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Comparison of articaine and prilocaine anesthesia by infiltration in maxillary and mandibular arches
Abstract
Claims that labial infiltration of the local anesthetic articaine HCl (Ultracaine DS) results in anesthesia of mandibular pulpal as well as maxillary and mandibular lingual soft tissue have never been scientifically substantiated. The aim of this investigation was to evaluate these claims, by comparing articaine to a standard anesthetic, prilocaine HCl (Citanest Forte). To investigate this, a double blind, randomized study was conducted in healthy adult volunteers. In each volunteer, the ability to induce maxillary and mandibular anesthesia following labial infiltration with articaine was compared to prilocaine given contralaterally. Anesthesia was determined by measuring sensation to electrical stimulation at the tooth, labial and lingual soft tissue for each of the 4 non-carious, non-restored, canines. Results showed that mandibular canine pulpal anesthesia had a success rate of 65% for articaine and 50% for prilocaine. Success rates for palatal and lingual anesthesia averaged 5% for each agent. As determined by chi-square analysis, no statistically significant differences were found between articaine and prilocaine for any tissue at any of the 6 sites (P greater than 0.05). A time-course assessment also failed to demonstrate a difference between the two drugs. Therefore these data are not consistent with superior anesthesia efficacy being produced by articaine at any site, including the mandibular pulpal, lingual or maxillary palatal tissues, in the canine teeth studied.
... The reasons for exclusion for 51 full-text articles are listed in Table S3. The number of included trials and participants were as follows: i) maxillary buccal infiltration: 19 trials, 793 participants [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], ii) mandibular buccal infiltration: 10 trials, 465 participants [25,26,[38][39][40][41][42][43][44][45], and iii) IANB: 16 trials, 477 participants [35,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. ...
... The reasons for exclusion for 51 full-text articles are listed in Table S3. The number of included trials and participants were as follows: i) maxillary buccal infiltration: 19 trials, 793 participants [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], ii) mandibular buccal infiltration: 10 trials, 465 participants [25,26,[38][39][40][41][42][43][44][45], and iii) IANB: 16 trials, 477 participants [35,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. ...
... Of the 42 articles selected, 2 [29,30] had an identical control arm; hence, these were analyzed as a single trial with 3 arms. Of a total of 41 trials, 2 had a parallel-group design [29,49], another 4 had a split-mouth design [25,26,35,48], and the remaining 35 had a crossover design [19][20][21][22][23][24]27,28,[31][32][33][34][36][37][38][39][40][41][42][43][44][45][46][47][50][51][52][53][54][55][56][57][58][59][60]. The LA was tested with various tooth types, mostly in young adults. ...
Objectives:
This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth.
Materials and methods:
Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application.
Results:
The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14-3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates.
Conclusions:
Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.
... [2][3][4] In irreversible pulpitis, the success rate of IANB ranges only from 19% to 56%. [5] The possible reason for the failure of IANB could be due to the existing inflammatory activation of nociceptors, [6,7] anatomic variations like cross and accessory innervations, [8][9][10][11] and tachyphylaxis due to anesthetic solutions. [11] Therefore, it would be highly desirable to improve the success rate of IANB in endodontics. ...
... [15] A study by Haas et al. found no statistical differences between 4% articaine and 4% prilocaine infiltrations in mandibular canines and second molars IN in asymptomatic patients. [8,9] Also, Kanaa et al. showed that 4% articaine (64.5%) produced more effective pulpal anesthesia than 2% lidocaine (38.7%) in mandibular molars after buccal infiltration in asymptomatic subjects. [10] Several studies compared articaine either as primary IANB or as supplemental infiltration alone. ...
... [14,16] Articaine with increased liposolubility and increased degree of dissociation along with the presence of unique thiophene ring instead of benzene ring which is not possessed by other amide groups and it may facilitate better diffusion through soft and hard tissues more reliably than other local anesthetics. [8,14,24] The results also showed that supplemental buccal infiltration had increased the success rate for lidocaine and articaine compared to lidocaine IANB alone. This is in concurrence with previous studies, which showed that addition of supplemental buccal infiltration to IANB resulted in increased success rate. ...
