title: Articaine and mepivacaine buccal infiltration in securing mandibular first molar pulp anesthesia following mepivacaine inferior alveolar nerve block: A randomized, double-blind crossover study.
abstract: OBJECTIVE
  A crossover double-blind, randomized study was designed to explore the efficacy of 2% mepivacaine with 1:100,000 adrenaline buccal infiltration and 4% articaine with 1:100,000 adrenaline buccal infiltration following 2% mepivacaine with 1:100,000 adrenaline inferior alveolar nerve block (IANB) for testing pulp anesthesia of mandibular first molar teeth in adult volunteers.
  
  
  METHODS
  A total of 23 healthy adult volunteers received two regimens with at least 1-week apart; one with 4% articaine buccal infiltration and 2% mepivacaine IANB (articaine regimen) and another with 2% mepivacaine buccal infiltration supplemented to 2% mepivacaine IANB (mepivacaine regimen). Pulp testing of first molar tooth was electronically measured twice at baseline, then at intervals of 2 min for the first 10 min, then every 5 min until 45 min postinjection. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation were obtained within 10 min and continuously sustained for 45 min postinjection.
  
  
  RESULTS
  In total, the number of no sensations to maximum pulp testing for first molar teeth were significantly higher after articaine regimen than mepivacaine during 45 min postinjection (267 vs. 250 episodes, respectively, P < 0.001), however, both articaine and mepivacaine buccal infiltrations are equally effective in securing anesthetic success for first molar pulp anesthesia when supplemented to mepivacaine IANB injections (P > 0.05). Interestingly, volunteers in the articaine regimen provided faster onset and longer duration (means 2.78 min, 42.22 min, respectively) than mepivacaine regimen (means 4.26 min, 40.74 min, respectively) for first molar pulp anesthesia (P < 0.001).
  
  
  CONCLUSIONS
  Supplementary mepivacaine and articaine buccal infiltrations produced similar successful first molar pulp anesthesia following mepivacaine IANB injections in volunteers. Articaine buccal infiltration produced faster onset and longer duration than mepivacaine buccal infiltration following mepivacaine IANB injections.
authors.affiliation: Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Saudi Arabia.
authors.forename: Giath
authors.initials: G
authors.lastname: Gazal
authors.affiliation: Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Saudi Arabia.
authors.forename: Abdullah Muteb
authors.initials: AM
authors.lastname: Alharbi
authors.affiliation: Department of Restorative Dentistry, College of Dentistry, Taibah University, Medina, Saudi Arabia.
authors.forename: Khalid HidayatAllah
authors.initials: KH
authors.lastname: Al-Samadani
authors.affiliation: Department of Oral and Maxillofacial Surgery, Kettering General Hospital, Kettering, NN16 8UZ, United Kingdom.
authors.forename: Mohammad Dib
authors.initials: MD
authors.lastname: Kanaa
keywords: Adrenaline; articaine; buccal infiltration; first molar pulp anesthesia; inferior alveolar nerve block; mepivacaine