Comparison of Anesthetic Efficacy of Lidocaine and Articaine in Non-Surgical Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis

Abstract

Background: Achieving profound pulpal anesthesia in mandibular molars with symptomatic irreversible pulpitis (SIP) remains a clinical challenge due to the inflammatory environment, which reduces anesthetic efficacy. Lidocaine is the conventional agent of choice, but articaine’s superior lipid solubility and tissue penetration may offer enhanced anesthetic performance, particularly when combined with supplemental infiltration techniques. Objective: To compare the anesthetic efficacy of 4% articaine and 2% lidocaine, both with 1:100,000 epinephrine, administered via inferior alveolar nerve block (IANB) combined with buccal infiltration (BI) during non-surgical endodontic treatment of permanent mandibular molars with SIP. Methods: In this double-blind, randomized controlled trial, 140 patients diagnosed with SIP were randomly assigned to receive either 4% articaine (Group B) or 2% lidocaine (Group A). All patients received IANB followed by BI. The primary outcome was anesthetic success, defined as absence of moderate-to-severe pain (VAS < 4) during access cavity preparation and instrumentation. Secondary outcomes included mean and median visual analogue scale (VAS) pain scores at 15 minutes and 1 hour post-injection, and the proportion of patients experiencing complete pain relief (VAS = 0). Data were analyzed using the Mann–Whitney U and Chi-square tests, with effect sizes and 95% confidence intervals (CI) reported. Results: Anesthetic success was achieved in all participants in both groups (100% vs. 100%, p = 1.00). Articaine demonstrated significantly lower pain scores compared to lidocaine at 15 minutes (mean ± SD: 0.87 ± 0.82 vs. 2.03 ± 0.72; mean difference: 1.16, 95% CI: 0.90–1.42; p < 0.0001) and at 1 hour (0.43 ± 0.50 vs. 1.03 ± 0.68; mean difference: 0.60, 95% CI: 0.40–0.80; p < 0.0001). The proportion of pain-free patients was also significantly higher with articaine (15 min: 62.8% vs. 5.7%; 1 h: 88.5% vs. 34.2%; p < 0.001). Conclusion: Although both anesthetics achieved high clinical success, articaine produced significantly deeper and more predictable pulpal anesthesia than lidocaine. Its superior analgesic profile supports its use as a preferred anesthetic in challenging endodontic cases involving SIP, particularly when profound anesthesia and patient comfort are critical.