1
|
de Souza Santos S, Bonatto MS, Mendes PGJ, Martins AVB, Pereira DA, de Oliveira GJPL. Efficacy of analgesia promoted by lidocaine and articaine in third molar extraction surgery. A split-mouth, randomized, controlled trial. Oral Maxillofac Surg 2024; 28:919-924. [PMID: 38355872 DOI: 10.1007/s10006-024-01223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE The aim of this study was to compare the analgesic efficacy of 4% articaine associated with epinephrine (1:100,000), and 2% lidocaine associated with epinephrine (1:100,000) in third molar extraction surgery. METHODS Sixty patients who underwent surgeries to extract upper and lower third molars were included in this split-mouth, double-blind, randomized, controlled trial. The groups in this study were divided according to the anesthetic solution used to provide local anesthesia during extraction of upper and lower third molars: (1) 4% articaine associated with epinephrine (1:100,000); (2) 2% lidocaine associated with epinephrine (1:100,000). The time to the beginning and end of the sensation of analgesia, pain sensation according to the VAS scale, and number of anesthetic tubes necessary for supplementation were analyzed. RESULTS It was found that the onset time for analgesia was shorter on the side anesthetized with articaine compared to the side anesthetized with lidocaine (122.1 ± 52.90 s vs. 144.5 ± 68.85 s) (p < 0.05). In addition, the number of tubes used for anesthetic supplementation was also reduced on the articaine side compared to the lidocaine side (0.26 ± 0.48 vs. 0.50 ± 0.75) (p < 0.05). There were no differences between the anesthetic solutions in the other evaluated parameters. CONCLUSION It can be concluded that the use of 4% articaine associated with epinephrine (1:100,000) reduced the time of onset of analgesia and the necessity for anesthetic supplementation in third molar extraction surgeries compared to the use of 2% lidocaine associated with epinephrine (1:100,000).
Collapse
Affiliation(s)
- Samara de Souza Santos
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Mariana Silva Bonatto
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Pedro Gomes Junqueira Mendes
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Ana Vitória Borges Martins
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Davisson Alves Pereira
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | | |
Collapse
|
2
|
Wanasathop A, Nimmansophon P, Murawsky M, Krishnan DG, Li SK. Iontophoresis on Porcine and Human Gingiva. Pharm Res 2023; 40:1977-1987. [PMID: 37258949 PMCID: PMC10524680 DOI: 10.1007/s11095-023-03535-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/12/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Iontophoresis is a noninvasive method that enhances drug delivery using an electric field. This method can improve drug delivery to the tissues in the oral cavity. The effects of iontophoresis on gingival drug delivery have not been investigated. The objectives of this study were to (a) determine the flux enhancement of model permeants across porcine and human gingiva during iontophoresis, (b) examine the transport mechanisms of gingival iontophoresis, and (c) evaluate the potential of iontophoretically enhanced delivery for three model drugs lidocaine, ketorolac, and chlorhexidine. METHODS Passive and iontophoretic fluxes were determined with porcine and human gingiva using a modified Franz diffusion cell and model drugs and permeants. To investigate the transport mechanisms of iontophoresis, the enhancement from the direct-field effect was determined by positively and negatively charged model permeants. The electroosmosis enhancement effect was determined with neutral permeants of different molecular weight. The alteration of the gingival barrier due to electropermeabilization was evaluated using electrical resistance measurements. RESULTS Significant flux enhancement was observed during gingival iontophoresis. The direct-field effect was the major mechanism governing the iontophoretic transport of the charged permeants. Electroosmosis was from anode to cathode. The effective pore radius of the iontophoretic transport pathways in the porcine gingiva was ~0.68 nm. Irreversible electropermeabilization was observed after 2 and 4 h of iontophoresis under the conditions studied. CONCLUSION Iontophoresis could enhance drug delivery and reduce transport lag time, showing promise for gingival drug delivery.
