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Radwan MZ, Wassel MO, El Geleel OA, Elghazawy RK. Influence of computerized intraosseous anesthesia compared with traditional mandibular nerve block on children's behavior: A randomized clinical trial. Int J Paediatr Dent 2024. [PMID: 38923102 DOI: 10.1111/ipd.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/31/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Effective pain management is crucial for the successful completion of dental procedures in children. Research has examined whether computerized intraosseous anesthesia (CIOA) could serve as a safe and viable substitute for the conventional inferior alveolar nerve block (IANB) technique in pediatric patients. This study investigates the efficacy of CIOA, aiming to determine its effectiveness as an alternative anesthesia method. AIM This study compared the efficacy of local intraosseous anesthesia using a computerized device (QuickSleeper 5) to conventional IANB anesthesia on cooperation and pain perception in children, using a randomized controlled trial design. DESIGN The study included 88 healthy children, aged between 6 and 9 years, who required pulpotomy for their mandibular second primary molars. The study was approved by the local research ethics committee and registered at clinicaltrials.gov (NCT05193487). The heart rate and Venham behavior rating scale were recorded and analyzed. Categorical data were analyzed using Fisher's exact test. Age and heart rate were compared using an independent t-test for intergroup comparison. The intragroup comparison was carried out using repeated measures ANOVA, followed by the Bonferroni post hoc test. The Mann-Whitney U-test was used to analyze the Venham scale scores. The significance level was set at p < .05 RESULTS: The mean Venham score was slightly higher in the IANB group than in the CIOA group, but was not statistically significant (p = .852). One minute after anesthesia administration, the heart rate (beats per minute [BPM]) was significantly higher in the IANB group (92.30 ± 13.45) than in the CIOA group (83.20 ± 10.40) (p < .001). Additionally, there was a significant difference in heart rate values measured at different intervals within the IANB group. CONCLUSION The QuickSleeper 5 device was found to be a feasible alternative for IANB in children over 6 years old.
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Affiliation(s)
- Mohamed Zayed Radwan
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Mariem Osama Wassel
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Ola Abd El Geleel
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Reham Khaled Elghazawy
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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Pökel C, Schulze A, Busse M. Cardiovascular and Vector-Cardiographic Effects of Articaine Anesthesia with Epinephrine. Int J Dent 2024; 2024:8610423. [PMID: 38962723 PMCID: PMC11221961 DOI: 10.1155/2024/8610423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/22/2024] [Accepted: 05/21/2024] [Indexed: 07/05/2024] Open
Abstract
The aim was to investigate the vector-cardiographic effects in patients submitted to dental extraction under local anesthesia. Twenty-one patients aged 36.6 ± 12.4 years with a clinical and radiographic indication of mandibular or maxillary tooth extraction were enrolled. The intervention was a local or mandibular nerve block anesthesia with 4% articaine hydrochloride containing epinephrine (1 : 100,000; 40 mg/ml + 10 μg/ml). Blood pressure (BP), heart rate (HR), pulse wave transit time, and vector-cardiography data were recorded throughout 3 min before and 5 min after injection. QRS- and T-wave area under the curve (QRS AUC/T AUC) were calculated from the X/Y/Z QRS-vector or T-vector. T-wave amplitude (T AM), T AUC values, and diastolic BP decreased, and HR significantly increased 4 min after injection. A transient moderate HR drop and a corresponding small increase in T AM and T AUC immediately after the injection procedure may be explained by a decreased sympathetic tone due to psychological relief. In dental anesthesia, the systemic epinephrine effects are represented by a decrease in T AUC. These effects are most pronounced in the X- and Y-leads. The 3D determination of vector planes or amplitudes is a simple method to register the sympathetic tone in local anesthesia independently of possible effects on T-wave characteristics in single leads. In conclusion, T-wave determination may help to detect even small increases in systemic adrenaline concentration in case of accidental intravascular injection. At the same time, full rhythm and spatial ischemia control is provided.
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Affiliation(s)
- Christoph Pökel
- General Outpatient Clinic of Sports MedicineUniversity Leipzig, Leipzig, Germany
| | - Antina Schulze
- Department of Sports DentistryInstitute of Sports MedicineUniversity Leipzig, Leipzig, Germany
| | - Martin Busse
- General Outpatient Clinic of Sports MedicineUniversity Leipzig, Leipzig, Germany
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Laham A, Clouet R, del Valle GA, Gaudin A, Prud’homme T. Anaesthetic efficacy and influence on cardiovascular parameters change of intraosseous computerised anaesthesia versus inferior alveolar nerve block anaesthesia in acute irreversible pulpitis of mandibular molars: study protocol for a prospective randomised controlled trial. Trials 2022; 23:979. [PMID: 36471427 PMCID: PMC9720960 DOI: 10.1186/s13063-022-06915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/11/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Irreversible pulpitis is a highly painful inflammatory condition of the dental pulp. The recommended care is the removal of the coronal pulp (pulpotomy) for emergency treatment in multi-rooted teeth. However, achieving adequate analgesia in the case of mandibular molars presents many difficulties according to the dental literature. Intraosseous computerised anaesthesia (ICA), in particular, the QuickSleeper™ system, has already been demonstrated to be clinically efficient, but ICA is known to increase the heart rate reversibly in a manner that depends on the speed of injection. Therefore, accelerated heart rate was examined as a potential adverse effect of this injection. This trial aims to compare the cardiovascular effects and the anaesthetic efficacy of ICA versus inferior alveolar nerve block anaesthesia (IANB) in acute irreversible pulpitis of mandibular molars. METHODS This study is a non-inferiority prospective, randomised, controlled, single-blind, two-group trial conducted at the Nantes University Hospital. The study design included two parallel arms at a ratio of 1:1 that will allocate seventy-two patients into two groups: the first group will receive QuickSleeper™ intraosseous anaesthesia; the second will receive an inferior alveolar nerve block before emergency treatment (pulpotomy). This study will include patients requiring emergency dental care under local anaesthesia with confirmed irreversible pulpitis in mandibular molars. The primary outcome is the time taken for the fluctuations in the cardiovascular parameters to return to baseline values during endodontic treatment in two different anaesthetic techniques. The secondary outcomes include efficacy of the technique, patient's pain perception before and after care, any post-operative effects, and factors associated with the delay of recovery of cardiovascular parameters between the 2 anaesthetic techniques. DISCUSSION This trial will evaluate the factors associated with heart rate increase during local anaesthesia administration. The use of blood pressure and cardiovascular measurements can be considered an asset and additional safety in managing local anaesthesia. Detecting early signs of potential adverse events (AEs), particularly patients with certain medical conditions (cardiac rhythm disorders), would suggest caution in administering anaesthesia. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03802305 registered January 14, 2019. (version no. 1.2; 5 November 2021).
