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Primary and supplementary anesthetic efficacy of a modified two-step buccal infiltration of 4% articaine in mandibular molars with symptomatic irreversible pulpitis: a randomized clinical trial

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Abstract

Objectives

To evaluate a modified two-step buccal infiltration (MBI) of 1.7 mL 4% articaine as primary or supplemental anesthesia in mandibular first and second molars diagnosed with symptomatic irreversible pulpitis (SIP).

Materials and methods

One hundred and eight patients with SIP were randomly assigned to one of three groups (n = 36). They were given an inferior alveolar nerve block (IANB) of 2% lidocaine with 1:80.000 epinephrine or a primary MBI of 4% articaine with 1:100.000 epinephrine in the IANB and MBI groups, respectively. Patients in the IANB + MBI group received an IANB followed by an MBI. Pain levels during the injection, access cavity preparation, and initial filing were recorded on the Heft-Parker visual analog scale (HP-VAS). No or mild pain (HP-VAS ≤ 54) upon access cavity preparation and initial filing was considered a success. Chi-square and Kruskal–Wallis tests were used to analyze the data.

Results

MBI (77.8%) and IANB + MBI (94.4%) had both significantly higher success rates than IANB (50.0%) (P < .001). However, when the Bonferroni adjustment was applied, there was no statistically significant difference between the MBI and IANB + MBI techniques (P = .041 > .017). MBI was associated with significantly less injection pain than IANB (P < .001).

Conclusions

Both primary and supplemental MBI with 4% articaine were superior to IANB with 2% lidocaine in mandibular first and second molars diagnosed with SIP. Further research may be needed to confirm the findings of this study.

Clinical relevance.

The findings of this study suggest that supplemental or primary MBI can be a clinically viable alternative to IANB, which has a relatively low success rate when managing mandibular molars diagnosed with SIP.

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Data availability

Upon request through email, the data will be shared in accordance with ethical considerations and the institutional policies.

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Authors and Affiliations

  1. Iranian Center for Endodontic Research, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohammadreza Vatankhah

  2. Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Nazanin Zargar, Mandana Naseri & Seyeddavood Sadeghi

  3. Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Alireza Akbarzadeh Baghban

  4. Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, MD, 21201, USA

    Omid Dianat

  5. Division of Endodontics, The Ohio State University, Columbus, OH, USA

    John M. Nusstein

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  1. Mohammadreza Vatankhah
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Contributions

MV: conceptualization; methodology; investigation; resources; visualization; formal analysis; writing – original draft preparation. NZ: conceptualization; methodology; supervision; writing – review and editing. MN: conceptualization; project administration. SS: resources. AAB: methodology; software; formal analysis. OD: conceptualization; methodology; validation; writing – review and editing. JMN: validation; writing – review and editing.

Corresponding author

Correspondence to Omid Dianat.

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The authors declare no competing interests.

Ethics approval and consent to participate

The protocol of this study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.DRC.REC.1398.227) and was registered in the Iranian Registry of Clinical Trials (IRCT20200301046656N1, https://irct.ir/trial/53111). Prior to the commencement of the study, written informed consent was obtained from each patient after describing the objectives and potential risks/benefits of the interventions.

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The authors declare no competing interests.

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Vatankhah, M., Zargar, N., Naseri, M. et al. Primary and supplementary anesthetic efficacy of a modified two-step buccal infiltration of 4% articaine in mandibular molars with symptomatic irreversible pulpitis: a randomized clinical trial. Clin Oral Invest 28, 33 (2024). https://doi.org/10.1007/s00784-023-05417-0

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