Collapse
Affiliation(s)
- Apipa Wanasathop
- Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, MSB # 3005, Cincinnati, OH, 45267-0514, USA
| | - Patcharawan Nimmansophon
- Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, MSB # 3005, Cincinnati, OH, 45267-0514, USA
| | - Michael Murawsky
- Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, MSB # 3005, Cincinnati, OH, 45267-0514, USA
| | - Deepak G Krishnan
- Division of Oral and Maxillofacial Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, 45267, USA
| | - S Kevin Li
- Division of Pharmaceutical Sciences, College of Pharmacy, University of Cincinnati, 231 Albert Sabin Way, MSB # 3005, Cincinnati, OH, 45267-0514, USA.
| |
Collapse
|
3
|
Alsager AS, Algubeal HM, Alanazi AF, Al-Omar A. Can Single Buccal Infiltration With 4% Articaine Induce Sufficient Analgesia for the Extraction of Maxillary Teeth? A Systematic Literature Review. Cureus 2023; 15:e42975. [PMID: 37671226 PMCID: PMC10475959 DOI: 10.7759/cureus.42975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
This systematic review evaluates the efficacy of single buccal infiltration of articaine for extracting upper teeth. A search of the PubMed, Ovid SP, Scopus, Embase, and Cochrane databases for English-language studies published between 2000 and 2021 was performed on August 26, 2022, based on the pre-specified question using the MeSH terms [(buccal) and (articaine) and (infiltration) and (dental)]. Of the 16 clinical trials identified involving 1,339 patients, six compared the subjective procedural pain associated with single buccal infiltration of articaine with that of lidocaine, three of which reported reduced pain and the other three greater success in extraction for the articaine group. Four of the 16 studies compared the procedural pain associated with single buccal infiltration of 4% articaine with double (buccal and palatal/lingual) infiltration; two reported insignificant differences between the groups; and the other two reported greater success using buccal and palatal injections. Five of the 16 studies compared the procedural pain associated with single buccal articaine with double buccal and palatal/lingual infiltration of 2% lidocaine and reported insignificant differences. The other of the 16 studies compared the subjective pain associated with single buccal infiltration of 4% articaine 1:100:000 with single buccal infiltration of 4% articaine 1:200:000 and found a statistically significant difference. All of these studies concluded that upper permanent maxillary teeth can be extracted using only a 4% articaine buccal infiltration, but further investigation is necessary to determine whether this approach can replace the gold standard of buccal and palatal infiltration.
Collapse
|
4
|
Afkhami F, Rostami G, Peters OA, Kamalian F. Pulpal anesthesia of maxillary first molars using 4% articaine infiltration in patients with symptomatic irreversible pulpitis: a randomized controlled clinical trial. Clin Oral Investig 2023:10.1007/s00784-023-05025-y. [PMID: 37243822 DOI: 10.1007/s00784-023-05025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 04/15/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study aimed to compare the anesthetic efficacy of 1.8 mL (one cartridge) and 3.6 mL (two cartridges) buccal infiltration and buccal plus palatal infiltration of 4% articaine in maxillary first molar teeth with symptomatic irreversible pulpitis. MATERIALS AND METHODS This randomized single-blind clinical trial was conducted on 45 patients with symptomatic irreversible pulpitis of maxillary first molars (Trial Registration No: IRCT2015011020238N2_2015). The patients were randomly divided into three groups (n = 15) for buccal infiltration of 1.8 mL articaine plus 1:100,000 epinephrine (group 1), buccal infiltration of 3.6 mL articaine (group 2), and buccal infiltration of 1.8 mL articaine plus palatal infiltration of 0.5 mL articaine (group 3). The pain intensity was measured by the Heft-Parker visual analog scale (VAS) during injection and during access cavity preparation. No pain or mild pain during treatment was considered as successful anesthesia. Data were analyzed by the Tukey's post hoc test. RESULTS The three groups had a significant difference in frequency of the perceived pain during injection (P = 0.01). A higher volume of 4% articaine and injection of articaine in both buccal and palatal sides provided a significantly higher anesthesia success rate (P = 0.049 and P < 0.01, respectively). The highest success rate was recorded in group 3 (93.33%) followed by group 2 (80%) and then group 1 (53.33%). CONCLUSIONS Increasing the administered volume of 4% articaine with 1:100,000 epinephrine and addition of palatal infiltration to buccal infiltration of articaine can significantly increase the success of anesthesia in maxillary first molars with symptomatic irreversible pulpitis. CLINICAL RELEVANCE Achieving deep anesthesia in teeth with irreversible pulpitis is a critical parameter in management of patients who are in urgent need of root canal treatments.
