An Evaluation of Buccal Infiltrations and Inferior Alveolar Nerve Blocks in Pulpal Anesthesia for Mandibular First Molars

Efficacy of the TuttleNumbNow Intraosseous Method for Pulpal Anesthesia in the Mandibular First Molar: A Prospective, Randomized, Crossover Study

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.

Comparison of Pain Perception Between Local Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Patients Undergoing Orthodontic Lower Premolar Extractions

Introduction The most frequently used local anesthesia administration techniques for extraction of lower teeth in dentistry are local infiltration and inferior alveolar nerve block. Therapeutic extraction of premolars is the most common procedure done for patients undergoing orthodontic treatment. Inferior alveolar nerve block has been used most commonly for extraction of mandibular posterior teeth; however, it is a technique-sensitive procedure and has complications such as facial nerve palsy, trismus, and long duration of anesthesia. Local infiltration is a simple and effective technique for anesthetizing teeth prior to extraction. Aim This study aims to compare the efficacy of local anesthesia administered through inferior alveolar nerve block and local infiltration techniques for extraction of lower premolar teeth for orthodontic purposes. Materials and methods A prospective comparative study was conducted for a period of six months in which a total of 100 patients who were referred for extraction of lower premolar teeth for orthodontic purposes were included. Among 100 patients, 60 patients were males, and 40 patients were females with a mean age of 16.5 ± 1.25 years. The patients were equally divided into two groups, in which Group 1 received local infiltration and Group 2 received an inferior alveolar nerve block. The outcome parameters assessed were pain during injection and pain during extraction using the visual analog scale (VAS) score and Wong-Baker Faces Pain Rating Scale score. Statistical analysis was done using an independent sample t-test with SPSS version 23.0 software (IBM Corp., Armonk, NY) at p < 0.05 considered statistically significant. Results The difference in mean pain scores between the two groups during injection as assessed using the Faces Pain Rating Scale (p = 0.001) and VAS (p = 0.001) was statistically significant, with the infiltration group exhibiting less pain than the inferior alveolar nerve block group. The difference in mean pain scores between the two groups during extraction as assessed using the Faces Pain Rating Scale (p = 0.308) and VAS (p = 0.350) was statistically not significant, with the infiltration group not significantly differing from the inferior alveolar nerve block group. Thus, the pain during local infiltration was significantly lesser when compared to the inferior alveolar nerve block during injection, whereas pain perception during extraction was similar in patients with both injection techniques. Conclusion It can be concluded that local infiltration is less painful for the patient during injection and as efficacious as nerve block for extraction, hence local infiltration can be routinely used for lower premolar orthodontic extractions.

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

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

Can 4% Articaine Buccal Infiltration Replace Inferior Alveolar Nerve Block (IANB) with 2% Xylocaine for Pulp Therapy in Primary Mandibular Molars? A Systematic Review

Aim and objective

This systematic review aims to compare the efficacy of 4% articaine buccal supraperiosteal/infiltration to that of inferior alveolar nerve block (IANB) with 2% xylocaine in providing pulpal anesthesia for carrying out pulp therapy of deciduous mandibular molars in children.

Materials and methods

PubMed, Cochrane Registry, and Ovid SP were searched in the timeframe between years 1991 and 2020 with appropriate MeSH terms. Full texts were selected only after a preliminary screening of relevant titles and abstracts.

Results

Five studies were involved for the final qualitative analysis. The parameter sought for was "Pain during pulp therapy after injection with buccal supraperiosteal/infiltration (4% articaine) or IANB (2% lignocaine) in primary mandibular molars. Three studies evaluated objective pain (operator reported) during pulp therapy, reported significantly lower pain scores with articaine buccal infiltration (BI). Among the two studies that evaluated subjective pain, one study reported a significantly lower pain score with the articaine BI group. The other study reported no difference statistically between both groups.

Conclusion

Under the bounds of this systematic review, BI with 4% articaine might be equivalent to IANB with 2% lignocaine for providing pulpal anesthesia required for pulp therapy procedures in primary mandibular molars; however, the quality of evidence is low, more number of well-controlled studies with adequate sized sample should be conducted out to verify the same.

How to cite this article

Tirupathi SP, Rajasekhar S, Ganesh M, et al. Can 4% Articaine Buccal Infiltration Replace Inferior Alveolar Nerve Block (IANB) with 2% Xylocaine for Pulp Therapy in Primary Mandibular Molars? A Systematic Review. Int J Clin Pediatr Dent 2021;14(3):420-425.

Assessing the Pain Reaction of Children and Evaluation of Efficacy of Buccal Infiltration with Articaine and Inferior Alveolar Nerve Block with Lignocaine for Pulp Therapy in Primary Mandibular Second Molars

Introduction

Pain-free operating is of obvious benefit to the patient, it also helps the operator as treatment can be performed in a calm, unhurried fashion. Articaine hydrochloride has steadily grown in popularity, and studies have shown that articaine hydrochloride performs better than lidocaine due to an enhanced anesthetic efficacy.

Aim and objective

To assess the efficacy of buccal infiltration with articaine in achieving anesthesia for pulp therapy in primary mandibular second molars as compared with inferior alveolar nerve block (IANB) with lignocaine.