Purpose:
This prospective, randomized, double-blinded study was conducted to compare the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine and 4% articaine with 1:200,000 epinephrine in inferior alveolar nerve block (IANB) combined with buccal infiltration in patients with irreversible pulpitis.
Methods:
Group I: Thirty patients received IANB of 2% lidocaine without buccal infiltration. Group II: Thirty patients received IANB of 2% lidocaine followed by buccal infiltration with 2% lidocaine. Group III: Thirty patients received IANB with 4% articaine followed by buccal infiltration with 4% articaine. Pain during the procedures was recorded by using a Heft Parker visual analog scale. No pain or mild pain on endodontic access was recorded as success and analyzed using Chi-square analysis.
Results:
Group I obtained 30% success rate. Fifty percent successful anesthesia was obtained for Group II. The success rate was increased to 70% for Group III with statistically significant difference among all the groups (P < 0.05).
Conclusion:
The use of 4% articaine as both IANB and buccal infiltration recorded the highest success rate (70%) when compared to either 2% lidocaine as IANB with buccal infiltration (50%) or 2% lidocaine as IANB alone (30%) in patients with irreversible pulpitis.
... Felypressin is weak vasoconstriction because it constricts venous outflow. [15] However, adrenaline is strong vasoconstriction because it constricts artery inflow. [14] Felypressin is similar to oxytocin, and it can induce oxytocic action on the uterus. ...
... Prilocaine is as effective as lidocaine and articaine for use in dentoalveolar surgery. [1,15,20] Prilocaine is safer than lidocaine and articaine because it is considered as the least vasodilator agent. [20] So, it has less toxicity and few hemodynamic effects making it a good choice for use in children, elderly people, and patients who have contraindications to the use of local anesthesia with adrenaline. ...
... However, 2% lidocaine, 1: 100,000 epinephrine was stronger than 4% prilocaine plain when used for the anesthesia of surgical procedures. [1] Moreover, a clinical trial was conducted in volunteers by Hass et al. [15] to compare the anesthetic efficacy of 4% articaine and 4% prilocaine when injected by infiltration technique to anesthetize the upper and lower teeth. The outcome of the study by Hass et al. reported that articaine was equivalent to prilocaine with respect to the ability to induce anesthesia of labial, lingual, and pulpal tissues when administered by labial infiltration. ...
Objective:
To compare the anesthetic performances of 3% prilocaine and 4% articaine when used for the extraction of the maxillary teeth.
Materials and methods:
Ninety-five patients, aged between 16 and 70 years, were included in this study. Patients were divided into two groups. Group one received articaine 4% with 1:00.000 adrenaline. Group two received prilocaine with 3% felypressin (0.03 I.U. per ml). Onset time of anesthesia was objectively evaluated by using electronic pulp testing.
Results:
Eighty-five patients in this study had a successful local anesthetic followed by extraction within the study duration time (10 minutes). However, there were six patients with failure anesthesia (5 in prilocaine group and 1 in articaine group). By applying Person's Chi-square test (x2), there were no significant differences in the number of episodes of the anesthetic success between articaine and prilocaine groups at time intervals (P = 0.5). T-test showed that there have been no important variations within the mean onset time of anesthesia for articaine and prilocaine buccal infiltrations (P = 0.1).
Conclusions:
3% Prilocaine with felypressin is as effective as 4% articaine with adrenaline when used for the extraction of maxillary teeth. Recommendations would be given to the dental practitioners to use prilocaine more frequently than articaine because of its low toxicity.
Trial registration number:
NCT04236115.
