4% articaine Buccal infiltration provides pain relief in symptomatic irreversible pulpitis

A study was conducted to compare the anaesthetic efficacy of buccal infiltration (BI) using 4% articaine vs 4% articaine or 2% lidocaine inferior alveolar nerve block (IANB) for mandibular molars with symptomatic irreversible pulpitis.

PubMed, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov were searched using MESH terms and specific keywords. Included articles were Randomized Clinical Trials (RCTs), which compared 4% articaine BI vs conventional IANB in terms of the efficacy of pulpal anaesthesia and success rate. The quality assessment of included studies was done according to the Cochrane risk of the bias assessment tool. Studies were quantitatively assessed using fixed or random effect models.

Results:

• Out of 756 articles, 5 RCT studies were included with a total number of 500 patients: 231 in 4% articaine BI group, 150 in 2% lidocaine IANB group, and 119 in the 4% articaine IANB group.
  
• The meta-analysis results showed that patients anaesthetized with 4% articaine BI had a similar success rate compared to 2% lidocaine IANB
• Similarly, there was a non-significant difference when compared to 4% articaine IANB
• Patients anaesthetized with 4% articaine BI presented comparable pain scores compared to IANB (4% articaine or 2% lidocaine)
• Regarding quality assessment, 3 studies were considered to have a low risk of bias, one study has an unclear risk of bias, and one study has a high risk of bias.

Thus, 4% articaine BI showed comparable results in terms of pain relief and success rate in comparison with 2% lidocaine IANB or 4% articaine IANB. However, due to the limited number and small sample size of included studies, these findings should be considered carefully, and further studies are required to confirm our findings.

Reference:

Hossam Waleed Almadhoon, ROAA WALEED ABUIRIBAN, HUTHYFA ALMASSRI, FAEZ SALEH AL-HAMED, EFFICACY OF 4% ARTICAINE BUCCAL INFILTRATION VERSUS INFERIOR ALVEOLAR NERVE BLOCK FOR MANDIBULAR MOLARS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS, Journal of Evidence-Based Dental Practice, Volume 22, Issue 2,2022, 101712, ISSN 1532-3382, https://doi.org/10.1016/j.jebdp.2022.101712.

Keywords:

Pulpitis, Hot tooth, Inferior, alveolar, nerve, block, Buccal, infiltration, Articaine, Lidocaine, Hossam Waleed, Almad, hoona, $ROAA WALEED, ABUIRIBANa, $HUTHYFA, ALMASSRIb, FAEZ SALEHAL-HAMED, Journal of Evidence-Based Dental Practice