Efficacy and safety of articaine versus lidocaine for irreversible pulpitis treatment: A systematic review and meta-analysis of randomised controlled trials

Comparing efficacy of curcumin with other treatment modalities in oral submucous fibrosis management - A systematic review and meta-analysis

BACKGROUND

Oral Submucous Fibrosis, OSF is an inflammatory mucosal disorder prevalent in areca nut chewing belts of the world. Although various treatments are available for its management, none provide complete resolution.Curcumin, an indigenous product, improves burning sensation, mouth opening along with other clinical signs of OSF and is potentially viable therapeutic option for its management.

OBJECTIVES

To assess the available evidence for employing curcumin in improving symptoms in patients with OSF.

METHODS

Systematic search was carried out in e-databases from January 2010 until July 2023 to identify relevant clinical trials comparing curcumin to active and/or nonactive controls (placebo) for the management of OSF.

RESULTS

A total of 20 studies were used for qualitative analysis out of which 11 studies were considered for quantitative synthesis.Curcumin was found to be highly effective in alleviating pain/burning sensation, improving mouth opening (MO), cheek flexibility, tongue protrusion and induces positive histological changes in patients with OSF.The standardized mean difference in mouth opening between both the Curcumin and Multivitamin group showed a statistically significant difference favouring the Curcumin group (SMD, 0.37, 95% CI = 0.18-0.56, p - 0.0001, I2- 0%).

CONCLUSION

Statistically curcumin was noted to be as effective as Aloe vera, lycopene and steroids in relieving symptoms of OSF in stages 1 and 2 and improving MO. It is seen to improve histopathological picture of lesions thereby suggesting its active role in preventing malignant transformation. Its found to be more effective than multivitamins in improving mouth opening of patients in OSF.

Survey investigation of articaine use in the United States

BACKGROUND

Local anesthesia is an essential component of dentistry, but there is limited quantifiable understanding of what techniques and local anesthetic solutions are used by practicing dentists. Use of the local anesthetic articaine has been highly debated in dentistry regarding its efficacy and risks for paresthesia. The aims of this study were to expand the knowledge of local anesthesia practices of dentists in the United States through a large-scale survey and associate potential influencing factors regarding articaine use specifically.

METHODS

The 23-item survey was sent to 10,340 practicing dentists in the United States, gathering demographic data and local anesthesia approaches and concerns. Statistical analysis consisted of descriptive, bivariate, and multivariate logistic regression analyses.

RESULTS

A total of 1,128 dentists completed the survey. Previous experience with articaine was reported by 97.6% of respondents, with 3.3% no longer using articaine. Sixty percent of respondents indicated using articaine for most local anesthetic injections administered. Multivariable regression analysis found those reporting to use articaine for all local anesthetic injections involving vasoconstrictors were more likely to be male (odds ratio, 1.59; P = .002) or general dentists (odds ratio, 1.63; P < .001).

CONCLUSIONS

Articaine has a perceived benefit to practitioners as most respondents reported using articaine as their primary local anesthetic. A practitioner's sex and type were found to affect the profile of use of articaine.

PRACTICAL IMPLICATIONS

Assembling evidenced-based local anesthesia practices would be beneficial to ensure US practitioners are more standardized in administering local anesthetics, particularly articaine, in the safest and most efficacious way.

Efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: An in vivo study

Aim

The aim of the present study was to assess the efficacy of articaine versus mepivacaine administered as different supplementary local anesthetic techniques after a failed inferior alveolar nerve block (IANB) with lidocaine in patients with irreversible pulpitis.

Materials and Methods

A total of 120 patients were included in the study. Patients were given IANB with 2 ml of 2% lidocaine hydrochloride with 1:80,000 epinephrine. Patients who showed subjective symptoms of IANB but did not secure pulpal anesthesia were randomly allocated to one of the following four groups by random sampling for supplementary local anesthesia - Group 1: buccal infiltration (BI) with 4% articaine with 1:100,000 epinephrine, Group 2: four-site intraligamentary (IL) injection with 4% articaine with 1:100,000 epinephrine, Group 3: BI with 2% mepivacaine with 1:100,000 epinephrine, and Group 4: four-site IL injection with 2% mepivacaine with 1:100,000 epinephrine.

Results

Group 1 - BI with articaine provided anesthesia success in 27 cases (90%, n = 30). Group 2 - IL injection with articaine provided anesthesia success in 20 cases (66.67%, n = 30). Group 3 - BI with mepivacaine provided anesthesia success in 21 cases (70%, n = 30). Group 4 - IL injection with mepivacaine provided anesthesia success in 15 cases (50%, n = 30). A significant difference between the four groups was found.