... This technique is relatively complex and has drawbacks, including a high failure rate (15%-20%), and complications such as trismus, haematoma, and paraesthesia. 3 Another shortcoming is the unnecessary anaesthesia of all branches of the nerve in cases in which only a small area needs to be anaesthetised. In some patients clinicians also prefer not to anaesthetise the lower lip to prevent accidental biting (as in children and the elderly). ...
... Research workers have therefore been in search of effective anaesthetic agents to provide adequate depth of anaesthesia by mandibular buccal infiltration. 3,4 Articaine hydrochloride was first introduced as carticaine in 1976, and marketed in Germany. 5 It is an amide anaesthetic agent and has a thiophene ring instead of a benzene ring, which is the reason that it differs from other anaesthetic agents. ...
... Hass et al failed to confirm the efficacy of articaine for anaesthesia of the palatal and lingual surfaces, and found no significant difference between equal doses of articaine and prilocaine. 3 Their findings were in line with our results, although they used an electric pulp tester, and evaluated the anterior teeth. Nuzum et al compared the efficacy of labial and lingual infiltration anaesthesia for mandibular incisors, and showed that although buccal infiltration seemed relatively successful, bilateral buccal and lingual infiltration anaesthesia was more effective. ...
It is hard to provide adequate anaesthesia by infiltration of lidocaine into the mandible because of the thick buccal cortex. An inferior alveolar nerve block is often used but has a high failure rate, which has led research workers to look for an anaesthetic agent that will anaesthetise the lower teeth by buccal infiltration alone. We have assessed the efficacy of buccal infiltration anaesthesia with articaine by designing a double-blind controlled clinical trial in 133 patients who required extraction of mandibular molars. They were randomly divided into two groups and given infiltration anaesthesia with either 4% articaine or 2% lidocaine by a single injection deep into the mucobuccal fold at the site of the tooth. After five minutes the mesial, distal, buccal, and lingual sides of the tooth were probed. Pain at this time or later during dissection of soft tissue by periosteal elevator was considered as failure, and an inferior alveolar nerve block was given. The amount of pain, and the number of patients who developed pain, were significantly greater in the group given 2% lidocaine (p<0.001). The two groups did not differ significantly in age or sex. Articaine is more successful in providing adequate depth of anaesthesia, but its efficacy was not sufficient to replace an inferior alveolar nerve block for extraction of mandibular molars (Registration code: IRCT2016062627111N2).
... To achieve pulpal anesthesia, electric pulp testing must be done on critical teeth. The pulp tester reading of 80 was also cited by Haas et al. [15] as the standard for pulpal anesthesia in the aforementioned research. Vishal et al. [16] and Bansal et al. [17] also observed similar findings, and the degree to which an anesthetic binds to proteins determines how long the effect lasts. ...
... Several studies have shown similar results with articaine having a higher duration of action compared to that of lignocaine, and it was attributed to the role of thiophene ring in the articaine group [12,[14][15][16]. According to the studies by Potocnik et al. [18] and Borchard et al. [19] articaine has more potency in blocking A fibers than of lignocaine. ...
Introduction
Local anesthesia plays a crucial role in ensuring patient comfort during orthodontic extractions. Among the various local anesthetic agents commonly used in the field of oral surgery are articaine and lidocaine, which differ in their duration of action and pain effectiveness (pain control) during surgical procedures. This article aimed to analyze the characteristics of 2% lignocaine with 1:80000 adrenaline and 4% articaine with 1:100000 adrenaline regarding duration of action and pain control in patients undergoing bilateral orthodontic maxillary premolar extractions.
Materials and methods
A split-mouth comparative study was conducted at Saveetha Dental College and Hospitals, Chennai, for which 50 patients of age less than 30 years and who required bilateral orthodontic premolar extractions were selected. Approximately 4% articaine hydrochloride solution was administered on one side, and 2% lignocaine hydrochloride was administered on the contralateral side. Palatal infiltration was not given in the articaine group. The degree of extraction difficulty was similar in both groups, with no discernible variation. In each patient, the duration of anesthesia and pain control were assessed. The IBM Statistical Package for Social Sciences (SPSS version 24.0, IBM SPSS Statistics for Windows, Armonk, NY) was used to perform the student's paired t-test for detecting the difference in outcome parameters between the two groups.