Materials and methods

Thirty patients (4-8 years) with an indication of pulp therapy in at least two primary mandibular second molars were selected. Patients were randomly assigned to receive nerve block with lignocaine on the first appointment and buccal infiltration with articaine on the second appointment spaced 1 week apart. A single researcher injected local anesthetic for all the patients. Two researchers standing at a distance of 1.5 m recorded the pain scores and sound, eye, motor (SEM) scores. After the completion of the procedure, the patient was asked to record facial image (FI) score and Heft-Parker visual analog score (HP-VAS).

Results

The pain-related behavior scores were higher for IANB when compared with infiltration. Facial image and HP-VAS scores were higher for the lignocaine IANB group when compared with the articaine infiltration.

Conclusion

With the increasing use of new delivery systems such as single tooth analgesia, a buccal infiltration with articaine provides an effective alternative, with minimal discomfort which would allow clinicians to avoid the use of IANB in children.

How to cite this article

Daneswari V, Venugopal Reddy N, Madhavi G, et al. Assessing the Pain Reaction of Children and Evaluation of Efficacy of Buccal Infiltration with Articaine and Inferior Alveolar Nerve Block with Lignocaine for Pulp Therapy in Primary Mandibular Second Molars. Int J Clin Pediatr Dent 2021;14(3):335-339.

Anaesthetic Efficacy of Lidocaine and Articaine in Inferior Alveolar Nerve Block Combined with Buccal Infiltration in Patients with Irreversible Pulpitis

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.

Anesthetic efficacy of primary and supplemental buccal/lingual infiltration in patients with irreversible pulpitis in human mandibular molars: a systematic review and meta-analysis

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.

Comparison of Effects Exerted by 4% Articaine Buccal Infiltration and 2% Lidocaine Inferior Alveolar Nerve Block on Pain Perception and Behavioral Feedback of Children during Pulp Treatment of Mandibular Second Primary Molars

Background: One of the most impressive factors discouraging many people from seeking dental treatment is the fear of experiencing pain during dental procedures. Thus, the use of an effective method for pain control is vital in this regard. Articaine, which has an additional ester and thiophene groups that increase its biosolubility and permeability compared to older anesthetic agents, can be more effective on inducing anesthesia during dental treatment. Given the inconsistent currently available information on this concept, the present study was designed to compare the efficacy of articaine with that of lidocaine on pain control during pulp treatment of deciduous molar. Methods and materials: In this cross-sectional study, 38 patients who needed pulpotomy in both mandibular second molar of primary teeth were randomly divided into two groups, using the Randlist software. In the first meeting, infiltration with articaine 4% (epinephrine 1/100 000) was performed for all patients in group 1 on the left side of the mandible. At the next appointment, inferior alveolar nerve block was done with lidocaine 2% on the right side of the mandible (epinephrine 1/80 000). Notably, for all patients in the second group, the first injection was performed on the right second primary molar with articaine 4% (epinephrine 1/100 000), and inferior alveolar nerve block was also done with lidocaine 2% on the left side of the mandible (epinephrine 1/80 000). Results:Of the 38 patients included in the current study, 10 (26.3%) subjects in the lidocaine group and nine (23.6%) in the articaine group complained of pain during their dental treatment procedures, but this difference was not statistically significant. Conclusion: According to the findings of this study, buccal infiltration of 4% articaine had a comparable anesthetic outcome to that of 2% lidocaine for inferior alveolar nerve block in pulp treatment of the second primary mandibular molars.

Pulpal-anesthesia of a mandibular first molar with irreversible pulpitis by inferior alveolar nerve block plus buccal infiltration using articaine or lignocaine

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.

Is it possible to extract lower third molars with infiltration anaesthesia techniques using articaine? A double-blind randomized clinical trial

OBJECTIVE

To compare the efficacy and safety of inferior alveolar nerve blocks (IANB) with additional buccal infiltration (standard technique) and of buccal and lingual anaesthetic infiltration (experimental technique) for lower third molar (L3M) extractions.

STUDY DESIGN

A randomised, double-blind clinical trial involving 129 L3M extractions was conducted. In the IANB group, an IANB was performed using the conventional approach, followed by a buccal injection in the extraction area. In the infiltration group (INF), an infiltration was performed in the buccal and lingual areas of the lower second molar. A 4% articaine solution was employed in all cases. The main outcome variable was anaesthetic efficacy. Other variables like intraoperative and postoperative pain, onset time and adverse events were also recorded. Descriptive and bivariate analyses of the data were made.

RESULTS

120 patients were randomised. The IANB group showed significantly higher anaesthetic efficacy than the INF group (64.4 vs. 45.8%) (odds ratio = 0.47; 95% confidence interval = 0.22-0.97; p = 0.042). No complications were observed.

CONCLUSIONS

IANB with additional buccal infiltration is more suitable than the experimental technique for achieving adequate analgesia in L3M extractions. Moreover, the standard method is safe and provides a shorter onset time and lower initial postoperative pain levels.

