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A COMPARISON OF THE ANESTHETIC EFFICACY OF LIDOCAINE AND ARTICAINE FOR BUCCAL INFILTRATION IN PATIENTS WITH ACUTE IRREVERSIBLE PULPITIS IN MAXILLARY FIRST PREMOLARS.

Byline: MUHAMMAD NABEEL ALIA AHMED and MARIA SIKANDER

Abstract

Articaine is fast becoming the anesthesia of choice for many endodontists across the globe. Before it completely replaces the" gold standard" lidocaine its anesthetic efficacy for dental use must be determined accurately. The objective of this study was to compare the anesthetic efficacy of articaine with lidocaine for buccal infiltration in patients with acute irreversible pulpitis. Seventy-six patients with acute irreversible pulpitis of maxillary first premolar were randomly selected. Patients receiving 1.7 ml of 2% lidocaine with 1:100000 epinephrine injection (group 1) and those receiving 1.7 ml of 4% articaine wtih 1:1000000 (group 2) were asked to rate their pain level on visual analogue scale (VAS) before receiving the anesthesia. Success was defined as mild or no pain on endodontic access or initial instrumentation based on the readings of visual analogue scale.

Statistically no significant difference in the anesthetic efficacy of articaine and lidocaine as buccal infiltration agents was found. Hence articaine hydrochloride has comparable anesthetic efficacy to that of lidocaine.

Key Words: Irreversible pulpitis buccal infiltration pulpal anesthesia Visual analogue scale Articaine Lidocaine.

INTRODUCTION

Profound local anesthesia is necessary for success ful patient management in endodontic therapy. Since the beginning of dentistry numerous compounds and methods have been tried and used to obtain anesthesia. Lidocaine hydrochloride became the first marketed amide local anesthetic and now it is considered the "Gold Standard" to which other anesthetic solutions are compared.1 In 1969 a newer anesthetic drug Articaine was introduced as carticaine. It contains a lipophilic thiophene ring than the usual benzene ring seen in other amide based local anesthetic solutions along with an additional ester ring. This unique property renders articaine better lipid soluble and increases its protein binding ability. Several studies have shown that 4% articaine has superior efficacy than 2% lignocaine as inferior blocking agent and mandibular buccal infiltration anesthesia.234 Same results were found in maxilla when buccal infiltration with lidocaine and articaine was compared.5

Most studies have been carried out on sound teeth. Very little data is available on maxillary teeth with irreversible pulpitis. One study by Srinivasan et al6 showed success rate of 100% with articaine and 80% with lidocaine when used for pulpal anesthesia of maxillary premolars and 100% and 30% in molars respectively. No research data is available in Pakistan for efficacy of articaine in maxillary teeth with irreversible pulpitis. This study would enable us to select a better anesthetic solution for treatment of maxillary premolars.

METHODOLOGY

Approval from the ethical committee of the Islamic International Dental College and Hospital was obtained before undertaking the study. Informed consent was taken from the patients. Seventy-six patients reporting to the out-patient Department of Operative Dentistry and Endodontics at Islamic International Dental Hospital (IIDH) Islamabad diagnosed with irreversible pulpitis of maxillary first premolars were included in the study. They were assigned group 1 or 2 by using a computer-generated list of random numbers with randomization ratio of 1:1 produced by random allocation software (version 1.0). Patients taking any drugs that could alter the pain perception or patients suffering from any allergy heart disease and diabetes mellitis were excluded from the study. Expecting and lactating mothers were also excluded.

