Clinical evaluation of anesthetic efficacy of 2% lignocaine versus 4% articaine intraligamentary injection using StarPen after an ineffective inferior alveolar nerve block in mandibular molars with acute irreversible pulpitis: A randomized clinical t

Abstract Context: Inferior alveolar nerve block (IANB) frequently fails in teeth with acute irreversible pulpitis. Supplementary anesthetic technique is required in such cases to achieve profound anesthesia. Aim: This randomized single-blind controlled trial evaluated and compared the anesthetic efficacy of 2% lignocaine versus 4% articaine as intraligamentary (IL) injections using StarPen after ineffective IANB in mandibular molars with acute irreversible pulpitis. Settings and Design: This is a randomized clinical trial. Subjects and Methods: Fifty subjects having irreversible pulpitis in mandibular molars with failed IANB were selected. Before IL injection, intraoperative pain was recorded on the Visual Analog Scale (VAS). Patients were divided into two groups (n = 25). Group I received 2% lignocaine and Group II received 4% articaine as IL injections using StarPen. Further access cavity was prepared, and canals were located, following working length determination. Then intraoperative pain was assessed on VAS. Statistical Analysis: Kolmogorov–Smirnov and Shapiro–Wilk tests were done to check for normal distribution of the data. An unpaired t-test was applied to compare the groups. Statistical significance was calculated at P < 0.05, and P < 0.001 was considered statistically highly significant. Results: Both the drugs, Group I (lignocaine IL, 1.67 ± 0.89) and Group II (articaine IL, 1.25 ± 0.87), were significantly effective in reducing pain levels in failed IANB cases, but the difference was not statistically significant. Conclusions: Both the drugs are almost equally effective as IL injection in achieving profound pulpal anesthesia. StarPen can be used for painless IL injections with better compliance and easy handling.