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Dolphin T, Fowler S, Drum M, Nusstein J, Reader A, Draper J. Efficacy of the TuttleNumbNow Intraosseous Method for Pulpal Anesthesia in the Mandibular First Molar: A Prospective, Randomized, Crossover Study. J Endod 2024; 50:406-413. [PMID: 38266911 DOI: 10.1016/j.joen.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/09/2024] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION Previous studies on intraosseous (IO) anesthesia as a primary injection have shown high success rates. The TuttleNumbNow (TNN; Orem, UT) is a new primary IO injection technique that has not been scientifically evaluated. Therefore, the purpose of this prospective randomized, crossover study was to evaluate the anesthetic efficacy of the TNN IO technique using the Septoject Evolution needle (Septodont, Saint-Maur-des-Fosses, France) compared with buccal infiltration for pulpal anesthesia in mandibular first molars. METHODS One hundred four healthy subjects were randomly assigned to 2 treatment groups separated by at least 2 weeks. One set of injections consisted of buccal infiltration of the mandibular first molar using 1.8 mL 4% articaine with 1:100,000 epinephrine followed by a mock TNN injection distal to the mandibular first molar. The other set of injections was a mock buccal infiltration of the mandibular first molar followed by a TNN injection of 1.8 mL 4% articaine with 1:100,000 epinephrine distal to the mandibular first molar. Statistical analyses were performed. RESULTS For the mandibular first molar, which had a 42% anesthetic success rate (highest 80 reading) with buccal infiltration compared with 49% with the TNN, no statistically significant difference in success was observed (P = .2115). CONCLUSIONS The TNN technique has been advocated as an IO injection. However, the inability to deliver anesthetic solution to the cancellous bone resulted in an anesthetic success rate of 49%. The success was statistically similar to a buccal infiltration (42%) and would not provide adequate pulpal anesthesia as a primary injection.
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Affiliation(s)
- Tyler Dolphin
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Sara Fowler
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - John Nusstein
- Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Division of Endodontics, The Ohio State University, Columbus, Ohio.
| | - John Draper
- Fisher College of Business, The Ohio State University, Columbus, Ohio
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Dixit A, Randhawa RK, Randhawa GS, Solanki P, Takvani R, Vaghela I. Comparative Analysis of Local Anesthetic Techniques for Pain Management in Pediatric Dental Procedures: A Randomized Clinical Trial. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S196-S198. [PMID: 38595428 PMCID: PMC11001098 DOI: 10.4103/jpbs.jpbs_454_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
Objective The present study aims to conduct a comparative analysis of different local anesthetic techniques for pain management in pediatric dental procedures. Goal is to evaluate and compare the efficacy and safety of various local anesthetic methods to identify the most effective approach in reducing pain and discomfort during dental treatments in children. Methods A prospective, randomized clinical trial was conducted with 60 pediatric patients (aged 3 to 10 years) undergoing dental procedures in a single dental clinic. The participants were randomly assigned into three groups: Group A received conventional infiltration anesthesia (lidocaine 2% with epinephrine 1:100,000), Group B received topical anesthesia followed by the same infiltration anesthesia, and Group C received intraosseous anesthesia using articaine 4% with epinephrine 1:100,000. The patients' demographic data, treatment details, and pre-procedure anxiety levels were recorded. Results The study demonstrated that all three local anesthetic techniques effectively managed pain during pediatric dental procedures. However, Group C, which received intraosseous anesthesia, showed significantly lower pain scores (mean ± standard deviation) compared to Group A and Group B: 1.5 ± 0.6, 2.3 ± 0.8, and 2.1 ± 0.7, respectively (P < 0.05). Additionally, Group C exhibited a shorter onset of anesthesia compared to Group A and Group B, with mean onset times of 1.8 ± 0.4, 3.2 ± 0.6, and 2.9 ± 0.5 minutes, respectively (P < 0.001). No significant differences in adverse events or post-procedure complications among the groups. Conclusion Intraosseous anesthesia (articaine 4% with epinephrine 1:100,000) was found most effective local anesthetic technique for pain management during pediatric dental procedures.
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Affiliation(s)
- Ankita Dixit
- Department of Pedodontics and Preventive Dentistry, Ahmedabad Dental College and Hospital, Bhadej, Near Science City, Ahmedabad, Gujarat, India
| | - Rajbir K Randhawa
- Department of Oral and Maxillofacial Surgery, Ahmedabad Dental College and Hospital, Bhadej, Near Science City, Ahmedabad, Gujarat, India
| | - Gagandeep S Randhawa
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Jamnagar, Gujarat, India
| | - Pranav Solanki
- Department of Prosthodontics, Goenka Research Institute of Dental Science, Gandhinagar, Gujarat, India
| | - Rimmy Takvani
- Department of Prosthodontics, Government Dental College and Hospital, Jamnagar, Gujarat, India
| | - Ishita Vaghela
- Department of Prosthodontics, Government Dental College and Hospital, Jamnagar, Gujarat, India
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Singh SS, Koul M. A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study. Int J Clin Pediatr Dent 2024; 17:67-71. [PMID: 38559865 PMCID: PMC10978513 DOI: 10.5005/jp-journals-10005-2748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Aim The objective of this research was to conduct a comparison and evaluate the pain perception and time of onset of 2% lignocaine 1:80,000 epinephrine with 4% articaine 1:100,000 epinephrine in the pediatric population. Materials and methods A split-mouth randomized control trial was conducted on 50 children aged 9-14 years who required inferior alveolar nerve block (IANB) anesthesia for bilateral dental treatment in the mandibular arch. The time of onset was recorded when no sensation was reported even when maximum electrical stimulus was applied in an electric pulp testing (EPT). The pain perception was assessed using a visual analog scale (VAS) rated by the patient for subjective symptoms and face, legs, activity, cry, and consolability (FLACC) scale for objective pain rated by the operator. Results The mean onset of time, pain-VAS, and FLACC score decreased by 1.31, 12.07, and 18.39%, respectively in 4% articaine as compared to 2% lignocaine but the difference did not reach statistical significance (p > 0.05), that is, found to be statistically the same.In conclusion, it can be inferred that the utilization of 4% articaine is as potent as 2% lignocaine solution but showed slightly better onset of anesthesia and pain experience among the children although the findings were not statistically significant. Clinical significance Local anesthesia (LA) is one of the main methods of pain management in pediatric practice which makes it essential to choose an LA agent with a shorter time of onset and less pain on administration. How to cite this article Singh SS, Koul M. A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study. Int J Clin Pediatr Dent 2024;17(1):67-71.
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Affiliation(s)
- Shivani S Singh
- Department of Pedodontics and Preventive Dentistry, Career Post Graduate Institute of Dental Sciences & Hospital, Lucknow, Uttar Pradesh, India
| | - Monika Koul
- Department of Pedodontics and Preventive Dentistry, Career Post Graduate Institute of Dental Sciences & Hospital, Lucknow, Uttar Pradesh, India
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Vatankhah M, Zargar N, Naseri M, Sadeghi S, Baghban AA, Dianat O, Nusstein JM. Primary and supplementary anesthetic efficacy of a modified two-step buccal infiltration of 4% articaine in mandibular molars with symptomatic irreversible pulpitis: a randomized clinical trial. Clin Oral Investig 2023; 28:33. [PMID: 38147088 DOI: 10.1007/s00784-023-05417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES To evaluate a modified two-step buccal infiltration (MBI) of 1.7 mL 4% articaine as primary or supplemental anesthesia in mandibular first and second molars diagnosed with symptomatic irreversible pulpitis (SIP). MATERIALS AND METHODS One hundred and eight patients with SIP were randomly assigned to one of three groups (n = 36). They were given an inferior alveolar nerve block (IANB) of 2% lidocaine with 1:80.000 epinephrine or a primary MBI of 4% articaine with 1:100.000 epinephrine in the IANB and MBI groups, respectively. Patients in the IANB + MBI group received an IANB followed by an MBI. Pain levels during the injection, access cavity preparation, and initial filing were recorded on the Heft-Parker visual analog scale (HP-VAS). No or mild pain (HP-VAS ≤ 54) upon access cavity preparation and initial filing was considered a success. Chi-square and Kruskal-Wallis tests were used to analyze the data. RESULTS MBI (77.8%) and IANB + MBI (94.4%) had both significantly higher success rates than IANB (50.0%) (P < .001). However, when the Bonferroni adjustment was applied, there was no statistically significant difference between the MBI and IANB + MBI techniques (P = .041 > .017). MBI was associated with significantly less injection pain than IANB (P < .001). CONCLUSIONS Both primary and supplemental MBI with 4% articaine were superior to IANB with 2% lidocaine in mandibular first and second molars diagnosed with SIP. Further research may be needed to confirm the findings of this study. CLINICAL RELEVANCE The findings of this study suggest that supplemental or primary MBI can be a clinically viable alternative to IANB, which has a relatively low success rate when managing mandibular molars diagnosed with SIP.
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Affiliation(s)
- Mohammadreza Vatankhah
- Iranian Center for Endodontic Research, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mandana Naseri
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyeddavood Sadeghi
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore, MD, 21201, USA.
| | - John M Nusstein
- Division of Endodontics, The Ohio State University, Columbus, OH, USA
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Hassan S, Ahmed A, Saqib W, Abulhamael AM, Habib SR, Javed MQ. Comparison of Efficacy of Lidocaine and Articaine as Inferior Alveolar Nerve Blocking Agents in Patients with Symptomatic Irreversible Pulpitis: Randomized Controlled Trial. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1840. [PMID: 37893558 PMCID: PMC10608202 DOI: 10.3390/medicina59101840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Lidocaine Hydrochloride has been the standard choice for local anesthesia in dentistry and Articaine's unique structure and growing popularity make it a viable alternative. Due to contradictory results in prior research and a scarcity of trials conducted in the Pakistani population, this study aims to compare the anesthetic efficacy of Lidocaine with Articaine for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. Materials and Methods: This double-blinded, randomized controlled trial included 152 patients who were selected by consecutive non-probability sampling. The participants included patients who presented with symptomatic irreversible pulpitis in mandibular posterior teeth (molars and premolars) and depicted normal apical tissue radiographically. The patients were equally and randomly divided into two groups. The control group received 2% Lidocaine Hydrochloride injections, and the experiment group received 4% Articaine Hydrochloride injections. Participants scored their pain on the HP-VAS both before and after the administration of anesthesia. A value of 54 mm or less on the scale indicated effective anesthesia. The data obtained were analyzed using SPSS. Chi-square test was applied to analyze data for statistical significance. Results: There was no statistically significant difference in the efficacy of the two anesthetic agents. During access cavity preparation, Lidocaine demonstrated a success rate of 93%, whereas Articaine exhibited a slightly higher success rate of 97%. During initial instrumentation, the success rates for Lidocaine and Articaine were 72% and 71%, respectively. This suggests that both Lidocaine and Articaine were effective in achieving anesthesia during the dental procedure in patients with symptomatic irreversible pulpitis, with Articaine showing a slightly better success rate, although the difference was not statistically significant. Conclusions: The anesthetic efficacy of Articaine is similar to that of lidocaine in subjects with symptomatic irreversible pulpitis. Hence, Articaine can serve as an alternative to Lidocaine for local anesthesia administration in dentistry.