Conclusion

In patients with a mandibular first molar exhibiting symptomatic irreversible pulpitis, block injection with lidocaine along with supplemental BI with articaine allowed more pain-free treatments. Articaine showed better results when compared with mepivacaine.

Inferior Alveolar Nerve Block Success of 2% Mepivacaine versus 4% Articaine in Patients with Symptomatic Irreversible Pulpitis in Mandibular Molars: A Randomized Double-Blind Single-Centre Clinical Trial

AIM

To assess inferior alveolar nerve block (IANB) success of 2% mepivacaine (Scandonest 2%, Septodont, France) and 4% articaine (Septanest 4%, Septodont) in patients with symptomatic irreversible pulpitis (SIP) in mandibular molars during access cavity preparation and instrumentation.

METHODOLOGY

Three hundred and thirty patients with moderate-to-severe pain in mandibular molars with SIP randomly received either 3.6 mL 2% mepivacaine hydrochloride with 1:100 000 adrenalin or 3.4mL 4% articaine hydrochloride with 1:100 000 adrenalin (n=165). Intraoperative pain (IOP) intensity was assessed during access cavity preparation and canal instrumentation using 11-point numerical rating scale (NRS). Overall success was considered if the patient felt no-to-mild pain without the need of supplemental anaesthesia throughout treatment; the incidence of need for supplemental anaesthesia was also recorded. Data were statistically analyzed using Mann Whitney U and Chi² (χ² ) tests. Relative risk (RR) and 95% confidence interval (CI) of anaesthetic failure was calculated. The effect of predisposing factors on outcome variables was assessed using multivariable regression analyses. None of the participants reported any adverse effects.

RESULTS

Baseline variables were balanced between groups (p>0.05). The IOP intensity during access cavity preparation and canal instrumentation was similar for both groups (p>0.05). IOP intensity was associated with preoperative pain intensity and tooth type (p<0.05). Overall anaesthetic success rate was 35.8% for mepivacaine and 41.2% for articaine (p>0.05) with a relative risk of failure [95%CI] 1.09 [0.92, 1.30]. The need for supplemental anaesthesia occurred 43.6% and 38.2% with mepivacaine and articaine respectively (p>0.05; RR [95%CI]: 1.14 [0.88, 1.48]). Preoperative pain level and age were associated with the need for supplemental anaesthesia.

CONCLUSIONS

2% mepivacaine and 4% articaine demonstrate similar IANB success rates for mandibular molars with SIP. Intraoperative pain experience during endodontic treatment can be associated with preoperative pain, tooth type and age.

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

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

Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis

OBJECTIVE

The goal of this systematic review and meta-analysis is to determine the performance of 4% Articaine vs. 2% Lidocaine for mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis (IP).

METHODS

PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Gray were used to conduct a thorough literature search. A manual search of the reference lists of the publications found was also carried out. Two reviewers critically evaluated the papers for inclusion and exclusion criteria, and data extraction was done on the selected publications. The Cochrane Collaboration Tool and the Minors checklist were used to assess the quality of the selected studies for randomised controlled trials (RCTs) and non-randomised studies, respectively. The RevMan software was used to perform a meta-analysis of the pooled data and subgroups according to the technique of anaesthetic solution delivery, as well as a sensitivity analysis (P < 0.05).

RESULTS

A total of twenty-six papers were included in the qualitative synthesis, with twenty-two of them being included in the meta-analysis. There were fifteen studies with a low potential for bias, three with a moderate potential for bias, and seven with a high potential for bias. The combined results of the 19 trials in the tooth level unit revealed that 4% articaine had a success rate 1.37 times greater than 2% lidocaine for mandibular teeth (RR, 1.37; 95% CI [1.17-1.62]; P = 0.0002). For the maxillary buccal infiltration method, the combined results from the three trials revealed that 4% articaine resulted in a success rate 1.06 times greater than 2% lidocaine (RR, 1.06; 95% CI [0.95-1.2]; P = 0.3). Excluding subgroups with a single study in sensitivity analysis for mandibular teeth revealed a substantial improvement in the success rate of the articaine group in treating IP when compared to the lidocaine group.

CONCLUSION

The findings of this meta-analysis back up the claim that articaine is more effective than lidocaine in providing anaesthesia in patients with IP. PROSPERO Registration No.: CRD42020204606 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020204606).

