Anesthetic Success of an Inferior Alveolar Nerve Block and Supplemental Articaine Buccal Infiltration for Molars and Premolars in Patients with Symptomatic Irreversible Pulpitis

J Endod. 2016 Mar;42(3):390-2. doi: 10.1016/j.joen.2015.12.025. Epub 2016 Jan 28.


Introduction: The purpose of this retrospective study was to determine the anesthetic success of the inferior alveolar nerve (IAN) block, and supplemental articaine buccal infiltration after a failed IAN block, in first and second molars and premolars in patients presenting with symptomatic irreversible pulpitis.

Methods: As part of 6 studies, 375 emergency patients presenting with symptomatic irreversible pulpitis received 2% lidocaine with 1:100,000 epinephrine via an IAN block. After profound lip numbness, endodontic access and instrumentation were initiated. If the patient felt moderate to severe pain, a supplemental buccal infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine was administered (204 patients), and endodontic treatment continued. Success was defined as the ability to access and instrument the tooth without pain (visual analogue scale rating of 0) or mild pain (visual analogue scale rating less than or equal to 54 mm).

Results: IAN block success was 28% for the first molars, 25% for the second molars, and 39% for the premolars. There were no significant differences when comparing molars with premolars. For the supplemental articaine buccal infiltration, success was 42% for the first molars, 48% for the second molars, and 73% for the premolars. There were no significant differences when comparing the molars, but there was a significant difference when comparing the premolars with the molars.

Conclusions: For patients presenting with symptomatic irreversible pulpitis, the success rates for the IAN block and supplemental buccal infiltration of articaine of the molars and premolars would not be high enough to ensure profound pulpal anesthesia.

Keywords: Anesthetic success; articaine; buccal infiltration; inferior alveolar nerve block; irreversible pulpitis; lidocaine; mandibular anesthesia.

MeSH terms

  • Administration, Buccal
  • Adolescent
  • Adult
  • Aged
  • Anesthesia, Dental / methods*
  • Anesthesia, Local / methods*
  • Anesthetics, Local / administration & dosage
  • Bicuspid / drug effects*
  • Bicuspid / innervation
  • Carticaine / administration & dosage*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Molar / drug effects*
  • Molar / innervation
  • Nerve Block / methods*
  • Pulpitis / therapy*
  • Retrospective Studies
  • Root Canal Preparation / instrumentation
  • Root Canal Preparation / methods
  • Root Canal Therapy
  • Treatment Outcome
  • Young Adult


  • Anesthetics, Local
  • Carticaine