Is nasopalatine nerve block still mandated for the extraction of maxillary anterior teeth?

Articaine versus Lidocaine in only buccal infiltration anesthesia for the extraction of mandibular anterior teeth. A prospective split-mouth randomized-controlled clinical study

OBJECTIVE

To investigate the effectiveness of a single labial infiltration of 4% articaine versus 2% lidocaine for the extraction of mandibular anterior teeth without an additional lingual injection.

PATIENTS AND METHODS

A prospective, randomized-controlled, split-mouth clinical study was implemented. Healthy adult patients seeking bilateral extraction of mandibular anterior teeth were included in this study. Teeth extractions were randomly assigned to two equal groups, where one mandibular anterior tooth was extracted using a solitary labial infiltration of either 4% articaine (the study group) or 2% lidocaine (the control group). After 14 days, the other mandibular anterior tooth was extracted using the other local anesthetic agent. The selection of the anesthetic agent injected in the first session was done in a randomized fashion. After 5 min of local anesthetic injection, the tooth was extracted, and each patient was asked to record the intensity of the extraction pain using the Visual Analogue Scale (VAS).

RESULTS

Thirty-one patients were included in the study. The efficacy of a single labial injection for mandibular anterior teeth extraction was established by the fact that none of the patients in the study or control group required re-administration of local anesthesia. The mean VAS for pain control during tooth extraction was 1.16 ± 0.93 for the articaine group and 1.71 ± 0.90 for the lidocaine group. The pain score showed a statistically significant decrease in the articaine group compared to that in the lidocaine group (P = 0.017).

CONCLUSION

Although the anesthetic effects of only buccal infiltration of 4% articaine and 2% lidocaine for extraction of mandibular anterior teeth were comparable, the use of 4% articaine would have more effective and predictable outcomes.

CLINICALTRIALS

ORG: (ID: NCT05223075) 3/2/2022.

Can Single Buccal Infiltration With 4% Articaine Induce Sufficient Analgesia for the Extraction of Maxillary Teeth? A Systematic Literature Review

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.

The Efficacy of 4% Articaine Versus 2% Lidocaine in Inducing Palatal Anesthesia for Tooth Extraction in Different Maxillary Regions

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.