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Affiliation(s)
- Sobia Hassan
- Department of Periodontology, Islamic International Dental College and Hospital, Riphah International University, Islamabad 44000, Pakistan;
| | - Alia Ahmed
- Department of Operative Dentistry, Islamic International Dental College and Hospital, Riphah International University, Islamabad 44000, Pakistan; (A.A.); (W.S.)
| | - Warda Saqib
- Department of Operative Dentistry, Islamic International Dental College and Hospital, Riphah International University, Islamabad 44000, Pakistan; (A.A.); (W.S.)
| | - Ayman M. Abulhamael
- Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, P.O. Box 80209, Jeddah 21589, Saudi Arabia;
| | - Syed Rashid Habib
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, King Abdullah Road, P.O. Box 60169, Riyadh 11545, Saudi Arabia;
| | - Muhammad Qasim Javed
- Department of Conservative Dental Sciences, College of Dentistry, Qassim University, P.O. Box 1162, Buraidah 51452, Qassim, Saudi Arabia
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Woo A, Nusstein J, Drum M, Fowler S, Reader A, Ni A. Success of Pulpal Anesthesia Following Buccal Infiltration of the Maxillary First Molar With 1.8 mL and 3.6 mL of 4% Articaine With 1:100,000 Epinephrine: A Prospective, Randomized Crossover Study. Anesth Prog 2023; 70:110-115. [PMID: 37850677 PMCID: PMC11080968 DOI: 10.2344/anpr-70-03-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/24/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE The purpose of this prospective, randomized crossover study was to compare the peak incidence of success, onset, and incidence over time of pulpal anesthesia in maxillary first molars following a buccal infiltration of 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine. METHODS A total of 118 adults received 1.8 mL or 3.6 mL of 4% articaine with 1:100 000 epinephrine via buccal infiltration of the maxillary first molar at 2 separate appointments. Electric pulp testing (EPT) of the maxillary first molar was performed over 68 minutes. RESULTS There was no significant difference in the peak incidence of anesthetic success (85% and 92%, respectively) in the maxillary first molar between 1.8 mL and 3.6 mL. The difference in onset times (4.5 min for 1.8 mL vs 4.4 min for 3.6 mL) was not statistically significant. However, the 3.6-mL volume did produce a significantly higher incidence of pulpal anesthesia from minutes 48 to 68 compared with the 1.8-mL volume. CONCLUSION There was no significant difference in peak incidence or onset of pulpal anesthesia in the maxillary first molar between 1.8 mL and 3.6 mL of articaine with epinephrine. The incidence of pulpal anesthesia was significantly higher with 3.6 mL of articaine at 48 minutes and beyond, but neither volume provided complete pulpal anesthesia for all subjects that lasted at least 60 minutes.
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Affiliation(s)
- Alexandra Woo
- Former Graduate Student in Endodontics, The Ohio State University, Columbus, Ohio, currently practicing endodontics in Baltimore, Maryland
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Professor and Graduate Program Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Sara Fowler
- Associate Professor and Predoctoral Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Emeritus Professor, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Ai Ni
- Assistant Professor, Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio
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Analgesia-based Sedation for Oral Surgery in Patients With Chronic Respiratory Obstructive Disease. J Craniofac Surg 2023; 34:e70-e74. [PMID: 36100967 DOI: 10.1097/scs.0000000000009004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/12/2022] [Indexed: 01/11/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a risk factor for postoperative cardiovascular and respiratory complications. Thus, intravenous sedation can be a better option than general anesthesia for surgery in patients with severe COPD. Herein, we present 2 cases of analgesia-based sedation in patients with severe COPD who underwent oral surgery. The current study aimed to discuss these cases to provide knowledge about the appropriate sedation management in patients with this disease. In the current cases, the patients received sufficient analgesia and minimum sedation (analgesia-based sedation). Moreover, dexmedetomidine was used for maintaining sedation and fentanyl for analgesic effects. Furthermore, we focused on providing the maximum analgesic effect of local anesthesia. The patients' vital signs were stable. They did not have any psychological or physical complaints, such as anxiety and pain, during the procedure. Then, they were discharged from the hospital without any complications. Thus, analgesia-based sedation can be an alternative option for oral surgery in patients with COPD.
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Singhal N, Vats A, Khetarpal A, Ahlawat M, Vijayran VKR, Harshita. Efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: An in vivo study. J Conserv Dent 2022; 25:654-660. [PMID: 36591593 PMCID: PMC9795688 DOI: 10.4103/jcd.jcd_299_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/08/2022] [Accepted: 07/14/2022] [Indexed: 01/04/2023] Open
Abstract
Aim The aim of the present study was to assess the efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block (IANB) with lidocaine in patients with irreversible pulpitis. Materials and Methods A total of 120 patients were included in the study. Patients were given IANB with 2 ml of 2% lidocaine hydrochloride with 1:80,000 epinephrine. Patients who showed subjective symptoms of IANB but did not secure pulpal anesthesia were randomly allocated to one of the following four groups by random sampling for supplementary local anesthesia - Group 1: buccal infiltration (BI) with 4% articaine with 1:100,000 epinephrine, Group 2: four-site intraligamentary (IL) injection with 4% articaine with 1:100,000 epinephrine, Group 3: BI with 2% mepivacaine with 1:100,000 epinephrine, and Group 4: four-site IL injection with 2% mepivacaine with 1:100,000 epinephrine. Results Group 1 - BI with articaine provided anesthesia success in 27 cases (90%, n = 30). Group 2 - IL injection with articaine provided anesthesia success in 20 cases (66.67%, n = 30). Group 3 - BI with mepivacaine provided anesthesia success in 21 cases (70%, n = 30). Group 4 - IL injection with mepivacaine provided anesthesia success in 15 cases (50%, n = 30). A significant difference between the four groups was found. Conclusion In patients with a mandibular first molar exhibiting symptomatic irreversible pulpitis, block injection with lidocaine along with supplemental BI with articaine allowed more pain-free treatments. Articaine showed better results when compared with mepivacaine.
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Affiliation(s)
- Neha Singhal
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Asit Vats
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Ambica Khetarpal
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Monika Ahlawat
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Vijay K. R. Vijayran
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
| | - Harshita
- Department of Conservative Dentistry and Endodontics, PDM University, Bahadurgarh, Haryana, India
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Syed GA, Shrivastava A, Sisodia S, Sisodiya B, Gupta K, Sapri AS, AboShetaih M, Alghamdi SIS. Comparative Evaluation of Buccal Infiltration Technique with Buccal Plus Palatal Infiltration Technique Using 4% Articaine in Patients with Irreversible Pulpitis of Maxillary 1 st Molars: A Prospective, Randomized, In-Vivo Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2022; 14:186-190. [PMID: 37051425 PMCID: PMC10084993 DOI: 10.4103/jpbs.jpbs_545_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 02/17/2023] Open
Abstract
Introduction The purpose of this study was to evaluate and compare the buccal infiltration (BI) technique with the buccal plus palatal infiltration (BPI) technique using 4% articaine with 1:100,000 epinephrine. Methods A total of 50 adult patients received BI, and the other 50 adult patients received BPI with 4% articaine with 1:100,000 epinephrine. During RCT procedure, when the patient experienced pain, the treatment was stopped and the extent of the procedure was documented. When a patient reported "no pain" (0 mm) or "weak/mild pain" (0 <= 54 mm), the anesthesia was considered successful. Results Statistical analysis using unpaired t-test showed that the mean pain scores in both groups were comparable. Conclusion The pain scores in both groups were comparable, but BI is better than BPI as a painful and traumatic palatal injection was avoided.