Intraosseous anesthesia in symptomatic irreversible pulpitis: Impact of bone thickness on perception and duration of pain

Background

Intraosseous anesthesia (IO) allows the anesthetic solution to be injected directly into the cancellous bone. The anesthetic solution immediately reaches the periapical region, and thus the axonal area of the nerve, where it can temporarily disable the sodium pump. The effect is felt almost without any time delay, and only a small amount of anesthetic solution is required.

Methods

This study aims to investigate the efficacy of IO using the Anesto® device after infiltration anesthesia (IA) and/or inferior alveolar nerve block anesthesia (IANB) failed to work in symptomatic irreversible pulpitis (hot tooth). The 33 patients included in the study were treated additionally with 1.7 ml articaine hydrochloride with 1:100,000 epinephrine hydrochloride (Ultracain® D-S, Sanofi-Aventis, Frankfurt, Germany) IO.

Results

The electrical pulp test showed that 95.76% of the volunteers reacted positively to the combination of IANB or IA with the IO. In women, the additive IO was effective at 97.22%. In men, the IO led to pain elimination in 94.00% of cases. The duration of the IO was less than a quarter of an hour (13.03 min). The IO worked longer in women than in men (13.61 min vs. 12.33 min). Overall, more than every third tooth that needed trepanation was located in the posterior area of the mandible (36.4%). Treatment of hot teeth in this area was associated with an increased pulse rate and increased residual pain. There was a moderate correlation (Spearman-Rho [IRI] = 0.280) between the Visual Analog Scale (VAS) score and bone density, and a significant correlation (IRI = 0.612) between subjective residual pain and bone width. The IO resulted in a moderate, transient increase in the pulse rate by approximately 20 bpm. This is similar to the temporary increase in heart rate after conventional anesthesia techniques in non-preloaded patients and can be considered clinically irrelevant.

Conclusion

IO with the Anesto® device as an extension and deepening of local pain elimination is recommended for the treatment of hot teeth.

Anesthetic Efficacy of Lidocaine/Ketorolac in Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Randomized Clinical Trial

OBJECTIVE

The purpose of this randomized, double-blind study was to evaluate the anesthetic efficacy of lidocaine-ketorolac administration by Inferior Alveolar Nerve Block (IANB) in patients with irreversible pulpitis.

METHODS

Eighty-eight adult patients received a combination of either one cartridge of '2% lidocaine with 1: 80.000 epinephrine' (Li) plus one cartridge of a mixture of 0.8 mL of the same solution and 1mL ketorolac tromethamine (KT)(30 mg/mL), or one cartridge of Li solution plus one cartridge of a mixture of the same solution and saline. Endodontic access was prepared after fifteen minutes. Anesthetic success was defined as no or mild pain [less than 54 mm on the Heft-Parker visual analog scale (HP-VAS)] during access cavity preparation and initial file insertion. Chi-square test was used for data analysis, and the level of significance was set at 0.05 (P=0.05).

RESULTS

Results showed that the success rates were 34.1% and 27.3% for Li-KT and Li-Saline groups, respectively, with no significant difference between the two groups (P=0.48). However, significant decrease of baseline mean VAS pain score of the participants in both groups was found during access cavity preparation or initial file insertion (P<0.05).

CONCLUSION

Mixed Li-KT solution did not increase the success rate of IANB injection significantly.

Is the only buccal infiltration anesthesia enough for extraction of mandibular anterior incisors and premolar teeth? A split-mouth randomized clinical trial

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.

The success of using 2% lidocaine in pain removal during extraction of mandibular premolars: a prospective clinical study

BACKGROUND

The purpose of this study was to evaluate the anesthetic effectiveness of a buccal infiltration technique combined with local massage (using 2% lidocaine) in the extraction of mandibular premolars to be utilized as an alternative to the conventional inferior alveolar nerve block.

METHODS

Patients eligible included any subject with a clinical indication for tooth extraction of the mandibular 1st or 2nd premolars. All patients were anesthetized buccally by local infiltration technique followed by an external pressure applied for 1 min directly over the injection area. In each case, another local injection was given lingually. All operations were started at approximately 5 min after the buccal injection. The collected data included age, gender, pain perception and its intensity during treatment at three checkpoints, apical tenderness, and the type of extraction. Any associated complications or difficulties were also recorded. Then the results were analyzed and interpreted using appropriate statistical tests. The significance level was set at P ≤ 0.05.

RESULTS

A total of 247 cases (1st premolar, n = 119; 2nd premolar, n = 128), predominantly male, were included. In 95% of study sample, the patients were satisfied with the dental extraction without any pain. However, in 5% of cases, pain was reported at the stage of tooth removal. Apical tenderness was found to be present in 11% of the total cases. Three teeth required surgical removal. Upon analysis, no significant differences in the success rates were detected between the 2 premolar groups or amongst the various age groups. Minor and transient side effects were reported in this study.

CONCLUSION

The technique is simple and effective as well. It might be considered as an alternative anesthetic injection to the inferior alveolar nerve block for dental extraction of the mandibular premolars.

