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Efficacy of 2% Lidocaine and 4% Articaine in Mandibular Molars with Different Pulp Diagnoses in the Mandibular Technique1

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Efficacy of 2% Lidocaine and 4% Articaine in Mandibular Molars with Different Pulp Diagnoses in the Mandibular Technique1 Efficacy of 2% lidocaine and 4% articaine in mandibular molars with different pulp diagnoses in the mandibular technique1 Eficacia de la lidocaína al 2% y la articaína al 4% en molares mandibulares con diferentes diagnósticos pulpares en la técnica mandibular1 Adel Martínez Martínez2, Evelyn Freyle Granados3, Natalia Senior Carmona3 1 Paper submitted in partial fulfillment of the requirements for the degree of Endodontist 2 Assistant Professor, GITOUC Group, School of Dentistry, Universidad de Cartagena 3 DDS, Specialist in Endodontics, Postgraduate program in Endodontics, School of Dentistry, Universidad de Cartagena ABSTRACT Introduction: the inferior alveolar dental nerve block is the method most commonly used by endodontists to achieve local anesthesia during treatments. This study compared the efficacy of two anesthetic solutions: 2% lidocaine with 1:80,000 epinephrine and 4% articaine with 1:100,000 epinephrine in patients with different ARTICLES ORIGINAL pulp diagnoses requiring endodontic treatment. Method: an interventional, randomized clinical trial. The sample included 36 patients who were treated at the postgraduate endodontics service at the Universidad de Cartagena in the year 2016. Descriptive statistics and the Chi2 test were used for data analysis, using a limit of 0.05. Results: articaine showed a greater anesthetic effect in vestibular mucosa (88.9%) and tip of tongue (55.6%), compared with lidocaine. The rates of anesthetic success in the lidocaine and articaine groups were 5.6% and 22.2% respectively, but this difference was not statistically significant (p = 0.633). In teeth with normal pulp, the efficacy was 27.3%, and this value considerably decreased in teeth with asymptomatic and symptomatic irreversible pulpitis, with percentages of 5.8% and 12.5% respectively, although this difference was not statistically significant (p = 0.276). Conclusions: no statistically significant Key words: dental differences were found in the anesthetic efficacy of 2% lidocaine and 4% articaine in lower molars with pulp, pulpitis, vital pulp. However, articaine showed a better anesthetic success rate. No statistically significant differences local anesthesia, were found when comparing the anesthetic efficacy in molars with normal pulp and molars with inflamed lidocaine, articaine pulp—although the percentage of success in normal pulp was greater than in teeth with irreversible pulpitis. RESUMEN Introducción: el bloqueo del nervio dentario inferior es el método más usado por los endodoncistas para obtener anestesia local en sus tratamientos. En este trabajo se comparó la eficacia de dos soluciones anestésicas: lidocaína al 2% con epinefrina 1:80.000 y articaína al 4% con epinefrina 1:100.000, en pacientes con diferentes diagnósticos pulpares que requirieron tratamiento de endodoncia. Método: estudio de intervención tipo ensayo clínico aleatorizado. La muestra estuvo conformada por 36 pacientes que asistieron al servicio del posgrado de endodoncia de la Universidad de Cartagena en el año 2016. Para el análisis de la información se utilizaron pruebas de estadística descriptiva y el test Chi2. Se asumió un límite de decisión de 0,05. Resultados: la articaína mostró mayor efecto anestésico en mucosa vestibular (88,9%) y punta de lengua (55,6%), en comparación con la lidocaína. Las tasas de éxito anestésico en los grupos de lidocaína y articaína fueron 5,6% y 22,2%, respectivamente, y la diferencia no fue estadísticamente significativa (p = 0,633). En dientes con pulpa normal, la eficacia fue de 27,3% y esta disminuyó considerablemente en dientes con pulpitis irreversible tanto asintomática como sintomática, con porcentajes de 5,8% y 12,5% respectivamente, aunque esta diferencia no fue estadísticamente significativa (p = 0,276). Conclusiones: Palabras clave: no se encontraron diferencias estadísticamente significativas en la eficacia anestésica entre la lidocaína al pulpa dental, 2% y la articaína al 4% en molares inferiores con pulpa vital. Sin embargo, la articaína demostró tener una pulpitis, anestesia mejor tasa de éxito anestésico. No se encontraron diferencias estadísticamente significativas al comparar la local, lidocaína, eficacia anestésica en molares con pulpa normal y molares con pulpa inflamada (aunque el porcentaje de articaína éxito en pulpa normal fue mayor que en dientes con pulpitis irreversible). Submitted: July 18/2017 – Accepted: May 15/2018. How to quote this article: Martínez-Martínez A, Freyle-Granados E, Senior-Carmona N. Efficacy of 2% lidocaine and 4% articaine in mandibular molars with different pulp diagnoses in the mandibular technique. Rev Fac Odontol Univ Antioq. 