Patients in group 1 received 1.7 ml of 2% lidocaine with 1:100000 epinephrine (Dentsply) and patients in group 2 were given 1.7ml of 4% atricaine with 1:100000 epinephrine (Septodont) by buccal infiltration to gain pulpal anesthesia in maxillary first premolar. A single operator gave all local infiltration injections using standard dental aspirating syringes with 27-gauge 1.5 inch needle and later did not took part in testing the outcome. A standard access cavity was made after 5 min of anesthetic administration. Endodontic procedure and pain recording using Visual Analogue Scale (VAS) was done by the other clinician throughout the study. Pain recorded more than 3 on VAS during access cavity or canal preparation was considered as failure and the procedure was stopped immediately. The readings on VAS were taken as: 0 for no pain 1-3 for mild pain 4-6 moderate pain and 7-10 as severe pain.

RESULTS

Seventy-six subjects participated in this study aged between 18-67 years out of which forty-three were female and thirty-three were male. Thirty-eight patients in group 1 and 2 each received lidocaine and articaine respectively. (Table 1 and Table 2)

On access cavity preparation and initial instrumentation (Table 3) 33 of the subjects who received lidocaine injection secured successful anesthesia whereas 35 of the subjects who received articaine injection experienced

TABLE 1: GENDER DISTRIBUTION FOR EFFICACY OF LIDOCAINE

###Gender

###Female###Male###Total

Efficay###0 VAS###12###9###21

###1-3 VAS###4###8###12

###4-6 VAS###2###0###2

###7-10 VAS###2###1###3

Total###20###18###38

TABLE 2: GENDER DISTRIBUTION FOR EFFICACY OF ARTICAINE

###Gender

###Female###Male###Total

Efficacy###0 VAS###10###12###22

###1-3 VAS###12###1###13

###4-6 VAS###1###1###2

###7-10 VAS###0###1###1

###Total###23###15###38

TABLE 3: PAIN ON ACCESS CAVITY PREPARATION AND INITIAL INSTRUMENTATION

###Efficacy

###Count###Artic-###Lidocaine Total

###aine

Pain###4-10 VAS###3###5###8

###0-3 VAS###35###33###68

Total###38###38###76

TABLE 4: CHI-SQUARE TESTS

###Value###df###As-###Exact Exact

###ymp. Sig. (2- Sig. (1-

###Sig. (2- sided) sided)

###sided)

Pearson###.559a###1###.455

Chi-Square

Continuity###.140###1###.709

Correctionb

Likelihood###.564###1###.453

Ratio

Fisher's###.711###.356

Exact Test

N of Valid###76

Cases

no or mild pain indicating that the local anesthesia was successful. Chi square test was used to compare the efficacy of the two anesthetic solutions .The difference between the two groups was not statistically significant (p less than 0.05). Table 4

DISCUSSION

Numerous chemical substances have been used as local anesthetic agents in dentistry to make dental treatment a pain free procedure for the patients. The lidocaine an amide local anesthetic is widely used anesthetic solution since its introduction. The newer drug articaine for local anesthesia has mechanism of blocking of reversible nerve conduction similar to that of other amide local anestetics. Howerver the presence of thiophene group is thought to increases its lipid solubility.7 Numerous studies comparing the anesthetic efficacy of 4% articaine and 2% lidocaine have shown no significant differences among the two groups89 similar to the results in this study while others have favoured the use of articaine.10

In this study we waited 5 minutes after the infiltration injections before access cavity preparation which was based on the time suggested by previous studies for these injections to take full effect.1112 The impacts of the anesthetics used were therefore maximized in this study.

Various studies have compared the effect of different volumes of local anesthetic solution and concentration of epinephrine in the success of anesthesia. Fowler S et al 13 and Parirokh et al 14 found no significant difference in anesthetic success between 3.6ml volume and 1.8 ml volume of 2% lidocaine for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. Wali et al15 found that increasing the concentration of epinephrine to 1:50000 or volume of lidocaine to 3.6 ml did not result in more successful anesthesia. Therefore in this study 1.7 ml of 2% lidocaine with 1:100000 epinephrine was used compared with 1.7 ml of 4% articaine with 1: 100000 epinephrine.

