Bhargava S et al.

Journal of Advanced Medical and Dental Sciences Research

@Society of Scientific Research and Studies NLM ID: 101716117

Journal home page: www.jamdsr.com doi: 10.21276/jamdsr Indian Citation Index (ICI) Index Copernicus value = 100

(e) ISSN Online: 2321-9599; (p) ISSN Print: 2348-6805

Original Research
A comparative analysis of 4% articaine and 2% lignocaine in evaluating
the efficacy during pulpectomy procedures in pediatric patients
1
Sanjana Bhargava, 2Kumar Ankit, 3Amit Kumar, 4Ashish Bhagde, 5Anusuya Mishra, 6Chirag Vyas
1
MDS (Pediatric & Preventive Dentistry), Private Practitioner and Consulting Pedodontist, Bhopal, Madhya
Pradesh, India
2
MDS (Oral Medicine & Radiology),Dental College Azamgarh, Private Practitioner & Consulting
Implantologist, Azamgarh, Uttar Pradesh, India
3
Senior Resident, Department of Dentistry (Conservative Dentistry and Endodontics), All India Institute of
Medical Sciences, Patna, Bihar, India
4
MDS Consulting Pedodontist and Private Practioneer, Jamnagar, Gujarat, India
5
Senior Resident, Department of Pediatrics and Preventive Dentistry, S.C.B. Dental College and Hospital,
Manglabag, Cuttack, Odisha, India
6
Senior Resident, MDS (Public Health Dentistry), Indra Gandhi District Hospital, Mandsaur, Madhya
Pradesh,India

ABSTRACT
Aim: A comparative analysis of 4% articaine and 2% lignocaine in pulpectomy procedure. Materials & methods: A total
of 30 subjects were enrolled. The children in the age group of 4-6 years were included. Pulpectomy in both mandibular
second molar of primary teeth was done and were randomly divided into two groups. The chi-squared test was done. The
results were analysed using SPSS software. Results: Based on SEM scale, in the articaine group, 6 (20%) patients reported
pain during dental procedure, and 24 (80%) no pain, while in the lidocaine group, 5 (16.7%) patients reported pain and 25
(83.4%) no pain. Conclusion:4% articaine had a comparable anesthetic outcome to that of 2% lidocaine in pulpectomy.
Keywords: Articaine, Lidocaine, Pulpectomy.

Received: 23 January, 2023 Accepted: 26 February, 2023

Corresponding author: Sanjana Bhargava, MDS (Pediatric & Preventive Dentistry), Private Practitioner and Consulting
Pedodontist, Bhopal, Madhya Pradesh, India

This article may be cited as: Bhargava S, Ankit K, Kumar A, Bhagde A, Mishra A, Vyas C. A comparative analysis of 4%
articaine and 2% lignocaine in evaluating the efficacy during pulpectomy procedures in pediatric patients. J Adv Med Dent
Scie Res 2023;11(3):65-68.

INTRODUCTION intrapulpal, buccal infiltrations etc.3,4 Articaine

Pain control in dentistry is an important part in entered into the clinical practice in 1976 and has been
reducing the fear and anxiety associated with dental widely used since then due to its enhanced efficacy
procedures especially in children. Local anaesthetics and safety. Along with the ester group, articaine
form the back bone of pain control in dentistry and consists of thiophene ring instead of benzene ring
there has been a substantial research for a safe and which makes it different from other anaesthetic
effective anaesthetic agent for a few decades for solutions. The increased diffusion of the articaine
endodontic procedures.1 Two percent lignocaine is the solution is attributed to the presence of thiophene ring,
gold standard and considered the most efficacious which increases the lipid solubility thereby allowing
anaesthetic agent for use in pediatric and adult the solution to cross the lipid membrane. 5
patients and has been widely used for inferior alveolar Clinical studies on articaine and lignocaine have
nerve blocks.2 Clinical studies have shown the failure focused on the time to onset of clinical anesthesia,
of IAN blocks to be approximately 44-84% and 0- dose, duration, depth of anesthesia along with the
36% in maxillary infiltrations which necessitated the safety and efficacy profile, and mean time of onset in
need for supplemental injections in the form of children versus adults, infiltrations and nerve blocks,

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Bhargava S et al.

