Comparative Evaluation of Anesthetic Efficacy of 4% Articaine and 2% Lignocaine as Inferior Alveolar Nerve Block in Patients With Symptomatic Irreversible Pulpitis in Permanent Mandibular First Molars: A Double-Blinded Randomized Clinical Trial

Achieving effective anesthesia during root canal treatment is particularly challenging in cases of symptomatic irreversible pulpitis due to the inflamed pulpal environment, which compromises anesthetic efficacy. Articaine and lignocaine are commonly used local anesthetics in endodontics, differing in onset time, duration, and pain control. The objective of this study was to compare the anesthetic efficacy of 2% lignocaine combined with 1:80,000 epinephrine with 4% articaine combined with 1:100,000 epinephrine during root canal treatment of permanent mandibular first molars in patients with symptomatic irreversible pulpitis. 100 patients, 18-30 years old, with symptomatic irreversible pulpitis in permanent mandibular first molars without any periapical pathology reported to the Department of Conservative Dentistry and Endodontics, Regional Dental College, Guwahati. Following the provision of written informed consent, participants were randomly assigned to receive a conventional inferior alveolar nerve block using either 1.8 mL of 2% lignocaine with 1:80,000 epinephrine (n = 50) or 1.7 mL of 4% articaine with 1:100,000 epinephrine (n=50). Randomization was performed by an individual who did not take part in data acquisition. To avoid identification, the independent observer covered 50 cartridges containing 2% lignocaine and 50 cartridges containing 4% articaine with blue and pink colored tapes, respectively. Patients were subjectively assessed for lip anesthesia. Absence/presence of pulpal anesthesia was tested by using electric pulp stimulation, and absence/presence of pain was assessed by using a Short-Form McGill Pain Questionnaire (Appendix). Data were analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp., with the Student's paired t-test to compare outcomes between the groups. The articaine group showed a faster onset of anesthesia (4.3 min vs. 7.8 min), longer duration (120.8 ± 3 min vs. 64.9 ± 5.2 min), and better pain control during root canal treatment (mean pain score: 1.09 vs. 1.63) compared to the lignocaine group. These differences were statistically highly significant (p < 0.001). Articaine demonstrated faster onset, longer duration, and better pain control than lignocaine, making it a preferred choice for inferior alveolar nerve block in permanent mandibular first molars with symptomatic irreversible pulpitis.