Anesthetic success using different volumes of articaine for inferior alveolar nerve block in symptomatic irreversible pulpitis: A randomized, double-blind study

Abstract

Aim: The purpose of this study was to achieve maximum anesthetic success using different volumes of articaine as inferior alveolar nerve block (IANB) and ketorolac with/without buccal infiltration (BI) when treating molars with symptomatic irreversible pulpitis (IP). Materials and methods: A total of 160 mandibular molars with symptomatic IP randomly received conventional IANB either with one (1.8 mL) or two cartridges (3.6 mL) of 4% articaine after ketorolac oral premedication. Each group was further divided into two subgroups: one with BI with 1.8 mL articaine and the other with mock BI. Patients recorded their pain before and during access cavity preparation as well as during root canal instrumentation using a Heft–Parker visual analog scale (HP VAS). No or mild pain was considered as successful anesthesia. Results: A statistical analysis demonstrated that double-volume (3.6 mL) articaine and ketorolac with or without BI (87.5% and 80%, respectively) has a higher success rate when compared with single-volume (1.8 mL) articaine and ketorolac with and without BI (75% and 42%, respectively). Conclusion: Double-volume articaine with oral premedication and BI resulted in a significantly higher success rate when compared with single-volume articaine and oral ketorolac premedication. The addition of BI to double/single-volume articaine IANB resulted in a higher success rate. Clinical significance: Double-volume articaine and infiltration with ketorolac premedication resulted in a higher success rate than single-volume articaine in mandibular teeth with IP.