Does Articaine Provide an Advantage over Lidocaine in Patients with Symptomatic Irreversible Pulpitis? A Systematic Review and Meta-analysis
Kung J, McDonagh M, Sedgley CM. Journal of Endodontics 2015;41(11):1784–1794.
First author
This is the question every nervous root canal patient really wants answered: "Will I actually be numb?" Dr. Kung led the most comprehensive analysis of this question to date — pooling 10 separate clinical trials covering 746 patients who all had symptomatic irreversible pulpitis (the hot, throbbing, hard-to-numb tooth that most often needs a root canal). The team found that overall, articaine was about twice as likely as lidocaine to achieve successful anesthesia (odds ratio 2.21, P = 0.0006). The most clinically useful finding was for the hardest cases: when a lower-jaw block injection numbed the lip but the tooth itself still hurt, switching to a supplemental articaine injection right at the tooth was 3.55× more effective than lidocaine at finally getting the patient numb. This is exactly the protocol Dr. Kung uses for difficult-to-anesthetize teeth — and it's why the practice can confidently tell patients that being "impossible to numb" is almost always a solvable problem.