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Affiliation(s)
- Gufaran A. Syed
- Department of Endodontics, Faculty of Dentistry, Batterjee Medical College, Jeddah, Saudi Arabia
| | | | - Suruchi Sisodia
- Department of Conservative Dentistry and Endodontics, Modern Dental College and Research Center, Indore, Madhya Pradesh, India
| | - Bhanupratap Sisodiya
- Department of Conservative Dentistry and Endodontics, Mandasaur, Madhya Pradesh, India
| | - Kanishk Gupta
- Department of Periodontology, Dentistry Program, Batterjee Medical College, Jeddah, Saudi Arabia
| | | | - Mohamed AboShetaih
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Egypt
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Onset of action and duration of efficacy of inferior alveolar nerve block versus single lingual subperi-osteal injection of 4% articaine in mandibular
second molars: A randomized clinical trial. JOURNAL OF RESEARCH IN DENTAL AND MAXILLOFACIAL SCIENCES 2022. [DOI: 10.52547/jrdms.7.3.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Almadhoon HW, ABUIRIBAN ROAAWALEED, ALMASSRI HUTHYFA, AL-HAMED FAEZSALEH. EFFICACY OF 4% ARTICAINE BUCCAL INFILTRATION VERSUS INFERIOR ALVEOLAR NERVE BLOCK FOR MANDIBULAR MOLARS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2022; 22:101712. [DOI: 10.1016/j.jebdp.2022.101712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/18/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
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Syed G, Mulay S. Comparative evaluation of anesthetic efficacy of 4% articaine and 2% lidocaine for buccal infiltration in adult patients with irreversible pulpitis of maxillary first molar: A prospective randomized study. Contemp Clin Dent 2022; 13:61-68. [PMID: 35466294 PMCID: PMC9030316 DOI: 10.4103/ccd.ccd_710_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/26/2020] [Accepted: 11/21/2020] [Indexed: 11/09/2022] Open
Abstract
Objective: The purpose of this prospective, randomized study was to evaluate and compare the anesthetic efficacy of 0.8 ml of 4% articaine and 1.6 ml of 2% lidocaine administered through buccal infiltration (submucosal) only in adult male and female patients with irreversible pulpitis of maxillary 1st molar. Study Design: Two hundred patients with irreversible pulpitis of the maxillary first molar were divided into four study groups and received only buccal infiltration of either 0.8 ml of 4% articaine or 1.6 ml of 2% lidocaine. Endodontic access was begun 7 min after the solution deposition. The success was defined as “no pain (0 mm)” or “weak/mild pain (>0 mm and ≤54 mm)” during access opening, and during the first file insertion till working length. Results: The compiled data of the number of failed cases were analyzed by two sample proportion test and of mean pain scores were analyzed by Student's unpaired t-test. P < 0.05 was taken as statistically significant. No significant difference was found in the number of failed cases on using 4% articaine and 2% lidocaine (P > 0.05). Moreover, no significant difference was found in the number of failed cases between the genders in Group I (4% articaine with 1:100,000 epinephrine) and also in Group II (2% lidocaine with 1:80,000 epinephrine). On comparing the mean pain scores of failed cases, it has been found that females experience more pain than males in Group I (not significant) and Group II (significant). Conclusion: The efficacy of 4% articaine with 1:100,000 epinephrine has been found to be better than 2% lidocaine with 1:80,000 epinephrine, as only 0.8 ml of 4% articaine with 1:100,000 epinephrine was effectively used as compared to 1.6 ml of 2% lidocaine with 1:80,000 epinephrine. Furthermore, females experience more pain as compared to males.
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Roozbahani N, Ghaffari E, Ghasemi D, Baninajarian H. A comparison between articaine mandibular infiltration and lidocaine mandibular block anesthesia in second primary molar: A randomized clinical trial. Dent Res J (Isfahan) 2022. [DOI: 10.4103/1735-3327.363533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Local anesthesia in oral and maxillofacial surgery: A review of current opinion. J Dent Sci 2021; 16:1055-1065. [PMID: 34484571 PMCID: PMC8403808 DOI: 10.1016/j.jds.2020.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/03/2020] [Indexed: 02/06/2023] Open
Abstract
Local anesthesia (LA) is the most important pain management process in oral and maxillofacial surgery. Safe and effective LA not only enable patients to obtain high-quality treatment, but also relieve the anxiety of patients when they come to the clinic. The choices of local anesthetic and injection methods determine the success of LA to a great extent. At present, in most countries or regions, common local anesthetics used in oral and maxillofacial surgery belong to amides and they are injected into patients' body mainly through block or infiltration anesthesia. In addition, the operators' technique level, patient's subjective psychology and anatomical variation of maxillofacial structure also have a strong influence on LA in dental clinic. Due to the existence of above factors, the worldwide success rates of LA in oral and maxillofacial surgery is very different. There are no specific LA methods that ensure 100% successful LA rates. Fortunately, the development of new local anesthetic and injection technology are providing us with new ideas to solve this problem. This review mainly report the new research progress on LA in oral and maxillofacial surgery in recent decades and help clinicians with dental LA operation.
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Gandhi SA, Das S, Das A, Agnihotri Y, Mohan RV, Dasu Subramanian VR. Anaesthetic Efficacy of Lidocaine and Articaine in Inferior Alveolar Nerve Block Combined with Buccal Infiltration in Patients with Irreversible Pulpitis. J Pharm Bioallied Sci 2021; 13:S731-S734. [PMID: 34447191 PMCID: PMC8375849 DOI: 10.4103/jpbs.jpbs_747_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/24/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose: This prospective, randomized, double-blinded study was conducted to compare the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine and 4% articaine with 1:200,000 epinephrine in inferior alveolar nerve block (IANB) combined with buccal infiltration in patients with irreversible pulpitis. Methods: Group I: Thirty patients received IANB of 2% lidocaine without buccal infiltration. Group II: Thirty patients received IANB of 2% lidocaine followed by buccal infiltration with 2% lidocaine. Group III: Thirty patients received IANB with 4% articaine followed by buccal infiltration with 4% articaine. Pain during the procedures was recorded by using a Heft Parker visual analog scale. No pain or mild pain on endodontic access was recorded as success and analyzed using Chi-square analysis. Results: Group I obtained 30% success rate. Fifty percent successful anesthesia was obtained for Group II. The success rate was increased to 70% for Group III with statistically significant difference among all the groups (P < 0.05). Conclusion: The use of 4% articaine as both IANB and buccal infiltration recorded the highest success rate (70%) when compared to either 2% lidocaine as IANB with buccal infiltration (50%) or 2% lidocaine as IANB alone (30%) in patients with irreversible pulpitis.
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Affiliation(s)
- Shrimanikandan Ayappa Gandhi
- Department of Craniofacial Surgery and Dentistry, Velammal Medical Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Sambarta Das
- Department of Conservative Dentistry and Endodontics, Hi-Tech Dental College and Hospital, Bhubaneswar, Odisha, India
| | - Abhisek Das
- Department of Conservative Dentistry and Endodontics, Hi-Tech Dental College, Bhubaneswar, Odisha, India
| | - Yoshaskam Agnihotri
- Department of Conservative Dentistry and Endodontics, Hi-Tech Dental College, Bhubaneswar, Odisha, India
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Liew AKC, Yeh YC, Abdullah D, Tu YK. Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis. Restor Dent Endod 2021; 46:e41. [PMID: 34513647 PMCID: PMC8411002 DOI: 10.5395/rde.2021.46.e41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth. MATERIALS AND METHODS Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application. RESULTS The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14-3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates. CONCLUSIONS Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.
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Affiliation(s)
- Amy Kia Cheen Liew
- Department of Family Oral Health, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Dalia Abdullah
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Yu-Kang Tu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Gupta A, Sahai A, Aggarwal V, Mehta N, Abraham D, Jala S, Singh A. Anesthetic efficacy of primary and supplemental buccal/lingual infiltration in patients with irreversible pulpitis in human mandibular molars: a systematic review and meta-analysis. J Dent Anesth Pain Med 2021; 21:283-309. [PMID: 34395897 PMCID: PMC8349668 DOI: 10.17245/jdapm.2021.21.4.283] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/28/2021] [Accepted: 06/05/2021] [Indexed: 12/02/2022] Open
Abstract
Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review aimed at evaluating the success of buccal/lingual infiltrations administered with a primary inferior alveolar nerve block (IANB) injection or as a supplemental injection after the failure of the primary injection in symptomatic and asymptomatic patients with irreversible pulpitis in human mandibular molars. The review question was “What will be the success of primary and supplemental infiltration injection in the endodontic treatment of patients with irreversible pulpitis in human mandibular molars?” We searched electronic databases, including Pubmed, Scopus, and Ebsco host and we did a comprehensive manual search. The review protocol was framed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We included clinical studies that evaluated and compared the anesthetic outcomes of primary IANB with primary and/or supplementary infiltration injections. Standard evaluation of the included studies was performed and suitable data and inferences were assessed. Twenty-six studies were included, of which 13 were selected for the meta-analysis. In the forest plot representation of the studies evaluating infiltrations, the combined risk ratio (RR) was 1.88 (95% CI: 1.49, 2.37), in favor of the secondary infiltrations with a statistical heterogeneity of 77%. The forest plot analysis for studies comparing primary IANB + infiltration versus primary IANB alone showed a low heterogeneity (0%). The included studies had similar RRs and the combined RR was 1.84 (95% CI: 1.44, 2.34). These findings suggest that supplemental infiltrations given along with a primary IANB provide a better success rate. L'Abbe plots were generated to measure the statistical heterogeneity among the studies. Trial sequential analysis suggested that the number of patients included in the analysis was adequate. Based on the qualitative and quantitative analyses, we concluded that the infiltration technique, either as a primary injection or as a supplementary injection, given after the failure of primary IANB, increases the overall anesthetic efficacy.
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Affiliation(s)
- Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Aarushi Sahai
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Milia Islamia, New Delhi, India
| | - Namrata Mehta
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Sucheta Jala
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
| | - Arundeep Singh
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, India
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Batista da Silva C, Volpato MC, Muniz BV, dos Santos CP, Serpe L, Ferreira LEN, de Melo NFS, Fraceto LF, Groppo FC, Franz-Montan M. Promising potential of articaine-loaded poly(epsilon-caprolactone) nanocapules for intraoral topical anesthesia. PLoS One 2021; 16:e0246760. [PMID: 33571275 PMCID: PMC7877576 DOI: 10.1371/journal.pone.0246760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/25/2021] [Indexed: 01/12/2023] Open
Abstract
To determine whether the permeation capacity and analgesic efficacy of articaine (ATC) could be increased and cytotoxicity decreased by encapsulation in poly(ɛ-caprolactone) nanocapsules (ATCnano), aiming at local or topical anesthesia in dentistry. Cellular viability was evaluated (using the MTT test and fluorescence microscopy) after 1 h and 24 h exposure of HaCaT cells to ATC, ATCnano, ATC with epinephrine (ATCepi), and ATC in nanocapsules with epinephrine (ATCnanoepi). The profiles of permeation of 2% ATC and 2% ATCnano across swine esophageal epithelium were determined using Franz-type vertical diffusion cells. Analgesic efficacy was evaluated with a von Frey anesthesiometer in a postoperative pain model in rats, comparing the 2% ATC, 2% ATCnano, 2% ATCepi, and 2% ATCnanoepi formulations to 4% ATCepi (a commercially available formulation). We show that use of the nanocapsules decreased the toxicity of articaine (P<0.0001) and increased its flux (P = 0.0007). The 2% ATCepi and 4% ATCepi formulations provided higher analgesia success and duration (P<0.05), compared to 2% ATC, 2% ATCnano, and 2% ATCnanoepi. Articaine-loaded poly(ɛ-caprolactone) nanocapsules constitute a promising formulation for intraoral topical anesthesia (prior to local anesthetic injection), although it is not effective when injected in inflamed tissues for pain control, such as irreversible pulpitis.