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Affiliation(s)
- Amany Laham
- grid.4817.a0000 0001 2189 0784Nantes Université, CHU Nantes, Unité d’Investigation Clinique en Odontologie, UIC 11, F-44000 Nantes, France
| | - Roselyne Clouet
- grid.4817.a0000 0001 2189 0784Nantes Université, CHU Nantes, F-44000 Nantes, France
| | - Gilles Amador del Valle
- grid.4817.a0000 0001 2189 0784Nantes Université, CHU Nantes, Unité d’Investigation Clinique en Odontologie, UIC 11, F-44000 Nantes, France
| | - Alexis Gaudin
- grid.4817.a0000 0001 2189 0784Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, F-44000 Nantes, France
| | - Tony Prud’homme
- grid.4817.a0000 0001 2189 0784Nantes Université, CHU Nantes, Unité d’Investigation Clinique en Odontologie, UIC 11, F-44000 Nantes, France
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Parirokh M, Abbott P. Present status and future directions - Mechanisms and management of local anaesthetic failures. Int Endod J 2022; 55 Suppl 4:951-994. [PMID: 35119117 DOI: 10.1111/iej.13697] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Paul Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
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Gupta A, Wadhwa J, Aggarwal V, Mehta N, Abraham D, Aneja K, Singh A. Anesthetic efficacy of supplemental intraligamentary injection in human mandibular teeth with irreversible pulpitis: a systematic review and meta-analysis. J Dent Anesth Pain Med 2022; 22:1-10. [PMID: 35169615 PMCID: PMC8814730 DOI: 10.17245/jdapm.2022.22.1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alpa Gupta
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Jitesh Wadhwa
- Department of Orthodontics and Dentofacial Orthopedics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Vivek Aggarwal
- Department of Conservative Dentistry and Endodontics, Faculty of Dentistry, Jamia Milia Islamia, New Delhi, India
| | - Namrata Mehta
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Dax Abraham
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Kritika Aneja
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
| | - Arundeep Singh
- Department of Conservative Dentistry and Endodontics, Manav Racha Dental College, Faridabad, Haryana, India
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Effectiveness of different anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis: a systematic review and meta-analysis. Clin Oral Investig 2021; 25:6477-6500. [PMID: 34453595 DOI: 10.1007/s00784-021-04145-7] [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: 05/13/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This systematic review aimed to assess the effectiveness of anesthetic methods for mandibular posterior teeth with symptomatic irreversible pulpitis, comparing to the inferior alveolar nerve block (IANB) by meta-analysis. MATERIALS AND METHODS Studies were identified from Cochrane Library, Embase, Lilacs, PubMed, Scopus, and Web of Science databases up to May 2021. Randomized clinical trials comparing the anesthetic success rate of IANB and any other alternative anesthetic method were included. The quality of the selected studies was assessed by the Cochrane Risk of Bias 2.0 tool. Meta-analyses using Mantel-Haenszel method and random-effect models were performed to find the pooled estimates of risk ratio (RR) with 95% confidence interval (CI). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS Twenty-two studies were selected, which included fourteen anesthetic methods. Two studies were classified as high risk of bias, five as uncertain risk and fifteen as low risk. Vazirani-Akinosi nerve block (VANB) [RR = 1.27; p = 0.007; 95% CI, 1.07-1.52; I2 = 0%] and intraosseous injection (IOI) [RR = 1.48; p = 0.04; 95% CI, 1.02-2.15; I2 = 46%] had superior effectiveness compared to IANB, with low certainty of evidence, as well as buccal infiltrations associated with IANB (BI + IANB) [RR = 1.84; p = 0.004; 95% CI, 1.22-2.79; I2 = 52%], with very low certainty. CONCLUSION Evidence suggests that buccal infiltrations associated with IANB, VANB, and IOI are more effective than IANB at anesthetizing posterior mandibular teeth with symptomatic irreversible pulpitis. CLINICAL SIGNIFICANCE Alternative primary methods of anesthesia might be indicated for mandibular posterior teeth presenting symptomatic irreversible pulpitis.