Collapse
Affiliation(s)
- Farzaneh Afkhami
- School of Dentistry, Tehran University of Medical Sciences, Mahan St, Tehran, 1894787545, Iran.
- School of Dentistry, The University of Queensland, Brisbane, Australia.
| | | | - Ove A Peters
- School of Dentistry, The University of Queensland, Brisbane, Australia
| | | |
Collapse
|
5
|
Chugh A, Singh S, Khatana S, Gaur S, Patnana AK, Chugh V, Kumar P. The Clinical Efficacy of EMLA as a Topical Anesthetic Agent Instead of Palatal Injection During Maxillary Dental Extractions: A Randomized Controlled Trial. J Maxillofac Oral Surg 2023; 22:172-177. [PMID: 36703663 PMCID: PMC9871143 DOI: 10.1007/s12663-021-01633-x] [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: 03/24/2020] [Accepted: 08/05/2021] [Indexed: 01/29/2023] Open
Abstract
Background Even after the invention of the modern injection techniques, palatal injection still remains a painful experience for patients, and this pain is attributed to the presence of rich nerve complement and displacement of tightly adherent palatal mucosa during anesthesia. Aim To check the clinical efficacy of EMLA as a topical anesthetic agent instead of palatal injection during maxillary dental extractions. Methodology The trial includes a total of 102 participants, in whom maxillary molar extractions were indicated, were randomly divided into the experimental group (eutectic mixture of local anesthesia (EMLA) topical application was used along with buccal injection) and control group (palatal injection along with buccal injection). Pain perception during extraction was recorded using the visual analog scale (VAS). Results Mean VAS score for 'injection' in control group patients was 5.2 ± 2.08 in contrast to no pain in experimental group. In experimental group, mean VAS score on 'probing' was 0.92 ± 1.50. VAS score on 'extraction' in EMLA group was little higher though the difference was not statistically significant. The overall experience using Liekert's scale was higher in experimental group (4.0 ± 0.76) as compared to (3.3 ± 0.82) in control group leading to higher overall satisfaction among patients who underwent extraction in the experimental group. Conclusion EMLA application produced a satisfactory level of anesthesia in the palatal tissue when compared with the palatal injection.
Collapse
Affiliation(s)
| | - Surjit Singh
- Department of Pharmacology, AIIMS, Jodhpur, India
| | - Shruti Khatana
- Department of Dentistry, Adesh Medical College, Ambala, India
| | | | | | - Vinay Chugh
- Department of Dentistry, AIIMS, Jodhpur, India
| | | |
Collapse
|
6
|
Hanif S, Sarfraz RM, Syed MA, Mahmood A, Hussain Z. Smart mucoadhesive buccal chitosan/ HPMC scaffold for sore throat: In vitro, ex vivo and pharmacokinetic profiling in humans. J Drug Deliv Sci Technol 2022. [DOI: 10.1016/j.jddst.2022.103271] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
7
|
Tirupathi SP, Rajasekhar S, Ganesh M, Vamshi A, Tyro D. 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; 14:420-425. [PMID: 34720518 PMCID: PMC8543995 DOI: 10.5005/jp-journals-10005-1974] [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: 11/23/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Sunny P Tirupathi
- Department of Pedodontics and Preventive Dentistry, Dr DY Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Srinitya Rajasekhar
- Department of Pedodontics, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Mayuri Ganesh
- Department of Pedodontics, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - Abhishek Vamshi
- Department of Oral Surgery, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| | - David Tyro
- Department of Oral Surgery, Malla Reddy Institute of Dental Sciences, Hyderabad, Telangana, India
| |
Collapse
|
8
|
Muhammad ZA, Abdullah RM, Majid OW. Articaine improves anesthetic achievement for exodontia performed by undergraduate dental students: A clinical comparative study. J Dent Educ 2021; 85:1702-1709. [PMID: 34268738 DOI: 10.1002/jdd.12743] [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: 02/13/2021] [Revised: 06/29/2021] [Accepted: 07/01/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE/OBJECTIVES To assess the clinical performance of undergraduate dental students in delivering inferior alveolar nerve block (IANB) with either articaine or lidocaine, and to compare the success rate of their IANBs between articaine and lidocaine for the extraction of mandibular molar teeth. METHODS In this clinical trial, patients were randomly distributed into 2 study groups: articaine and lidocaine groups. In each group, dental students performed IANB followed by forceps extraction of 1 mandibular molar under close supervision. The operative parameters measured included: assessment of anesthetic technique (on 10 points visual analogue scale 'VAS-10'), onset and depth of anesthesia, intra-operative pain perceived by patients and their satisfaction level (on VAS-10), and the success rate of IANB (in terms of need to additional anesthesia). Data analyses used were descriptive statistics, t-test, χ2 test, and Pearson's correlation. RESULTS One-hundred sixty patients were included in the final analysis, 80 in each group. The overall students' IANB technique was assessed as good (mean score 7.3). Articaine group showed significantly higher success rate of IANB (71%) compared to (55%) in lidocaine group, (P = 0.03). Patients also reported significantly higher satisfaction scores in the articaine group (P = 0.04). There were no significant difference in the onset of action and intra-operative pain level between the 2 groups. CONCLUSIONS Students' IANBs were generally assessed as "good." Articaine IANBs performed by undergraduate students showed significantly higher success rate than lidocaine IANBs. By using articaine, the anesthetic achievement was greater for mandibular molar extraction performed by undergraduate students.