Articaine in dentistry: an overview of the evidence and meta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment

OBJECTIVES

To comprehensively review the existing studies of articaine in dentistry and conduct a systematic review and meta-analysis to answer the following Population, Intervention, Comparison and Outcome question: "Is articaine a safe and efficacious local anaesthetic for routine dental treatment compared to lidocaine?"

METHODS

Database searches were conducted in Medline Ovid, Medline Pubmed, Scopus, Emcare, Proquest and the Cochrane Central register of Controlled Trials. Inclusion criteria were all existing English, human, randomised controlled trials of interventions involving 4% articaine and 2% lidocaine in routine dental treatment. Twelve studies were included for meta-analysis using Cochrane Review Manager 5 software. Anaesthetic success odds ratios were calculated using a random-effects model.

RESULTS

Articaine had a higher likelihood of achieving anaesthetic success than lidocaine overall and in all subgroup analyses with varying degrees of significance. Overall (OR: 2.17, 95% CI: 1.50, 3.15, I² = 62%) articaine had 2.17 times the likelihood of anaesthetic success of lidocaine (P < 0.0001). For mandibular blocks (OR: 1.50, 95% CI: 1.14, 1.98, I² = 0%) articaine had 1.5 times the likelihood of anaesthetic success of lidocaine (P = 0.004). For all infiltrations, maxillary and mandibular (OR: 2.78, 95% CI: 1.61, 4.79, I² = 66%) articaine had 2.78 times the likelihood of anaesthetic success of lidocaine (P = 0.0002). None of the studies reported any major local anaesthetic-related adverse effects as a result of the interventions.

CONCLUSIONS

Articaine is a safe and efficacious local anaesthetic for all routine dental procedures in patients of all ages, and more likely to achieve successful anaesthesia than lidocaine in routine dental treatment. Neither anaesthetic has a higher association with anaesthetic-related adverse effects.

Inferior alveolar nerve block: is articaine better than lidocaine?

This opinion article seeks to analyse current literature surrounding the question: is articaine better than lidocaine for inferior alveolar nerve blocks? It does so with regards to efficacy and risk of paraesthesia associated with administration.

United Kingdom pediatric dentistry specialist views on the administration of articaine in children

Background

Lidocaine is the gold standard local anesthetic (LA) for UK pediatric dental treatment. Recent reports suggest frequent Articaine use in Europe and Canada, with evidence indicating more profound anesthesia. The aim of this study was to examine pediatric dentistry specialist experiences and practices relating to Articaine administration in the UK.

Methods

A literature review was followed by a survey using an anonymous 15-item electronic questionnaire, which was sent to 200 registered British Society of Pediatric Dentistry (BSPD) specialists. Descriptive analyses, Z score, chi-squared test, Fisher's exact test, and Spearman's correlation test were performed.

Results

Sixty-one (30.5%) participants responded, and 12 (19.7%) indicated Articaine as their first line anesthetic. Articaine was used daily or weekly by 38 (62.3%) respondents, depending on the clinical context. Articaine was commonly used to avoid inferior alveolar nerve blocks and gain more profound anesthesia in abscessed or hypomineralized teeth. Participants reported significantly more adverse effects with lidocaine (Fisher's exact test, P < 0.0001) than with Articaine. Articaine was most often administered in children aged > 4 years via infiltration techniques. Only 15 (24.6%) respondents reported awareness of guidelines for Articaine use in pediatric patients.

Conclusions

Articaine use in pediatric dentistry is common; however, evidence supporting its practice is limited. Several specialists follow conventions based on anecdotal evidence. Formulating guidance to aid decision-making when treating pediatric patients under LA would be beneficial.

Does the Use of Articaine Increase the Risk of Hypesthesia in Lower Third Molar Surgery? A Systematic Review and Meta-Analysis

PURPOSE

The aim of this study was to assess the risk of hypesthesia with the use of articaine in comparison with other local anesthetics in lower third molar surgery, through a systematic review and meta-analysis.

METHODS

MEDLINE/PubMed, EMBASE, Cochrane Library (CENTRAL), Web of Science, and SCOPUS databases were searched. Gray literature and manual searches were also performed.

RESULTS

Altogether 342 articles were found; only 13 met the eligibility criteria. A total of 886 third molars were removed; 436 using articaine, 430 using other local anesthetics, and 20 using an anesthetic mixture. Altogether 5 cases of hypesthesia were found in the articaine group, with 4 temporary and 1 with no mention of nerve involved; there was no case of permanent confirmed hypesthesia. A total of 9 articles demonstrated a low risk of bias, and 4 articles showed some concern. The meta-analysis demonstrated a 3.96 relative risk for hypesthesia with the use of articaine compared with other local anesthetics, but this result was not statistically significant. The heterogeneity of the studies was low from a clinical, methodological, and statistical point of view.