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Wakita R, Ito T, Fukayama H. Small doses of adrenaline contained in the local anaesthetic may result in prolonged increased cardiac function even after the vital signs return to normal. ADVANCES IN ORAL AND MAXILLOFACIAL SURGERY 2021. [DOI: 10.1016/j.adoms.2021.100104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kijsamanmith K, Sriworapongpun C, Pawasut N, Huayhongthong N, Sakulyuenyong T, Krongyoungyuen P, Samdrup T. The effect of single buccal infiltration anesthesia of 4% articaine with either 1:100,000 or 1:200,000 epinephrine on pulpal blood flow and anesthesia of maxillary first molars and second premolars in humans. Clin Oral Investig 2021; 26:343-351. [PMID: 34041607 DOI: 10.1007/s00784-021-04005-4] [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: 01/22/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to determine the effect of single buccal infiltration of 4% articaine with either 1:100,000 (EP100) or 1:200,000 (EP200) epinephrine on pulpal blood flow (PBF), pulpal anesthesia and soft tissue anesthesia of maxillary first molars and second premolars in human subjects. MATERIALS AND METHODS Fifteen healthy volunteers with intact maxillary first molars and second premolars received an infiltration of 4% articaine with either EP100 or EP200 at buccal aspect of maxillary first molars. The PBF, pulpal anesthesia and soft tissue anesthesia were assessed with a laser Doppler flowmeter (LDF), an electric pulp tester (EPT) and Aesthesiometer II, respectively. RESULTS Articaine (4%) with either EP100 or EP200 produced PBF reduction in maxillary first molars (injected teeth) by 68.09 and 69.83%, and produced PBF reduction in second premolars (adjacent teeth) by 76.81 and 75.02%, respectively at 15 min post injection. Duration of PBF returned to baseline was 159.00 ± 21.06 (EP100) and 159.00 ± 31.97 (EP200) min in the molars, and 161.00 ± 20.02 (EP100) and 159.00 ± 25.86 (EP200) min in the premolars. The onset of pulpal anesthesia was 2.80 ± 1.26 (EP100) and 3.07 ± 1.28 (EP200) min in the molars, and 2.13 ± 0.52 (EP100) and 2.40 ± 0.83 (EP200) min in the premolars; the duration of pulpal anesthesia was 74.53 ± 24.16 (EP100) and 76.27 ± 34.03 (EP200) min in the molars, and 82.53 ± 31.03 (EP100) and 75.60 ± 37.17 (EP200) min in the premolars. Buccal tissue anesthesia was found in both teeth (100%), but palatal anesthesia was achieved by 13.33% in the premolars and 6.67% in the molars for each solution. CONCLUSIONS Single buccal infiltration to maxillary first molar produced PBF reduction and successful pulpal anesthesia, evaluated by EPT, in both first molar and second premolar. This anesthetic technique also produced high success of buccal tissue anesthesia, but demonstrated very low success for palatal tissue anesthesia. CLINICAL RELEVANCE Single buccal infiltration to maxillary first molar is potent enough for pulpal and buccal tissue anesthesia, except palatal tissue anesthesia, in both first molar and second premolar.
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Affiliation(s)
- Kanittha Kijsamanmith
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand.
| | - Chayanit Sriworapongpun
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Nichanan Pawasut
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Nadpatchamon Huayhongthong
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Thanawin Sakulyuenyong
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Piyatida Krongyoungyuen
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Yothi Road, Bangkok, 10400, Thailand
| | - Tshering Samdrup
- Dental Department, Lungtenphu Military Hospital, Royal Bhutan Army, 11001, Thimphu, Bhutan
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Nilius M, Mueller C, Nilius MH, Haim D, Leonhardt H, Lauer G. Intraosseous anesthesia in symptomatic irreversible pulpitis: Impact of bone thickness on perception and duration of pain. J Dent Anesth Pain Med 2020; 20:367-375. [PMID: 33409365 PMCID: PMC7783377 DOI: 10.17245/jdapm.2020.20.6.367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Manfred Nilius
- Niliusklinik, Londoner Bogen 6, D-44269 Dortmund, Germany
| | | | | | - Dominik Haim
- Technische Universität Dresden, University Hospital "Carl Gustav Carus", Department of Oral and Maxillofacial Surgery, Dresden, Germany
| | - Henry Leonhardt
- Technische Universität Dresden, University Hospital "Carl Gustav Carus", Department of Oral and Maxillofacial Surgery, Dresden, Germany
| | - Guenter Lauer
- Technische Universität Dresden, University Hospital "Carl Gustav Carus", Department of Oral and Maxillofacial Surgery, Dresden, Germany
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Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis. J Endod 2019; 45:1435-1464.e10. [DOI: 10.1016/j.joen.2019.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 08/21/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022]
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Smaïl-Faugeron V, Muller-Bolla M, Sixou JL, Courson F. Evaluation of intraosseous computerized injection system (QuickSleeper™) vs conventional infiltration anaesthesia in paediatric oral health care: A multicentre, single-blind, combined split-mouth and parallel-arm randomized controlled trial. Int J Paediatr Dent 2019; 29:573-584. [PMID: 30883951 DOI: 10.1111/ipd.12494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/28/2019] [Accepted: 03/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Conventional infiltration anaesthesia (CIA) is the most frequently used in paediatric oral health care. However, other techniques are available, such as intraosseous anaesthesia (IOA), that can beneficiate from newly developed technologies. AIM To compare the pain caused by CIA and IOA delivered by the computerized system (QuickSleeper™) in children. DESIGN We used an innovative design consisting in simultaneously conducting a multicentre split-mouth and parallel-arm randomized controlled trial (RCT) to allow for increased power. The primary outcome was pain reported by the patient on a visual analogue scale (0-10 cm) concerning the insertion of the needle and injection. RESULTS A total of 30 children were included in the split-mouth RCT and 128 in the parallel-arm RCT. We combined treatment effect estimates by using an inverse-variance weighting meta-analysis approach. Pain scores were significantly decreased with IOA vs CIA (mean difference -0.69 cm, 95% confidence intervals -1.13 to -0.25 cm). For each patient enrolled in the split-mouth RCT, about five were enrolled in the parallel-arm RCT, which allowed for not losing any eligible patients. CONCLUSION Pain during the insertion of the needle and injection was less with IOA vs CIA in children. The design of this study allowed for increasing statistical power and using all generated evidence. (ClinicalTrials.gov NCT02084433).
