Comparative Efficacy of Buccal Infiltration Anesthesia with 4% Articaine versus Inferior Alveolar Nerve Block With 2% Lidocaine for Extraction of Primary Mandibular Molars: A Randomized Clinical Trial

This study aimed to compare the efficacy of buccal infiltration anesthesia (BIA) with 4% articaine versus inferior alveolar nerve block (IANB) with 2% lidocaine for extraction of primary mandibular molars.

This single-blind randomized controlled clinical trial evaluated 100 children between 4-8 years requiring extraction of primary mandibular molars. The children were randomly assigned to two groups (n=50) of IANB with 2% lidocaine and 1:100,000 epinephrine (control), and BIA with 4% articaine and 1:200,000 epinephrine. The Wong-Baker Faces Pain Rating Scale (WBFPS) and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale were used to assess the analgesic efficacy of each technique, and the resultant behavioral reaction of children. Data were analyzed by the Mann-Whitney, Chi-square, and independent t-tests (alpha=0.05). 

In total, 43 girls and 57 boys with a mean age of 6.59±1.20 years were evaluated. The mean FLACC score was 0.98 in the lidocaine and 1.44 in the articaine group with no significant difference (P=0.246). The mean WBFPS score was significantly higher in the articaine than in the lidocaine group (P=0.039), but the difference between the two groups separately for each tooth type was not significant (P>0.05).

Despite the significantly lower pain score of the IANB with lidocaine group, BIA with 4% articaine was comparable to IANB with 2% lidocaine in behavioral control of children, and may be considered as an acceptable alternative.