CONCLUSIONS

Thus, this systematic review and meta-analysis suggests that the use of articaine does not increase the risk of hypesthesia compared with other local anesthetics in lower third molar extraction, and when present, this complication is temporary.

Interventions for anesthetic success in symptomatic irreversible pulpitis: A network meta-analysis of randomized controlled trials

Background

Local anesthetics alone or in combination with adjuncts, such as oral medications, have routinely been used for pain control during endodontic treatment. The best clinical choice amongst the vast numbers of agents and techniques available for pain control for irreversible pulpitis is unclear. This network meta-analysis combined the available evidence on agents and techniques for pulpal anesthesia in the maxilla and mandible, in order to identify the best amongst these approaches statistically, as a basis for future clinical trials.

Methods

Randomized trials in MEDLINE, DARE, and COCHRANE databases were screened based on inclusion criteria and data were extracted. Heterogeneity was assessed and odds ratios were used to estimate effects. Inconsistencies between direct and indirect pooled estimates were evaluated by H-statistics. The Grading of Recommendation, Assessment, Development, and Evaluation working group approach was used to assess evidence quality.

Results

Sixty-two studies (nine studies in the maxilla and 53 studies in the mandible) were included in the meta-analysis. Increased mandibular pulpal anesthesia success was observed on premedication with aceclofenac + paracetamol or supplemental 4% articaine buccal infiltration or ibuprofen+paracetamol premedication, all the above mentioned with 2% lignocaine inferior alveolar nerve block (IANB). No significant difference was noted for any of the agents investigated in terms of the success rate of maxillary pulpal anesthesia.

Conclusion

Direct and indirect comparisons indicated that some combinations of IANB with premedication and/or supplemental infiltration had a greater chance of producing successful mandibular pulpal anesthesia. No ideal technique for maxillary anesthesia emerged. Randomized clinical trials with increased sample size may be needed to provide more conclusive data. Our findings suggest that further high-quality studies are required in order to provide definitive direction to clinicians regarding the best agents and techniques to use for mandibular and maxillary anesthesia for irreversible pulpitis.

Different anesthetics on the efficacy of inferior alveolar nerve block in patients with irreversible pulpitis: A network systematic review and meta-analysis

BACKGROUND

The authors of this systematic review and meta-analysis aimed to evaluate the effect of different anesthetics on the efficacy of inferior alveolar nerve block (IANB) in patients with irreversible pulpitis.

TYPES OF STUDIES REVIEWED

The authors conducted a search of MEDLINE databases (PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials, Latin American and Caribbean Health Sciences Literature, and Brazilian Library of Dentistry). There was no restriction on publication year or idiom. The gray literature was also explored. The authors included only randomized clinical trials that compared different anesthetics in the efficacy of IANB in patients with irreversible pulpitis. The risk of bias was evaluated by using the Cochrane Collaboration's tool. A random-effects Bayesian mixed treatment comparison model was used to compare different anesthetic solutions in randomized clinical trials with low or unclear risk of bias. Heterogeneity was assessed by using Cochran Q test and I² statistics. Quality of evidence was assessed by using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

A total of 7,981 studies were identified; only 16 met the eligibility criteria, and they were all meta-analyzed. A significant difference was observed in the pair lidocaine versus articaine, with higher success with articaine (risk ratio, 0.76; 95% confidence interval, 0.63 to 0.88) in the mixed treatment comparison analysis, as this comparison was graded as high-quality evidence. The probability of success for each treatment was 73% for articaine, 57% for prilocaine, 55% for mepivacaine, 53% for bupivacaine, and 12% for lidocaine. This ranking was considered high quality of evidence.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The use of articaine can increase the IANB success rate in patients with irreversible pulpitis. Among the anesthetic solutions, lidocaine was the least effective.

Role(s) of cytokines in pulpitis: Latest evidence and therapeutic approaches

Pulpitis is known as a typical inflammation of dental pulp tissue, and microorganisms of the oral microbiome are involved in this opportunistic infection. Studies indicated that several factors related to host response have a crucial role in pulpitis. Among these factors, inflammatory mediators of the immune system such as cytokines and chemokines contribute to pulpal defense mechanisms. A wide range of cytokines have been observed in dental pulp and these small molecules are able to trigger inflammation and participate in immune cell trafficking, cell proliferation, inflammation, and tissue damage in pulp space. Therefore, the aim of this review was to describe the role of cytokines in the pathogenesis of pulpitis.

