Effect of 4% Articaine Infiltration Versus 2% Lidocaine Nerve Block after Premedication by Ibuprofen on Anesthetic Efficacy in Endodontic Treatment of Acute Irreversible Pulpitis: A Randomized Clinical Trial (Part 2) Thesis

Abstract

This parallel, randomized clinical trial was conducted to assess effect of 4 % articaine infiltration versus 2 % lidocaine nerve block after premedication by ibuprofen on anesthetic efficacy in a single visit endodontic treatment of first permanent molar with symptomatic irreversible pulpitis. Participants and methods: Fifty-two patients diagnosed with symptomatic irreversible pulpitis in the first permanent mandibular molar were included in the present study, with 26 patients in lidocaine group and 26 patients in articaine group. Patients were given one tablet of 600 mg ibuprofen as premedication one hour before anesthesia with one carpule of either 2 % lidocaine by IANB or 4 % articaine infiltration. Triad of electric pulp tester reading, NRS and soft tissue numbness were recorded to assess pulpal anesthesia. Then root canal treatment was done in single visit by using Rotary Ni Ti Revo-S system. Numerical rating system (NRS) was used to assess pain preoperatively, during access cavity, cleaning and shaping and postoperatively at 6, 12 and 24 hours where score 0= no pain, score 1-3= mild pain, score 4-7= moderate pain and score 8-10= severe pain. Success of anesthesia is considered as no or mild pain. Number of analgesic tablets taken was recorded. All demographic data, clinical findings, NRS scores and electric pulp tester reading obtained from the patients were statistically analyzed. Chi square test was used to compare between categorical data and Mann Whitney U test was used to compare NRS scores between groups.

Results: Results of the present study showed that there was no statistically significant difference in percent of successful cases in lidocaine group and articaine group in both access (38% vs 50%) and cleaning and shaping (61.5% vs 73%), respectively. Supplemental intrapulpal anesthesia was needed to complete treatment painlessly. After 24 hours, most of the patients reported no or mild pain in both groups with no statistically significant difference and just only one tablet was taken when needed. Conclusions: Within the limitation of the present study, the following can be concluded: 1- Articaine mandibular buccal infiltration can be a reliable alternative to IANB during emergency access cavity of cases of mandibular molars with irreversible pulpitis.

2- The success rates of both 2 % lidocaine IANB and 4 % articaine infiltration with ibuprofen premedication are still not sufficient enough for profound pulpal anesthesia and effective pain control for mandibular molars with symptomatic irreversible pulpitis.