Dr Mohammad Hossein Nekoofar
Immediate Past President of Iranian Association of Endodontists
Director of International Relations, Tehran University of Medical Sciences
Honorary Senior Clinical Lecturer, Cardiff University

Anesthetic Efficacy of Mental/Incisive Nerve Block Compared to Inferior Alveolar Nerve Block Using 4% Articaine in Mandibular Premolars with Symptomatic Irreversible Pulpitis: a Randomized Clinical Trial


Objectives The aim of this study was to compare the onset, success rate, injection pain, and post-injection pain of mental/incisive nerve block (MINB) with that of inferior alveolar nerve block (IANB) using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis. The accuracy of electrical pulp test (EPT) in determining pulpal anesthesia was also examined.

Materials and Methods The study was designed as a randomized clinical trial with two study arms-MINB and IANB. Injections were performed using a standardized technique. Root canal treatment was initiated 10 min after the injection. Success was defined as no pain or mild pain during access cavity preparation and instrumentation. Injection pain and post-injection pain (up to 7 days) were recorded. All pain ratings were done using Heft-Parker Visual Analog Scale (HP VAS).

Results Sixty-four patients were enrolled. The success rate of MINB (93.8%) was higher than IANB (81.2%) but the difference was not significant (p > 0.05). The onset of anesthesia with MINB was significantly quicker, and injection pain was significantly less (p < 0.05), but post-injection pain was significantly higher during the first 4 days (p < 0.001). The accuracy of EPT in determining pulpal anesthesia was 96.88%.

Conclusions MINB and IANB with 4% articaine had similar efficacy in anesthetizing mandibular premolars with irreversible pulpitis. Post-injection pain with MINB was higher than with IANB.

Clinical relevance MINB and IANB with 4% articaine can be used interchangeably to anesthetize mandibular premolars with irreversible pulpitis.

Keywords: 4% Articaine, Inferior Alveolar Nerve Block, Local Anesthesia, Mental/Incisive Nerve Block, Pain
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