title: Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block.
abstract: OBJECTIVE
  To compare mandibular tooth pulpal anaesthesia and reported discomfort following lidocaine inferior alveolar nerve block (IANB) with and without supplementary articaine buccal infiltration.
  
  
  METHODS
  In this prospective randomized double-blind cross-over study, thirty-six healthy adult volunteers received two IANB injections of 2 mL lidocaine 2% with epinephrine 1 : 80,000 over two visits. At one visit, an infiltration of 2 mL of articaine 4% with epinephrine 1 : 100,000 was administered in the mucobuccal fold opposite a mandibular first molar. At the other visit, a dummy injection was performed. Injection discomfort was recorded on 100 mm visual analogue scales. Pulpal anaesthesia of first molar, premolar, and lateral incisor teeth was assessed with an electronic pulp tester until 45 min post-injection. A successful outcome was recorded in the absence of sensation on two or more consecutive maximal pulp tester stimulations. Data were analysed using McNemar and Student's t-tests.
  
  
  RESULTS
  The IANB with supplementary articaine infiltration produced more success than IANB alone in first molars (33 volunteers vs. 20 volunteers respectively, P < 0.001), premolars (32 volunteers vs. 24 volunteers respectively, P = 0.021) and lateral incisors (28 volunteers vs. 7 volunteers respectively, P < 0.001). Buccal infiltration with articaine or dummy injection produced less discomfort than IANB injection (t = 4.1, P < 0.001; t = 3.0, P = 0.005 respectively).
  
  
  CONCLUSIONS
  The IANB injection supplemented with articaine buccal infiltration was more successful than IANB alone for pulpal anaesthesia in mandibular teeth. Articaine buccal infiltration or dummy buccal infiltration was more comfortable than IANB.
authors.affiliation: School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: M D
authors.initials: MD
authors.lastname: Kanaa
authors.forename: J M
authors.initials: JM
authors.lastname: Whitworth
authors.forename: I P
authors.initials: IP
authors.lastname: Corbett
authors.forename: J G
authors.initials: JG
authors.lastname: Meechan
mesh_terms: D000328:Adult; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001641:Bicuspid / Q000294:innervation; D002355:Carticaine / Q000008:administration & dosage*; D018592:Cross-Over Studies; D003782:Dental Pulp / Q000187:drug effects / Q000294:innervation; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007180:Incisor / Q000294:innervation; D007267:Injections / Q000009:adverse effects; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008340:Mandibular Nerve / Q000187:drug effects; D008963:Molar / Q000294:innervation; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D011446:Prospective Studies; D012677:Sensation / Q000187:drug effects; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D008012:Lidocaine; D002355:Carticaine; D004837:Epinephrine