***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : This study was done to compare the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine with that of 2 % lidocaine with 1:80,000 epinephrine during pulpectomy in patients with irreversible pulpitis for inferior alveolar nerve block in m and ibular posterior teeth . Material and Methods : Patients with irreversible pulpitis referred to the Department of Conservative Dentistry and Endodontics , K.D. Dental College , r and omly received a conventional inferior alveolar nerve block containing 1.8 mL of either 4 % articaine with 1:100,000 epinephrine or 2 % lidocaine with 1:80,000 epinephrine . After the patient ’s subjective assessment of lip anesthesia , the  absence/presence of pulpal anesthesia through electric pulp stimulation  was recorded and the absence/presence of pain was recorded through visual analogue scale . Results : The pulpal anesthesia success for articaine ( 76 % ) was slightly more than with lidocaine ( 58 % ) as measured with pulp tester as well as for the pain reported during the procedure the success rate of articaine ( 88 % ) was slightly more than that of lidocaine ( 82 % ) although the difference between the two solutions was not statistically significant . Conclusions : Both the local anesthetic solutions had similar effects on patients with irreversible pulpitis when used for inferior alveolar nerve block . Key words : Anesthesia , articaine , lignocaine , pulpitis AIM To compare the anaesthetic efficacy of inferior alveolar nerve blocks ( IANB ) with 1.8 mL of 2 % lidocaine ( LI ) to a buccal infiltration ( BI ) with 1.8 mL of 4 % articaine ( AR ) , both with 1 : 100 000 epinephrine , in patients with symptomatic irreversible pulpits in a r and omized controlled trial . METHODOLOGY Volunteers presenting at the Emergency Centre ( FOP-UNICAMP ) were r and omly divided into two groups ( 30 for AR and 20 for LI ) . Operator and patient were not blinded . Success was recorded when complete pain-free treatment was achieved after a single injection ( IANB or BI ) or when one supplemental injection was needed for emergency endodontic procedures . Success rate of supplemental injection was evaluated between and within groups using Fisher 's exact test and chi-square test . RESULTS A higher success rate ( P = 0.03/Fisher 's exact test ) was observed with AR ( 40 % ) than with LI ( 10 % ) . No significant difference was found when a single injection plus one supplemental injection was compared between groups ( P = 1.0 ; AR = 70 % ; LI = 80 % ) . However , supplemental injection increased the anaesthetic success rates ( AR , P = 0.04 ; LI , P = 0.0001 ) within groups . CONCLUSIONS Single anaesthesia techniques ( IANB or BI ) were not able to achieve pain-free emergency endodontic treatment .  Supplemental anaesthetic techniques should be considered prior to treatment procedures in order to increase success rate ( consort : registration number - NCT01912755/Fapesp : # 2009/10834 - 4 ) The purpose of the present study was to compare the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine with that of 2 % lidocaine with 1:100,000 epinephrine during pulpectomy in patients with irreversible pulpitis in m and ibular posterior teeth . Forty volunteers , patients with irreversible pulpitis admitted to the Emergency Center of the School of Dentistry at the University of São Paulo , r and omly received a conventional inferior alveolar nerve block containing 3.6 mL of either 4 % articaine with 1:100,000 epinephrine or 2 % lidocaine with 1:100,000 epinephrine . During the subsequent pulpectomy , we recorded the patients ' subjective assessment s of  lip anesthesia  , the  absence/presence of pulpal anesthesia through electric pulp stimulation  , and the  absence/presence of pain through a verbal analogue scale . All tested patients reported lip anesthesia after the application of either inferior alveolar nerve block . Regarding pulpal anesthesia success as measured with the pulp tester , the lidocaine solution had a higher success rate ( 70 % ) than the articaine solution ( 65 % ) . For patients reporting none or mild pain during pulpectomy , the success rate of the articaine solution ( 65 % ) was higher than that of the lidocaine solution ( 45 % ) . Yet , none of the observed differences between articaine and lidocaine were statistically significant . Apparently , therefore , both local anesthetic solutions had similar effects on the patients with irreversible pulpitis in m and ibular posterior teeth . Neither of the solutions , however , result ed in an effective pain control during irreversible pulpitis treatments INTRODUCTION The objective of this study was to compare the anesthetic efficacy of 2 % mepivacaine combined with 1:100,000 epinephrine with 2 % lidocaine combined with 1:100,000 epinephrine during pulpectomy of m and ibular posterior teeth in patients with irreversible pulpitis . METHODS Forty-two patients with irreversible pulpitis who were admitted to the Emergency Center at the University of São Paulo School of Dentistry volunteered to take part in the study and were r and omized to receive conventional inferior alveolar nerve block containing 1.8 or 3.6 mL of either 2 % mepivacaine with 1:100,000 epinephrine or 2 % lidocaine with 1:100,000 epinephrine . We recorded patients ' subjective assessment s of  lip anesthesia , absence/presence of pulpal anesthesia tested by using electric pulp stimulation  , and absence/presence of pain during the subsequent pulpectomy  by using a verbal analogue scale . RESULTS All patients tested reported lip anesthesia after application of either type of inferior alveolar nerve block . Pulpal anesthesia success rates measured by using the pulp tester were satisfactory for both solutions ( 86 % for mepivacaine and 67 % for lidocaine ) . Success rates according to patient report of no pain or mild pain during pulpectomy were higher for mepivacaine solution ( 55 % ) than for lidocaine solution ( 14 % ) . The differences between mepivacaine and lidocaine were statistically significant . CONCLUSIONS Mepivacaine result ed in effective pain control during irreversible pulpitis treatments . The success rates with either solution were not high enough to ensure complete pulpal anesthesia INTRODUCTION Profound pulpal anesthesia in