Comparison of Efficacy of Two Anesthetic Solutions in Irreversible Pulpitis

Objectives: The aim of this study was to evaluate the effectiveness of 3% mepivacaine plain and 2% mepivacaine (1:20.000 levonordephrine) applicated by the computer controlled anesthetic delivery system (CCADS) (Wand-Plus, Milestone Scientific) and conventional syringe for inferior alveolar nerve blocks (IANB) in patients with irreversible pulpitis. Methods: One hundred-twenty adult patients, between the ages of 18–35, participated in current study. Each patient had a tooth that fulfilled the criteria for a clinical diagnosis of irreversible pulpitis. The 120 patients randomly divided into two main groups as IANB with conventional syringe (n=60) and IANB with the CCADS (n=60). Each main group divided into two subgroups: the patients of the first group received 1.8ml 3% mepivacaine plain or 1.8ml 2% mepivacaine (1:20.000 levonordephrine) with the conventional syringe and the patients in the second group received 1.4 ml 3% mepivacaine plain or 1.4 ml 2% mepivacaine (1:20.000 levonordephrine) with the CCADS for IANB. Endodontic access preparation was initiated after 15 minutes of anesthesia. Pain during treatment was recorded using a Heft-Parker visual analog scale. "None" or "mild" pain was recorded as success. Following these procedures, the patients were also evaluated for injection pain, lip numbness onset time (LNOT) and heart rate. Mann-Whitney test was used to evaluate the comparison of effectiveness of the anesthetic solutions applicated with two techniques. Results: There were no significant differences among the injection pain, LNOT and heart rates of the groups (p>0.05). There were no significant differences between 2% and %3 mepivacaine when applied with conventional syringe however when applied with the CCADS 3% mepivacaine plain was less effective than 2% mepivacaine (1:20.000 levonordephrine) (p<0.05). Conclusions: The dose of 1.4ml 3% mepivacaine plain may not be enough for anesthetic effect. There is no superiority of levonordephrine containing mepivacaine to the mepivacaine plain form when applied with conventional syringe.