The effect of inferior alveolar nerve block anesthesia of 4% articaine and epinephrine 1:100,000 on blood flow and anesthesia of human mandibular teeth

Abstract

Background/purpose Local anesthetics and anesthetic techniques affect the patterns of pulpal blood flow (PBF) and pulpal anesthesia in human teeth. This study aimed to determine PBF changes and pulpal anesthesia of intact mandibular first molars and canines after administration of 4% articaine with epinephrine 1:100,000 using inferior alveolar nerve block (IANB). Materials and methods Ten healthy subjects received IANB of 4% articaine with epinephrine 1:100,000. Laser Doppler flowmetry and electrical pulp testing were combined to assess PBF changes and pulpal anesthesia of intact mandibular first molars and canines. The data were analyzed using one-way repeated-measures analysis of variance and Student–Newman–Keuls test. Results IANB with 4% articaine and epinephrine 1:100,000 did not have any significant change in PBF for the first 20 min post injection in mandibular first molars, and for 45 min post injection in the canines ( P > 0.05). However, a hyperemic response occurred during 25–60 min post injection in the molars, and between 60 and 75 min post injection in the canines ( P < 0.05). Thereafter, the PBF in both teeth returned to the baseline. Onset of pulpal anesthesia was 8.60 ± 2.12 min in the molars, and 9 ± 1.94 min in the canines. Duration of pulpal anesthesia was 82.40 ± 41.56 min in the molars, and 84 ± 47.40 min in the canines. Conclusion In case of successful IANB, 4% articaine and epinephrine 1:100,000 caused insignificant changes in PBF up to 30 min but a hyperemic response at later time points. Thereafter, the PBF returned to the baseline.

Present status and future directions—Mechanisms and management of local anaesthetic failures

“…In teeth with healthy pulps, 4% articaine with 1:200 000 epinephrine for IANB provided significantly faster onset and longer duration of anaesthesia compared to 2% lidocaine with 1:100 000 epinephrine (Tortamano et al, 2013). When 4% articaine with 1:100 000 epinephrine was used for an IANB for teeth with healthy pulps, the onset of anaesthesia was 8.60 ± 2.12 min and 9.0 ± 1.94 min in molars and canines, respectively (Samdrup et al, 2021).…”

“…It should also be noted that the onset of anaesthesia may be influenced by the condition of the pulp. A drawback of most investigations on the onset of anaesthesia is that they usually assess teeth that do not need root canal treatment—that is, they have normal, healthy pulps (Currie et al, 2013; McEntire et al, 2011; Samdrup et al, 2021; Tortamano et al, 2013).…”