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Affiliation(s)
- Violaine Smaïl-Faugeron
- Hôpital Bretonneau, Service d'Odontologie, Assistance Publique-Hôpitaux de Paris, Paris, France.,Faculté de Chirurgie Dentaire, Unité de Recherches Biomatériaux Innovants et Interface EA4462, Université Paris Descartes - Sorbonne Paris Cité, Montrouge, France
| | - Michèle Muller-Bolla
- Faculté de Chirurgie Dentaire, Unité de Recherches Biomatériaux Innovants et Interface EA4462, Université Paris Descartes - Sorbonne Paris Cité, Montrouge, France.,Department of Pediatric Dentistry, UFR d'Odontologie de Nice Sophia Antipolis, Université Côte d'Azur, CHUN, Nice, France
| | - Jean-Louis Sixou
- Université Européenne de Bretagne, Université de Rennes 1 and Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Frédéric Courson
- Hôpital Bretonneau, Service d'Odontologie, Assistance Publique-Hôpitaux de Paris, Paris, France.,Faculté de Chirurgie Dentaire, Unité de Recherches Biomatériaux Innovants et Interface EA4462, Université Paris Descartes - Sorbonne Paris Cité, Montrouge, France
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Hussein HM, Raafat AS, Amory ZS, Al-Juboori MJ. The influence of endodontic treatment on blood pressure reduction in patients with vital irreversible pulpitis. Clin Cosmet Investig Dent 2019; 11:143-155. [PMID: 31417319 PMCID: PMC6594044 DOI: 10.2147/ccide.s206513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/22/2019] [Indexed: 11/23/2022] Open
Abstract
Background During endodontic treatment, endodontists must be aware of the various factors that may decrease or increase blood pressure. This study aimed to assess the mean percentages of systolic, diastolic, and arterial blood pressure (MSBP, MDAP, MABP) reduction in patients with vital irreversible pulpitis in teeth and who were treated at three visits to endodontists in three age groups (20–34 years, 35–50 years, 51–65 years). Materials and methods A total of 100 teeth with vital irreversible pulpitis from 100 patients were included. All patients underwent 3 visits for endodontic treatment. The 1st visit included removal of vital pulp tissue and a determination of working length, the 2nd visit included canal preparation and widening, and at the 3rd visit the canal was obturated and sealed by gutta percha and sealer. Blood pressure for all patients was checked and documented once before starting treatment and three times during treatment at different intervals during all visits. Results There were significantly higher percentage reductions in MSBP, MDBP, and MABP at the 1st visit for endodontic treatment in comparison to other visits (2nd and 3rd) for all patients. Additionally, there were significantly higher percentage reductions in MSBP, MDBP, and MABP at the 1st visit for endodontic treatment in comparison to other visits in males and females, for all age groups, both anesthesia injection-type groups (infiltration and block), and all treated tooth types except mandibular anterior teeth, and there were nonsignificant differences among groups. However, there were nonsignificant differences in MSBP, MDBP, and MABP between males and females, between infiltration and block injection groups and in relation to teeth types at all visits. Conclusions The reduction of blood pressure in patients undergoing endodontic treatment of vital teeth with irreversible pulpits is common, especially at the 1st visit for pulp extirpation.
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Affiliation(s)
- Hashim M Hussein
- Department of Dentistry, Al-Rafidain University-College, Baghdad, Iraq
| | - Ahmed S Raafat
- Department of Dentistry, Al-Rafidain University-College, Baghdad, Iraq
| | - Zainab S Amory
- Department of Dentistry, Al-Rafidain University-College, Baghdad, Iraq
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Sovatdy S, Vorakulpipat C, Kiattavorncharoen S, Saengsirinavin C, Wongsirichat N. Inferior alveolar nerve block by intraosseous injection with Quicksleeper® at the retromolar area in mandibular third molar surgery. J Dent Anesth Pain Med 2019; 18:339-347. [PMID: 30637344 PMCID: PMC6323038 DOI: 10.17245/jdapm.2018.18.6.339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 11/15/2022] Open
Abstract
Background There are many techniques of inferior alveolar nerve block injection (IANBI); one among them is the computer-assisted intraosseous injection (CAIOI). Here we aim to evaluate the effectiveness of CAIOI with Quicksleeper® in mandibular third molar surgery. Methods This study is a clinical, single-blind, randomized, split-mouth, controlled trial including 25 patients (10 males and 15 females, mean age 21 years). The patients underwent surgical removal of bilateral mandibular third molars with two different IANBI techniques. One side was injected using Quicksleeper®, and the other side was injected using a conventional IANBI. Both techniques used one cartridge (1.7 ml) of 1:100,000 epinephrine 4% articaine. A supplementary injection was used if necessary. All volumes of anesthetic agent used were recorded. Statistical analysis was performed using paired t-test and Wilcoxon test. Results This research showed that CAIOI has faster onset and shorter duration of action than IANBI (P < 0.05). The pain was similar in both techniques. In the CAIOI group, one-third of the cases could be completed without additional anesthesia. The remaining two-thirds required minimal supplementary volume of anesthesia. The success rates were 68% for CAIOI and 72% for IANBI, respectively. Conclusion CAIOI is an advantageous anesthetic technique. It can be used as an alternative to conventional IANBI for mandibular third molar surgery.