Results
Upon comparing both groups, it was concluded that the articaine group had a longer mean anesthetic duration of action of 217 minutes, whereas for the lignocaine group, it was 169 minutes, and greater pain reduction was present with the articaine group. The articaine group exhibited less pain (superior pain control) with a mean visual analogue scale (VAS) score of 1.07 compared to that of the lignocaine group with a mean VAS score of 1.53 during orthodontic premolar extractions. Both the results were statistically significant (P=0.001).
Conclusion
This split-mouth comparative study concludes that articaine is a more effective local anesthetic in terms of duration of action and pain reduction than that of lignocaine, and it can be used as a local anesthetic of choice for orthodontic maxillary premolar extractions.
... Other studies also compared articaine to different anesthetics, such as the one conducted by Haas et al 20 , who compared articaine with adrenaline 1:200 000 to prilocaine with same adrenaline concentration. The aim of their study was to test the claims that labial injection of articaine is enough to provide anesthesia for mandibular teeth (pulpal anesthesia) as well as lingual and palatal soft tissue. ...
... The determination was made by measuring sensation to electrical stimulation at the teeth, lingual and labial soft tissue for canines and second molars. There were no statistically significant differences 20 . ...
... Heterogeneity: I 2 = 0%, t 2 = < 0.0001, P = . 39 Aggarwal and Colleagues, 36 2017 ...
... 18 The presence of a thiophene ring in the articaine molecule, instead of the usual benzene ring, increases the liposolubility of the anesthetic, as well as its potency. 38,39 Lidocaine hydrochloride is the most widely used local anesthetic for routine dental procedures, as its good pharmacokinetic properties provide a safe anesthetic solution with low toxicity compared with other amide-type anesthetics 40 ; however, teeth with irreversible pulpitis often require a greater concentration of anesthetic, direct pulpal anesthesia, or even the use of another rescue anesthetic product. ...
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.
... Due to the buccal cortical bone thickness and the width of alveolar bone in the posterior area of the mandible, infiltration anesthetic approaches were not successful for pulpal anesthesia. 19 So, for pulpal anesthesia of teeth in this area, IANB technique was required. However, block anesthesia was significantly more painful and more difficult to be injected where cooperation in children is inadequate particularly that the behavior of children 3-5 years old sometimes turned negative following the block injection. ...
... Regarding the success rate of articaine in this study, it ranged between 86.7% for complex cases to 95% in simple cases when used as infiltration anesthesia in children utilizing dental treatment in mandibular posterior teeth. This result is similar to that reported by Robertson et al, where successful pulpal anesthesia ranged from 75 to 92 %, 21 but it was higher than that 65% of Corbett et al, 22 for mandibular first molar and Haas et al, 19 for mandibular canine in adults.The success rate of 4% articaine infiltration was also found to be similar to 2% lidocaine IANB, 22,23 except in one study when pulpotomies were performed in the mandibular second primary molar, where articaine infiltration proved to be unreliable regardless of age. 20 This high success was not seen with lidocaine buccal infiltration in the mandible in our study. ...