Collapse
Affiliation(s)
- Zaid Abdulazeez Muhammad
- Assistant lecturer, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Mosul, Mosul, IRAQ
| | - Rayyan Mohammed Abdullah
- Assistant lecturer, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Mosul, Mosul, IRAQ
| | - Omer Waleed Majid
- Professor, Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Mosul, Mosul, IRAQ
| |
Collapse
|
9
|
Needle-free injection: Dental infiltration anesthesia. Int J Pharm 2021; 604:120765. [PMID: 34087413 DOI: 10.1016/j.ijpharm.2021.120765] [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: 02/09/2021] [Revised: 05/22/2021] [Accepted: 05/30/2021] [Indexed: 11/21/2022]
Abstract
This study aimed to develop an optimal Needle-Free Liquid Jet Injection (NFLJI) technique for dental infiltration anesthesia and evaluate its clinical safety and feasibility. The fluid dynamics of NFLJI in the dentoalveolar region were investigated using soft tissue phantoms supported by rigid glass. NFLJIs were performed at different incident angles and recorded using a high-speed camera. Accordingly, an optimal NFLJI for infiltration anesthesia was developed and validated on cadavers, then assessed in two pilot Randomized Controlled Trials (RCT): one for validating the safety of optimal NFLJI technique, the other for evaluating its feasibility and safety. High-speed videos showed that perpendicular NFLJIs induced significantly more regurgitation than oblique NFLJIs, which was confirmed in cadavers. Clinical trials revealed that perpendicular NFLJIs induced a high risk of bleeding (83.3%) and laceration (83.3%), whereas oblique NFLJIs induced a low risk of bleeding (33.3%) and laceration (16.7%). Moreover, the preliminary success rates of oblique NFLJIs and needle injections were both 83.3%. The recruitment took 3-5 weeks with a rate of 100%. Oblique NFLJIs could be a promising approach for dental infiltration anesthesia, causing minimal drug regurgitation with a relatively low risk of complication. The pilot RCTs confirmed the feasibility for conducting a non-inferiority RCT.
Collapse
|
10
|
The Efficacy of 4% Articaine Versus 2% Lidocaine in Inducing Palatal Anesthesia for Tooth Extraction in Different Maxillary Regions. J Oral Maxillofac Surg 2021; 79:1643-1649. [PMID: 33757745 DOI: 10.1016/j.joms.2021.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE This study was conducted to ascertain the efficacy of buccal injection of articaine compared to lidocaine in inducing palatal anesthesia in different maxillary regions. MATERIALS AND METHODS This double-blinded, randomized clinical trial included 300 patients who referred for extraction of 1 maxillary tooth. The patients were categorized into 3 strata according to the extraction area (anterior, premolar, molar), and then randomly assigned to 2 groups based on the administered medication. The first group received buccal infiltration by 0.6 mL of 2% lidocaine, whereas the second group was buccally administered using 0.6 mL of 4% articaine. After a waiting period of 2 minutes, the failure or success in achieving palatal anesthesia was assessed by the instrumentation technique. In cases of failed anesthesia, an additional 0.6 mL of the same anesthetic was given, and the procedure was repeated if palatal anesthesia was not attained after a 2-minute delay. If pain remained 2 minutes after the third injection, a supplemental palatal infiltration was administered and the extraction was attempted. RESULTS The success rate of buccal infiltration in achieving palatal anesthesia was 82.7% in the articaine group and 1.3% in the lidocaine group. There was a significant difference in the success rate and drug volume required to induce palatal anesthesia between the 2 groups (P < .001), but no significant difference was found between different maxillary regions, using either of the medications (P > .05). CONCLUSIONS Articaine can be considered as a suitable alternative to lidocaine for eliminating painful palatal infiltration in the extraction of maxillary teeth.
