Onset and duration periods of articaine and lidocaine on maxillary infiltration

Howard E. Strassler, DMD

Costa DG, Tortamano IP, Rocha RG, et al. Quintessence Int. 2005;36(3):197-201.

Abstract

OBJECTIVES: The aim of this study was to compare the onset and duration of pulpal anesthesia by maxillary infiltration using 2% lidocaine with 1: 100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. METHOD AND MATERIALS: Twenty healthy patients randomly received 1.8 mL or one of the three local anesthetics during operative procedures of low complexity on three maxillary posterior teeth. Onset and duration were determined using an electric pulp tester. RESULTS: The mean values for pulpal onset were 2.8, 1.6, and 1.4 minutes and for pulpal duration were 39.2, 56.7, and 66.3 minutes, respectively, for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. Statistical analysis by the Kruskal-Wallis nonparametric test showed significant differences with better results (shorter onset and longer duration periods) for both articaine solutions compared with the lidocaine solution. Although 4% articaine with 1:100,000 epinephrine clinically presented the shortest onset and the longest duration periods, there was no statistically significant difference between the articaine solutions. CONCLUSION: Both articaine solutions produced shorter onset and longer duration of pulpal anesthesia by maxillary infiltration than the lidocaine solution did. Statistical analysis did not confirm better clinical results of 4% articaine with 1:100,000 epinephrine than with 4% articaine with 1:200,000 epinephrine.

COMMENTARY

Controlling patient pain during dental procedures is an important factor that contributes to successful dental treatment. While articaine was introduced in Europe in 1969, it was not available in the United States until 2000. Articaine has been well accepted for its use as a local anesthetic because it has a high rate of diffusion through soft tissue and bone that in some instances with maxillary infiltration allows it to provide for anesthesia to the palatal hard and soft tissues, which eliminates the need for a palatal block. One other benefit is the short onset time of articaine when compared to lidocaine. However, some clinicians have described a shorter duration for articaine when compared to lidocaine.

This well-planned and conceived research study provides further insight into the use and expectations when using articaine. This study demonstrated an almost immediate anesthesia onset for articaine when compared to lidocaine. Also of importance, this study agreed with previous studies that the duration of anesthesia is extended when compared to lidocaine. One important aspect of this study that every practitioner can bring into the operatory is the method used to test pulpal anesthesia. It is not uncommon for a patient to describe not being numb when a tooth is prepared even though the gingival tissues are anesthetized. If a patient has a history of difficulty in a tooth or teeth getting numb, using an electric pulp test or a cold test to demonstrate pulpal anesthesia is a good patient-management technique. The bottom line is that when a clinician decides to administer anesthesia, it is important that the anesthetic selected be effective. With articaine, not only is it effective but it works faster (onset) and longer (duration).

Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School, Baltimore,Maryland