Effect of Precooling the Anesthetic Agent in Comparison to Increasing the Dosage on the Success Rate of Inferior Alveolar Nerve Block Using Articaine in Mandibular First Molars with Symptomatic Irreversible Pulpitis: A Double-Blind, Randomized, Controlled Clinical Trial

Abstract

Introduction: Achieving anesthesia in mandibular molar teeth with irreversible pulpitis has been challenging. This study aimed to compare the efficacy of precooling articaine and increasing its dosage for inferior alveolar nerve block (IANB) in the mandibular first molars with symptomatic irreversible pulpitis.

Methods: In this randomized double-blind clinical trial, 90 first mandibular molar teeth with symptomatic irreversible pulpitis (visual analog scale >54) were randomly divided into three groups and received conventional IANB injection with 1.8 mL (1 cartridge) 1C group or 3.6 mL (two cartridges) 2C group of 4% articaine with 1:200,000 epinephrine with room temperature or 1.8 ml of the same agent with 4°C temperature cold cartridge (CC) group. The patients recorded their pain during the injection and access cavity preparation, pulp chamber, and root canal entrance using a visual analog scale. Data were analyzed by repeated measure of analysis of variance and Bonferroni tests (P < .05).

Results: In all three groups, the pain levels at different injection times were significantly different (P < .05). The pain level did not differ significantly between the 2C group and the CC group (P > .05), but the difference was significant between the 1C group and 2C groups (P < .05) and also between the 1C group and CC group (P < .05).

Conclusions: Administration of cold articaine provides a significantly higher success rate of IANBs in mandibular first molar teeth with symptomatic irreversible pulpitis compared to IANB with articaine kept at room temperature; however, increasing the dosage of articaine led to a significantly higher success rate.

Keywords: Dental anesthesia; inferior alveolar nerve; local anesthesia; mandibular molar; pulpitis.