Collapse
|
11
|
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.
Collapse
|
12
|
Phyo HE, Chaiyasamut T, Kiattavorncharoen S, Pairuchvej V, Bhattarai BP, Wongsirichat N. Single buccal infiltration of high concentration lignocaine versus articaine in maxillary third molar surgery. J Dent Anesth Pain Med 2020; 20:203-212. [PMID: 32934986 PMCID: PMC7470997 DOI: 10.17245/jdapm.2020.20.4.203] [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] [Received: 04/02/2020] [Revised: 05/23/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022] Open
Abstract
Background This research evaluated the numbness produced by lignocaine at an equal or higher concentration than that of 4% articaine through a single point of injection for maxillary third molar surgery. This randomized double-blind study was conducted to compare the anesthetic efficiency of 4% lignocaine with that of 4% articaine in impacted maxillary third molar surgery using a single buccal infiltration alone. Methods The study participants were 30 healthy patients requiring the bilateral surgical removal of symmetrically-positioned maxillary third molars. Using a split-mouth design, each patient randomly received buccal infiltration of 1.7 ml of 4% lignocaine and 1.7 ml of 4% articaine during two separate appointments. After 15 minutes of anesthetic injection, surgery was performed by the same surgeon using a consistent technique on both sides. Pinprick test pain scores of the buccal and palatal gingiva of the maxillary third molar after 10 minutes and 15 minutes latencies, pain scores during the surgery, the need for supplemental anesthesia, and patients' satisfaction with anesthetic efficiency were recorded. Surgery performed without supplemental anesthesia was categorized as successful. Results The success rates of 4% lignocaine and 4% articaine (83.34% vs. 86.67%, P = 1.00) were not significantly different. Only 5 cases (4 cases in the articaine group and 1 case in the lignocaine group) reported mild pain and pressure sensation (NRS ≤ 1) on probing at the palatal side after 15 minutes of latency (P = 0.25). The pain scores of maxillary third molar surgery in the two groups were not significantly different (P > 0.05). Moreover, the statistical analysis confirmed the comparable patient satisfaction of two study groups (P = 0.284). Conclusion This study provides evidence that single buccal infiltrations of 4% lignocaine and 4% articaine have comparable anesthetic efficacy and success rates for impacted maxillary third molar surgery. Both 4% lignocaine and 4% articaine can produce effective palatal anesthesia and pain control using buccal infiltration alone after 15 minutes of latency.
Collapse
Affiliation(s)
- Hnin Ei Phyo
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.,Department of Oral and Maxillofacial Surgery, University of Dental Medicine, Mandalay, Myanmar
| | - Teeranut Chaiyasamut
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Sirichai Kiattavorncharoen
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Verasak Pairuchvej
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.,Walailak University International College of Dentistry, Bangkok, Thailand
| |
Collapse
|
13
|
Tirupathi SP, Rajasekhar S. Can single buccal infiltration with 4% articaine induce sufficient analgesia for the extraction of primary molars in children: a systematic literature review. J Dent Anesth Pain Med 2020; 20:179-186. [PMID: 32934983 PMCID: PMC7470996 DOI: 10.17245/jdapm.2020.20.4.179] [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: 05/31/2020] [Revised: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 11/18/2022] Open
Abstract
This systematic review aims to determine if a single buccal infiltration (without palatal infiltration in the maxilla and Inferior Alveolar Nerve Block in the mandible) with 4% articaine can induce adequate analgesia for the extraction of primary molars (Maxillary and Mandibular) in children. PubMed, Ovid SP, and Embase were searched for studies published between January 1990 and March 2020 with the relevant MeSH terms. Titles and abstracts were screened preliminarily, followed by the full-texts of the included studies. Five articles were included for this systematic review. The outcome investigated was “Procedural pain during the extraction of primary molars after injection with single buccal infiltration of 4% articaine in comparison to single buccal infiltration, double infiltration (buccal and palatal/lingual), and inferior alveolar nerve block with 2% lignocaine.” Of the five studies that evaluated subjective pain during extraction, two reported no significant difference between the articaine and lignocaine groups, and the remaining three reported lower subjective pain during extraction in the articaine group. Only two studies evaluated objective pain scores during extraction, and both studies reported lower pain scores in the articaine group. There is insufficient evidence to justify the statement that a single buccal infiltration of 4% articaine alone is sufficient for the extraction of primary molars. Further evidence is required to justify the claim that palatal infiltrations and IANB can be replaced with the use of 4% articaine single buccal infiltration for the extraction of primary molars in children.
