.”

The authors concluded that “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.”

In carrying out the study the authors also found that “In general, pulpal anesthesia peaked between 25 and 28 minutes and then gradually began to decline for all anesthetic formulations. Clinically, this is important in that mandibular first molar buccal infiltrations of 4% concentrations of articaine, lidocaine, and prilocaine, if successful, decline in efficacy at approximately 25–28 minutes after injection.

The published abstract appears below:

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.

Dr. Barry H. Korzen

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