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Affiliation(s)
- Camila Batista da Silva
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- Health Sciences, University of Mogi das Cruzes–UMC, Mogi das Cruzes, São Paulo, Brazil
| | - Maria Cristina Volpato
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
| | - Bruno Vilela Muniz
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- Itapeva Faculty of Social and Agrarian Sciences—FAIT, Itapeva, São Paulo, Brazil
| | - Cleiton Pita dos Santos
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
| | - Luciano Serpe
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- Department of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Luiz Eduardo Nunes Ferreira
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- Laboratory of Inflammation and Immunology, Guarulhos University–UNG, Guarulhos, São Paulo, Brazil
| | - Nathalie Ferreira Silva de Melo
- Department of Environmental Engineering, São Paulo State University, Sorocaba, SP, Brazil
- Department of Immunology and Molecular Biology, São Leopoldo Mandic Research Institute, Campinas, SP, Brazil
| | | | - Francisco Carlos Groppo
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
| | - Michelle Franz-Montan
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- * E-mail:
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Olley RC, Renton TF, Frost P. A 15-year unique observational study of intraligamentary local anaesthesia for posterior mandibular extractions. Br Dent J 2021:10.1038/s41415-020-2350-8. [PMID: 33574577 DOI: 10.1038/s41415-020-2350-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 11/09/2022]
Abstract
Introduction Intraligamentary local anaesthesia (ILA) with articaine is described as an effective alternative to inferior alveolar nerve block (IANB) for extraction of posterior teeth in the mandible, with reduced risk of complications.Aim To investigate ILA with 4% articaine and conventional syringe as a unique method for providing tooth extractions in the posterior mandible.Materials and methods All consecutive teeth to be extracted in the posterior mandible were recruited to the study, within exclusion criteria, between 2002 and 2017 in one London NHS and private dental practice. Four percent articaine was given by ILA with a conventional syringe slowly at two points lingual and two points buccal adjacent to each tooth. Extraction procedures were all performed flapless. Heavily broken-down teeth (n = 43) were extracted by sectioning of roots, guttering and elevation with luxators using socket preservation techniques. Demographic, quantitative and qualitative data were collected at initial appointments and up to 15 years at review.Results The median age was 64 years (interquartile range 17). Teeth extracted included 272 mandibular molars and second premolars, due to periodontal disease (34%), irreversible pulpitis (29%) or posterior tooth fracture (27%). The majority of extractions were second molars (44%), followed by first molars (29%), second premolars (17%) and third molars (10%). Sufficient anaesthesia was achieved within five minutes for all extractions. Procedures lasted less than 30 minutes. Patient feedback reported that the extraction using ILA was quicker than expected and painless, with limited anaesthesia of tissues other than the teeth to be extracted. Numeric rating scale (NRS) scores for pain (0-10) were all less than 3. No complications were recorded.Conclusion The ILA anaesthetic technique is effective for the purpose of a broad range of posterior tooth extractions in the mandible and within certain clinical parameters. It mitigates risks, including nerve injury and cardiovascular disturbances, associated with repeated IANB. This is the largest study of its kind and is conducted in primary care.
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Affiliation(s)
- Ryan C Olley
- Senior Lecturer and Honorary Consultant in Restorative Dentistry, School of Dentistry, University Hospital Wales, Heath Park Cardiff, CF14 4XY, UK; Clinical Academic and Specialist in Prosthodontics, Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, UK; Dentist and Specialist in Prosthodontics, Dental Practices, Essex, UK.
| | - Tara F Renton
- Professor and Honorary Consultant in Oral Surgery, King´s College London, UK
| | - Peter Frost
- Research Champion, NIHR and Honorary Senior Specialist Clinical Teacher, King´s College London, UK
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Bahrololoomi Z, Rezaei M. Anesthetic efficacy of single buccal infiltration of 4% articaine compared to routine inferior alveolar nerve block with 2% lidocaine during bilateral extraction of mandibular primary molars: a randomized controlled trial. J Dent Anesth Pain Med 2021; 21:61-69. [PMID: 33585685 PMCID: PMC7871180 DOI: 10.17245/jdapm.2021.21.1.61] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/04/2021] [Accepted: 01/05/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Inferior alveolar nerve block (IANB) using lidocaine 2% is commonly used for anesthetizing primary mandibular molars; however, this technique has the highest level of patient discomfort compared to other local anesthesia techniques. Therefore, alternative anesthesia techniques are necessary. The aim of this study was to evaluate the efficacy of a single buccal infiltration of 4% articaine with IANB using 2% lidocaine, for the bilateral extraction of primary mandibular molars. METHODS The present study was conducted on 30 patients aged between 6 and 9 years, who required the extraction of bilateral primary mandibular molars. The patients were randomly divided into two groups as follows: In the first session, Group A received IANB with lidocaine 2% and group B received infiltration with articaine 4%. In the second session, another injection method was performed on the opposite side. The Wong-Baker Facial Pain scale (WBFPS), Face Leg Activity Cry, and Consolability (FLACC), and physiologic parameters were used to assess pain perception. RESULTS The independent t-test showed no statistically significant difference in blood pressure and heart rate before and after extraction (P > 0.05). The mean FLACC index in the lidocaine and articaine groups was 0.89 and 1.36, respectively; there was no statistically significant difference between them (P > 0.05). According to the results of the chi-square test, there was no statistically significant difference between the groups for WBFPS (P > 0.05). CONCLUSION The articaine infiltration technique may be an alternative to the IANB for the extraction of primary mandibular molars.
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Affiliation(s)
- Zahra Bahrololoomi
- Department of Pediatric Dentistry, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Maedeh Rezaei
- Department of Pediatric Dentistry, Faculty of Dentistry, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Bhatnagar NB, Mantri SP, Dube KA, Jaiswal NU, Singh VJ. Pulpal-anesthesia of a mandibular first molar with irreversible pulpitis by inferior alveolar nerve block plus buccal infiltration using articaine or lignocaine. J Conserv Dent 2021; 23:201-205. [PMID: 33384496 PMCID: PMC7720765 DOI: 10.4103/jcd.jcd_410_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 07/23/2020] [Accepted: 08/18/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: This study aims to compare the efficacy of a combination of an inferior alveolar nerve block (IANB) plus buccal infiltration using 4% articaine versus 2% lignocaine in achieving anesthesia of lower first molar teeth with irreversible pulpitis. Materials and Methods: Seventy adult patients were selected. A random sequence list was employed to administer IANB plus buccal infiltration. After the onset of lip numbness, cold test and electric pulp testing were performed. Five patients, four missed blocks and one no bleeding, were excluded. Heft Parker Visual Analog Scale scores during pulp extirpation were recorded. The data of sixty-five patients were statistically analyzed using Chi-square and Mann–Whitney U-test. Results: The success rate after lip-numbness for articaine is 91.42% and for lignocaine is 94.28%. The difference is statistically, not significant (P = 0.6425). During access, the success rate for lignocaine is 96.87%, whereas 96.96% for articaine. This difference is also not significant (P = 0.982366). Conclusion: IANB plus buccal infiltration using articaine or lignocaine is equally effective in anesthetizing mandibular first molar with irreversible pulpitis.
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Affiliation(s)
- Nupur B Bhatnagar
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
| | - Shivkumar P Mantri
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
| | - Kavita A Dube
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
| | - Neelam U Jaiswal
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
| | - Vaishnavi J Singh
- Department of Conservative Dentistry and Endodontics, Hitkarini Dental College, Jabalpur, Madhya Pradesh, India
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Is the only buccal infiltration anesthesia enough for extraction of mandibular anterior incisors and premolar teeth? A split-mouth randomized clinical trial. Clin Oral Investig 2020; 25:3077-3085. [PMID: 33051814 DOI: 10.1007/s00784-020-03628-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The issue of needing additional lingual injection in extractions of mandibular premolar and incisors is still not clarified. The aim of this study is to investigate whether it is necessary to perform lingual injection in addition to buccal infiltration anesthesia in mandibular incisors and premolar teeth extractions. MATERIALS AND METHODS Sixty-six patients who admitted to our clinic for the removal of bilateral mandibular anterior teeth were included in the present study. Patients were divided into two groups. The experimental group received only 1.5 ml of 2% lidocaine with 1:80,000 epinephrine by injection into the buccal vestibule of the tooth. The control group received 1.5 ml of 2% lidocaine with 1:80,000 epinephrine by buccal injection into the buccal side and 0.3 ml same lidocaine solution injected into the lingual side of the tooth. After 5 min, tooth was extracted and each patient was asked to record the intensity of injection and extraction pain by 0-100 mm and a 10-point Visual Analogue Scale (VAS) and six-pointed Face Pain Scale (FPS). RESULTS The injection pain scores were significantly higher in terms of the VAS 0-10 point and 0-100 mm and FPS in the control group to which additional lingual injections were applied than the experimental group (p < 0.05). No statistically significant differences were found in all three scales between the groups in terms of extraction pain (p > 0.05). The mean extraction pain scores were lower in the experimental group according to the three scales. No additional anesthetic injection and post-operative complications were observed in all patients. CONCLUSIONS The extraction of mandibular incisors and premolar teeth can only be done with only the buccal infiltration. CLINICAL RELEVANCE In the extraction of mandibular anterior teeth, it can be performed with less anesthetic amount without the need for an additional lingual injection.