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Affiliation(s)
- Sam Sovatdy
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chakorn Vorakulpipat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | | | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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14
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Efficacy of Articaine Versus Lidocaine Administered as Supplementary Intraligamentary Injection after a Failed Inferior Alveolar Nerve Block: A Randomized Double-blind Study. J Endod 2019; 45:1-5. [DOI: 10.1016/j.joen.2018.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/16/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022]
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15
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Talib H, Mousa H, Mahmood A. Effect of manual and air nonsurgical periodontal therapy on systolic and diastolic blood pressure. J Int Oral Health 2019. [DOI: 10.4103/jioh.jioh_177_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Collier T. Intraosseous anaesthesia as a primary technique for mandibular posterior teeth with symptomatic irreversible pulpitis. Acta Odontol Scand 2018; 76:535-537. [PMID: 30175933 DOI: 10.1080/00016357.2018.1489558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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17
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Farhad A, Razavian H, Shafiee M. Effect of intraosseous injection versus inferior alveolar nerve block as primary pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis: a prospective randomized clinical trial. Acta Odontol Scand 2018; 76:442-447. [PMID: 29374995 DOI: 10.1080/00016357.2018.1428826] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study sought to assess the success rate, effect on blood pressure, and pain of intraosseous injection (IO) and inferior alveolar nerve block (IANB) for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis as the primary anaesthetic technique. MATERIALS AND METHODS This randomized clinical trial (IRCT2013022712634N1) was conducted on 60 patients between 18 and 65 years suffering from symptomatic irreversible pulpitis of a mandibular posterior tooth. Patients were randomly divided into two groups. Group one received IO while group two received IANB with 3% mepivacaine. After anaesthetic injection, success rate of pulpal anaesthesia was assessed by pulp testing in the two groups. Systolic and diastolic blood pressures of patients were compared before and after the anaesthetic injections. Level of pain during injection was scored using a visual analogue scale. The data were analyzed using SPSS version 20, t-test and chi square test at p = .05 level of significance. RESULTS Success rate of IO (56.7%) was significantly higher than that of IANB (23.3%) (p = .008). There was no significant difference in pain during anaesthetic injection (p = .304) or change in systolic (p = .80) and diastolic (p = .28) blood pressures following injection between the two techniques. CONCLUSIONS IO had a higher success rate than IANB for pulpal anaesthesia of mandibular posterior teeth with symptomatic irreversible pulpitis. Neither technique provided profound pulpal anaesthesia.
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Affiliation(s)
- Alireza Farhad
- Dental Research Center, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Razavian
- Dental Research Center, Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Shafiee
- Department of Endodontics, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
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18
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The effect of intraosseous local anesthesia of 4% articaine with 1:100,000 epinephrine on pulpal blood flow and pulpal anesthesia of mandibular molars and canines. Clin Oral Investig 2018; 23:673-680. [DOI: 10.1007/s00784-018-2481-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
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19
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Vieira WA, Paranhos LR, Cericato GO, Franco A, Ribeiro MAG. Is mepivacaine as effective as lidocaine during inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. Int Endod J 2018; 51:1104-1117. [PMID: 29577321 DOI: 10.1111/iej.12926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/20/2018] [Indexed: 11/29/2022]
Abstract
This study aimed to compare the effectiveness of mepivacaine and lidocaine for pulpal anaesthesia and pain control when administered via an inferior alveolar nerve block during the root canal treatment of mandibular molars in patients with symptomatic irreversible pulpitis. A research protocol was developed and registered in PROSPERO. The systematic search was conducted during May 2017 in eight databases. The studies were selected based on inclusion and exclusion criteria. Two examiners analysed the sample independently, decided the eligibility for inclusion and classified the articles according to their quality. Statistical analysis was performed with Mantel-Haenszel and I-square (I2 ) tests considering a confidence interval of 95%. The initial sample consisted of 1130 articles, out of which four were eligible. The articles were published between 1993 and 2016. For both pulpal anaesthesia and pain control, there was no significant difference between mepivacaine and lidocaine (P = 0.843, I2 = 0%, and P = 0.183, I2 = 21.1%, respectively). Mepivacaine and lidocaine were similarly effective for pulpal anaesthesia and pain control after inferior alveolar nerve blocks for root canal treatment.
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Affiliation(s)
- W A Vieira
- Department of Dentistry, Federal University of Sergipe, Aracaju, SE, Brazil
| | - L R Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlandia, Uberlândia, MG, Brazil
| | - G O Cericato
- Department of Dentistry, Faculdade Meridional (IMED), Passo Fundo, RS, Brazil
| | - A Franco
- Department of Stomatology, Federal University of Paraná, Curitiba, PR, Brazil
| | - M A G Ribeiro
- Department of Dentistry, Federal University of Sergipe, Aracaju, SE, Brazil
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20
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Huang JIS, Chang HH, Liao WC, Lin CP, Kao CT, Huang TH. Blood pressure reduction in patients with irreversible pulpitis teeth treated by non-surgical root canal treatment. J Dent Sci 2017; 12:382-387. [PMID: 30895079 PMCID: PMC6395357 DOI: 10.1016/j.jds.2017.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Indexed: 11/05/2022] Open
Abstract
Background/purpose The hypotension in patients during non-surgical root canal treatment (NSRCT) has not yet investigated. This study aimed to assess the mean systolic blood pressure (MSBP), mean diastolic blood pressure (MDBP), and mean arterial blood pressure (MABP) reduction percentages in patients with irreversible pulpitis teeth treated by NSRCT. Materials and methods We prospectively recruited 111 patients with a total of 138 irreversible pulpitis teeth. All patients underwent two NSRCT sessions. The first NSRCT session involved mainly the removal of vital pulp tissue with the direct stimulation of the dental branches of the trigeminal nerve, and the second NSRCT session included the root canal debridement and enlargement with minimal disturbance to the dental nerves. The blood pressure of each patient was recorded before and during both NSRCT sessions. Results There were significantly higher reduction percentages of MSBP, MDBP, and MABP in the first NSRCT session than in the second NSRCT session for all treated patients (all the P-values < 0.001). If the patients were divided into 2 or more groups according to the clinical variables including the patients' gender, age, tooth type, and anesthesia type, we also found significantly higher reduction percentages of MSBP, MDBP, and MABP in the first NSRCT session than in the second NSRCT session for all treated patients except for patients below 40 years of age and for patients with lower anterior teeth treated (all the P-values < 0.05). Conclusion The decrease in blood pressure in patients receiving vital pulpal extirpation is a relatively common phenomenon.