Anesthetic efficacy of articaine/epinephrine plus mannitol in comparison with articaine/epinephrine anesthesia for inferior alveolar nerve block in patients with symptomatic irreversible pulpitis: A randomized controlled clinical trial

Background. It is difficult to achieve successful pulpal anesthesia in mandibular posterior teeth with symptomatic irreversible pulpitis. The present study aimed to compare the effect of articaine/epinephrine anesthesia with articaine/epinephrine at a combination of 0.5 mol/mL of mannitol for the inferior alveolar nerve block (IANB) in patients presenting with symptomatic irreversible pulpitis in the mandibular first molar tooth.

Methods. One hundred patients with symptomatic irreversible pulpitis in the mandibular first molar tooth were selected and randomly divided into two groups based on the injection method. The first group underwent an IANB technique with 1.8 mL of articaine, whereas the second group received 2.9 mL of a formulation, consisting of 1.8 mL of articaine plus 1.1 mL of 0.5 mol/L of mannitol. Fifteen minutes after injections and anesthesia of the lip, the access cavity was prepared. According to the visual analog scale (VAS) criteria, no pain or mild pain for caries removal, pulp exposure and canal instrumentation were regarded as success. Chi-squared test was used for the analysis of data. The level of significance was set at 0.05.

Results. The success rate in the group with articaine/epinephrine anesthesia plus mannitol was higher than that in the group with articaine/epinephrine anesthesia, with no significant difference between the two groups (P>0.05).

Conclusion. It was concluded, under the limitations of this study, that adding mannitol to articaine/epinephrine anesthesia did not increase the success of IANB in mandibular posterior teeth with symptomatic irreversible pulpitis.

Pulpal anesthesia in pediatric patients following supplemental mandibular buccal infiltration in vital permanent mandibular molars with deep caries

OBJECTIVES

Inferior alveolar nerve block (IANB) does not always provide adequate pulpal anesthesia, and supplemental techniques have been investigated in adults. This study aimed to pre- and intraoperatively evaluate the success of pulpal anesthesia following supplemental mandibular buccal infiltration (SMBI) after failure of IANB in permanent mandibular molars with deep caries of pediatric patients.

MATERIALS AND METHODS

Following IANB, preoperative pulpal anesthesia was assessed using the cold test, and success was defined when there was a negative response. In cases with failed IANB, SMBI was administered, and pulpal anesthesia was re-evaluated. A maximum of three SMBIs was allowed. After achieving successful preoperative pulpal anesthesia, treatment was then initiated. Intraoperatively, success of pulpal anesthesia was determined when the Wong-Baker FACES Pain Rating Scale reported by the patients was ≤ four.

RESULTS

Sixty molars of patients aged 9.6 ± 2.3 years were included in the study. The success of preoperative pulpal anesthesia following IANB was 33.3%. The overall cumulative preoperative pulpal anesthesia after three SMBIs was 95%. However, the success of intraoperative pulpal anesthesia was only 66.7%.

CONCLUSIONS

SMBI greatly improved the success of preoperative pulpal anesthesia after failure of IANB. However, the success of preoperative pulpal anesthesia, confirmed by the cold test, does not always guarantee intraoperative pulpal anesthesia, especially in teeth with irreversible pulpitis.

CLINICAL RELEVANCE

IANB produced low pulpal anesthesia in vital permanent mandibular molars with deep caries of pediatric patients. Clinicians should always prepare for supplemental injection both pre- and intra-operatively.

Safety of buccal infiltration local anaesthesia for dental procedures

AIM

To assess the safety of buccal infiltration local anaesthetic (LA) without additional factor replacement in patients with haemophilia (PWH) and association with clinical experience of the operator.

METHODS

A consecutive sample of participants with mild, moderate and severe haemophilia scheduled to have dental treatment were recruited from a comprehensive care centre in Ireland. Infiltration LA was administered using a standard technique. Safety was defined as any adverse event at time of administration, immediate postoperative, or postoperative period. Clinical experience was dichotomized into fewer or greater than three years clinical experience.

RESULTS

N = 135 buccal infiltration LAs without additional factor replacement were provided to N = 71 participants with mild (n = 20; 28%) and moderate to severe haemophilia (n = 51; 72%). Successful local anaesthesia was achieved in n = 133 cases (99%). No (0%) adverse bleeding events were recorded for any participants at time of administration of LA or during follow-up. Three out of 135 (2.2%) LAs recorded superficial bleeding 30 seconds after administration of LA, all of which resolved within 2 minutes with application of pressure; 4 out of 135 (3%) LAs produced a superficial haematoma at the site of injection no greater than 2 mm all of which resolved at 4 minutes. There were no differences in bleeding rates between clinicians by level of experience (P = 0.435) or by severity of bleeding disorder (P = 1.0).

CONCLUSION

Local anaesthetic is safe to administer via buccal infiltration for people with mild, moderate and severe haemophilia without additional factor cover. This finding holds true regardless of operator experience.

Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia

OBJECTIVES

This study was aimed at evaluating the anesthetic success rates in various regions of soft tissue after inferior alveolar nerve (IAN) block and comparing the success rates of soft tissue anesthesia with those of pulpal anesthesia to find correlations.