Collapse
Affiliation(s)
- Sunny Priyatham Tirupathi
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Institute of Dental Sciences, Hyderabad Telangana, India
| | - Srinitya Rajasekhar
- Department of Pedodontics & Preventive Dentistry, Malla Reddy Dental College for Women, Hyderabad, Telangana, India
| |
Collapse
|
14
|
Comparison of the efficacy of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 buccal infiltration for single maxillary molar extraction: a double-blind, randomised, clinical trial. Br J Oral Maxillofac Surg 2020; 59:695-699. [PMID: 34053801 DOI: 10.1016/j.bjoms.2020.09.009] [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: 03/01/2020] [Accepted: 09/04/2020] [Indexed: 11/22/2022]
Abstract
The present study was designed to compare the efficiency of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 in providing adequate anaesthesia for maxillary molar extraction with buccal infiltration only. In this randomised, double-blind clinical trial, 139 patients who needed maxillary molars extracting were enrolled. Individuals were randomly divided into two groups of 2% lidocaine with epinephrine 1:100,000 treated by buccal infiltration without palatal injection and 4% articaine with epinephrine 1:100,000 treated with the same method. Then, teeth were extracted and the pain assessed. During the extraction of teeth, 90.63% of patients in the lidocaine-treated group and 36% of patients in the articaine-treated group experienced pain (p<0.0001). In other words, the rates of successful anaesthesia with lidocaine and articaine buccal infiltration were 9.38% and 64%, respectively. Despite the better performance of articaine, it seems that some factors such as bone thickness and anatomical variations among individuals, besides the condition of the tooth, affects articaine's level of efficiency in each case.
Collapse
|
15
|
Comparison of the buccal injection versus buccal and palatal injection for extraction of permanent maxillary posterior teeth using 4% articaine: a split mouth study. Br J Oral Maxillofac Surg 2020; 59:281-285. [PMID: 33581884 DOI: 10.1016/j.bjoms.2020.08.023] [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: 08/16/2018] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Abstract
In spite of the development of modern injection techniques, palatal injection is still a painful experience for patients. A plethora of techniques has been tested to reduce this. One such technique that has been claimed to work is administering articaine on the buccal side alone for the extraction of maxillary teeth due to its ability to diffuse through soft and hard tissues more reliably than other local anaesthetics. This split mouth study evaluated the efficacy of 4% articaine with 1:100000 adrenaline to avoid the painful palatal injection for bilateral permanent maxillary tooth extraction in 50 patients. The 100mm 10 point Visual Analog Scale/Wong Baker Facial Pain Scale was used to rate the amount of pain felt on injection, on probing the tissues prior to, or during, extraction, and one hour postoperatively. Although the buccal injection alone resulted in lower pain while injecting the anaesthetic, it did not result in the absence of pain before tooth extraction as has been suggested by various studies. A total of 74% patients required a palatal injection on the study side. We conclude that in most cases, when using a buccal injection alone, one cannot rely on the diffusion of articaine for effective palatal anaesthesia. Despite this, we suggest that as an initial option in young patients, the operator can consider avoiding the painful palatal injection by the use of articaine to prevent aversion to dental treatment. Postoperatively, the difference in pain levels was not statistically significant and no patient showed signs of lesions at the injection sites.
Collapse
|
16
|
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]
|
17
|
Donovan TE, Marzola R, Murphy KR, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2018; 120:816-878. [DOI: 10.1016/j.prosdent.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023]
|