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Comparative study of the anaesthetic efficacy of 4% articaine versus 2% lidocaine with adrenaline during extraction of mandibular molars using an inferior alveolar nerve blocking technique. Br J Oral Maxillofac Surg 2020; 59:783-787. [PMID: 34301445 DOI: 10.1016/j.bjoms.2020.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022]
Abstract
Various anaesthetic agents have been used in dentistry for the extraction of teeth. The most commonly used local anaesthetic agent is lidocaine hydrochloride. Recently, articaine hydrochloride came into existence because of its versatile properties and longer duration of action. Due to lack of study of effects of articaine on various systems, the present study is aimed to compare the anaesthetic efficacy of articaine and lidocaine with adrenaline during the extraction of mandibular molars. A total of 100 patients was randomly divided into two groups (50 each) and clinical variables such onset and duration of anaesthesia, blood pressure, oxygen saturation, pulse rate, and pain perception were recorded at different time intervals using a visual analogue scale. The statistical analysis was performed using SPSS version 22.0. Mean and standard deviations, frequency distribution analysis, and the chi squared test were performed to calculate variables and a p< 0.05 was considered significant. Statistically significant differences were obtained regarding mean time of onset of anaesthesia (p< 0.001), mean duration of the anaesthetic effect (p< 0.001), and pain perception for the articaine group. No significant results were obtained for blood pressure, oxygen saturation, or pulse rate. During the deposition of articaine, patients reported less pain than with lidocaine. Articaine hydrochloride helped to achieve increased anaesthetic success in dental applications over lidocaine hydrochloride in terms of fast time of onset, longer duration, and less pain, all of which were attributed to its greater diffusion properties.
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Does the Use of Articaine Increase the Risk of Hypesthesia in Lower Third Molar Surgery? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2020; 79:64-74. [PMID: 32976834 DOI: 10.1016/j.joms.2020.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to assess the risk of hypesthesia with the use of articaine in comparison with other local anesthetics in lower third molar surgery, through a systematic review and meta-analysis. METHODS MEDLINE/PubMed, EMBASE, Cochrane Library (CENTRAL), Web of Science, and SCOPUS databases were searched. Gray literature and manual searches were also performed. RESULTS Altogether 342 articles were found; only 13 met the eligibility criteria. A total of 886 third molars were removed; 436 using articaine, 430 using other local anesthetics, and 20 using an anesthetic mixture. Altogether 5 cases of hypesthesia were found in the articaine group, with 4 temporary and 1 with no mention of nerve involved; there was no case of permanent confirmed hypesthesia. A total of 9 articles demonstrated a low risk of bias, and 4 articles showed some concern. The meta-analysis demonstrated a 3.96 relative risk for hypesthesia with the use of articaine compared with other local anesthetics, but this result was not statistically significant. The heterogeneity of the studies was low from a clinical, methodological, and statistical point of view. CONCLUSIONS Thus, this systematic review and meta-analysis suggests that the use of articaine does not increase the risk of hypesthesia compared with other local anesthetics in lower third molar extraction, and when present, this complication is temporary.
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Joshi A, Soni HK. Efficacy of Infiltration Anaesthesia of 4% Articaine HCl (buccal) Versus 2% Lignocaine HCl (buccolingual) in Extraction of Mandibular Premolars: A Single Centred, Randomised, Crossover Group Study. J Maxillofac Oral Surg 2020; 19:431-437. [PMID: 32801540 DOI: 10.1007/s12663-019-01297-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/27/2019] [Indexed: 11/26/2022] Open
Abstract
Purpose The purpose of the study was to evaluate and compare the efficacy of buccal and lingual infiltration (B/L I) of 2% lignocaine HCl and buccal infiltration (BI) of 4% articaine for orthodontic extraction of mandibular premolars. Materials and Method One hundred and four patients (age group 14-26 years) were selected with the indication of bilateral mandibular first or second premolar extraction for orthodontic treatment. Patients were randomly distributed in 2 groups. Group A received B/L I with lignocaine and Group B for BI with articaine in two different appointments in 2-week interval. The pain scores for each patient were evaluated during extraction using the visual analogue scale (VAS) and verbal pain scale (VPS). Statistical analysis was performed by descriptive and inferential statistics using Chi-square test. The agreement between VAS and VPS was obtained by applying intra-class correlation coefficient. Results No pain was experienced during extraction in 77% (VAS) and 79% (VPS) patients infiltrated in group A and 84% (VAS) and 90% (VPS) patients of group B with articaine. The difference between the groups was statistically significant. A strong positive correlation was found between VAS and VPS scores in the both groups. Conclusion Buccal infiltration with articaine proved to be an effective alternative to buccal and lingual infiltration with lignocaine in the extraction of mandibular premolars.
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Affiliation(s)
- Ajit Joshi
- Department of Dentistry, Government Medical College, Ram Nagar, Chandrapur, Maharashtra 442402 India
| | - Harleen Kaur Soni
- Department of Pedodontics and Preventive Dentistry, Manubhai Patel Dental College, Near Vishwajoti Ashram, Munjmahuda, Vadodara, Gujarat 390011 India
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A Prospective, Randomized Double-Blinded Study to Evaluate the Efficacy of Buffered Local Anesthetics in Infected and Inflamed Pulp and Periapical Tissues. J Maxillofac Oral Surg 2020; 19:246-250. [PMID: 32346235 DOI: 10.1007/s12663-019-01188-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022] Open
Abstract
Aim The aim of this study is to evaluate the efficacy of sodium bicarbonate as an additive alkalizing agent to local anesthetic solutions in inflamed and infected pulpal and periapical tissues. Type of Study A prospective, randomized crossover double-blinded study was carried out in a university-affiliated hospital in Chennai. Materials and Methods A randomized crossover double-blinded study was designed wherein ninety-six patients were enrolled for the study. 1.8 ml of 2% lignocaine with 1:200,000 adrenaline was administered. The latency time period was found to be 5-10 min and extraction was attempted. During extraction, if the patient experienced pain, 0.5 ml of 8.4% sodium bicarbonate was injected into the previously injected local anesthesia site. A time period of 3 min was allowed for the alkalinization to occur. Extraction was carried out only when the patient did not complain of pain. Pain score was assessed before and after administration of 8.4% sodium bicarbonate using visual analog scale. Pulse rate at the baseline, before and after administration of 8.4% sodium bicarbonate, was recorded and the pain scale values were correlated with pulse rate. Results It was found that there was a significant decrease in pain after injecting buffered local anesthetics (p < 0.1). Pain score before injecting sodium bicarbonate was higher when compared to post-injection of sodium bicarbonate. There was also significant reduction in pulse rate following the administration of sodium bicarbonate. Conclusion Buffered 2% lignocaine with 1:200,000 epinephrine had early onset of anesthesia when compared to unbuffered form. Injecting 2% buffered lignocaine pain was significantly reduced during extraction in the teeth.
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Sandilya V, Andrade NN, Mathai PC, Aggarwal N, Sahu V, Nerurkar S. A Randomized Control Trial Comparing Buccal Infiltration of 4% Articaine with Buccal and Palatal Infiltration of 2% Lignocaine for the Extraction of Maxillary Premolar Teeth. Contemp Clin Dent 2020; 10:284-288. [PMID: 32308291 PMCID: PMC7145254 DOI: 10.4103/ccd.ccd_529_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The use of articaine has been claimed to obviate the need for routine palatal local anesthetic injections on account of its better diffusion through soft and hard tissues as compared to other local anesthetic agents. Objective The objective of the study is to evaluate the efficacy of 4% articaine (with 1:100,000 adrenaline) infiltrated only buccally in the extraction of maxillary premolars for orthodontic reasons. Materials and Methods A double-blind randomized clinical trial with a split-mouth design, where each patient (n = 100) was part of two groups, was conducted. Experimental Group 1: single buccal infiltration of 4% articaine with 1:100,000 adrenaline (Septanest™ with adrenaline 1:100,000 by Septodont). Control Group 2: routine buccal and palatal infiltrations of 2% lignocaine with 1:200,000 adrenaline (Lox™ 2% with adrenaline 1:200,000 by Neon). The parameters studied were time to onset of anesthesia, pain during the extraction procedure (not during the injecting of the local anesthetic), and frequency of extra amount of local anesthetic injected. Results The difference was not statistically significant (P > 0.05) between the two groups with respect to all three parameters. This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases. Conclusion This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases.
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Affiliation(s)
- Vikas Sandilya
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Neelam Noel Andrade
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Paul C Mathai
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Neha Aggarwal
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Vyankatesh Sahu
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Shibani Nerurkar
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
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Olley RC, Renton TF, Frost PM. Intraligamentary Local Anaesthesia for Posterior Mandibular Extractions. ACTA ACUST UNITED AC 2020. [DOI: 10.12968/denu.2020.47.3.213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reviews research and author experience behind Intraligamentary Local Anaesthesia (ILA) and Infiltration Local Anaesthesia (IFA) with Inferior Alveolar Nerve Block (IANB). In particular, the use of ILA with 4% articaine is discussed as an effective anaesthetic technique to replace both IANB and IFA for the purpose of tooth extraction in the posterior mandible. ILA also avoids the possible complications associated with IANB. Other advantages and some shortfalls of the ILA technique are described in relation to primary dental care. The technique for achieving ILA is described. CPD/Clinical Relevance: The ILA technique with articaine is a simple, swift and effective alternative to IANB and IFA for extraction of posterior teeth in the mandible in primary dental care. ILA has fewer potential debilitating complications than IANB and is likely to be more effective than IFA.
