Objective. The authors conducted a randomized, double-blind clinical trial to evaluate pulpal anesthesia achieved after mandibular infiltration of five commonly marketed dental local anesthetic formulations as compared with a control formulation of lidocaine with epinephrine.
Methods. The authors evaluated 2 percent lidocaine with 1:100,000 epinephrine (L100) against 4 percent articaine with 1:100,000 epinephrine (A100), 4 percent articaine with 1:200,000 epinephrine (A200), 4 percent prilocaine with 1:200,000 epinephrine (P200), 3 percent mepivacaine without vasoconstrictor (Mw/o) and 0.5 percent bupivacaine with 1:200,000 epinephrine (B200). This repeated-treatment trial involved 18 healthy participants. The investigators administered mandibular infiltration injections (six sessions per participant) of 0.9 milliliters of anesthetic into the buccal fold adjacent to the distal root of the mandibular first molar. The authors determined anesthetic efficacy across a 20-minute period by measuring changes in sensory threshold to electrical pulp test (EPT) stimulation.
Results. Twelve female and six male participants (mean age, 24.9 years; range, 18–53 years) completed the study. The maximum mean increase from baseline of EPT measurements for the six formulations were 43.5 percent for L100, 44.8 percent for B200, 51.2 percent for P200, 66.9 percent for A200, 68.3 percent for Mw/o and 77.3 percent for A100 (A100 versus L100, P = .029). Adverse reactions were minor and not formulation dependent.
Conclusions and Clinical Implications. The authors found that mandibular infiltration with 0.9 mL of the tested dental anesthetics could induce only partial pulpal anesthesia, a level likely to be inadequate for most dental procedures. When compared with L100, only the A100 induced statistically greater pulpal anesthesia after mandibular buccal infiltration.
