This study sought to determine the
anesthetic efficacy of 4%
articaine with 1:100,000
epinephrine in patients with symptomatic and asymptomatic irreversible
pulpitis in mandibular posterior teeth and if individual patient factors, pulpal disease characteristics, and previous medication are correlated to
local anesthetic success. A second objective was to determine the specificity and sensibility of a cold test for prediction of
anesthetic success prior to endodontic treatment. Seventy patients diagnosed with irreversible
pulpitis in mandibular posterior teeth received 1.6 mL of 4%
articaine with 1:100,000
epinephrine for an inferior alveolar nerve block (IANB) using a
metal guide. The
anesthetic solution was injected with a computer-preprogrammed delivery system for
local anesthesia. Endodontic access was begun 15 minutes after
solution deposition; later, patients rated their discomfort using the visual analog scale (VAS). The success rate for the IA NB using
articaine was 64.2% in patients with symptomatic irreversible
pulpitis and 86.9% in patients with asymptomatic irreversible
pulpitis. Cold test prior to root canal treatment had a specificity and sensibility of 12.5% and 87.1%, respectively. The
anesthetic efficacy of
articaine in irreversible
pulpitis is moderately acceptable, and
anesthetic success increases when the patient has been premedicated with
NSAIDs. The cold test appears to be a favorable
indicator for predicting
anesthetic success.