conventional syringe versus computer-controlled drug Table 2: The number of cases with or without
delivery system Single Tooth Anesthesia-Wand experience of pain according to VAS scale
(STA-Wand) administered for restorative procedures Number of cases
and extractions. 6,7The available literature on articaine VAS scale Pain Without pain
confirms the effectiveness of conventional single Lidocaine 16 14
buccal infiltrations in maxillary primary molar Articaine 12 18
extractions replacing the need of painful palatal
injections which is usually required whenever DISCUSSION
conventional infiltration anesthesia with lignocaine is Pain control is mandatory to reduce anxiety during
preferred. 8Interestingly, the literature available on the dental treatments, particularly in children.1 IANB is
efficacy of articaine intraligamentary injections the preferred technique for achieving pulpal
administered with Wand for pulpectomy procedures anesthesia during treatment of mandibular primary
on primary molar teeth seems to be limited, and molars.11 Clinical studies have reported the failure of
sometimes, the intraligamentary injections have also IANB as high as 44‒84%, necessitating
been considered to overcome the drawbacks of nerve supplementary injections.3,4 Two percent lidocaine,
block particularly when there is a need for treatment the most commonly used anesthetic agent in dentistry,
procedures in bilateral quadrants at the same generally in the IANB technique. 1 Buccal infiltration
appointment.9,10 Hence, this study was conducted to (BI) using 2% lidocaine is not as effective as the
compare and analyse 4% articaine and 2% lignocaine IANB for achieving profound anesthesia in
in pulpectomy procedure. mandibular molars, due to the low penetration of
anesthetic solutions through the buccal cortical plate.
MATERIALS & METHODS 12,13
The prolonged soft tissue anesthesia frequently
A total of 30 subjects were enrolled. The children in associated with IANB could result in self-inflicted
the age group of 4-6 years were included. Pulpectomy trauma such as biting of lip/cheek. 1 Hence, this study
in both mandibular second molar of primary teeth was was conducted to compare and analyse 4% articaine
done and were randomly divided into two groups. and 2% lignocaine in pulpectomy procedure.
Average pain rate in SEM (sound, eye, and motor) In the present study, based on SEM scale, in the
was noted. In the first meeting, infiltration with articaine group, 6 (20%) patients reported pain during
articaine 4% (epinephrine 1/100 000) was performed dental procedure, and 24 (80%) no pain, while in the
for all patients in group 1 on the left side of the lidocaine group, 5 (16.7%) patients reported pain and
mandible. At the next appointment, inferior alveolar 25 (83.4%) no pain. There was no statistically
nerve block was done with lidocaine 2% on the right significant difference between these two groups. A
side of the mandible (epinephrine 1/80 000). Notably, study by Arali V et al, the onset of anaesthesia with
for all patients in the second group, the first injection 4% articaine was faster as compared to 2% lignocaine.
was performed on the right second primary molar The duration of anaesthesia with articaine infiltration
with articaine 4% (epinephrine 1/100 000), and was shorter. The need for supplemental injection in
inferior alveolar nerve block was also done with the articaine group was less. Four percent articaine
lidocaine 2% on the left side of the mandible infiltration can be used in children with irreversible
(epinephrine 1/80 000).The chi-squared test was done. pulpitis. It can be used to replace the IAN block in
The results were analysed using SPSS software. children thereby reducing the post anaesthetic
complications like lip biting.14
RESULTS In the present study, according to VAS scale, in the
Based on SEM scale, in the articaine group, 6 (20%) articaine group, 12 (40%) patients reported pain and
patients reported pain during dental procedure, and 24 18 (60%) no pain, while in the lidocaine group, 16
(80%) no pain, while in the lidocaine group, 5 (53.4%) patients reported pain and 14 (46.7%) no
(16.7%) patients reported pain and 25 (83.4%) no pain. Another study by Erfanparast L et al, Of the 38
pain. There was no statistically significant difference patients included in the current study, 10 (26.3%)
between these two groups.According to VAS scale, in subjects in the lidocaine group and nine (23.6%) in
the articaine group, 12 (40%) patients reported pain the articaine group complained of pain during their
and 18 (60%) no pain, while in the lidocaine group, dental treatment procedures, but this difference was
16 (53.4%) patients reported pain and 14 (46.7%) no not statistically significant. According to the findings
pain. of this study, buccal infiltration of 4% articaine had a
Table 1: The number of cases with or without comparable anesthetic outcome to that of 2%
experience of pain according to SEM scale lidocaine for inferior alveolar nerve block in pulp
Number of subjects treatment of the second primary mandibular molars.15
Pain Without pain The study by Berlin et al.16 reported that “mean onset
Lidocaine 5 25 times of pulpal anesthesia with 4% articaine is 1.3
Articaine 6 24 min and with 2% lignocaine is 2.2 min when
delivered as an intraligamentary injection using a
computer-controlled local anesthetic delivery system.”