Objective quantification and standardization of pain across a group of individuals is a difficult task. Based on various studies Visual analogue scale (VAS) was found to fulfill their established criteria because it is methodologically sound theoretically simple easy to run and unassuming to the respondent 7. Dreven et al concluded that in irreversible pulpitis lack of response to electric pulp testing does not always guarantee successful pulpal anesthesia. If the chamber is necrotic and the canals are vital no objective test can determine the extent of clinical anesthesia 16. Hence recording patient's response on access cavity preparation and initial instrumentation is a feasible alternative and therefore has been used in this study.

CONCLUSION

Based on the results of this study the anesthetic efficacy of articaine is comparable to that of lidocaine in subjects with acute irreversible pulpitis of maxillary teeth with irreversible pulpitis. Articaine is a safe and viable alternative to secure pulpal anesthesia for endodontic therapy. However further research is needed to determine its efficacy in pediatric and geriatric patients.

REFERENCES

1 Malamed SF Handbook of local anesthesia. 5th ed. St.louis: Mosby; 2004.

2 Tortamano IP Siviero M Costa CG Buscariolo IA Armonia IP. A comparison of anesthetic efficacy of articaine and lidocaine in patients with irreversible pulpitis". J Endod 2009; 35(2):165-8.

3 Kanaa MD Whitworth JM Corbett IP Meechan JG. Articaine and lidocaine mandibular buccal infiltration anesthesia: A prospective randomized double-blind crossover study". J Endod 2006; 32:296-98.

4 Robetson D Nusstein J Reader A Beck M McCartney M. The anesthetic efficacy of artcaine in buccal infiltration of mandibular posterior teeth." J Am Dent Assoc 2007; 138:1140-12.

5 Kanaa MD Whitworth JM Meechan JG. A comparison of the efficacy of 4% articaine with 1:100000 epinephrine and 2% lidocaine with 1:80000 epinephrine in achieving the pulpal anesthesia in maxillary teeth with irreversible pulpitis. J Endod 2012; 38 (3): 279-82.

6 Srinivasan N Kavitha M Loganathan CS Padmini G. Comparison of anesthetic efficacy of 4% articaine and 2% lidocaine for maxillary buccal infiltration in patients with irreversible pulpitis." Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107:133-63.

7 Poorni S Veniashok B Senthilkumar AD Indira R Ramachandran S. Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial. J Endod. 2011 Dec; 37(12):1603-07.

8 Claffey E Reader A Nusstein J Beck M Weaver J. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod. 2004 Aug;30(8):568-71.

9 Aggarwal V Jain A Kabi D. Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis. J Endod. 2009 Jul; 35(7):925-29.

10 Katyal V. The efficacy and safety of articaine versus lignocaine in dental treatments: a meta-analysis. J Dent. 2010 Apr; 38(4):307-17.

11 Vreeland DL Reader A Beck M et al. An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endod 1989; 15:6-12.

12 Robertson D Nusstein J Reader A et al. The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teetg. J Am Dent Assoc 2007; 138:1104-12.

13 Fowler S Reader A. Is the volume of 3.6ml better than 1.8 ml for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis J Endod 2013; 39: 970-02.

14 Parirokh M Satvati SA Sharifi R et al. Efficacy of combining a buccal infiltration with an inferior alveolqr nerve block for mandibular molars with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 468-73

15 Wali M Drum M Reader A et al. Prospective randomized single-blind study of the anesthetic efficacy of 1.8 and 3.6 milliliters of 2% lidocaine with 1:50000 epinephrine for inferior alveolar nerve block. J Endod 2010; 36: 1459-62.

16 Dreven LJ Reader A Beck M Meyers WJ Weaver J. An evaluation of an electric pulp tester as a measure of analgesia in human vital teeth. J Endod 1987; 13(5):233-38.
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Publication:Pakistan Oral and Dental Journal
Article Type:Report
Geographic Code:9PAKI
Date:Dec 31, 2014
Words:1920
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