The effect of inferior alveolar nerve block anesthesia of 4% articaine and epinephrine 1:100,000 on blood flow and anesthesia of human mandibular teeth

Adrenaline in pulp capping treatment of reversible pulpitis

BACKGROUND

The role of epinephrine in the treatment of pulp capping in patients with reversible pulpitis is not clear.

AIM

To explore the role of epinephrine in the treatment of pulp capping in patients with reversible pulpitis.

METHODS

A total of 100 patients with reversible pulpitis who were treated in Anhui Jieshou People's Hospital from January 2020 to December 2021 were included in the study. They were categorized into an observation group (n = 50; treatment with adrenaline) and a control group (n = 50; treatment with zinc oxide eugenol paste). The 24-h postoperative pain, regression time of gingival congestion and redness, clinical efficacy, and incidence of adverse reactions were compared between the groups. Patients were further categorized into the ineffective and effective treatment groups based on clinical efficacy. Logistic multiple regression analysis explored factors affecting the efficacy of pulp capping treatment.

RESULTS

A significant difference in 24-h postoperative pain was observed between the groups (P < 0.05), with a higher proportion of grade I pain noted in the observation group than in the control group (P < 0.01). The regression time of gingival congestion and swelling was lower in the observation group (2.61 ± 1.44 d and 2.73 ± 1.36 d, respectively) than in the control group (3.85 ± 1.47 d and 4.28 ± 1.61 d, respectively) (P < 0.05). The 2-wk postoperative total effective rate was lower in the control group (80.00%) than in the observation group (94.00%) (P < 0.05). The incidence of adverse reactions was not significantly different between the control (14.00%) and observation (12.00%) groups (P > 0.05). The proportion of adrenaline usage was lower (P < 0.05) and that of anaerobic digestion by Streptococcus and Fusobacterium nucleatum was higher in the ineffective treatment group than in the effective treatment group (P < 0.05). Logistic multiple regression analysis revealed adrenaline as a protective factor (P < 0.05) and anaerobic digestion by Streptococcus and F. nucleatum as risk factors for pulp capping in reversible pulpitis (P < 0.05).

CONCLUSION

Adrenaline demonstrated therapeutic efficacy in pulp capping treatment for reversible pulpitis, reducing pain and improving clinical symptoms safely. It is a protective factor for pulp capping, whereas Streptococcus and F. nucleatum are risk factors. Targeted measures can be implemented to improve clinical efficacy.

Comparative study of articaine 4% versus lidocaine 2% in the local anesthesia of permanent mandibular first molars affected by MIH: a randomized controlled trial

PURPOSE

The current study compares articaine 4% with lidocaine 2% in terms of injection pain and effectiveness of anesthesia when treating permanent mandibular first molars (PMFMs) affected by molar incisor hypomineralization (MIH). In addition to comparing the complications of local anesthesia for both solutions.

METHODS

The sample included 20 children. Each child was randomly assigned to either articaine 4% or lidocaine 2% in their first session with the other solution being used at the subsequent session. Injection pain and the effectiveness of anesthesia were assessed using the Wong-Baker Faces® Pain Rating Scale and the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Parents were asked to report any complications of local anesthesia. The Wilcoxon-matched pairs signed-rank test was used to analyze the data.

RESULTS

Patients experienced greater pain when receiving articaine 4% injections according to both scales, differences were statistically significant when using the Wong-Baker Faces® Pain Rating scale (p < 0.05). Whereas, the FLACC scale did not show such differences (P > 0.05). Although there were no significant differences between the two solutions regarding the effectiveness of local anesthesia according to both scales (P > 0.05), articaine 4% was clinically found to be more effective than lidocaine 2%. No complications of local anesthesia were reported.

CONCLUSIONS

Articaine 4% injection was more painful than lidocaine 2%. However, both solutions were effective in anesthetizing PMFMs affected by MIH and without anesthetic complications in the studied sample.

TRIAL REGISTRATION

Clinical trial, NCT05200884, ( https://clinicaltrials.gov/ct2/show/NCT05200884 ).

Present status and future directions - Mechanisms and management of local anaesthetic failures

Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.

The effect of single buccal infiltration anesthesia of 4% articaine with either 1:100,000 or 1:200,000 epinephrine on pulpal blood flow and anesthesia of maxillary first molars and second premolars in humans

OBJECTIVES

The aim of this study was to determine the effect of single buccal infiltration of 4% articaine with either 1:100,000 (EP100) or 1:200,000 (EP200) epinephrine on pulpal blood flow (PBF), pulpal anesthesia and soft tissue anesthesia of maxillary first molars and second premolars in human subjects.

MATERIALS AND METHODS

Fifteen healthy volunteers with intact maxillary first molars and second premolars received an infiltration of 4% articaine with either EP100 or EP200 at buccal aspect of maxillary first molars. The PBF, pulpal anesthesia and soft tissue anesthesia were assessed with a laser Doppler flowmeter (LDF), an electric pulp tester (EPT) and Aesthesiometer II, respectively.

RESULTS

Articaine (4%) with either EP100 or EP200 produced PBF reduction in maxillary first molars (injected teeth) by 68.09 and 69.83%, and produced PBF reduction in second premolars (adjacent teeth) by 76.81 and 75.02%, respectively at 15 min post injection. Duration of PBF returned to baseline was 159.00 ± 21.06 (EP100) and 159.00 ± 31.97 (EP200) min in the molars, and 161.00 ± 20.02 (EP100) and 159.00 ± 25.86 (EP200) min in the premolars. The onset of pulpal anesthesia was 2.80 ± 1.26 (EP100) and 3.07 ± 1.28 (EP200) min in the molars, and 2.13 ± 0.52 (EP100) and 2.40 ± 0.83 (EP200) min in the premolars; the duration of pulpal anesthesia was 74.53 ± 24.16 (EP100) and 76.27 ± 34.03 (EP200) min in the molars, and 82.53 ± 31.03 (EP100) and 75.60 ± 37.17 (EP200) min in the premolars. Buccal tissue anesthesia was found in both teeth (100%), but palatal anesthesia was achieved by 13.33% in the premolars and 6.67% in the molars for each solution.

CONCLUSIONS

Single buccal infiltration to maxillary first molar produced PBF reduction and successful pulpal anesthesia, evaluated by EPT, in both first molar and second premolar. This anesthetic technique also produced high success of buccal tissue anesthesia, but demonstrated very low success for palatal tissue anesthesia.

CLINICAL RELEVANCE

Single buccal infiltration to maxillary first molar is potent enough for pulpal and buccal tissue anesthesia, except palatal tissue anesthesia, in both first molar and second premolar.