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Affiliation(s)
- Ryan C Olley
- Senior Clinical Lecturer and Consultant in Restorative Dentistry, Cardiff University; Honorary Clinical Lecturer, King's College London; Specialist in Prosthodontics, West Mersea Dental Practice, Colchester and Goodleigh Dental Practice, Chelmsford
| | - Tara F Renton
- Professor and Honorary Consultant in Oral Surgery, King's College London
| | - Peter M Frost
- Honorary Senior Specialist Clinical Teacher, King's College London, London, UK
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Gazal G, Omar E, Fareed WM, Alsharif A, Bahabri R. Impact of maxillary teeth morphology on the failure rate of local anesthesia. Saudi J Anaesth 2020; 14:57-62. [PMID: 31998021 PMCID: PMC6970379 DOI: 10.4103/sja.sja_542_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 09/02/2019] [Indexed: 12/12/2022] Open
Abstract
Objective: To investigate the effect of maxillary single and multiple rooted teeth on the success rate of buccal infiltration anesthesia. Subjects and Methods: This clinical study was performed by dividing the participants into three groups. Group one included 30 patients with upper anterior teeth, group two 23 patients with upper premolars teeth and group three 39 patients with upper molars for extraction. Onset time of anesthtic action was evaluted by using electronic pulp tester. Pulp testing assessments were carried out immediately before the injection and at the intervals of 2 mins following the injection until the anesthetic success obtains. Results: Seventy-nine patients in this study secured anesthetic success within study duration time (10 min). However, there were 13 patients with dental anesthesia failures (3 patients with single rooted teeth and 10 patients with multiple rooted teeth). There were no significant differences in the mean onset time of pulpal anesthesia between the anterior, middle and posterior teeth (P value = 0.449). Clinically, patients with single rooted teeth reported faster dental anesthesia and earlier teeth extraction than patients with multiple rooted teeth. Conclusion: This study showed that the single rooted teeth have faster pulpal anesthesia and early extraction than teeth with multiple roots but not statistically significant. Administration of extra local anesthetic cartridge or using intraseptal injection technique can be a solution to overcome the failure of anesthesia in the maxillary posterior teeth.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Esam Omar
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Wamiq M Fareed
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Ali Alsharif
- Department of Prosthodontics, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
| | - Rayan Bahabri
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Madinah Al-Munawwarah, Kingdom of Saudi Arabia
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Comparison of the efficacy of a standard inferior alveolar nerve block versus articaine infiltration for invasive dental treatment in permanent mandibular molars in children: a pilot study. Eur Arch Paediatr Dent 2019; 21:171-177. [PMID: 31832992 DOI: 10.1007/s40368-019-00496-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022]
Abstract
AIM To determine whether there is a clinical difference between an inferior dental block (IDB) using 2% lidocaine and a buccal infiltration (BI) using 4% articaine, when anaesthetising mandibular first permanent molars in children. METHODS Patients aged 8-15 years who required invasive dental treatment on a lower molar tooth were randomised. The patient and dental operator were blind to the type of LA used. The patient used a visual analogue scale to record their experience of pain during injection and treatment. RESULTS Twenty six teeth were anaesthetised (13 articaine, 13 lidocaine). When using an IDB, all treatment was completed successfully. On one occasion, anaesthesia was deemed unsuccessful when using a BI of articaine. There was no statistical difference in the mean VAS for the perceived pain of injection or treatment. CONCLUSION This study showed that invasive dental treatment on a mandibular molar tooth can be completed successfully in children using a BI of articaine. In addition, the perceived pain of injection and treatment when using a BI of articaine is comparable to an IDB with lidocaine.
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Effectiveness of Articaine Buccal Infiltration Anesthesia for Mandibular Premolar Extraction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Oral Maxillofac Surg 2019; 77:1784-1789. [DOI: 10.1016/j.joms.2019.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/19/2019] [Accepted: 03/23/2019] [Indexed: 11/17/2022]
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Jadun S, Monaghan L, Darcey J. Endodontic microsurgery. Part two: armamentarium and technique. Br Dent J 2019; 227:101-111. [PMID: 31350492 DOI: 10.1038/s41415-019-0516-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Modern endodontic microsurgery has a high reported success rate of up to 93.5%, making it a viable treatment option in the management of periapical disease when orthograde root treatment is not possible or inappropriate. This high success rate is intimately related to advanced techniques that have allowed practitioners to overcome historical barriers to the success seen in traditional surgical endodontics. When comparing traditional root-end surgery and endodontic microsurgery there are key differences when considering the flap design, access armamentarium, size of osteotomy, instruments used and root-end material. This paper highlights such key differences and advises practitioners on the techniques and instruments used to achieve high success rates, firmly establishing non-surgical endodontic treatment as an important treatment option in well-selected cases.
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Affiliation(s)
- Sarah Jadun
- University Dental Hospital of Manchester, Oral Surgery, Higher Cambridge Street, Manchester, UK
| | - Liam Monaghan
- University Dental Hospital of Manchester, Orthodontic Department, Higher Cambridge Street, Manchester, UK
| | - James Darcey
- University Dental Hospital of Manchester, Restorative Department, Higher Cambridge Street, Manchester, UK.
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Dianat O, Mozayeni MA, Layeghnejad MK, Shojaeian S. The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible pulpitis. Clin Oral Investig 2019; 24:1281-1286. [DOI: 10.1007/s00784-019-03006-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
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Shakeel AM, Christopher PJ, Kengasubbiah S, Kumar S, Shenoy V. Hemodynamic Changes Associated with Two Different Concentrations of Adrenaline in Lignocaine Solution: A Comparative Analysis. Cureus 2019; 11:e4434. [PMID: 31245221 PMCID: PMC6559701 DOI: 10.7759/cureus.4434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Local anesthetic (LA) agents are commonly employed during surgical procedures in dentistry to control pain. There are a variety of LA agents available in the market with different concentration of adrenaline added to increase the efficacy. The systemic effects of adrenaline used as vasoconstrictors in LA solution are short lived or transient in nature; however, there are instances of associated cardiovascular problems. This study compares the efficacy and cardiovascular effects with the use of 2% lignocaine with two different concentrations of adrenaline.
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Affiliation(s)
- Abu Mohammed Shakeel
- Oral and Maxillofacial Surgery, Thai Moogambigai Dental College & Hospital, Chennai, IND
| | - Pradeep J Christopher
- Oral and Maxillofacial Surgery, Thai Moogambigai Dental College & Hospital, Chennai, IND
| | - Srivatsa Kengasubbiah
- Oral and Maxillofacial Surgery, Thai Moogambigai Dental College & Hospital, Chennai, IND
| | - Senthil Kumar
- Oral and Maxillofacial Surgery, Thai Moogambigai Dental College & Hospital, Chennai, IND
| | - Vandana Shenoy
- Oral and Maxillofacial Surgery, Thai Moogambigai Dental College & Hospital, Chennai, IND
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Soysa NS, Soysa IB, Alles N. Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: A systematic review and meta-analysis. ACTA ACUST UNITED AC 2019; 10:e12404. [PMID: 30887677 DOI: 10.1111/jicd.12404] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/20/2018] [Indexed: 11/28/2022]
Abstract
The aim of the present systematic review and meta-analysis was to address the following Population, Intervention, Comparison, and Outcome question: Is the efficacy of articaine better than lignocaine in adults requiring dental treatment? Four percent articaine was compared with 2% lignocaine for maxillary and mandibular infiltrations and block anesthesia, and with the principal outcome measures of anesthetic success. Using RevMan software, the weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared using a random-effects model. For combined studies, articaine was more likely to achieve successful anesthesia than lignocaine (N = 18, odds ratio [OR]: 1.92, 95% CI: 1.45-2.56, P < 0.00001, I2 = 32%). Maxillary and mandibular infiltration studies showed obvious superiority of articaine to lignocaine (N = 8, OR: 2.50, 95% CI: 1.51-4.15, P = 0.0004, I2 = 41%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lignocaine (N = 5, OR: 1.69, 95% CI: 0.88-3.23, P = 0.11, I2 = 19%). For combined mandibular anesthesia studies, articaine was superior to lignocaine (N = 14, OR: 1.99, 95% CI: 1.45-2.72, P < 0.0001, I2 = 32%), with further subgroup analysis showing significant differences in both mandibular block anesthesia (N = 11, OR: 1.55, 95% CI: 1.19-2.03, P = 0.001), I2 = 0%) and mandibular infiltration (N = 3, OR: 3.87, 95% CI: 2.62-5.72, P < 0.00001, I2 = 0%), indicating that articaine is more effective than lignocaine in providing anesthetic success in routine dental procedures.
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Affiliation(s)
- Niroshani S Soysa
- Department of Oral Medicine and Periodontology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ishani B Soysa
- School of Engineering and Advanced Technology, Massey University, Palmerston North, New Zealand
| | - Neil Alles
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
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Anesthetic Efficiency of Articaine Versus Lidocaine in the Extraction of Lower Third Molars: A Meta-Analysis and Systematic Review. J Oral Maxillofac Surg 2019; 77:18-28. [DOI: 10.1016/j.joms.2018.08.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/21/2018] [Accepted: 08/21/2018] [Indexed: 12/17/2022]
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Alsharif A, Omar E, Alolayan ABB, Bahabri R, Gazal G. 2% lidocaine versus 3% prilocaine for oral and maxillofacial surgery. Saudi J Anaesth 2018; 12:571-577. [PMID: 30429739 PMCID: PMC6180686 DOI: 10.4103/sja.sja_259_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objective To investigate the speed of action and injection discomfort of 2% lidocaine and 3% prilocaine for upper teeth extractions. Materials and Methods Forty-six patients were included in the prilocaine 3% group, and 46 in the lidocaine 2% control group. After all injections, soft and hard tissue numbness was objectively gauged by dental probe at intervals of 15 s. Moreover, the pain of the injections was recorded by the patients after each treatment on standard 100 mm visual analog scales, tagged at the endpoints with "no pain" (0 mm) and "unbearable pain" (100 mm). Results There were no significant differences in the meantime of first numbness to associated buccal, palatal mucosa, and tooth of patients in the lidocaine and prilocaine buccal infiltration groups (P = 0.56, 0.37, and 0.33). However, clinically, the patients in prilocaine group recorded earlier buccal, palatal mucosa, and teeth numbness than those in lidocaine group. With regards to the discomfort of the needle injections, there was a significant difference for lidocaine and prilocaine groups when comparing the post buccal scores with the post palatal injection scores (t-test: P < 0.001). Lidocaine and prilocaine buccal injections were significantly more comfortable than palatal injections. Conclusions Using 2% lidocaine and 3% prilocaine for extractions of upper maxillary teeth produces similarly successful anesthesia. Clinically, prilocaine has slightly rapid onset of action, earlier buccal mucosa, hard palate, and teeth numbness. Prilocaine and lidocaine buccal injection was significantly more comfortable than palatal injection.