Analgesic efficacy of articaine hydrochloride for velvet antler removal in red deer (Cervus elaphus) and analysis of drug residues in the harvested velvet antlers

AIMS

To investigate the analgesic efficacy of articaine hydrochloride for antler removal in red deer (Cervus elaphus) following S/C administration as a ring block, and to quantify the residue concentrations of articaine compared to lignocaine in the harvested antlers.

METHODS

Articaine hydrochloride (40 mg/mL) was administered to 10 male red deer as a ring block around the base of each antler at 1 mL/cm of pedicle circumference. Analgesia was evaluated by determining the response to a saw cut test every 1-minute, until no response was observed. Behaviour during and following removal of antlers was also recorded. Twenty commercially harvested velvet antlers were also collected following S/C administration of 2% lignocaine hydrochloride. A liquid chromatography-mass spectrometry (LC-MS) method for quantification of residues of articaine and lignocaine in velvet antlers was developed and validated.

RESULTS

In red deer administered 4% articaine hydrochloride as a ring block, the median interval to analgesia was 4 (min 3, max 5) minutes and no deer showed withdrawal responses during antler removal. There were no signs of toxicity or adverse effects up to 2 hours after administration. The sample preparation method developed for the LC-MS was simple and had acceptable extraction recoveries of articaine and lignocaine from the velvet antlers. The lower limits of quantification of lignocaine and articaine were 5 and 50 ng/g, respectively. Mean concentrations of articaine in antlers following ring block with 4% articaine hydrochloride were 1.50 (SD 1.09) mg/kg, and of lignocaine following ring block with 2% lignocaine hydrochloride were 0.66 (SD 0.71) mg/kg.

CONCLUSIONS AND CLINICAL RELEVANCE

A ring block with 4% articaine hydrochloride at a dose of 1 mL/cm of pedicle circumference provided effective analgesia for velvet antler removal in red deer. The LC-MS method developed and validated to quantify articaine and lignocaine was simple and sensitive. Based on these results, articaine hydrochloride appears to be an effective alternative to lignocaine hydrochloride for velvet antler removal. However, further studies to evaluate the safety and residue concentrations of articaine and articainic acid are required before it can be recommended for use in deer.Abbreviations: DMA: 2,6-dimethylaniline; LC-MS: Liquid chromatography-mass spectrometry; MEGX: Monoethylglycinexylidide; MRL: Maximum residue level.

PRISMA for abstracts: best practice for reporting abstracts of systematic reviews in Endodontology

An abstract is a brief overview of a scientific, clinical or review manuscript as well as a stand-alone summary of a conference abstract. Scientists, clinician-scientists and clinicians rely on the summary information provided in the abstracts of systematic reviews to assist in subsequent clinical decision-making. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Abstracts checklist was developed to improve the quality, accuracy and completeness of abstracts associated with systematic reviews and meta-analyses. The PRISMA for Abstracts checklist provides a framework for authors to follow, which helps them provide in the abstract the key information from the systematic review that is required by stakeholders. The PRISMA for Abstracts checklist contains 12 items (title, objectives, eligibility criteria, information sources, risk of bias, included studies, synthesis of results, description of the effect, strength and limitations, interpretation, funding and systematic review registration) under six sections (title, background, methods, results, discussion, other). The current article highlights the relevance and importance of the items in the PRISMA for Abstracts checklist to the specialty of Endodontology, while offering explanations and specific examples to assist authors when writing abstracts for systematic reviews when reported in manuscripts or submitted to conferences. Strict adherence to the PRISMA for Abstracts checklist by authors, reviewers, and journal editors will result in the consistent publication of high-quality abstracts within Endodontology. This article is protected by copyright. All rights reserved.

Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: A systematic review and meta-analysis

The aim of the present systematic review and meta-analysis was to address the following Population, Intervention, Comparison, and Outcome question: Is the efficacy of articaine better than lignocaine in adults requiring dental treatment? Four percent articaine was compared with 2% lignocaine for maxillary and mandibular infiltrations and block anesthesia, and with the principal outcome measures of anesthetic success. Using RevMan software, the weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared using a random-effects model. For combined studies, articaine was more likely to achieve successful anesthesia than lignocaine (N = 18, odds ratio [OR]: 1.92, 95% CI: 1.45-2.56, P < 0.00001, I²  = 32%). Maxillary and mandibular infiltration studies showed obvious superiority of articaine to lignocaine (N = 8, OR: 2.50, 95% CI: 1.51-4.15, P = 0.0004, I²  = 41%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lignocaine (N = 5, OR: 1.69, 95% CI: 0.88-3.23, P = 0.11, I²  = 19%). For combined mandibular anesthesia studies, articaine was superior to lignocaine (N = 14, OR: 1.99, 95% CI: 1.45-2.72, P < 0.0001, I²  = 32%), with further subgroup analysis showing significant differences in both mandibular block anesthesia (N = 11, OR: 1.55, 95% CI: 1.19-2.03, P = 0.001), I²  = 0%) and mandibular infiltration (N = 3, OR: 3.87, 95% CI: 2.62-5.72, P < 0.00001, I²  = 0%), indicating that articaine is more effective than lignocaine in providing anesthetic success in routine dental procedures.

Preclinical application of recombinant human bone morphogenetic protein 2 on bone substitutes for vertical bone augmentation: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Recombinant human bone morphogenetic protein 2 (rhBMP-2) has been introduced to clinical practice because of its osteoinductive capacity. However, the evidence of its efficacy in vertical bone augmentation procedures is not clear.

PURPOSE

The purpose of this systematic review and meta-analysis was to investigate the efficacy of rhBMP-2 in vertical bone augmentation and to establish whether its addition in preclinical experiments (animal studies) would be sufficient to justify further clinical and histometric studies.

MATERIAL AND METHODS

An electronic search of 3 databases, PubMed/MEDLINE, EMBASE, and Web of Science, and a manual search of the reference list of relevant studies were performed. Only randomized controlled trials regarding animal studies comparing the efficacy of bone grafts supplemented with and without rhBMP-2 in vertical bone augmentation procedures were included and reviewed.

RESULTS

Nine studies were included. The results of the meta-analysis showed that the pooled weighted mean difference (WMD) of the percentage of newly formed bone was 9.97% (95% confidence interval [CI]=-0.79% to 20.72%; P=.070), the WMD of the percentage of residual materials was -21.31% (95% CI=-70.62% to 28.00%; P=.400), the WMD of the augmented bone height was 1.70 mm (95% CI=-0.23 to 3.63 mm; P=.080), the WMD of the augmented bone height for studies with space-providing barriers was 1.00 mm (95% CI=0.43 to 1.57 mm; P<.001), and the WMD of the percentage of regenerated tissue was 17.07% (95% CI=8.52% to 25.62%; P<.001).

CONCLUSIONS

The application of rhBMP-2 in bone substitutes did not enhance new bone formation and residual graft resorption in vertical bone augmentation procedures. Tissue regeneration and the augmented bone height were significantly improved by the additional use of BMP-2.

Efficacy of dental local anesthetics: A review

The objective of this review was to investigate the efficacy of dental local anesthetics, as it is well known among clinicians that local anesthesia may be challenging in some circumstances. Therefore, the focus of this review was on the efficacy of the products used in dental local anesthesia.

In a Pubmed database literature search conducted, a total of 8646 articles were found to be related to dental local anesthetics. After having applied the inclusion criteria (human research, performed in the last 10 years, written in English language, and focus on dental local anesthetics) and having assessed the quality of the papers, 30 were deemed eligible for inclusion in this review.

The conclusion of this review is that none of the dental local anesthetic amides provide 100% anesthesia. The problem appears to be more pronounced when mandibular teeth are attempted to be anaesthetized and especially if there is irreversible pulpitis involved. The authors conclude that this finding suggest exploration of more efficient techniques to administer dental local anesthesia, especially in the mandible, to establish a 100% efficacy, is needed.

Injectable local anaesthetic agents for dental anaesthesia

BACKGROUND

Pain during dental treatment, which is a common fear of patients, can be controlled successfully by local anaesthetic. Several different local anaesthetic formulations and techniques are available to dentists.

OBJECTIVES

Our primary objectives were to compare the success of anaesthesia, the speed of onset and duration of anaesthesia, and systemic and local adverse effects amongst different local anaesthetic formulations for dental anaesthesia. We define success of anaesthesia as absence of pain during a dental procedure, or a negative response to electric pulp testing or other simulated scenario tests. We define dental anaesthesia as anaesthesia given at the time of any dental intervention.Our secondary objective was to report on patients' experience of the procedures carried out.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2018, Issue 1), MEDLINE (OVID SP), Embase, CINAHL PLUS, WEB OF SCIENCE, and other resources up to 31 January 2018. Other resources included trial registries, handsearched journals, conference proceedings, bibliographies/reference lists, and unpublished research.

