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Pulpal anesthesia of maxillary first molars using 4% articaine infiltration in patients with symptomatic irreversible pulpitis: a randomized controlled clinical trial

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Abstract

Objectives

This study aimed to compare the anesthetic efficacy of 1.8 mL (one cartridge) and 3.6 mL (two cartridges) buccal infiltration and buccal plus palatal infiltration of 4% articaine in maxillary first molar teeth with symptomatic irreversible pulpitis.

Materials and methods

This randomized single-blind clinical trial was conducted on 45 patients with symptomatic irreversible pulpitis of maxillary first molars (Trial Registration No: IRCT2015011020238N2_2015). The patients were randomly divided into three groups (n = 15) for buccal infiltration of 1.8 mL articaine plus 1:100,000 epinephrine (group 1), buccal infiltration of 3.6 mL articaine (group 2), and buccal infiltration of 1.8 mL articaine plus palatal infiltration of 0.5 mL articaine (group 3). The pain intensity was measured by the Heft-Parker visual analog scale (VAS) during injection and during access cavity preparation. No pain or mild pain during treatment was considered as successful anesthesia. Data were analyzed by the Tukey’s post hoc test.

Results

The three groups had a significant difference in frequency of the perceived pain during injection (P = 0.01). A higher volume of 4% articaine and injection of articaine in both buccal and palatal sides provided a significantly higher anesthesia success rate (P = 0.049 and P < 0.01, respectively). The highest success rate was recorded in group 3 (93.33%) followed by group 2 (80%) and then group 1 (53.33%).

Conclusions

Increasing the administered volume of 4% articaine with 1:100,000 epinephrine and addition of palatal infiltration to buccal infiltration of articaine can significantly increase the success of anesthesia in maxillary first molars with symptomatic irreversible pulpitis.

Clinical relevance

Achieving deep anesthesia in teeth with irreversible pulpitis is a critical parameter in management of patients who are in urgent need of root canal treatments.

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Data availability

Data available on reasonable request from the corresponding author.

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Acknowledgements

The authors would like to thank Dr. Kharazi Fard for performing the statistical analysis.

Funding

This study was supported by a grant from the International campus of Tehran University of Medical Sciences (Grant No: 11089).

Author information

Authors and Affiliations

  1. School of Dentistry, Tehran University of Medical Sciences, Mahan St, Tehran, 1894787545, Iran

    Farzaneh Afkhami

  2. School of Dentistry, The University of Queensland, Brisbane, Australia

    Farzaneh Afkhami & Ove A. Peters

  3. Private Practice, Tehran, Iran

    Golriz Rostami

  4. Private Practice, Toronto, Canada

    Fardad Kamalian

Authors
  1. Farzaneh Afkhami
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Contributions

F.A. conceptualization, methodology; F.A., G.R., F.K. investigation; F.K. gathering data and formal analysis; O.P., F.A., G.R., F.K. writing, reviewing and revising. All the authors critically reviewed the manuscript.

Corresponding author

Correspondence to Farzaneh Afkhami.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

The study protocol was approved by the Ethics Committee of the Tehran University of Medical Sciences (No: 92–01-168–21092), and the written informed consent was obtained from all of the patients.

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The authors declare no competing interests.

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Afkhami, F., Rostami, G., Peters, O.A. et al. Pulpal anesthesia of maxillary first molars using 4% articaine infiltration in patients with symptomatic irreversible pulpitis: a randomized controlled clinical trial. Clin Oral Invest 27, 3999–4006 (2023). https://doi.org/10.1007/s00784-023-05025-y

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