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Affiliation(s)
- Ali Alsharif
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Esam Omar
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Al-Braa Badr Alolayan
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Rayan Bahabri
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
| | - Giath Gazal
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Kingdom of Saudi Arabia
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Bataineh AB, Nusair YM, Al-Rahahleh RQ. Comparative study of articaine and lidocaine without palatal injection for maxillary teeth extraction. Clin Oral Investig 2018; 23:3239-3248. [DOI: 10.1007/s00784-018-2738-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 10/24/2018] [Indexed: 11/29/2022]
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Rayati F, Noruziha A, Jabbarian R. Efficacy of buccal infiltration anaesthesia with articaine for extraction of mandibular molars: a clinical trial. Br J Oral Maxillofac Surg 2018; 56:607-610. [DOI: 10.1016/j.bjoms.2018.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 06/18/2018] [Indexed: 11/29/2022]
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Affiliation(s)
- Tara Renton
- King's College London Dental Institute; London UK
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St George G, Morgan A, Meechan J, Moles DR, Needleman I, Ng Y, Petrie A. Injectable local anaesthetic agents for dental anaesthesia. Cochrane Database Syst Rev 2018; 7:CD006487. [PMID: 29990391 PMCID: PMC6513572 DOI: 10.1002/14651858.cd006487.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pain during dental treatment, which is a common fear of patients, can be controlled successfully by local anaesthetic. Several different local anaesthetic formulations and techniques are available to dentists. OBJECTIVES Our primary objectives were to compare the success of anaesthesia, the speed of onset and duration of anaesthesia, and systemic and local adverse effects amongst different local anaesthetic formulations for dental anaesthesia. We define success of anaesthesia as absence of pain during a dental procedure, or a negative response to electric pulp testing or other simulated scenario tests. We define dental anaesthesia as anaesthesia given at the time of any dental intervention.Our secondary objective was to report on patients' experience of the procedures carried out. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2018, Issue 1), MEDLINE (OVID SP), Embase, CINAHL PLUS, WEB OF SCIENCE, and other resources up to 31 January 2018. Other resources included trial registries, handsearched journals, conference proceedings, bibliographies/reference lists, and unpublished research. SELECTION CRITERIA We included randomized controlled trials (RCTs) testing different formulations of local anaesthetic used for clinical procedures or simulated scenarios. Studies could apply a parallel or cross-over design. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological approaches for data collection and analysis. MAIN RESULTS We included 123 studies (19,223 participants) in the review. We pooled data from 68 studies (6615 participants) for meta-analysis, yielding 23 comparisons of local anaesthetic and 57 outcomes with 14 different formulations. Only 10 outcomes from eight comparisons involved clinical testing.We assessed the included studies as having low risk of bias in most domains. Seventy-three studies had at least one domain with unclear risk of bias. Fifteen studies had at least one domain with high risk of bias due to inadequate sequence generation, allocation concealment, masking of local anaesthetic cartridges for administrators or outcome assessors, or participant dropout or exclusion.We reported results for the eight most important comparisons.Success of anaesthesiaWhen the success of anaesthesia in posterior teeth with irreversible pulpitis requiring root canal treatment is tested, 4% articaine, 1:100,000 epinephrine, may be superior to 2% lidocaine, 1:100,000 epinephrine (31% with 2% lidocaine vs 49% with 4% articaine; risk ratio (RR) 1.60, 95% confidence interval (CI) 1.10 to 2.32; 4 parallel studies; 203 participants; low-quality evidence).When the success of anaesthesia for teeth/dental tissues requiring surgical procedures and surgical procedures/periodontal treatment, respectively, was tested, 3% prilocaine, 0.03 IU felypressin (66% with 3% prilocaine vs 76% with 2% lidocaine; RR 0.86, 95% CI 0.79 to 0.95; 2 parallel studies; 907 participants; moderate-quality evidence), and 4% prilocaine plain (71% with 4% prilocaine vs 83% with 2% lidocaine; RR 0.86, 95% CI 0.75 to 0.99; 2 parallel studies; 228 participants; low-quality evidence) were inferior to 2% lidocaine, 1:100,000 epinephrine.Comparative effects of 4% articaine, 1:100,000 epinephrine and 4% articaine, 1:200,000 epinephrine on success of anaesthesia for teeth/dental tissues requiring surgical procedures are uncertain (RR 0.85, 95% CI 0.71 to 1.02; 3 parallel studies; 930 participants; very low-quality evidence).Comparative effects of 0.5% bupivacaine, 1:200,000 epinephrine and both 4% articaine, 1:200,000 epinephrine (odds ratio (OR) 0.87, 95% CI 0.27 to 2.83; 2 cross-over studies; 37 participants; low-quality evidence) and 2% lidocaine, 1:100,000 epinephrine (OR 0.58, 95% CI 0.07 to 5.12; 2 cross-over studies; 31 participants; low-quality evidence) on success of anaesthesia for teeth requiring extraction are uncertain.Comparative effects of 2% mepivacaine, 1:100,000 epinephrine and both 4% articaine, 1:100,000 epinephrine (OR 3.82, 95% CI 0.61 to 23.82; 1 parallel and 1 cross-over study; 110 participants; low-quality evidence) and 2% lidocaine, 1:100,000 epinephrine (RR 1.16, 95% CI 0.25 to 5.45; 2 parallel studies; 68 participants; low-quality evidence) on success of anaesthesia for teeth requiring extraction and teeth with irreversible pulpitis requiring endodontic access and instrumentation, respectively, are uncertain.For remaining outcomes, assessing success of dental local anaesthesia via meta-analyses was not possible.Onset and duration of anaesthesiaFor comparisons assessing onset and duration, no clinical studies met our outcome definitions.Adverse effects (continuous pain measured on 170-mm Heft-Parker visual analogue scale (VAS))Differences in post-injection pain between 4% articaine, 1:100,000 epinephrine and 2% lidocaine, 1:100,000 epinephrine are small, as measured on a VAS (mean difference (MD) 4.74 mm, 95% CI -1.98 to 11.46 mm; 3 cross-over studies; 314 interventions; moderate-quality evidence). Lidocaine probably resulted in slightly less post-injection pain than articaine (MD 6.41 mm, 95% CI 1.01 to 11.80 mm; 3 cross-over studies; 309 interventions; moderate-quality evidence) on the same VAS.For remaining comparisons assessing local and systemic adverse effects, meta-analyses were not possible. Other adverse effects were rare and minor.Patients' experiencePatients' experience of procedures was not assessed owing to lack of data. AUTHORS' CONCLUSIONS For success (absence of pain), low-quality evidence suggests that 4% articaine, 1:100,000 epinephrine was superior to 2% lidocaine, 1:100,000 epinephrine for root treating of posterior teeth with irreversible pulpitis, and 2% lidocaine, 1:100,000 epinephrine was superior to 4% prilocaine plain when surgical procedures/periodontal treatment was provided. Moderate-quality evidence shows that 2% lidocaine, 1:100,000 epinephrine was superior to 3% prilocaine, 0.03 IU felypressin when surgical procedures were performed.Adverse events were rare. Moderate-quality evidence shows no difference in pain on injection when 4% articaine, 1:100,000 epinephrine and 2% lidocaine, 1:100,000 epinephrine were compared, although lidocaine resulted in slightly less pain following injection.Many outcomes tested our primary objectives in simulated scenarios, although clinical alternatives may not be possible.Further studies are needed to increase the strength of the evidence. These studies should be clearly reported, have low risk of bias with adequate sample size, and provide data in a format that will allow meta-analysis. Once assessed, results of the 34 'Studies awaiting classification (full text unavailable)' may alter the conclusions of the review.
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Affiliation(s)
- Geoffrey St George
- Eastman Dental HospitalEndodontics Unit256 Grays Inn RoadLondonUKWC1X 8LD
| | - Alyn Morgan
- Eastman Dental HospitalEndodontics Unit256 Grays Inn RoadLondonUKWC1X 8LD
| | - John Meechan
- The Dental SchoolDepartment of Oral and Maxillofacial SurgeryFramlington PlaceNewcastle Upon TyneUKNE2 4BW
| | - David R Moles
- Peninsula Dental SchoolOral Health Services ResearchThe John Bull Building, Tamar Science Park, Research WayPlymouthUKPL6 8BU
| | - Ian Needleman
- UCL Eastman Dental InstituteUnit of Periodontology and International Centre for Evidence‐Based Oral Health256 Gray's Inn RoadLondonUKWC1X 8LD
| | - Yuan‐Ling Ng
- UCL Eastman Dental InstituteUnit of Endodontology256 Grays Inn RoadLondonUKWC1X 8LD
| | - Aviva Petrie
- UCL Eastman Dental InstituteBiostatistics Unit256 Gray's Inn RoadLondonUKWC1X 8LD
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Gazal G. Is Articaine More Potent than Mepivacaine for Use in Oral Surgery? J Oral Maxillofac Res 2018; 9:e5. [PMID: 30429965 PMCID: PMC6225598 DOI: 10.5037/jomr.2018.9305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/28/2018] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate the potency and speed of action of 4% articaine and 2% mepivacaine for maxillary teeth extractions. MATERIAL AND METHODS Ninety-four patients, aged between 16 to 70 years old, were recruited in this study. Two regimens were randomly administered over one visit. Patients of treatment group 1 received mepivacaine 2% with 1:100,000 adrenaline, whereas treatment group 2 - articaine 4% with 1:100,000 adrenaline. The onset time of pulp anaesthesia for maxillary teeth indicated for extraction was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out. RESULTS In this study, 85 patients had successful local anaesthetic followed by extraction within the study duration time (10 min). However, 5 patients had failed dental extraction (4 in mepivacaine group and 1 in articaine group). Patients in the articaine buccal infiltration group recorded faster onset time of action regarding anaesthesia and teeth extraction than patients in mepivacaine buccal infiltration group (P = 0.03). CONCLUSIONS Articaine is an effective anaesthetic with a rapid onset, comparable to mepivacaine in infiltrative techniques used for maxillary teeth extraction. However, articaine has clinically achieved faster dental anaesthesia and earlier teeth extraction than mepivacaine. So, articaine can be the local anaesthetic of first choice in oral surgery.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-MunawwarahSaudi Arabia.