MATERIALS AND METHODS

Fifty-nine dental students received an IAN block injection. A total of four test sites were used for soft tissue anesthesia using a pressure algometer (PA): the corner of the lower lip vermilion border (LL); the buccal-attached gingiva of the lateral incisor (BGI), the molar (BGM), and the lingual gingiva (LG). The lateral incisor (LI) and the first molar (M1) were evaluated for pulpal anesthesia using an electric pulp tester. To evaluate whether soft tissue anesthesia can be an indicator of pulpal anesthesia, the positive predictive value (PPV) and negative predictive value (NPV) were calculated.

RESULTS

The highest success rate for soft tissue anesthesia was seen on the LG (93.9%), followed by LL (79.6%), BGI (53.1%), and BGM (14.3%). The PPVs of LL for the M1 and Ll were 74.4 and 59.0%. The NPVs for the M1 and LI were much higher in the LL (90.0 and 100%, respectively) than in the BGI (56.5 and 69.6%, respectively).

CONCLUSIONS

The highest success rate was found in the LG. Lip numbness was not an indicator of pulpal anesthesia of M1 and LI. However, if the LL was not anesthetized, the probabilities of failed pulpal anesthesia were very high in the LI and M1.

CLINICAL RELEVANCE

The clinicians need to consider not doing an additional lingual nerve block after IAN block.

Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery

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.

Insulin Syringe: A Gimmick in Pediatric Dentistry

Aim

The management of pain and anxiety in dentistry encompasses a number of procedural issues, including the delivery of anesthetic solution. One of the most important ways to manage the behavior of children is pain control. Trypanophobia is very common among dental patients and the most important goal of guidelines on behavior guidance for pediatric dental patient is to ease fear and anxiety in dental procedures in children. For the stated reasons, the purpose of the present study was to record child’s pain sensation both objectively and subjectively while receiving dental local anesthesia using conventional syringes and diabetic needles.

Materials and methods

Twenty children of age group 6 to 12 years undergoing routine dental procedures participated in the study. Every child acted as one’s own control, while receiving treatment on the opposite side of the same arch. Each patient was randomly assigned to receive the injection either with conventional syringe or diabetic needle for the first visit, while the injection with the other needle was administered during the second visit. Rating scales were used for objective and subjective evaluations.

Results

Statistical analysis of the measurements were made using Wilcoxon signed U test and Mann-Whitney U test which showed the mean sound, eye, motor (SEM) score difference using insulin syringe. The outcome was statistically significant when compared using the mean ranks between male and female patients with that of control group.

Conclusion

It can be concluded that diabetic syringes exhibit clinical advantage and its use in pediatric dentistry for local anesthetics (LA) infiltration can prove beneficial.

How to cite this article: Kour G, Masih U, Singh C, Srivastava M, Yadav P, Kushwah J. Insulin Syringe: A Gimmick in Pediatric Dentistry. Int J Clin Pediatr Dent 2017;10(4):319-323.

Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars

AIM

The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline.

MATERIALS AND METHODS

A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias.

RESULTS

The pain scores in both groups were analyzed using the Mann-Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted.

CONCLUSION

From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.

Failure rate of inferior alveolar nerve block among dental students and interns

OBJECTIVES

To report the failure rate of inferior alveolar nerve block (IANB) among dental students and interns, causes of failure, investigate awareness of different IANB techniques, and to report IANB-associated complications.  

METHODS

A 3-page questionnaire containing 13 questions was distributed to a random sample of 350 third to fifth years students and interns at the College of Dentistry, King Saud University, Riyadh, Saudi Arabia on January 2011. It included demographic questions (age, gender, and academic level) and questions on IANB failure frequency and reasons, actions taken to overcome the failure, and awareness of different anesthetic techniques, supplementary techniques, and complications.  

RESULTS

Of the 250 distributed questionnaires, 238 were returned (68% response rate). Most (85.7%) of surveyed sample had experienced IANB failure once or twice. The participants attributed the failures most commonly (66.45%) to anatomical variations. The most common alternative technique used was intraligamentary injection (57.1%), although 42.8% of the sample never attempted any alternatives. Large portion of the samples stated that they either lacked both knowledge of and training for other techniques (44.9%), or that they had knowledge of them but not enough training to perform them (45.8%). 

CONCLUSION

To  decrease IANB failure rates for dental students and interns, knowledge of landmarks, anatomical variation and their training in alternatives to IANB, such as the Gow-Gates and Akinosi techniques, both theoretically and clinically in the dental curriculum should be enhanced.

Evaluation of Buccal Infiltration with Articaine and Inferior Alveolar Nerve Block with Lignocaine for Pulp Therapy in Mandibular Primary Molars

OBJECTIVE

Failure of inferior alveolar nerve block in achieving profound anesthesia of the pulp due to various reasons has led to the introduction of more potent local anesthetic agents like articaine. This study was conducted to compare the efficacy of buccal infiltration with articaine in achieving pulpal anesthesia of primary molars as compared to inferior alveolar nerve block with lignocaine.