Objective: The purpose of this study was to compare the effectiveness of 4% articaine to 2% lidocaine as buccal infiltration anesthesia during dental treatment of teeth in the mandibular posterior region in pediatric patients above 6 years. Materials and methods: This prospective, randomized, split-mouth clinical study was conducted on 70 children, from 6 to 12 years old, requiring dental treatment for bilateral mandibular primary molars or first permanent molar. Children were randomly assigned to receive buccal infiltrations of either 4 % articaine on one side or 2 % lidocaine on the other side, both with 1: 100,000 epinephrine, at two separate visits. Pulpal anesthesia was assessed using electric pulp tester (EPT), and anesthesia was considered successful when two consecutive maximum output readings were obtained with no child response within 9 minutes. Children's self report of pain was assessed using the Wong-Baker FACES pain rating scale. Results: Using the EPT, the success of articaine (91.4%) was statistically significantly higher than that of the lidocaine (52.9%) (P=0.002). Articaine in the cases of pulpotomy as well as in simple dental procedures cases showed a statistically significantly higher success rate (86.7%) and (95%) than lidocaine (46.7%) and (57.5%) with P=0.003 and P=0.006 respectively. Regarding the Wong-Baker FACES pain scale, children anesthetized with lidocaine showed statistically significantly higher mean pain scores 6.7 ± 3.6 (SD) than those anesthetized with articaine 1 ± 2.8 (SD) with the P-Value <0.001. The onset of pulpal anesthesia after articaine infiltration was faster than that of lidocaine. Conclusion: 4% articaine is more effective than 2% lidocaine as buccal infiltration anesthesia in the mandibular posterior region in children from 6 to 12 years. The high success rate of articaine infiltration adds a great value in dentistry by augmenting the use of infiltration and reducing the use of inferior alveolar nerve blocks during dental treatment of mandibular posterior teeth in children.
... However, these studies have only used lidocaine as the anesthetic solution. [56][57][58][59][60][61][62][63][64][65][66][67][68]61 Irreversible pulpits , which is a severe damage to the pulp via bacteria in the vital dental pulp, would cause necrosis or death to pulp tissues, and thus leads to very intolerable severe spontaneous pain and forces patients to seek immediate treatment 62 articaine was the second most used dental local anesthetic in the US, only after lidocaine. 63 Articaine is generally effective in providing patients with pain-free treatment because of its high liposolubility which facilitates the diffusion of the anesthetic solution to the teeth, but local anesthetic failure is still a concern in treatment of irreversible pulpitis. ...
... 65 It is not a preferable technique because it requires special equipment, drilling of the cortical bone, and preparing a site for administration of the anesthetic solution. 66 The intraligamentary injections have a short duration of action and may increase postoperative pain. 67 The intraosseous and intraligamentary techniques are effective in raising anesthesia levels in difficult anesthetic situations; however, it would be beneficial if similar results could be achieved by simpler options such as the infiltration technique. ...
... Instead, Uihlein et al (21) determined that binding properties of the local anesthetic agent to plasma proteins have a greater correlation to action on ionic channels than does lipid solubility. Available literature indicates that articaine is equally effective in nerve block and infiltration anesthetic techniques when compared with other local anesthetics including lidocaine with epinephrine, mepivacaine with epinephrine or with levonordefrin, mepivacaine with norepinephrine, and prilocaine with epinephrine (19,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33). ...
... Recently, Kanaa et al (12) reported that mandibular buccal infiltration is more effective with 4% articaine with 1:100,000 epinephrine than 2% lidocaine with 1:100,000 epinephrine. Hass et al (22) noted success for lower second molar pulpal anesthesia after mandibular buccal infiltration in 63% of subjects with 4% articaine and 53% with 4% prilocaine. Similarly, Vahatalo et al (23) did not find any differences between articaine and lidocaine, although the solutions had different concentrations of adrenaline. ...
Introduction
The study was designed as a randomized double blinded cross over trial comparing the anaesthetic efficacy of buccal infiltration of 4% articaine with 1:100,000 epinephrine with that of 2% lignocaine with 1:200,000 epinephrine in inferior alveolar nerve block in mandibular second premolars.
Methods
The study was designed as a cross over trial. Each subject received both the anaesthetic agent and the order of anaesthetic administration was randomized. All the subjects received 1.8 ml of articaine with 1:100,000 epinephrine in buccal infiltration and 1.8 ml of 2% lignocaine with 1:200,000 epinephrine in inferior alveolar nerve block in an interval of one week. Pulp sensibility measures were recorded using an electric pulp tester. Data was analyzed using SPSS version 22.
