Clinical Oral Investigations

, Volume 23, Issue 2, pp 673–680 | Cite as

The effect of intraosseous local anesthesia of 4% articaine with 1:100,000 epinephrine on pulpal blood flow and pulpal anesthesia of mandibular molars and canines

  • Kadkao Vongsavan
  • Tshering Samdrup
  • Kanittha KijsamanmithEmail author
  • Praphasri Rirattanapong
  • Noppakun Vongsavan
Original Article



The aim of this study was to determine the effect of intraosseous (IO) anesthesia with 4% articaine and 1:100,000 epinephrine on pulpal blood flow (PBF) and pulpal anesthesia of mandibular first molars and canines in human subjects.

Materials and methods

Ten healthy volunteers with intact mandibular first molar and canine were given an osteocentral technique of IO injection using the Quick Sleeper 5 system and 4% articaine with 1:100,000 epinephrine at distal site of mandibular first molar. The PBF was monitored by a laser Doppler flowmeter (LDF). Pulpal anesthesia was assessed with an electric pulp tester (EPT).


IO injection caused a decrease in PBF in molars from 6.31 ± 3.85 perfusion units (P.U.) before injection to 2.51 ± 2.53 P.U. 1 min after injection (P < 0.001). The percentage reduction in PBF was 60% after 1 min and PBF returned back to the baseline after 45 min. No significant reduction in PBF was observed in the canines (P = 0.212). For pulpal anesthesia in the molars, the mean onset was 2.40 ± 0.84 min and the mean duration was 38 ± 16.19 min. In the canines, there was a decrease in the sensitivity to EPT but complete pulpal anesthesia was not achieved.


IO injection distal to mandibular first molar caused a decrease in PBF and successful pulpal anesthesia in first molar, but not in canine. Both PBF and EPT readings returned to normal, suggesting that pulpal ischemia may not occur.

Clinical relevance

IO anesthesia is safe to use as a primary technique in teeth with normal pulp.


4% articaine Intraosseous anesthesia Laser-Doppler flowmetry Mandibular molars Pulpal anesthesia Pulpal blood flow 



This study was supported by the Faculty of Dentistry, Mahidol University. The authors would like to express gratitude to the Department of Pediatric Dentistry, Faculty of Dentistry, Mahidol University, for their support and assistance.


For this study, no funding was received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Pediatric Dentistry, Faculty of DentistryMahidol UniversityBangkokThailand
  2. 2.Department of Oral Biology, Faculty of DentistryMahidol UniversityBangkokThailand

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