Comparision of success rate of inferior alveolar nerve block protocol in mandibular first molars with symptomatic irriversible pulpitis by Prilocain and Mepivacain local anaesthesia: A randomized control clinical trial

Abstract

Introduction: It is difficult to achieve sufficient pulpal anesthesia in mandibular posterior teeth with symptomatic irreversible pulpitis. This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine . Method and Material: The current randomized controlled clinical trial was conducted on 100 patients in two groups (n=50). In the first group, standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine, and in the second group with two cartridges of 3% prilocaine. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, first, the tooth was assessed by cold and electric tests, and in case of a negative response to these tests, they were isolated with a rubber dam. The pain severity of patients was recorded during access cavity preparation (dentin cutting), entry into the pulp chamber, and instrumentation using a visual analog scale (VAS). Data were analyzed with SPSS 17 using the chi-squared test. Results: The patients’ pain severities during access cavity preparation, entry into the pulp chamber, and instrumentation were significantly different. The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 higher with prilocaine than mepivacaine. Conclusion: The success rate of inferior alveolar nerve block in teeth with symptomatic irreversible pulpitis was higher using prilocaine than mepivacaine