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Affiliation(s)
- James I-Sheng Huang
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hao-Hueng Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Chuen Liao
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Pei Lin
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei, Taiwan.,Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chia-Tze Kao
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Oral Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsui-Hsien Huang
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Oral Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
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21
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Tuk JG, Lindeboom JA, Hoogendoorn L, Taylor BW, van Wijk AJ. Anxiety and pain related to mandibular block injections: comparison of self-reported measures and physiological response. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:456-463. [PMID: 29032948 DOI: 10.1016/j.oooo.2017.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/22/2017] [Accepted: 08/26/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether patients with a pain score ≥7 (high pain group) after a mandibular block injection had a higher physiologic response compared with patients with scores <7 (low pain group). STUDY DESIGN Before oral surgery, patients (n = 66) filled out questionnaires to measure anxiety and expected pain. The questionnaires also assessed patients' experiences with dental injections and dental anxiety, as well as their emotional state and intensity of anxiety. Before, during, and after the injection, physiologic responses were measured by using Nexus-10. Patients were then asked about the pain and anxiety they had experienced. RESULTS The mean score for pain experienced was 3.45 (standard deviation 2.17) on an 11-point rating scale. Eight patients (12.1%) experienced high injection pain. There was a significant increase in mean sweat secretion and a significant decrease in mean respiration between the relaxing phase and the injection phase. There was a significant positive relationship between experienced anxiety and mean heart rate during the injection phase. No significant difference in physiologic response was found between patients who experienced high pain and those who experienced low pain. CONCLUSIONS Reported pain was not associated with the physiologic response of patients receiving mandibular block injections.
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Affiliation(s)
- Jacco G Tuk
- Departments of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Amstelland Hospital Amstelveen, Amsterdam, The Netherlands.
| | - Jerome A Lindeboom
- Departments of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Amstelland Hospital Amstelveen, Amsterdam, The Netherlands
| | - Linda Hoogendoorn
- Departments of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Amstelland Hospital Amstelveen, Amsterdam, The Netherlands; Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Byron W Taylor
- Departments of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands; Amstelland Hospital Amstelveen, Amsterdam, The Netherlands; Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
| | - Arjen J van Wijk
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam and Vrije Universiteit, Amsterdam, The Netherlands
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22
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Effective anaesthesia of the acutely inflamed pulp: part 2. Clinical strategies. Br Dent J 2017; 219:439-45. [PMID: 26564355 DOI: 10.1038/sj.bdj.2015.843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 11/08/2022]
Abstract
Achieving profound pulpal anaesthesia in a mandibular molar diagnosed with irreversible pulpitis can be argued to be the most testing of dental anaesthetic challenges. Following discussion on the possible reasons for this occurrence in part 1, part 2 outlines the various local anaesthetic techniques that practitioners can use to overcome the acutely inflamed mandibular molar. They should then be able to apply these same principles to help anaesthetise any other tooth presenting with an acutely inflamed pulp. Techniques are discussed in detail along with key variables that have been associated with having an impact on the anaesthetic efficacy. This is to bring to light factors that can aid anaesthetic success as well as dispel common misnomers.
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23
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Kämmerer PW, Schneider D, Palarie V, Schiegnitz E, Daubländer M. Comparison of anesthetic efficacy of 2 and 4 % articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial. Clin Oral Investig 2016; 21:397-403. [PMID: 27020911 DOI: 10.1007/s00784-016-1804-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this clinical prospective, randomized, double-blind trial was to compare the anesthetic efficacy of 2 % articaine and 4 % articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth. MATERIALS AND METHODS In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2 % articaine (group I) and, in 52 cases, 4 % articaine (group II) was administered. The primary objective was to analyze the differences of anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min)), as well as in length of soft tissue anesthesia (min), were evaluated. Additionally, the need of a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analyzed. RESULTS Anesthesia was sufficient for dental extractions in both groups without significant differences (p = 0.201). The onset of anesthesia did not differ significantly (p = 0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9 vs. 4 h; p < 0.001). There was no significant difference in the need for a second injection (p = 0.359), in injection pain (p = 0.386), as well as in pain during (p = 0.287) or after treatment (p = 0.121). In both groups, no complications were seen. CONCLUSIONS The local anesthetic effect of the 4 % articaine solution is not significantly better when compared to 2 % articaine. CLINICAL RELEVANCE For mandibular tooth extraction, articaine 2 % may be used as alternative as well.
