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What is the Anesthetic Efficacy of Mepivacaine and Lidocaine in Patients with Irreversible Pulpitis?

This summary is based on the article published in the Journal of Endodontics: Comparison of the Anesthetic Efficacy of Mepivacaine and Lidocaine in Patients with Irreversible Pulpitis: A Double-blind Randomized Clinical Trial (September 2016)

Ana Maria Antonelli da Veiga, Amanda Carneiro Cunha, Daniele Masterson Tavares Pereira Ferreira, Tatiana Kelly da Silva Fidalgo, Thomaz Kauark Chianca, Kátia Rodrigues Reis, Lucianne Cople Maia

Context 

Pain sensation is difficult to define as it varies in patients based on their emotions, experiences and pain thresholds. Both mepivacaine and lidocaine, amide-based local anesthetics, are very common in dentistry due to their history of safety and efficacy in achieving regional anesthesia required for dental procedures. The use of Mepivacaine is favourable in clinical situations since its lower pKa value is more compatible in tissues that are inflamed. It also has a longer duration of action and quicker onset.

Irreversible pulpitis is a frequent endodontic issue where the patient’s pain must be relieved quickly. The pain is caused by acute pulpal inflammation and since the pulp cannot expand, the pressure builds up significantly within the tissues. The effectiveness of local anesthesia and pain control can be challenging for the patient and the practitioner.

Purpose

The purpose of this study was to determine the anesthetic efficacy of both 2% lidocaine (1:100,000 epinephrine) and 2% mepivacaine (1:100,000 epinephrine) when an inferior alveolar block was administered to patients diagnosed with irreversible pulpitis in posterior mandibular teeth.

Key Findings

  • At low volumes (1 cartridge), mepivacaine blocked the IAN more effectively than lidocaine.
  • Better clinical comfort was achieved with mepivacaine using less anesthetic (fewer injections and lower volumes)
  • Sample sizes could be increased in further studies to improve the results

List of References (PDF)

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