Comparative Efficacy of Buccal Infiltration Anesthesia with Articaine and Inferior Alveolar Nerve Block with Lidocaine for Pulpotomy of Primary Mandibular Second Molars Under Sedation: A Clinical Trial

This study compared the efficacy of buccal infiltration anesthesia (BIA) with articaine versus inferior alveolar nerve block (IANB) with lidocaine for pulpotomy of primary mandibular second molars under intravenous sedation.  

This split-mouth randomized clinical trial was conducted on 29 uncooperative children (Frankl scores I & II) between 3-6 years with bilateral primary mandibular second molars requiring pulpotomy. After intravenous sedation, one random quadrant received IANB with 2% lidocaine and the respective tooth underwent pulpotomy with mineral trioxide aggregate and subsequent coronal restoration with a stainless-steel crown. The other quadrant received BIA with 4% articaine in the next session for pulpotomy of the respective tooth. The behavior of children was evaluated right after receiving the sedative (T0), during anesthetic injection (T1), during pulp exposure (T2), and in the recovery room (T3) using non-verbal pain scale-revised (NVPS-R). Data were analyzed by one-way and two-way repeated measures ANOVA (alpha=0.05). 

The odds of calmness of children during the entire procedure were 1.7 times higher in BIA than IANB but this difference was not significant (P=0.061). The mean heart rate (HR) of children was generally higher in IANB than BIA (P=0.04 at T1, P<0.001 at T2, and P=0.01 at T3). The effect of time on HR was also significant (P<0.001). Blood oxygen saturation rate (SPO2) was higher in BIA than IANB during the procedure (P<0.001).

BIA with articaine had optimal efficacy comparable to that of IANB with lidocaine for pulpotomy of primary second molars under sedation.