STUDY DESIGN

30 patients (4-8 years) with indication of pulp therapy in at least two mandibular primary molars were selected. Patients were randomly assigned to receive nerve block with lignocaine or infiltration with articaine on first appointment and the other solution on second appointment. All the pulpotomies and pulpectomies were performed by a pediatric dentist. Two researchers standing at a distance of 1.5 m recorded the Pain Scores and Sound, Eye, Motor (SEM) scores. After the completion of procedure, the patient was asked to record the Facial Image score and Heft-Parker Visual Analogue Score (HP-VAS).

RESULTS

Pain Score recorded at the time of injection showed significantly more movements with block as compared to infiltration (p<0.001). SEM scores at time of pulp extirpation were also higher for block than infiltration (p<0.001).

CONCLUSION

Articaine infiltration has the potential to replace inferior alveolar nerve block for primary mandibular molars.

Anesthetic Efficacy of 4 % Articaine During Extraction of the Mandibular Posterior Teeth by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques

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.

Articaine and mepivacaine buccal infiltration in securing mandibular first molar pulp anesthesia following mepivacaine inferior alveolar nerve block: A randomized, double-blind crossover study

Aims:

A crossover double-blind, randomized study was designed to explore the efficacy of 2% mepivacaine with 1:100,000 adrenaline buccal infiltration and 4% articaine with 1:100,000 adrenaline buccal infiltration following 2% mepivacaine with 1:100,000 adrenaline inferior alveolar nerve block (IANB) for testing pulp anesthesia of mandibular first molar teeth in adult volunteers.

Materials and Methods:

A total of 23 healthy adult volunteers received two regimens with at least 1-week apart; one with 4% articaine buccal infiltration and 2% mepivacaine IANB (articaine regimen) and another with 2% mepivacaine buccal infiltration supplemented to 2% mepivacaine IANB (mepivacaine regimen). Pulp testing of first molar tooth was electronically measured twice at baseline, then at intervals of 2 min for the first 10 min, then every 5 min until 45 min postinjection. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation were obtained within 10 min and continuously sustained for 45 min postinjection.

Results:

In total, the number of no sensations to maximum pulp testing for first molar teeth were significantly higher after articaine regimen than mepivacaine during 45 min postinjection (267 vs. 250 episodes, respectively, P < 0.001), however, both articaine and mepivacaine buccal infiltrations are equally effective in securing anesthetic success for first molar pulp anesthesia when supplemented to mepivacaine IANB injections (P > 0.05). Interestingly, volunteers in the articaine regimen provided faster onset and longer duration (means 2.78 min, 42.22 min, respectively) than mepivacaine regimen (means 4.26 min, 40.74 min, respectively) for first molar pulp anesthesia (P < 0.001).

Conclusions:

Supplementary mepivacaine and articaine buccal infiltrations produced similar successful first molar pulp anesthesia following mepivacaine IANB injections in volunteers. Articaine buccal infiltration produced faster onset and longer duration than mepivacaine buccal infiltration following mepivacaine IANB injections.

Articaine hydrochloride: is it the solution?

In recent times there has been raised interest regarding the use of articaine hydrochloride as a dental local anaesthetic solution. The use of articaine hydrochloride as a dental local anaesthetic agent has been reported to be safe and effective. Paraesthesia is a rare but unwanted adverse effect attributed to the use of this local anaesthetic in dentistry, particularly following the administration of a nerve block injection. There is no evidence to support the opinion that the use of articaine carries a greater associated risk of paraesthesia than with the use of any other local anaesthetic. Clinical Relevance: The aim of this article is to review the relative merits of articaine hydrochloride against its documented potential drawbacks. The article will also aim to update readers on the use of articaine hydrochloride for local analgesia in dentistry, including the pharmacology, efficacy and safety concerns (including the risks of nerve paraesthesia) commonly associated with the administration of this agent.

Buffered 4% Articaine as a Primary Buccal Infiltration of the Mandibular First Molar: A Prospective, Randomized, Double-blind Study

INTRODUCTION

Articaine is superior to lidocaine when used as a primary buccal infiltration of the mandibular first molar. Buffered local anesthetics have been purported to improve anesthetic success. Buffering a 4% articaine formulation may increase the success of a mandibular first molar buccal infiltration. The purpose of this study was to compare the degree of pulpal anesthesia obtained with a buffered 4% articaine with 1:100,000 epinephrine formulation versus a nonbuffered 4% articaine with 1:100,000 epinephrine formulation as a primary buccal infiltration of the mandibular first molar.

METHODS

Eighty adults randomly received mandibular buccal infiltrations using 4% articaine with 100,000 epinephrine buffered with 8.4% sodium bicarbonate (18 mEq) and 4% articaine with 1:100,000 epinephrine in a double-blind manner at 2 separate appointments. An electric pulp tester was used to test the first molar for pulpal anesthesia every 30 seconds for the first 5 minutes and every minute for the remaining 55 minutes. Successful pulpal anesthesia was defined as 2 consecutive 80/80 readings with the electric pulp tester. Pain ratings for each injection were recorded as well as the onset time of pulpal anesthesia.

RESULTS

Anesthetic success rates for buffered articaine and nonbuffered articaine were 71% and 65%, respectively. There was no significant difference between the formulations (P = .3018). No significant differences were found between the 2 formulations for pain of injection or onset of anesthesia.