SELECTION CRITERIA

We included randomized controlled trials (RCTs) testing different formulations of local anaesthetic used for clinical procedures or simulated scenarios. Studies could apply a parallel or cross-over design.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodological approaches for data collection and analysis.

MAIN RESULTS

We included 123 studies (19,223 participants) in the review. We pooled data from 68 studies (6615 participants) for meta-analysis, yielding 23 comparisons of local anaesthetic and 57 outcomes with 14 different formulations. Only 10 outcomes from eight comparisons involved clinical testing.We assessed the included studies as having low risk of bias in most domains. Seventy-three studies had at least one domain with unclear risk of bias. Fifteen studies had at least one domain with high risk of bias due to inadequate sequence generation, allocation concealment, masking of local anaesthetic cartridges for administrators or outcome assessors, or participant dropout or exclusion.We reported results for the eight most important comparisons.Success of anaesthesiaWhen the success of anaesthesia in posterior teeth with irreversible pulpitis requiring root canal treatment is tested, 4% articaine, 1:100,000 epinephrine, may be superior to 2% lidocaine, 1:100,000 epinephrine (31% with 2% lidocaine vs 49% with 4% articaine; risk ratio (RR) 1.60, 95% confidence interval (CI) 1.10 to 2.32; 4 parallel studies; 203 participants; low-quality evidence).When the success of anaesthesia for teeth/dental tissues requiring surgical procedures and surgical procedures/periodontal treatment, respectively, was tested, 3% prilocaine, 0.03 IU felypressin (66% with 3% prilocaine vs 76% with 2% lidocaine; RR 0.86, 95% CI 0.79 to 0.95; 2 parallel studies; 907 participants; moderate-quality evidence), and 4% prilocaine plain (71% with 4% prilocaine vs 83% with 2% lidocaine; RR 0.86, 95% CI 0.75 to 0.99; 2 parallel studies; 228 participants; low-quality evidence) were inferior to 2% lidocaine, 1:100,000 epinephrine.Comparative effects of 4% articaine, 1:100,000 epinephrine and 4% articaine, 1:200,000 epinephrine on success of anaesthesia for teeth/dental tissues requiring surgical procedures are uncertain (RR 0.85, 95% CI 0.71 to 1.02; 3 parallel studies; 930 participants; very low-quality evidence).Comparative effects of 0.5% bupivacaine, 1:200,000 epinephrine and both 4% articaine, 1:200,000 epinephrine (odds ratio (OR) 0.87, 95% CI 0.27 to 2.83; 2 cross-over studies; 37 participants; low-quality evidence) and 2% lidocaine, 1:100,000 epinephrine (OR 0.58, 95% CI 0.07 to 5.12; 2 cross-over studies; 31 participants; low-quality evidence) on success of anaesthesia for teeth requiring extraction are uncertain.Comparative effects of 2% mepivacaine, 1:100,000 epinephrine and both 4% articaine, 1:100,000 epinephrine (OR 3.82, 95% CI 0.61 to 23.82; 1 parallel and 1 cross-over study; 110 participants; low-quality evidence) and 2% lidocaine, 1:100,000 epinephrine (RR 1.16, 95% CI 0.25 to 5.45; 2 parallel studies; 68 participants; low-quality evidence) on success of anaesthesia for teeth requiring extraction and teeth with irreversible pulpitis requiring endodontic access and instrumentation, respectively, are uncertain.For remaining outcomes, assessing success of dental local anaesthesia via meta-analyses was not possible.Onset and duration of anaesthesiaFor comparisons assessing onset and duration, no clinical studies met our outcome definitions.Adverse effects (continuous pain measured on 170-mm Heft-Parker visual analogue scale (VAS))Differences in post-injection pain between 4% articaine, 1:100,000 epinephrine and 2% lidocaine, 1:100,000 epinephrine are small, as measured on a VAS (mean difference (MD) 4.74 mm, 95% CI -1.98 to 11.46 mm; 3 cross-over studies; 314 interventions; moderate-quality evidence). Lidocaine probably resulted in slightly less post-injection pain than articaine (MD 6.41 mm, 95% CI 1.01 to 11.80 mm; 3 cross-over studies; 309 interventions; moderate-quality evidence) on the same VAS.For remaining comparisons assessing local and systemic adverse effects, meta-analyses were not possible. Other adverse effects were rare and minor.Patients' experiencePatients' experience of procedures was not assessed owing to lack of data.

