Clinical Oral Investigations

, Volume 23, Issue 2, pp 839–845 | Cite as

Anesthetic efficacy of mental/incisive nerve block compared to inferior alveolar nerve block using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis: a randomized clinical trial

  • Sholeh Ghabraei
  • Ashraf Shubbar
  • Mohammad H. NekoofarEmail author
  • Ali NosratEmail author
Original Article



The aim of this study was to compare the onset, success rate, injection pain, and post-injection pain of mental/incisive nerve block (MINB) with that of inferior alveolar nerve block (IANB) using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis. The accuracy of electrical pulp test (EPT) in determining pulpal anesthesia was also examined.

Materials and methods

The study was designed as a randomized clinical trial with two study arms—MINB and IANB. Injections were performed using a standardized technique. Root canal treatment was initiated 10 min after the injection. Success was defined as no pain or mild pain during access cavity preparation and instrumentation. Injection pain and post-injection pain (up to 7 days) were recorded. All pain ratings were done using Heft-Parker Visual Analog Scale (HP VAS).


Sixty-four patients were enrolled. The success rate of MINB (93.8%) was higher than IANB (81.2%) but the difference was not significant (p > 0.05). The onset of anesthesia with MINB was significantly quicker, and injection pain was significantly less (p < 0.05), but post-injection pain was significantly higher during the first 4 days (p < 0.001). The accuracy of EPT in determining pulpal anesthesia was 96.88%.


MINB and IANB with 4% articaine had similar efficacy in anesthetizing mandibular premolars with irreversible pulpitis. Post-injection pain with MINB was higher than with IANB.

Clinical relevance

MINB and IANB with 4% articaine can be used interchangeably to anesthetize mandibular premolars with irreversible pulpitis.


4% articaine Local anesthesia Mental/incisive nerve block Inferior alveolar nerve block Pain 



The authors gratefully acknowledge Dr. Prashant Verma, at University of Maryland School of Dentistry, for the scientific and grammar editing of the manuscript.


This work was supported by Tehran University of Medical Sciences in Tehran, Iran.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed involving human participants in this study 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.

Supplementary material

784_2018_2500_MOESM1_ESM.xlsx (152 kb)
ESM 1 (XLSX 151 kb)


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Copyright information

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

Authors and Affiliations

  1. 1.Department of Endodontics, School of DentistryTehran University of Medical SciencesTehranIran
  2. 2.Endodontology Research Group, School of Dentistry, College of Biomedical and Life SciencesCardiff UniversityCardiffUK
  3. 3.Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, School of DentistryUniversity of Maryland BaltimoreBaltimoreUSA
  4. 4.Iranian Center for Endodontic Research, Dental Research Center, School of DentistryShahid Beheshti University of Medical SciencesTehranIran

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