Clinical Evaluation of Buccal Infiltration with Articaine for Endodontic Anesthesia in Mandibular Molars with Irreversible Pulpitis

Background and Objectives: This study investigates the efficacy of 4% articaine buccal infiltration in patients with mandibular molar irreversible pulpitis. The goal is to understand the anatomical factors contributing to articaine’s success in mandibular infiltrations. Materials and Methods: A randomized controlled trial was conducted with 50 patients diagnosed with symptomatic irreversible pulpitis in mandibular molars. Patients were divided into two groups: 4% articaine buccal infiltration (n = 30) and 2% lidocaine nerve block (n = 20). Pain was assessed using visual analog scales (VASs) before diagnosis, after thermal pulp sensitivity testing, and 5 and 10 min post-anesthetic application. Cone beam computed tomography (CBCT) was used to measure mandibular bone parameters. Results: The success rate for articaine buccal infiltration was 36.55%, with no significant difference between the efficacy in the first and second molars. CBCT measurements indicated no significant influence of buccal cortical bone thickness or distance from the mental foramen on anesthetic efficacy. However, articaine administration achieved anesthesia in some cases where lidocaine did not. Conclusions: Anatomical structures such as cortical bone thickness and distance from the mental foramen do not significantly influence the anesthetic efficacy of articaine in mandibular posterior infiltration for irreversible pulpitis treatment. These findings suggest that factors other than anatomical variations contribute to articaine’s superior performance in some clinical scenarios.