AUTHORS' CONCLUSIONS

For success (absence of pain), low-quality evidence suggests that 4% articaine, 1:100,000 epinephrine was superior to 2% lidocaine, 1:100,000 epinephrine for root treating of posterior teeth with irreversible pulpitis, and 2% lidocaine, 1:100,000 epinephrine was superior to 4% prilocaine plain when surgical procedures/periodontal treatment was provided. Moderate-quality evidence shows that 2% lidocaine, 1:100,000 epinephrine was superior to 3% prilocaine, 0.03 IU felypressin when surgical procedures were performed.Adverse events were rare. Moderate-quality evidence shows no difference in pain on injection when 4% articaine, 1:100,000 epinephrine and 2% lidocaine, 1:100,000 epinephrine were compared, although lidocaine resulted in slightly less pain following injection.Many outcomes tested our primary objectives in simulated scenarios, although clinical alternatives may not be possible.Further studies are needed to increase the strength of the evidence. These studies should be clearly reported, have low risk of bias with adequate sample size, and provide data in a format that will allow meta-analysis. Once assessed, results of the 34 'Studies awaiting classification (full text unavailable)' may alter the conclusions of the review.

Methodological and Reporting Quality of Systematic Reviews and Meta-analyses in Endodontics

INTRODUCTION

The aim of this systematic review (SR) was to evaluate the quality of SRs and meta-analyses (MAs) in endodontics.

METHODS

A comprehensive literature search was conducted to identify relevant articles in the electronic databases from January 2000 to June 2017. Two reviewers independently assessed the articles for eligibility and data extraction. SRs and MAs on interventional studies with a minimum of 2 therapeutic strategies in endodontics were included in this SR. Methodologic and reporting quality were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), respectively. The interobserver reliability was calculated using the Cohen kappa statistic. Statistical analysis with the level of significance at P < .05 was performed using Kruskal-Wallis tests and simple linear regression analysis.

RESULTS

A total of 30 articles were selected for the current SR. Using AMSTAR, the item related to the scientific quality of studies used in conclusion was adhered by less than 40% of studies. Using PRISMA, 3 items were reported by less than 40% of studies, which were on objectives, protocol registration, and funding. No association was evident comparing the number of authors and country with quality. Statistical significance was observed when quality was compared among journals, with studies published as Cochrane reviews superior to those published in other journals. AMSTAR and PRISMA scores were significantly related.

CONCLUSIONS

SRs in endodontics showed variability in both methodologic and reporting quality.

Double-blind, randomized controlled clinical trial on analgesic efficacy of local anesthetics articaine and bupivacaine after impacted third molar extraction

OBJECTIVE

The objective of this randomized controlled clinical trial (RCT) was to compare the effect of bupivacaine and articaine at habitual doses on pain intensity and the need for analgesics after lower third molar extraction.

MATERIALS AND METHODS

The final study sample comprised 50 Caucasian volunteers (26 males and 24 females; age range, 18-30 years) undergoing scheduled surgical extraction of impacted lower third molar. A computer-generated random sequence was used to allocate participants to the articaine (4%) or bupivacaine (0.5%) group. Surgeons and patients were blinded by labeling the articaine and bupivacaine carpules with numbers (1 and 2, respectively). Postoperative pain intensity (primary outcome) was evaluated with a visual analogue scale (VAS), while the requirement for and timing of rescue medication and the quality of intraoperative anesthesia were also measured (secondary outcomes).

RESULTS

VAS-measured pain intensity was significantly higher (p < 0.05) in the articaine group than in the bupivacaine group at all time points except for 8 h post-surgery (p = 0.052). Rescue medication was required by 13 (52%) patients in the articaine group and 8 (32%) patients in the bupivacaine group, although the difference did not reach statistical significance (p = 0.252). The groups did not significantly differ (p = 0.391) in the quality of the intraoperative anesthesia.

CONCLUSIONS

Bupivacaine is a valid alternative to articaine in third molar surgery and may offer residual anesthesia as a means of reducing postoperative pain. However, further well-designed RCTs are required in larger study populations to verify the effectiveness of bupivacaine to achieve residual analgesia after oral surgery.

CLINICAL RELEVANCE

These findings suggest that bupivacaine may be useful as a coadjuvant to control acute postoperative pain.

TRIAL REGISTRATION

ACTRN12617001138370.