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Objectives: To investigate the success rate of supplemental intraseptal and buccal infiltration anaesthesia in mandibular molars undergoing endodontic therapy/extraction when the inferior alveolar nerve block has failed. Material and Methods: A prospective clinical trial including 200 patients undergoing lower molar root canal treatment/teeth extraction was conducted. Only 80 patients of the participants who had profound lower lip anaesthesia after the administration of inferior alveolar nerve block (IANB) were in pain within treatment. Patients experiencing moderate to severe pain upon using elevators, forceps, bur, or endodontic file were randomly allocated to the 2% lidocaine intraseptal injection and 4% articaine buccal infiltration groups. Level of pain was assessed every 2 to 10 min on standard 100 mm visual analogue scales. Results: Overall, 55 (69%) of patients who were given either intraseptal injection of 2% lidocaine or buccal infiltration of 4% articaine had successful anaesthesia of lower molar teeth within 10 min. However, 25 (31%) of participating patients in the buccal infiltration and the intraseptal groups had failed anaesthesia within the study duration (10 min), and they received additional local anaesthetic. IANBs were more painful than buccal and intraseptal injections. However, buccal articaine injections were significantly more comfortable than intraseptal lidocaine injections (P > 0.001). Conclusions: Supplemental intraseptal injection of 2% lidocaine and buccal infiltration of 4% articaine achieved profound pulpal anaesthesia in 69% of patients when the inferior alveolar nerve block failed. Recommendations can be given to dental practitioners to use infiltration of 4% articaine in conjunction with intraseptal injection of 2% lidocaine to anaesthetize the lower molar teeth when inferior alveolar nerve block fails.

Objectives: To investigate the potency and speed of action of 4% articaine and 2% mepivacaine for maxillary teeth extractions. Material and Methods: Ninety-four patients, aged between 16 to 70 years old, were recruited in this study. Two regimens were randomly administered over one visit. Patients of treatment group 1 received mepivacaine 2% with 1:100,000 adrenaline, whereas treatment group 2 - articaine 4% with 1:100,000 adrenaline. The onset time of pulp anaesthesia for maxillary teeth indicated for extraction was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out. Results: In this study, 85 patients had successful local anaesthetic followed by extraction within the study duration time (10 min). However, 5 patients had failed dental extraction (4 in mepivacaine group and 1 in articaine group). Patients in the articaine buccal infiltration group recorded faster onset time of action regarding anaesthesia and teeth extraction than patients in mepivacaine buccal infiltration group (P = 0.03). Conclusions: Articaine is an effective anaesthetic with a rapid onset, comparable to mepivacaine in infiltrative techniques used for maxillary teeth extraction. However, articaine has clinically achieved faster dental anaesthesia and earlier teeth extraction than mepivacaine. So, articaine can be the local anaesthetic of first choice in oral surgery.