Evaluation of anesthetic efficacy of 4% articaine as buccal infiltration vs 2% lidocaine as IANB in the mandibular 1st molar with irreversible pulpitis

The purpose of this prospective, randomized, study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:200,000 epinephrine for buccal infiltration and inferior alveolar nerve block respectively in patients experiencing irreversible pulpitis in permanent mandibular first molars. Sixty emergency patients diagnosed with irreversible pulpitis of a mandibular first molar ran-domly divided into two groups. Thirty patients received buccal infiltration of 1.7 ml of 4% articaine with 1:100,000 epinephrine and thirty patients received standard inferior alveolar nerve block with 1.8 ml of 2% lidocaine with 1:200,000 epinephrine. Endodontic access was begun 10 minutes after solution deposition, success [anesthetic efficacy] was defined as none or mild pain [Visual Analogue Scale recordings] on endodontic access preparation or pulp extirpation. Twenty-two patients out of 30 did not experience pain with 4% articaine [success = 52.4%] and 20 out of 30 patients did not experience pain in 2% lignocaine group [success = 47.6%]. There was no statistically significant difference between the articaine formulation as buccal infiltration and lidocaine formulation as IANB with regard to anesthetic success [p value =0.220]. Even though buccal infiltration of 4% articaine and IANB of 2% lidocaine were equally effective, buccal infiltration can be considered a viable substitute in IANB for anesthetizing mandibular first molar with irreversible pulpitis