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In contrary, Ram and Amir 17 reported no difference 4. Kaufman E, Weinstein P, Milgrom P. Difficulties in
in the onset time between 4% articaine and 2% achieving local anaesthesia. J Am Dent Assoc.
lignocaine. Furthermore, it has been proven that mean 1984;108:205.
5. Isen DA. Articaine: pharmacology and clinical use of a
onset time of anesthesia with 4% articaine was
recently approved local anaesthetic. Dent Today.
generally shorter for children than adults. 18Many 2000;19:72–77.
previous studies have concluded that 4% articaine can 6. Rahul G, Nandlal B, Prashanth Pain perception and
be successfully used in children of 4 to10 y of age. procedural tolerance with computer controlled and
Lemay et al and Dudkeiwich et al., 19,20found the conventional local anesthetic technique: An in vivo
mean time of onset of anaesthesia to be shorter in comparative study. Indian J Pain. 2014;28:143–8.
children than adults. This could be attributed to the 7. Tortamano IP, Siviero M, Lee S, Sampaio RM, Simone
cancellous nature of the paediatric maxilla and JL, Rocha RG. Onset and duration period of pulpal
mandible. Articaine’s excellent pediatric safety and anesthesia of articaine and lidocaine in inferior alveolar
efficacy profile supported by other studies in the nerve block. Braz Dent J. 2013;24:371–4.
8. Kolli NK, Nirmala SV, Nuvvula S. The Effectiveness
literature. 21Clinical trials comparing the time of onset of Articaine and Lidocaine Single Buccal Infiltration
of clinical anaesthesia and the duration and depth of versus Conventional Buccal and Palatal Injection
anaesthesia have shown that 4% articaine provides Using Lidocaine during Primary Maxillary Molar
significantly shorter time of anaesthesia as well as Extraction: A Randomized Control Trial. Anesth
greater consistency than 2% articaine. 22,23 Toxicity of Essays Res. 2017;11:160–4.
4% articaine as compared to lowered concentrations 9. Adewumi A, Hall M, Guelmann M, Riley J. The
was found to be non-significant. 22 incidence of adverse reactions following 4% septocaine
Root canal filling material of primary teeth should be (articaine) in children. Pediatr Dent. 2008;30:424–8.
resorbed at an identical rate, or as similarly as 10. Oztas N, Ulusu T, Bodur H, Dogan C. The wand in
pulp therapy: An alternative to inferior alveolar nerve
possible, to that of physiological root resorption. This block. Quintessence Int. 2005;36:559–64.
study used a modified paste comprising a mixture of 11. Yilmaz Y, Eyuboglu O, Keles S. Comparison of the
ZOE, iodoform, and calcium hydroxide as root canal efficacy of articaine and prilocaine local anaesthesia
filling material in primary molars. Our results for pulpotomy of maxillary and mandibular primary
indicated that the modified paste with a success rate of molars. Eur J Paediatr Dent. 2011;12(2):117–22.
92.5% is a much better material compared with 12. Oulis CJ, Vadiakas GP, Vasilopoulou A. The
Vitapex and had better absorbability compared with effectiveness of mandibular infiltration compared to
ZOE alone. The possible reason was that the mixture mandibular block anesthesia in treating primary molars
does not set into a hard mass. The potential in children. Pediatr Dent. 1996;18(4):301–5.
13. Naser Asl Aminabadi, Ensiyeh Maljaei, Leila
mechanism lied in two aspects. Firstly, the essence of Erfanparast, Amir Ala Aghbali, Hamed Hamishehkar ,
formation of ZOE is the reaction of eugenol and Ebrahim Najafpour . Simvastatin versus Calcium
bivalent zinc ions to form insoluble chelation, Hydroxide Direct Pulp Capping of Human Primary
wrapping remanent zinc oxide in it and forming a Molars: A Randomized Clinical Trial. J Dent Res Dent
solid mass. Because calcium ion dissolves more easily Clin Dent Prospects. 2013 Winter;7(1):8–14. doi:
than zinc ions, adding calcium hydroxide forms 10.5681/joddd.2013.002.
divalent metal chelate salt containing mainly eugenol 14. Arali V, P M. Anaesthetic efficacy of 4% articaine
calcium. Owing to the high solubility of calcium mandibular buccal infiltration compared to 2%
hydroxide, the reaction time is shorter, but strength of lignocaine inferior alveolar nerve block in children
with irreversible pulpitis. J Clin Diagn Res. 2015
chelation was slightly low, thus degrade more quickly. Apr;9(4):ZC65-7.
Secondly, iodoform dissolves easily upon contact with 15. Erfanparast L, Rahbar M, Pourkazemi M, Vatandoust
solutions and tissue fluid, changing the structure of M, Balar S, Vafaei A. Comparison of Effects Exerted
the filling mass to a porous and loose state that might by 4% Articaine Buccal Infiltration and 2% Lidocaine
be resorbed more easily. 24 Inferior Alveolar Nerve Block on Pain Perception and
Behavioral Feedback of Children during Pulp
CONCLUSION Treatment of Mandibular Second Primary Molars.
Buccal infiltration of 4% articaine had a comparable Maedica (Bucur). 2020 Dec;15(4):477-483.
anesthetic outcome to that of 2% lidocaine in 16. Berlin J, Nusstein J, Reader A, Beck M, Weaver J.
Efficacy of articaine and lidocaine in a primary
pulpectomy. intraligamentary injection administered with a
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