International Journal of Clinical Pediatric Dentistry

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VOLUME 14 , ISSUE 3 ( May-June, 2021 ) > List of Articles


Can 4% Articaine Buccal Infiltration Replace Inferior Alveolar Nerve Block (IANB) with 2% Xylocaine for Pulp Therapy in Primary Mandibular Molars? A Systematic Review

Abhishek Vamshi, David Tyro

Keywords : Articaine, Buccal, Children, Inferior alveolar nerve block, Infiltration, Lignocaine, Pulp therapy

Citation Information : Vamshi A, Tyro D. Can 4% Articaine Buccal Infiltration Replace Inferior Alveolar Nerve Block (IANB) with 2% Xylocaine for Pulp Therapy in Primary Mandibular Molars? A Systematic Review. Int J Clin Pediatr Dent 2021; 14 (3):420-425.

DOI: 10.5005/jp-journals-10005-1974

License: CC BY-NC 4.0

Published Online: 29-09-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aim and objective: This systematic review aims to compare the efficacy of 4% articaine buccal supraperiosteal/infiltration to that of inferior alveolar nerve block (IANB) with 2% xylocaine in providing pulpal anesthesia for carrying out pulp therapy of deciduous mandibular molars in children. Materials and methods: PubMed, Cochrane Registry, and Ovid SP were searched in the timeframe between years 1991 and 2020 with appropriate MeSH terms. Full texts were selected only after a preliminary screening of relevant titles and abstracts. Results: Five studies were involved for the final qualitative analysis. The parameter sought for was “Pain during pulp therapy after injection with buccal supraperiosteal/infiltration (4% articaine) or IANB (2% lignocaine) in primary mandibular molars. Three studies evaluated objective pain (operator reported) during pulp therapy, reported significantly lower pain scores with articaine buccal infiltration (BI). Among the two studies that evaluated subjective pain, one study reported a significantly lower pain score with the articaine BI group. The other study reported no difference statistically between both groups. Conclusion: Under the bounds of this systematic review, BI with 4% articaine might be equivalent to IANB with 2% lignocaine for providing pulpal anesthesia required for pulp therapy procedures in primary mandibular molars; however, the quality of evidence is low, more number of well-controlled studies with adequate sized sample should be conducted out to verify the same.

