Efficacy of Articaine Versus Lidocaine Administered as Supplementary Intraligamentary Injection after a Failed Inferior Alveolar Nerve Block: A Randomized Double-blind Study

J Endod. 2019 Jan;45(1):1-5. doi: 10.1016/j.joen.2018.09.012. Epub 2018 Dec 6.


Introduction: The present study comparatively evaluated the anesthetic efficacy of 4% articaine versus 2% lidocaine given as supplemental intraligamentary injections after a failed inferior alveolar nerve block.

Methods: One hundred six adult patients with symptomatic irreversible pulpitis in a mandibular first or second molar received an initial inferior alveolar nerve block with 2% lidocaine with 1:80,000 epinephrine. Pain during the endodontic treatment was assessed using the Heft-Parker visual analog scale. Eighty-two patients with unsuccessful anesthesia were randomly allocated to 2 treatment groups: 1 group received 0.6 mL/root of supplementary intraligamentary injection of 4% articaine with 1:100,000 epinephrine, and the second group received 2% lidocaine with 1:80,000 epinephrine. Endodontic treatment was reinitiated. Success after the primary injection or supplementary injection was defined as no or mild pain (less than 55 mm on the Heft-Parker visual analog scale) during access preparation and root canal instrumentation. Patients' heart rate was monitored using a finger pulse oximeter. The anesthetic success rates were analyzed with the Pearson chi-square test at 5% significance levels. The heart rate changes were analyzed using the t test.

Results: The patients receiving supplementary intraligamentary injections of 4% articaine had a success rate of 66%, whereas 2% lidocaine injections were successful in 78% of cases. The difference was statistically nonsignificant (χ2 = 1.51, P = .2). There was no significant effect of the different anesthetic agents on the heart rate.

Conclusions: Both 4% articaine and 2% lidocaine improved the success rates after a failed primary anesthetic injection, with no significant difference between them.

Keywords: Articaine; inferior alveolar nerve block; intraligamentary injection; irreversible pulpitis; lidocaine; mandibular molars.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Anesthesia, Dental / methods*
  • Anesthetics, Local / administration & dosage*
  • Carticaine / administration & dosage*
  • Double-Blind Method
  • Female
  • Humans
  • Injections / methods
  • Lidocaine / administration & dosage*
  • Male
  • Mandible
  • Mandibular Nerve*
  • Molar
  • Nerve Block*
  • Pain / prevention & control*
  • Pain Measurement
  • Pulpitis / surgery*
  • Root Canal Therapy
  • Treatment Failure*
  • Treatment Outcome
  • Young Adult


  • Anesthetics, Local
  • Lidocaine
  • Carticaine