2018; 30(1): 5-13. DOI: http://dx.doi.org/10.17533/udea. rfo.v30n1a1 Revista Facultad de Odontología Universidad de Antioquia - Vol. 30 N.o 1 - Second semester, 2018 / ISSN 0121-246X / ISSNe 2145-7670 5 Efficacy of 2% lidocaine and 4% articaine in mandibular molars with different pulp diagnoses in the mandibular technique INTRODUCTION 1:100,000 epinephrine in lower molars with vital pulp in a mandibular block, and to The mandibular technique is the block analyze the relationship between anesthetic method most frequently used in anesthetizing efficacy and diagnosis. mandibular molars during endodontic treatments. However, the failures reported after the use of this technique range from MATERIALS AND METHODS 10% to 81%, with higher values in teeth with inflamed dental pulp.1, 2 This was a randomized, double-blind, Several studies have compared lidocaine parallel-controlled clinical trial. It was and articaine in mandibular techniques, with registered with the Department of Research some showing no statistically significant of the School of Dentistry. All patients signed differences between these anesthetic a written informed consent to participate. solutions, in contrast to other trials that The sample included 36 subjects over 18 suggest that articaine is superior in terms of years of age requiring endodontic treatment degree of pulp anesthesia when compared in a mandibular molar with vital pulp. The with lidocaine.3-5 In 2017, Aggarwal et al6 researchers first standardized the criteria for conducted a clinical trial to evaluate the pulp diagnosis, obtaining a Kappa index of efficacy of 2% lidocaine with 1:200,000 0.80. The researcher with the highest index epinephrine, 4% articaine with 1:100,000 value was calibrated, taking into account the epinephrine, and 0.5% bupivacaine with 2009 criteria of the American Endodontic 8 1:200,000 epinephrine in mandibular block Association. The clinical record of each in patients with asymptomatic irreversible patient was recorded, excluding those with pulpitis, finding out clinical differences a history of allergies to lidocaine or articaine, between articaine and the other studied as well as patients in pregnancy, with solutions, but with no statistical significance. contraindications to the use of epinephrine, and those using consciousness-altering In 2012, Kanna et al,7 in a study in 182 patients medications. Sample size was calculated with irreversible pulpitis in mandibular teeth, using the EPINFOTM software (Centers for concluded that conventional mandibular Disease Control and Prevention, USA) and its block using 2% lidocaine with 1:80,000 StatCalc application. The statistical formula epinephrine does not provide a pain- was used to compare two independent free endodontic procedure, and that means, and the calculation yielded 15 complementary vestibular infiltration using subjects for each group. Considering a 4% articaine with 1:100,000 epinephrine dropout of 10%, each group was increased and intraosseous anaesthesia using 2% to 18 patients, for a total of 36 participants. lidocaine with epinephrine provides a painless procedure with successful pulpal Two local anesthetics were used: 2% anaesthesia averaging 84% and 68%, lidocaine with 1:80,000 epinephrine ® respectively. (Roxicaína 2%-E80, Ropsohn Therapeutics, Colombia) and 4% articaine with 1:100,000 This study aimed to compare the anesthetic epinephrine (Artheek® 4%-E100; Newstetic, efficacy of 2% lidocaine with 1:80,000 Colombia). The anesthetic cartridges were epinephrine and 4% articaine with masked by a third person who did not 6 Revista Facultad de Odontología Universidad de Antioquia - Vol. 30 N.o 1 - Second semester, 2018 / ISSN 0121-246X / ISSNe 2145-7670 Efficacy of 2% lidocaine and 4% articaine in mandibular molars with different pulp diagnoses in the mandibular technique belong to the research team, removing Pulp sensitivity was determined using a the label of the active ingredient and using vitalometer (Analytic Technology, Redmond, colors to encode each cartridge according WA, USA). The contralateral molar was to the active ingredient. The cartridges were evaluated with the vitalometer, in order to inserted in encoded envelopes, one for each validate its reading and for the patient to group. Data analysis was done using this perceive how the stimulus felt in the absence codification and the blinding was removed of anesthesia. This evaluation was performed at the end of the clinical trial. In addition, 10 minutes before starting the test. In all the anesthetic solution that was applied to cases, the electric pulp testing was done in each patient was dosed, as each cartridge the vestibular side of the mandibular molar was externally divided into four equal parts to be treated in the anesthetized side, 5 and and marked with a non-erasable marker, 10 minutes after injecting the anesthetic, to to ensure that each patient was
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