  1. Kaufman E, Epstein JB, Naveh E, et al. A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections. Anesth Prog 2005;52(4):122–127. DOI: 10.2344/0003-3006(2005)52[122:ASP]2.0.CO;2.
  2. Hwang TJ, Hsu SC, Huang QF, et al. Age changes in location of mandibular foramen. Zhonghua Ya Yi Xue Hui Za Zhi 1990;9(3): 98–103.
  3. Pourkazemi M, Erfanparast L, Sheykhgermchi S, et al. Is inferior alveolar nerve block sufficient for routine dental treatment in 4- to 6-year-old children? Int J Clin Pediatr Dent 2017;10(4):369–372. DOI: 10.5005/jp-journals-10005-1467.
  4. Abu Sharkh M, Khalil A, Ong-Ly C, et al. Buccal injection of articaine to anesthetize the palatal mucosa. Gen Dent 2009;67(3):26–30.
  5. Al-Mahalawy H, Abuohashish H, Chathoth S, et al. Articaine versus lidocaine concentration in the palatal tissues after supraperiosteal buccal infiltration anesthesia. J Oral Maxillofac Surg 2018;76(2):315.e1–315.e7. DOI: 10.1016/j.joms.2017.10.001.
  6. Bataineh AB, Nusair YM, Al-Rahahleh RQ. Comparative study of articaine and lidocaine without palatal injection for maxillary teeth extraction. Clin Oral Investig 2019;23(8):3239–3248. DOI: 10.1007/s00784-018-2738-x.
  7. Hosseini HR, Parirokh M, Nakhaee N, et al. Efficacy of articaine and lidocaine for buccal infiltration of first maxillary molars with symptomatic irreversible pulpitis: a randomized double-blinded clinical trial. Iran Endod J 2016;11(2):79–84. DOI: 10.7508/iej.2016.02.001.
  8. Kolli NK, Nirmala SV, Nuvvula S. The effectiveness of articaine and lidocaine single buccal infiltration versus conventional buccal and palatal injection using lidocaine during primary maxillary molar extraction: a randomized control trial. Anesth Essays Res 2017;11(1):160–164. DOI: 10.4103/0259-1162.186589.
  9. Kumar DP, Sharma M, Patil V, et al. Anesthetic efficacy of single buccal infiltration of 4% articaine and 2% lignocaine in extraction of maxillary 1(st) molar. Ann Maxillofac Surg 2019;9(2):239–246. DOI: 10.4103/ams.ams_201_18.
  10. Majid OW, Ahmed AM. The anesthetic efficacy of articaine and lidocaine in equivalent doses as buccal and non-palatal infiltration for maxillary molar extraction: a randomized, double-blinded, placebo-controlled clinical trial. J Oral Maxillofac Surg 2018;76(4):737–743. DOI: 10.1016/j.joms.2017.11.028.
  11. Sandilya V, Andrade NN, Mathai PC, et al. A randomized control trial comparing buccal infiltration of 4% articaine with buccal and palatal infiltration of 2% lignocaine for the extraction of maxillary premolar teeth. Contemp Clin Dent 2019;10(2):284–288. DOI: 10.4103/ccd.ccd_529_18.
  12. Bartlett G, Mansoor J. Articaine buccal infiltration vs lidocaine inferior dental block - a review of the literature. Br Dent J 2016;220(3):117–120. DOI: 10.1038/sj.bdj.2016.93.
  13. Corbett IP, Kanaa MD, Whitworth JM, et al. Articaine infiltration for anesthesia of mandibular first molars. J Endod 2008;34(5):514–518. DOI: 10.1016/j.joen.2008.02.042.
  14. Jung IY, Kim JH, Kim ES, et al. An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod 2008;34(1):11–13. DOI: 10.1016/j.joen.2007.09.006.
  15. Monteiro MR, Groppo FC, Haiter-Neto F, et al. 4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: a randomized clinical study. Int Endod J 2015;48(2):145–152. DOI: 10.1111/iej.12293.
  16. Poorni S, Veniashok B, Senthilkumar AD, et al. Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial. J Endod 2011;37(12):1603–1607. DOI: 10.1016/j.joen.2011. 09.009.
  17. Yilmaz K, Tunga U, Ozyurek T. Buccal infiltration versus inferior alveolar nerve block in mandibular 2(nd) premolars with irreversible pulpitis. Niger J Clin Pract 2018;21(4):473–477. DOI: 10.4103/njcp.njcp_135_17.
  18. Alinejhad D, Bahrololoomi Z, Navabazam A, et al. Comparison of visual analog scale scores in pain assessment during pulpotomy using different injection materials in children aged 6 to 8 and 8 to 10 years. J Contemp Dent Pract 2018;19(3):313–317. DOI: 10.5005/jp-journals-10024-2259.
  19. Alzahrani F, Duggal MS, Munyombwe T, et al. Anaesthetic efficacy of 4% articaine and 2% lidocaine for extraction and pulpotomy of mandibular primary molars: an equivalence parallel prospective randomized controlled trial. Int J Paediatr Dent 2018;28(3):335–344. DOI: 10.1111/ipd.12361.
  20. Arali V, Mytri M. Anaesthetic efficacy of 4% articaine mandibular buccal infiltration compared to 2% lignocaine inferior alveolar nerve block in children with irreversible pulpitis. J Clin Diagn Res 2015;9(4):Zc65–Zc67. DOI: 10.7860/JCDR/2015/12821.5856.
  21. Arrow P. A comparison of articaine 4% and lignocaine 2% in block and infiltration analgesia in children. Aust Dent J 2012;57(3):325–333. DOI: 10.1111/j.1834-7819.2012.01699.x.
  22. Chopra R, Marwaha M, Bansal K, et al. Evaluation of buccal infiltration with articaine and inferior alveolar nerve block with lignocaine for pulp therapy in mandibular primary molars. J Clin Pediatr Dent 2016;40(4):301–305. DOI: 10.17796/1053-4628-40.4.301.
  23. Ghadimi S, Shahrabi M, Khosravi Z, et al. Efficacy of articaine infiltration versus lidocaine inferior alveolar nerve block for pulpotomy in mandibular primary second molars: a randomized clinical trial. J Dent Res Dent Clin Dent Prospects 2018;12(2):97–101. DOI: 10.15171/joddd.2018.015.
  24. Jorgenson K, Burbridge L, Cole B. Comparison of the efficacy of a standard inferior alveolar nerve block versus articaine infiltration for invasive dental treatment in permanent mandibular molars in children: a pilot study. Eur Arch Paediatr 2020;21(1):171–177. DOI: 10.1007/s40368-019-00496-8.
  25. Venkat Narayanan J, Gurram P, Krishnan R, et al. Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars. Oral Maxillofac Surg 2017;21(3):295–299. DOI: 10.1007/s10006-017-0628-z.
  26. Zain M, Rehman Khattak SU, Sikandar H, et al. Comparison of anaesthetic efficacy of 4% articaine primary buccal infiltration versus 2% lidocaine inferior alveolar nerve block in symptomatic mandibular first molar teeth. J Coll of Physicians Surg Pak 2016;26(1):4–8. DOI: 01.2016/JCPSP.0408.
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