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Affiliation(s)
- P W Kämmerer
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | | | - V Palarie
- Laboratory of Tissue Engineering, State University of Medicine and Pharmacy "N. Testemitanu", Chisinau, Moldova
| | - E Schiegnitz
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center Mainz, Mainz, Germany
| | - M Daubländer
- Department of Oral Surgery, University Medical Centre Mainz, Mainz, Germany
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24
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Lasemi E, Sezavar M, Habibi L, Hemmat S, Sarkarat F, Nematollahi Z. Articaine (4%) with epinephrine (1:100,000 or 1:200,000) in inferior alveolar nerve block: Effects on the vital signs and onset, and duration of anesthesia. J Dent Anesth Pain Med 2015; 15:201-205. [PMID: 28879280 PMCID: PMC5564155 DOI: 10.17245/jdapm.2015.15.4.201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 12/19/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022] Open
Abstract
Background This prospective, randomized, double-blind, clinical study was conducted to compare the effects of 4% articaine with 1:100,000 epinephrine (A100) and 4% articaine with 1:200,000 epinephrine (A200) on the vital signs and onset and duration of anesthesia in an inferior alveolar nerve block (IANB). Methods In the first appointment, an IANB was performed by injecting A100 or A200 in 1 side of the mouth (right or left) randomly in patients referred for extraction of both their first mandibular molars. In the second appointment, the protocol was repeated and the other anesthetic solution was injected in the side that had not received the block in the previous session. Systolic and diastolic blood pressures (SBP and DBP) and pulse rate were measured during and 5 min after the injection. The onset and duration of anesthesia were also evaluated. Data were analyzed using t-test and Mann-Whitney U-test, and p-value was set at 0.05. Results SBP and pulse rate changes were slightly more with A100; however, DBP changes were more with A200, although the differences were not significant (P > 0.05). There were no statistically significant differences in the parameters evaluated in this study. The onset and duration of anesthesia, and the changes in SBP, DBP, and pulse rate during and 5 min after the injection were the same in both the groups. Conclusions For an IANB, A200 and A100 were equally efficient and successful in producing the block. Epinephrine concentration did not influence the effects of 4% articaine.
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Affiliation(s)
- Esshagh Lasemi
- Craniomaxillofacial Research Center, Azad University, Dental Branch, Tehran, Iran and Department of Oral and Maxillofacial Surgery,Islamic Azad University, Dental Branch, Tehran, Iran
| | - Mehdi Sezavar
- Craniomaxillofacial Research Center, Azad University, Dental Branch, Tehran, Iran and Department of Oral and Maxillofacial Surgery,Islamic Azad University, Dental Branch, Tehran, Iran
| | | | - Seyfollah Hemmat
- Department of Oral and Maxillofacial Surgery, Hormozgan University of Medical Science, Bandar Abbas, Iran and Craniomaxillofacial Research Center, Azad University, Dental Branch, Tehran, Iran
| | - Farzin Sarkarat
- Craniomaxillofacial Research Center, Azad University, Dental Branch, Tehran, Iran and Department of Oral and Maxillofacial Surgery,Islamic Azad University, Dental Branch, Tehran, Iran
| | - Zahra Nematollahi
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran and Craniomaxillofacial Research Center, Azad University, Dental Branch, Tehran, Iran
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Abu-Mostafa N, Al-Showaikhat F, Al-Shubbar F, Al-Zawad K, Al-Zawad F. Hemodynamic changes following injection of local anesthetics with different concentrations of epinephrine during simple tooth extraction: A prospective randomized clinical trial. J Clin Exp Dent 2015; 7:e471-6. [PMID: 26535092 PMCID: PMC4628800 DOI: 10.4317/jced.52321] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/27/2015] [Indexed: 11/12/2022] Open
Abstract
Background Presence of epinephrine in local anesthetic cartridge increases the duration of local anesthesia (LA), decreases the risk of toxicity, and provides hemostasis. However, the unfavorable effects are increasing heart rate (HR) and raising blood pressure (BP). The aim was to evaluate hemodynamic changes in the BP, HR, and oxygen saturation (SpO2) of normal patients undergoing tooth extraction using LA with various epinephrine concentrations. Material and Methods A prospective randomized clinical trial was conducted on 120 patients who were divided randomly into 3 parallel groups according to the LA received. Group 1: lidocaine 2% with epinephrine 1:80,000 (L80). Group 2: articaine 4% with epinephrine 1:100,000 (A100). Group 3: articaine 4% with epinephrine 1:200,000 (A200). Inclusion criteria: normal patients whose BP < 140/90. Exclusion criteria: hypertension, cardiovascular disease, hyperthyroidism, pregnancy, and allergy to LA. BP, HR, and (SpO2) were evaluated in 3 different time points: 3 minutes before LA, 3 minutes after LA, and 3 minutes after extraction. Results Systolic blood pressure (SBP) significantly increased after injection of L80 and continued after extraction to be significant than pre-injection. SBP significantly increased after injection of A100 then decreased after extraction. In the group of A200, SBP insignificantly decreased after injection then increased after extraction. The increasing of SBP between time point 1and 2 was significantly higher in G1 than G3 (p=0.014). Diastolic blood pressure decreased after LA in the 3 groups; however it was significant only with L80, then increased after extraction for all. Conclusions The changings of DBP, HR and SpO2 after anesthesia and extraction showed no significant difference among the three groups. However, A200 had significant lesser effect on SBP than L80 and the least effect on other parameters. Therefore, A200 is considered safer than L80 and A100 and is recommended for LA before teeth extraction in normal patient.
Key words:Local anesthesia, lidocaine, epinephrine 1:80,000, articaine, epinephrine 1:100,000, epinephrine 1:200,000, tooth extraction.
