Efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: An in vivo study

Aim: The aim of the present study was to assess the efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block (IANB) with lidocaine in patients with irreversible pulpitis.

Materials and methods: A total of 120 patients were included in the study. Patients were given IANB with 2 ml of 2% lidocaine hydrochloride with 1:80,000 epinephrine. Patients who showed subjective symptoms of IANB but did not secure pulpal anesthesia were randomly allocated to one of the following four groups by random sampling for supplementary local anesthesia - Group 1: buccal infiltration (BI) with 4% articaine with 1:100,000 epinephrine, Group 2: four-site intraligamentary (IL) injection with 4% articaine with 1:100,000 epinephrine, Group 3: BI with 2% mepivacaine with 1:100,000 epinephrine, and Group 4: four-site IL injection with 2% mepivacaine with 1:100,000 epinephrine.

Results: Group 1 - BI with articaine provided anesthesia success in 27 cases (90%, n = 30). Group 2 - IL injection with articaine provided anesthesia success in 20 cases (66.67%, n = 30). Group 3 - BI with mepivacaine provided anesthesia success in 21 cases (70%, n = 30). Group 4 - IL injection with mepivacaine provided anesthesia success in 15 cases (50%, n = 30). A significant difference between the four groups was found.

Conclusion: In patients with a mandibular first molar exhibiting symptomatic irreversible pulpitis, block injection with lidocaine along with supplemental BI with articaine allowed more pain-free treatments. Articaine showed better results when compared with mepivacaine.