Comparative evaluation of anesthetic efficacy of 2% lidocaine and 4% articaine in irreversible pulpitis cases during endodontic therapy – a randomized double blind study

Introduction: Profound local anesthesia in permanent mandibular molars in irreversible pulpitis cases is difficult to attain with inferior alveolar nerve block (IANB) alone. In many cases, supplemental anesthesia is required during root canal therapy. The objectives of the present study are to compare the effectiveness of 2% Lidocaine and 4% Articaine when used for inferior alveolar nerve block (IANB) and supplemental buccal infiltration (BI) in irreversible pulpitis cases. Materials and Methods: Twenty five patients were randomly alloted to control and test groups. Test group included thirteen patients, anesthetized with 4% Articaine (with 1:100,000 epinephrine) and twelve patients were anesthetized with 2% Lidocaine (with 1:80,000 epinephrine) in control group. The pain experienced by patients during treatment was analyzed by using Heft-Parker visual analogue scale (HP-VAS). In case of pain after IANB, a supplemental buccal infiltration was given with the same anesthetic that was used for IANB. Absence of pain or presence of mild pain was considered as anesthetic success and presence of moderate or severe pain was considered as anesthetic failure. The data was recorded and evaluated using Chi-square test and proportion test. The level of significance was set at 0.05. Results: After inferior alveolar nerve block, anesthetic success was 54% in Articaine (test) group and 17% in Lidocaine (control) group.Following buccal infiltration, it was 83% in Articaine group and 70% in Lidocaine group. There was no significant difference between two groups after IANB and buccal infiltration. Overall success of Articaine was 92% and Lidocaine was 75%. Conclusion: There was no significant difference in the proportions of the overall success rate between the two groups. Articaine 4% can be considered as a useful alternative for 2% Lidocaine in teeth with irreversible pulpitis cases during root canal therapy. Keywords: Articaine, Lidocaine, Inferior alveolar nerve block, Buccal inf