posterior m and ibular teeth with irreversible pulpitis usually requires administering an inferior alveolar nerve block ( IANB ) plus other supplemental injections . The purpose of this prospect i ve , r and omized , double-blind study was to compare the anesthetic success rate of buccal infiltration injections of articaine and lidocaine when supplemented with an IANB . METHODS One hundred twenty-five emergency patients who had their first or second m and ibular molar diagnosed with irreversible pulpitis participated in the study and received the IANB by using either 2 % lidocaine with 1:100,000 epinephrine or 4 % articaine with 1:100,000 epinephrine . One hundred two of the patients reported moderate-to-severe pain upon initiation of their endodontic treatment or through filing of their tooth canals and received supplemental buccal infiltration injections by using the same anesthetic that the IANB had been performed . After the block or the supplemental buccal infiltration injections , success was achieved with no or mild pain during instrumentation of the tooth canals . RESULTS The success rate after the administration of the infiltration injections after an incomplete IANB by using lidocaine was 29 % , whereas by using articaine it was 71 % ( P < .001 ) . No statistical differences were detected in the success rates between the 2 anesthetics after the block injections . CONCLUSIONS Supplementing an incomplete articaine IANB with articaine infiltration raises the anesthetic success more effectively compared with lidocaine in m and ibular molars with irreversible pulpitis INTRODUCTION The success rate of  inferior alveolar nerve block ( IANB ) decreases in patients with irreversible pulpitis . It was hypothesized that supplemental infiltration of lidocaine and articaine may improve the success rates . METHODS Eighty-four adult volunteers , actively experiencing pain , participated in this prospect i ve , r and omized , double-blinded study . All patients received st and ard IANB of 2 % lidocaine with 1:200,000 epinephrine . Twenty-four patients did not receive supplemental infiltrations ( control ) . Thirty patients received supplemental buccal and lingual infiltrations of 2 % articaine with 1:200,000 epinephrine , and 30 patients received buccal and lingual infiltrations of 2 % lidocaine with 1:200,000 epinephrine at 2 minutes after the IANB . Endodontic access preparation was initiated after 15 minutes of initial IANB .  Pain during treatment was recorded by using a Heft Parker visual analog scale . Success was recorded as " none " or " mild " pain . RESULTS Statistical analysis using nonparametric McNemer tests showed that supplemental buccal and lingual infiltration of 2 % lidocaine with 1:200,000 epinephrine or 4 % articaine with 1:200,000 epinephrine improved the success rate from 33 % to 47 % and 67 % , respectively . Also the success rate with 4 % articaine with 1:200,000 epinephrine was significantly more than 2 % lidocaine with 1:200,000 epinephrine ( p < 0.05 ) . CONCLUSIONS Although supplemental buccal and lingual infiltrations of 4 % articaine or 2 % lidocaine increased the success rate of the inferior alveolar nerve block in patients with irreversible pulpitis , none of the techniques provided acceptable success rates INTRODUCTION The study was design ed as a r and omized double-blind trial to evaluate the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine in inferior alveolar nerve block ( IANB ) and infiltration anesthetic techniques to anesthetize m and ibular molars with irreversible pulpitis . METHODS The study was composed of 2 test arms and 1 control arm . Subjects in the test arms received either a st and ard IANB or a buccal infiltration ( B Infil ) of 4 % articaine with 1:100,000 epinephrine , whereas the subjects in the control arm received a st and ard IANB of 2 % lidocaine with 1:100,000 epinephrine . Subject 's self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anesthetic administration during access preparation and pulp extirpation . RESULTS For statistical analysis Pearson χ(2 ) , Student 's paired t test , 1-way analysis of variance , and Friedman tests showed no significant difference in success rates among the 3 arms of the trial . CONCLUSIONS Although B Infil and IANB of 4 % articaine were equally effective , B Infil can be considered a viable alterative in IANB for pulpal anesthesia in m and ibular molars with irreversible pulpitis The purpose of this prospect i ve , r and omized , double-blind study was to compare the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine to 2 % lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in m and ibular posterior teeth . Seventy-two emergency patients diagnosed with irreversible pulpitis of a m and ibular posterior tooth r and omly received , in a double-blind manner , 2.2 ml of 4 % articaine with 1:100,000 epinephrine or 2.2 ml of 2 % lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block . Endodontic access was begun 15 min after solution deposition , and all patients were required to have profound lip numbness . Success was defined as none or mild pain ( Visual Analogue Scale recordings ) on endodontic access or initial instrumentation . The success rate for the inferior alveolar nerve block using articaine was 24 % and for the lidocaine solution success was 23 % . There was no significant difference ( p = 0.89 ) between the articaine and lidocaine solutions . Neither solution result ed in an acceptable rate of anesthetic success in patients with irreversible pulpitis The present study tested the hypothesis that the amount and severity of preoperative pain will affect the anesthetic efficacy of inferior alveolar nerve block ( IANB ) in patients with symptomatic irreversible pulpitis . One-hundred seventy-seven adult volunteer subjects , actively experiencing pain in a m and ibular molar , participated in this prospect i ve double-blind study carried out at 2 different centers . The patients were 
    Output:
    
In conclusion , based on the evidence from the r and omized clinical trials included in this review , mepivacaine with epinephrine demonstrated the highest probability of providing effective pulpal anaesthesia using IANB for teeth with irreversible pulpitis compared to prilocaine , articaine , bupivacaine and lidocaine .