CONCLUSIONS

Buffered articaine did not provide any advantage over nonbuffered articaine for anesthetic success, anesthesia onset, or pain of injection for a primary buccal infiltration of the mandibular first molar.

Comparison of speed of action and injection discomfort of 4% articaine and 2% mepivacaine for pulpal anesthesia in mandibular teeth: A randomized, double-blind cross-over trial

Objective:

To compare the injection pain and speed of local anesthetic effect induced by tissue infiltration of mepivacaine 2% with epinephrine 1:100,000 versus articaine 4% with epinephrine 1:100,000 in securing mandibular first molar pulp anesthesia.

Materials and Methods:

Totally, 25 patients were recruited in a crossover, randomized, double-blind study. Each subject received injections of mepivacaine 2% with epinephrine 1:100,000 as inferior alveolar nerve block (IANB) supplemented with either articaine 4% with epinephrine 1:100,000 (septocaine) or mepivacaine 2% buccal infiltration (BI) injection on two visits. The time of first numbness to associated lip, tongue and tooth was recorded by asking the participant directly and using electrical pulp tester. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation. The patients rated the pain of infiltration using a 100 mm visual analog scale immediately after receiving each injection. The pain scores were compared using the paired t-test.

Results:

There were significant differences in the meantime of first numbness to associated lip and tooth of volunteers between mepivacaine and articaine BI groups P = 0.03 and 0.002. Volunteers in articaine group recorded earlier lip and teeth numbness than those in mepivacaine group. There were significant differences between the mean pain scores for volunteers in the post IANB and postbuccal injection groups (t-test: P <0.001). Mepivacaine IANB injection was significantly more painful than articaine/mepivacaine buccal injection.

Conclusions:

About 4% articaine was faster than 2% mepivacaine (both with 1:100,000 adrenaline) in anesthetizing the pulps of lower molar teeth after BIs. Earlier lip and teeth numbness were recorded in articaine group. Articaine and mepivacaine BIs were more comfortable than mepivacaine IANB injections.

4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: a randomized clinical study

AIM

To compare the anaesthetic efficacy of inferior alveolar nerve blocks (IANB) with 1.8 mL of 2% lidocaine (LI) to a buccal infiltration (BI) with 1.8 mL of 4% articaine (AR), both with 1 : 100 000 epinephrine, in patients with symptomatic irreversible pulpits in a randomized controlled trial.

METHODOLOGY

Volunteers presenting at the Emergency Centre (FOP-UNICAMP) were randomly divided into two groups (30 for AR and 20 for LI). Operator and patient were not blinded. Success was recorded when complete pain-free treatment was achieved after a single injection (IANB or BI) or when one supplemental injection was needed for emergency endodontic procedures. Success rate of supplemental injection was evaluated between and within groups using Fisher's exact test and chi-square test.

RESULTS

A higher success rate (P = 0.03/Fisher's exact test) was observed with AR (40%) than with LI (10%). No significant difference was found when a single injection plus one supplemental injection was compared between groups (P = 1.0; AR = 70%; LI = 80%). However, supplemental injection increased the anaesthetic success rates (AR, P = 0.04; LI, P = 0.0001) within groups.

CONCLUSIONS

Single anaesthesia techniques (IANB or BI) were not able to achieve pain-free emergency endodontic treatment. Supplemental anaesthetic techniques should be considered prior to treatment procedures in order to increase success rate (consort: registration number - NCT01912755/Fapesp: #2009/10834-4).

Comparison of the anaesthetic efficacy of different volumes of 4% articaine (1.8 and 3.6 mL) as supplemental buccal infiltration after failed inferior alveolar nerve block

AIM

To compare the anaesthetic efficacy of different volumes (1.8 mL vs. 3.6 mL) of 4% articaine with 1 : 100 000 epinephrine injected as buccal infiltrations after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis.

METHODOLOGY

Two hundred and thirty-four adult patients, diagnosed with irreversible pulpitis in a mandibular tooth, participated in this multicentre, randomized double-blinded trial. Patients received IANB with 1.8 mL of 4% articaine with 1 : 100 000 epinephrine. Pain during treatment was recorded using the Heft-Parker visual analogue scale (HP VAS). The primary outcome measure, and the definition of 'success', was the ability to undertake pulp chamber access and canal instrumentation with no or mild pain (HP VAS score <55 mm). Patients who experienced 'moderate-to-severe' pain (HP VAS score ≥ 55 mm) were randomly allocated into two groups and received buccal infiltrations with either 1.8 mL or 3.6 mL of 4% articaine with 1 : 100 000 epinephrine. Root canal treatment was re-initiated after 10 min. Success was again defined as no pain or weak/mild pain during endodontic access preparation and instrumentation. Statistical analysis was performed using Mann-Whitney U and chi-square tests.

RESULTS

The initial IANB of 4% articaine gave an overall success rate of 37%. The success rate of supplementary buccal infiltration with 1.8 and 3.6 mL volumes was 62% and 64%, respectively. The difference between the success rates of the two volumes was not statistically significant.

