***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: 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 OBJECTIVE The authors conducted a r and omized , double-blind clinical trial to evaluate pulpal anesthesia achieved after m and ibular infiltration of five commonly marketed dental local anesthetic formulations as compared with a control formulation of lidocaine with epinephrine . METHODS The authors evaluated 2 percent lidocaine with 1:100,000 epinephrine ( L100 ) against 4 percent articaine with 1:100,000 epinephrine ( A100 ) , 4 percent articaine with 1:200,000 epinephrine ( A200 ) , 4 percent prilocaine with 1:200,000 epinephrine ( P200 ) , 3 percent mepivacaine without vasoconstrictor ( Mw/o ) and 0.5 percent bupivacaine with 1:200,000 epinephrine ( B200 ) . This repeated-treatment trial involved 18 healthy participants . The investigators administered m and ibular infiltration injections ( six sessions per participant ) of 0.9 milliliters of anesthetic into the buccal fold adjacent to the distal root of the m and ibular first molar . The authors determined anesthetic efficacy across a 20-minute period by measuring changes in sensory threshold to electrical pulp test ( EPT ) stimulation . RESULTS Twelve female and six male participants ( mean age , 24.9 years ; range , 18 - 53 years ) completed the study . The maximum mean increase from baseline of EPT measurements for the six formulations were 43.5 percent for L100 , 44.8 percent for B200 , 51.2 percent for P200 , 66.9 percent for A200 , 68.3 percent for Mw/o and 77.3 percent for A100 ( A100 versus L100 , P = .029 ) . Adverse reactions were minor and not formulation dependent . CONCLUSIONS AND CLINICAL IMPLICATION S The authors found that m and ibular infiltration with 0.9 mL of the tested dental anesthetics could induce only partial pulpal anesthesia , a level likely to be inadequate for most dental procedures . When compared with L100 , only the A100 induced statistically greater pulpal anesthesia after m and ibular buccal infiltration OBJECTIVE The purpose of this prospect i ve , r and omized , double-blind study was to compare the anesthetic efficacy of 4 % articaine and 2 % lidocaine ( both with 1:100,000 epinephrine ) for buccal infiltration in patients experiencing irreversible pulpitis in maxillary posterior teeth . STUDY DESIGN Forty patients with irreversible pulpitis in first premolar or first molar were divided into 4 study groups and received buccal infiltration of either 4 % articaine or 2 % lidocaine in a double-blind manner . Endodontic access was begun 5 minutes after solution deposition . Success was defined as no or mild discomfort ( VAS recordings ) during the endodontic procedure . RESULTS The success rate for maxillary buccal infiltration to produce pulpal anesthesia using articaine was 100 % in first premolar and first molar , and for the lidocaine solution , success rate was 80 % in first premolar and 30 % in first molar . There was high significant difference between the articaine and lidocaine solutions ( ANOVA ; P < .001 ) . CONCLUSION The efficacy of 4 % articaine was superior to 2 % lidocaine for maxillary buccal infiltration in posterior teeth 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 INTRODUCTION To assess the efficacy of buccal infiltrations of 4 % articaine with 1:100,000 epinephrine and 2 % lidocaine with 1:80,000 epinephrine in achieving anesthesia in maxillary teeth with irreversible pulpitis . METHODS This r and omized double-blind clinical trial included 100 patients diagnosed with irreversible pulpitis in maxillary teeth . Patients received 2.0 mL 4 % articaine with 1:100,000 epinephrine or 2 % lidocaine with 1:80,000 epinephrine in the buccal sulcus adjacent to the tooth with pulpitis . Before and every 2 minutes up to a maximum of 10 minutes after injection , the response of the test tooth was assessed using an electronic pulp tester . Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation ( 80 reading ) of the pulp tester during the test period , at which time treatment commenced . Treatment was regarded as being successfully completed when it was associated with no pain . The time to onset of successful pulp anesthesia was recorded for each test tooth . Injection discomfort was recorded on st and ard 100-mm visual analog scales ( VASs ) . Data were analyzed by the Chi-square and Student t tests . RESULTS Fifty patients received articaine and 50 received lidocaine . Seventy-three of the 100 patients achieved pulpal anesthesia within 10 minutes of injection : 38 after articaine and 35 after lidocaine ( P = .5 ) . The onset of pulpal anesthesia  after articaine and lidocaine buccal infiltrations was similar ( mean and st and ard deviations : 4.9 ± 2.7 minutes vs 5.1 ± 2.4 minutes , respectively ; t = 0.2 ; P = .82 ) . Pain-free treatment was completed in 33 patients after articaine and 29 after lidocaine buccal infiltrations ( P = .63 ) . Although articaine buccal injection was significantly more comfortable than lidocaine buccal injection ( t = 2.3 , P = .026 ) , both were associated with mild discomfort on VAS ( means ± st and ard deviation : 10.8 mm ± 11.7 mm vs 17.5 mm ± 17.6 mm , respectively ) . CONCLUSIONS There was no significant difference in efficacy between 4 % articaine with 1:100,000 epinephrine and 2 % lidocaine with 1:80,000 epinephrine in achieving anesthesia in maxillary teeth with irreversible pulpitis after buccal infiltration Soft tissue signs are inadequate to assess pulpal anesthesia during root canal therapy ( RCT ) . The intention of this study was to determine if a negative response to cold testing is a more effective measure to assess pulpal anesthesia compared to soft tissues signs . Using a r and omized , blinded , placebo-controlled design , subjects with baseline responsiveness to cold testing were enrolled . Test subjects achieved a negative response to cold testing prior to RCT . Control subjects were given a sham cold test after demonstrating soft tissue signs . Visual analog scale determined pain level . Unadjusted results showed 12 % of test subjects experienced pain during RCT compared with 38 % of control subjects ( N = 83 , p = .004 , power = 84 % ) . Multiple logistic regression controlled for confounders and effect modifiers , OR = .20 ( p = .01 ) . Subjects who achieved a negative response to the cold test were approximately 80 % less likely to experience pain during RCT 
    Output:
    
Given the efficacy and safety of the two solutions , 4 % articaine with 1:100,000 epinephrine was superior to 2 % lidocaine with 1:100,000 epinephrine in dental treatments in IP