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Affiliation(s)
- Nedal Abu-Mostafa
- BDS. MSc. Lecturer in Oral and Maxillofacial Surgery, Riyadh Colleges of Dentistry and Pharmacy, Oral and Maxillofacial Surgery and Diagnostic Science Department, Dental Hospital (Namuthajia) Riyadh, Kingdom of Saudi Arabia
| | - Fatimah Al-Showaikhat
- BDS. Dental Intern, Riyadh Colleges of Dentistry and Pharmacy, Oral and Maxillofacial Surgery and Diagnostic Science Department, Dental Hospital (Namuthajia) Riyadh, Kingdom of Saudi Arabia
| | - Fatimah Al-Shubbar
- BDS. Dental Intern, Riyadh Colleges of Dentistry and Pharmacy, Oral and Maxillofacial Surgery and Diagnostic Science Department, Dental Hospital (Namuthajia) Riyadh, Kingdom of Saudi Arabia
| | - Kawther Al-Zawad
- BDS. Dental Intern, Riyadh Colleges of Dentistry and Pharmacy, Oral and Maxillofacial Surgery and Diagnostic Science Department, Dental Hospital (Namuthajia) Riyadh, Kingdom of Saudi Arabia
| | - Fatimah Al-Zawad
- BDS. Dental Intern, Riyadh Colleges of Dentistry and Pharmacy, Oral and Maxillofacial Surgery and Diagnostic Science Department, Dental Hospital (Namuthajia) Riyadh, Kingdom of Saudi Arabia
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Intraosseous anaesthesia in children with 4 % articaine and epinephrine 1:400,000 using computer-assisted systems. Eur Arch Paediatr Dent 2015; 16:477-81. [DOI: 10.1007/s40368-015-0197-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
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Goldschalt C, Doll S, Ihle B, Kirsch J, Mutzbauer TS. Intraosseous vascular access through the anterior mandible--a cadaver model pilot study. PLoS One 2014; 9:e112686. [PMID: 25405476 PMCID: PMC4236097 DOI: 10.1371/journal.pone.0112686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/10/2014] [Indexed: 11/19/2022] Open
Abstract
Background Several insertion sites have been described for intraosseous puncture in cases of emergencies when a conventional vascular access cannot be established. This pilot study has been designed to evaluate the feasibility of the mandibular bone for the use of an intraosseous vascular access in a cadaver model. Methodology/Principal Findings 17 dentistry and 16 medical students participating in a voluntary course received a short introduction into the method and subsequently used the battery powered EZ-IO system with a 15 mm cannula for a puncture of the anterior mandible in 33 cadavers. The time needed to perform each procedure was evaluated. India ink was injected into the accesses and during the anatomy course cadavers were dissected to retrace the success or failure of the puncture. Dental students needed 25.5±18.9(mean±standard deviation)s and medical students 33±20.4 s for the procedure (p = 0.18). Floor of mouth extravasation occurred in both groups in 3 cases. Success rates were 82 and 75% (p = 0.93). Conclusions/Significance Despite floor of mouth extravasation of injected fluid into a mandibular intraosseous access might severely complicate this procedure, the anterior mandible may be helpful as an alternative to other intraosseous and intravenous insertion sites when these are not available in medical emergencies.
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Affiliation(s)
- Christin Goldschalt
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
| | - Sara Doll
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
| | - Brit Ihle
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
| | - Joachim Kirsch
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
| | - Till Sebastian Mutzbauer
- University of Heidelberg, Institute for Anatomy and Cell Biology, Heidelberg, Germany
- Mutzbauer&Partner, Maxillofacial Surgery and Anesthesiology, Zuerich, Switzerland
- * E-mail:
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Monteiro MRFP, Groppo FC, Haiter-Neto F, Volpato MC, Almeida JFA. 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. Int Endod J 2014; 48:145-52. [PMID: 24702239 DOI: 10.1111/iej.12293] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/02/2014] [Indexed: 11/29/2022]
Abstract
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).
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Affiliation(s)
- M R F P Monteiro
- Endodontics Division, Department of Restorative Dentistry, Piracicaba Dental School, State University of Campinas, Piracicaba, SP, Brazil
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Effects of mepivacaine 2% with epinephrine in the cardiovascular activity of patients undergoing third molar surgery: a prospective clinical study. J Craniofac Surg 2013; 25:e9-12. [PMID: 24275775 DOI: 10.1097/scs.0b013e3182a2ec06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiovascular effects of epinephrine, especially on blood pressure (BP) and heart rate (HR), have been well documented. When present in dental local anesthetic solutions, epinephrine concentration ranges from 5 to 20 µg/mL. Doses less than 200 µg are recommended to be clinically safe. OBJECTIVES This study investigated the effects of the anesthetic solution of mepivacaine (2%) with epinephrine (10 µg/mL) in cardiovascular activity (HR and BP). METHODS Twenty-six patients underwent outpatient surgery for the removal of 2 unilateral (group I, n = 15) or 4 (group II, n = 11) third molars in a single session, being injected 5.4 and 10.8 mL of anesthetic solution, equivalent to 54 and 108 µg of epinephrine, respectively. The cardiovascular activity was monitored by cardioscope during the experimental period of 2 hours. Heart rate and BP were measured at the intervals of 0, 5, 10, 15, 20, 30, 40, 60, 90, and 120 minutes after anesthetic injection. RESULTS After application of 2-way analysis of variance test, comparison between groups was not statistically significant for HR (P = 0.1388), systolic BP (P = 0.0228), and diastolic BP (P = 0.9846). However, patients from group II presented significantly greater sway in HR (P < 0.0001), systolic BP (P = 0.0169), and diastolic BP (P < 0.0001) in the course of 2 hours. CONCLUSIONS Blood pressure did not present significant alterations after a local injection of 54 or 108 µg of epinephrine during surgery to remove 2 or 4 third molars. Although without significance, HR was more elevated in the 108-µg dose of epinephrine during the removal of 4 third molars.
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