Efficacy of 4% Articaine vs 2% Lidocaine in Mandibular and Maxillary Block and Infiltration Anesthesia in Patients with Irreversible Pulpitis

Background: Achieving effective anesthesia in patients with irreversible pulpitis remains a significant clinical challenge, particularly in mandibular molars, as standard inferior alveolar nerve blocks with lidocaine frequently fail due to inflammation-induced tissue changes and nerve resistance. Objective: This study aimed to compare the anesthetic efficacy, pain perception, and need for supplemental anesthesia between 4% articaine and 2% lidocaine, administered via inferior alveolar nerve block and buccal infiltration in patients with symptomatic irreversible pulpitis. Methods: In this prospective observational clinical study (n = 113), adult patients aged 18–65 years diagnosed with irreversible pulpitis in molars were consecutively enrolled based on strict inclusion and exclusion criteria. Patients received either 4% articaine or 2% lidocaine, with pain measured at multiple time points using the Visual Analog Scale (VAS). Cold test response and frequency of supplemental intraosseous anesthesia were also recorded. Ethical approval was obtained from the local institutional review board, and written informed consent was secured in accordance with the Declaration of Helsinki. Data were analyzed using SPSS version 26, employing appropriate statistical tests for continuous and categorical variables, with significance set at p < 0.05. Results: Articaine demonstrated superior anesthetic efficacy, with a buccal infiltration access success rate of 74% versus 57% for lidocaine (p = 0.03), and significantly lower VAS pain scores during access (12 ± 28 mm vs 42 ± 50 mm, p = 0.02). Both agents were effective in intraosseous anesthesia, but articaine consistently required fewer supplemental injections. Conclusion: The findings support the preferred use of 4% articaine, especially via buccal infiltration, for reliable anesthesia in irreversible pulpitis, offering improved pain management and procedural outcomes with direct relevance for dental and endodontic clinical practice.