CONCLUSIONS

Increasing the volume of 4% articaine with 1 : 100 000 epinephrine from 1.8 to 3.6 mL, given as supplementary buccal infiltrations after a failed primary IANB with 1.8 mL of 4% articaine with 1 : 100 000, did not improve the anaesthetic success rates in patients with symptomatic irreversible pulpitis.

Factors affecting the success rate of buccal infiltration anaesthesia in the mandibular molar region

AIM

To compare the anaesthetic efficacy of mandibular second premolar infiltration (SP) with that of mandibular first molar infiltration (FM) in inducing pulpal anaesthesia in the mandibular first molar. To further investigate the mechanisms of action that underlie mandibular infiltration, gender-related differences in the anaesthetic efficacy were also assessed.

METHODOLOGY

A total of 29 adult subjects randomly received two sets of SP and FM injections using one cartridge (1.7 mL) of 4% articaine and 1 : 100 000 adrenaline at two separate appointments. The responses of the teeth were assessed using an electronic pulp tester over a 30-min period. A comparison of the anaesthetic success between the SP and FM infiltration routes was analysed using the McNemar's test. Gender-related differences in the anaesthetic success of infiltration routes were assessed using the Fisher's exact test.

RESULTS

For the second premolar and the first and second molar teeth, the success rates of SP were 72.4%, 62.1% and 48.3%, whereas the success rates of FM were 75.9%, 51.7% and 55.1%, respectively. There were no significant differences between the success rates of SP and FM or between the rates obtained for each tooth. Significant gender-related differences were observed for the second premolar (P < 0.01) and the first molar (P < 0.05) using FM. However, a significant difference was observed only for the second premolar using SP (P < 0.05).

CONCLUSIONS

The differences in the injection sites did not affect the anaesthetic success rates for the mandibular second premolar and molar teeth. However, articaine buccal infiltration produced a higher anaesthetic success rate in the second premolar and first molar teeth of Korean female patients.

Estudo comparativo entre dois protocolos anestésicos envolvendo bloqueio do nervo alveolar inferior convencional e de Vazirani-Akinosi para exodontia de terceiro molar inferior

INTRODUÇÃO: O bloqueio do nervo alveolar inferior (BNAI) apresenta alta porcentagem de falha na Odontologia. A fim de melhorar esse índice, vêm-se estudando diferentes alternativas, como diferentes técnicas e soluções anestésicas. OBJETIVO: Avaliar duas diferentes técnicas - técnica convencional e de Vazirani-Akinosi - para o bloqueio do nervo alveolar inferior, bem como compará-las quanto à sua efetividade e quantificar o percentual de aspirações positivas nas duas diferentes técnicas. MATERIAL E MÉTODO: Foram avaliados 160 pacientes de ambos os sexos, sendo 80 submetidos ao bloqueio do nervo alveolar inferior de Vazirani-Akinosi e bloqueio do nervo bucal (G1), e 80 submetidos ao bloqueio do nervo alveolar inferior convencional e ao bloqueio do nervo bucal (G2). Em ambos os grupos, utilizou-se a combinação de articaína 4% com epinefrina 1:100.000 para bloqueio do nervo bucal, e lidocaína 2% com epinefrina 1:100.000 para bloqueio do nervo alveolar inferior. Foram avaliados: a quantidade de aspirações positivas, a eficácia da anestesia e o momento em que ocorreu a falha anestésica durante o procedimento cirúrgico. RESULTADO: Não houve diferenças estatisticamente significantes (p = 0,2453) entre os grupos G1 e G2 observando-se a eficácia e o índice de aspirações positivas, e o momento em que ocorreu a falha anestésica, observando-se uma maior eficácia de ambas as técnicas, quando comparadas com a literatura (90%) CONCLUSÃO: Não houve diferença significativa entre o BNAI pela técnica convencional e o BNAI pela técnica de Vazirani-Akinosi quanto a quantidade de aspirações positivas e eficácia, sendo que o uso da articaína 4% com epinefrina 1:100.000 no bloqueio do nervo bucal possivelmente aumentou a eficácia anestésica de ambas as técnicas.

Effect of topical anesthesia on pain during infiltration injection and success of anesthesia for maxillary central incisors

INTRODUCTION

This study was performed to investigate the effect of topical anesthesia on pain during needle penetration and infiltration injection as well as the effect of pain during injection on success rate of anesthesia in maxillary central incisors.

METHODS

In a crossover double-blind study, 25 volunteers randomly received either topical anesthesia or placebo before infiltration injection with prilocaine for their maxillary central incisors in 2 separate appointments. The pain after needle penetration and during injection was separately recorded. An electric pulp tester was used to evaluate the success of the anesthetic injection. Data were analyzed by McNemar, Wilcoxon, and χ(2) tests.

RESULTS

Overall for 50 injections, 72% of the teeth had successful anesthesia. No significant difference was found between placebo and topical anesthetic groups for the pain of needle penetration as well as pain during injection (P > .05). The volunteers who reported moderate-to-severe pain during injection showed no significant difference in the success rate of anesthesia compared with those with no or mild pain during injections (P > .05).

CONCLUSIONS

Use of topical anesthesia had no significant effect on pain during either needle penetration or injection. Pain during injection had no significant effect on the success of anesthesia.