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Sawadogo A, Coulibaly M, Quilodran C, Bationo R, Konsem T, Ella B. Success rate of first attempt 4% articaine para-apical anesthesia for the extraction of mandibular wisdom teeth. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2018; 119:486-488. [PMID: 29936238 DOI: 10.1016/j.jormas.2018.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/03/2018] [Accepted: 06/17/2018] [Indexed: 11/30/2022]
Abstract
Dental extraction is one of the acts that cannot be undertaken or carried out without total analgesia. Unfortunately, the success of anesthesia is not always systematic. Failures are noted during the extraction of mandibular wisdom teeth and pain management therefore remains a challenge for their extraction. The anesthesia technique and nature of the adapted anesthetic solution are controversial. However, the most commonly used technique is the Lower Alveolar Nerve Block (IANB). This technique has disadvantages (trismus, risk of intra-arterial injection and hematoma) and a failure rate of up to 88%. In some survey, 90% of 93 practitioners had difficulty obtaining proper anesthesia. Other clinical studies have also shown overall failure rates of 37%-47%, and 15%-35% on healthy lower molars. Recent studies have evaluated the success rate of articaine at between 54% and 94%, while others have shown that for mandibular teeth, articaine is more effective in para-apical anesthesia than lidocaine. Sixty subjects were selected for the study. The aim was to evaluate the overall success rate of first intention 4% articaine para-apical anesthesia during extraction of third mandibular molars. The overall success rate of para-apical anesthesia was 87%.
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Affiliation(s)
- A Sawadogo
- UFR/SDS, Université Ouaga, 1, Pr Joseph Ki-Zerbo, 03 B.P. 7021, 03 Ouagadougou, Burkina Faso.
| | - M Coulibaly
- Pvrsandemic Prevention ECOWAS Region (RPPP) GIZ C/O, West African Health Organization (WAHO), 01 BP 153, 01 Bobo-Dioulasso, Burkina Faso
| | - C Quilodran
- UFR des Sciences odontologiques, Bordeaux University, 16, Cours de la Marne, 33082 Bordeaux cedex, France
| | - R Bationo
- Medical center Camp Sangoulé Lamizana, BP. 610, 01 Ouagadougou, Burkina Faso
| | - T Konsem
- Université Ouaga, 1, Pr Joseph Ki-Zerbo, 03 B.P. 7021, 03 Ouagadougou, Burkina Faso
| | - B Ella
- Department of Anatomy et Physiology at UFR des Sciences, Odontologiques, Bordeaux University, 16, Cours de la Marne, 33082 Bordeaux, France
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da Silva-Junior GP, de Almeida Souza LM, Groppo FC. Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery. Anesth Prog 2018; 64:80-84. [PMID: 28604089 DOI: 10.2344/anpr-64-02-06] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In order to compare the efficacy of lidocaine and articaine for pain control during third molar surgery, 160 patients presenting bilateral asymptomatic impacted mandibular third molars were selected. They received 1.8 mL of 2% lidocaine with epinephrine 1:100,000 during inferior alveolar nerve block. In group 1 (n = 80), an infiltrative injection of 0.9 mL of 2% lidocaine with epinephrine 1:100,000 was performed in buccal-distal mucosa of the third molar. Group 2 (n = 80) received 0.9 mL of 4% articaine with epinephrine 1:100,000 in the contralateral side. All procedures were performed at the same visit, by a single operator, in a double-blind and parallel design. The duration of each surgery and the moment when the patient expressed pain were noted. Data were analyzed by nonpaired t test and chi-square test (alpha = 5%). Duration of surgery did not differ (p = .83) between Groups 1 (19.8 ± 2.3 minutes) and 2 (19.7 ± 3.0 minutes). Pain was expressed more in group 1 (26.3%) than in group 2 (10%) (odds ratio = 3.2, p = .0138). In both groups, tooth sectioning was the most painful event (p < .0001). No influence of gender (p = .85) or age (p = .96) was observed in pain response. Buccal infiltration of 4% articaine with epinephrine 1:100,000 showed more efficacy than 2% lidocaine with epinephrine 1:100,000 when used in combination with inferior alveolar nerve block in controlling intraoperative pain related to impacted mandibular third molar surgery.
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45
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Awal DH, Yilmaz Z, Osailan S, Renton T. Articaine-only buccal infiltrations for mandibular molar extractions: an alternative to inferior dental nerve blocks. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/denu.2017.44.9.838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Danyal H Awal
- Senior House Officer, King's College Hospital, London, UK
| | - Zehra Yilmaz
- Research Affiliate, King's College Hospital, London, UK
| | - Samira Osailan
- Consultant Oral Surgeon, King's College Hospital, London, UK
| | - Tara Renton
- Consultant Oral Surgeon, Department of Oral Surgery, King's College Hospital, London, UK
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Sawang K, Chaiyasamut T, Kiattavornchareon S, Pairuchvej V, Bhattarai BP, Wongsirichat N. Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery. J Dent Anesth Pain Med 2017; 17:121-127. [PMID: 28879339 PMCID: PMC5564145 DOI: 10.17245/jdapm.2017.17.2.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/11/2017] [Accepted: 05/23/2017] [Indexed: 11/15/2022] Open
Abstract
Background There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. Method This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. Results The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P < 0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. Conclusion We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery.
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Affiliation(s)
- Kamonpun Sawang
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Teeranut Chaiyasamut
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Verasak Pairuchvej
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Jain NK, John RR. Anesthetic efficacy of 4% articaine versus 2% lignocaine during the surgical removal of the third molar: A comparative prospective study. Anesth Essays Res 2016; 10:356-61. [PMID: 27212774 PMCID: PMC4864681 DOI: 10.4103/0259-1162.171445] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Aim: The study aimed at evaluating the clinical efficacy of articaine over lidocaine in the surgical removal of impacted mandibular third molars. Objective: The objectives were to compare the onset of anesthesia, pain during injection, during the procedure and after the procedure, compare the duration of anesthesia, and need for re-anesthesia. Materials and Methods: A prospective study was conducted on 70 subjects planned for surgical removal of mandibular third molars. Subjects were randomly administered one of two local anesthetics. The anesthetic agent used was unknown for the patient and the observer who performed the measurements. Results: The differences in latency with 4% articaine (56.57 ± 9.8 s) and with 2% lignocaine (88.26 ± 12.87 s), pain during procedure for articaine 1.31 ± 0.87 and for lignocaine 2.60 ± 1.06, pain after procedure was 0.89 ± 0.58 for articaine and 1.31 ± 1.05 for lignocaine, and mean duration of anesthetic effect for articaine was 231 ± 57.15 min and 174.80 ± 37.02 min for lignocaine, which was statistically significant. For re-anesthesia, 6 out of 35 patients needed re-anesthesia at the frequency of 8.57% for articaine and 13 out of 35 patients needed re-anesthesia at a frequency of 18.57% for lignocaine. Conclusion: The results proved that articaine had a significant faster onset of action and longer duration of action when compared to lignocaine. Hence, the pain experienced by the patients during and after the surgical procedure was significantly less. The study was concluded that articaine is a safe alternative to lignocaine, which is potent and effective in minor surgical procedures such as removal of mandibular third molars.
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Affiliation(s)
- Nikil Kumar Jain
- Department of Oral and Maxillofacial Surgery, Kalinga Institute of Dental Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Reena Rachel John
- Department of Oral and Maxillofacial Surgery, Vinayaka Missions Sankarachariyar Dental College, Salem, Tamil Nadu, India
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Kämmerer PW, Schneider D, Palarie V, Schiegnitz E, Daubländer M. Comparison of anesthetic efficacy of 2 and 4 % articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial. Clin Oral Investig 2016; 21:397-403. [PMID: 27020911 DOI: 10.1007/s00784-016-1804-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this clinical prospective, randomized, double-blind trial was to compare the anesthetic efficacy of 2 % articaine and 4 % articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth. MATERIALS AND METHODS In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2 % articaine (group I) and, in 52 cases, 4 % articaine (group II) was administered. The primary objective was to analyze the differences of anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min)), as well as in length of soft tissue anesthesia (min), were evaluated. Additionally, the need of a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analyzed. RESULTS Anesthesia was sufficient for dental extractions in both groups without significant differences (p = 0.201). The onset of anesthesia did not differ significantly (p = 0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9 vs. 4 h; p < 0.001). There was no significant difference in the need for a second injection (p = 0.359), in injection pain (p = 0.386), as well as in pain during (p = 0.287) or after treatment (p = 0.121). In both groups, no complications were seen. CONCLUSIONS The local anesthetic effect of the 4 % articaine solution is not significantly better when compared to 2 % articaine. CLINICAL RELEVANCE For mandibular tooth extraction, articaine 2 % may be used as alternative as well.
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Affiliation(s)
- P W Kämmerer
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | | | - V Palarie
- Laboratory of Tissue Engineering, State University of Medicine and Pharmacy "N. Testemitanu", Chisinau, Moldova
| | - E Schiegnitz
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center Mainz, Mainz, Germany
| | - M Daubländer
- Department of Oral Surgery, University Medical Centre Mainz, Mainz, Germany
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Anesthetic Success of an Inferior Alveolar Nerve Block and Supplemental Articaine Buccal Infiltration for Molars and Premolars in Patients with Symptomatic Irreversible Pulpitis. J Endod 2016; 42:390-2. [DOI: 10.1016/j.joen.2015.12.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022]
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50
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El-Kholey KE. Anesthetic Efficacy of 4 % Articaine During Extraction of the Mandibular Posterior Teeth by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques. J Maxillofac Oral Surg 2016; 16:90-95. [PMID: 28286391 DOI: 10.1007/s12663-015-0877-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/23/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The study was designed to evaluate the anesthetic efficacy of 4 % articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth. METHODS This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale. RESULTS Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94 %, whereas by using IANB with the same anesthetic it was 92 %. No statistical differences were detected in the success rates between the two anesthetic techniques (P = 0.15). CONCLUSIONS Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.
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Affiliation(s)
- Khalid E El-Kholey
- Ain-Shames University Hospitals, Cario, Egypt ; Oral Surgery Department, Ibn Sina College for Medical Studies, Jeddah, 21418 Saudi Arabia
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