Results
Among the 46 subjects who completed the trial, 82.6% showed successful anaesthesia following articaine buccal infiltration compared with 89.1% following lignocaine inferior alveolar nerve block. There was no statistically significant difference between the success rates of 4% articaine buccal infiltration and 2% lignocaine IANB.
Conclusions
Study concluded that the buccal infiltration of 4% articaine can be used as a viable alternative anaesthetic technique for inferior alveolar nerve block of 2% lignocaine in mandibular second premolars.
... All subjects were given conventional IANB anaesthesia and infiltration with 4% articaine HCL (19) containing 1:100.000 epinephrine. With a side-loading cartridge syringe and 27-G long needles. ...
... Many local anesthetics are vasodilators, leading to increased absorption and shorter duration of action. To tackle these challenges, dental practitioners are increasingly turning to articaine and prilocaine amides as local anesthetic agents [2] . Prilocaine, categorized as an aminoamide and known as the weakest potent vasodilator among local anesthetics, exerts therapeutic effects on the nervous system. ...
... Though some evidence supports this hypothesis, there is not any consensus on the superior anesthetic efficiency of articaine. Haas et al (6) stated that the anesthetic efficacy of articaine is similar to the efficiency of other anesthetics, and it is not superior to the others in both the maxilla and mandible. Nydegger et al (7) stated that although articaine is significantly more efficient than lidocaine and prilocaine in INF of mandibular first molars, IANB cannot be considered as an alternative. ...
Background:
The aim of this study is to compare the effects of %4 articaine and %2 lidocaine on inferior alveolar nerve block (IANB) for implant surgery in the posterior mandible.
Material and methods:
The patients who have inserted implants in the posterior mandible were divided into 2 groups for IANB: lidocaine and articaine. VAS = visual analog scale, pain during surgery and injection, lip numbness time, mandibular canal-implant apex distance, age, gender, bone density, implant number, release incision, adjacent teeth, and duration of surgery were analyzed using t-test, Mann-Whitney U test, Spearman's coefficient, and, Pearson's chi-squared test. This trial followed the recommendations of the Consort Statement for reporting randomized controlled trials.
Results:
577 patients were included and 1185 dental implants were analyzed. There was no significant difference between the two groups in terms of injection and surgery VAS values (p>0.05). The lip numbness time of lidocaine was 3.06±3.22min while articaine was found to be 2.96±3.09min (p>0.05). Mandibular canal-implant apex distance was found to be 2.28±0.75mm in the articaine and 2.45±0.86mm in the lidocaine group (p<0.05). Release incision was made more in the articaine group (51/252) than in the lidocaine group (40/325) (p<0.05).
Conclusions:
There was no difference between the %4 articaine and %2 lidocaine in terms of pain perception in posterior mandible implant applications. Both anesthetics provided adequate anesthesia for implant application.
... where they concluded that 4% articaine was found to had significantly more duration of action when compared to 2% lignocaine [15] . In 2005, Costa et al. [16] conducted a similar study where they stated that 4% articaine clinically presented the longest duration of action, which was further conducted by Haas et al. [17] and Vahatalo et al. [18] In another study done to compare the anesthetic efficacy of 4% articaine and 2% lignocaine by Sree Kumar et al. concluded that 4% articaine had better duration of action along with anesthetic efficacy [19] . According to many studies, though articaine is considered as the best and effect alternative to lignocaine, articaine has the potential to cause neuropathies, methemeglobinemia, hypersentivity, allergy and paresthesia. ...
... However LA suffer a number of drawbacks [16][17][18]; ...
Context: Pain is one of the most commonly experienced symptoms in dentistry, and managing pain is of greater importance during dental treatment. Local anesthetics are chemicals that block nerve conduction in a specific, temporary and reversible manner, without affecting the patient’s consciousness. Aims: The aim of this study is to evaluate the anesthetic efficacy of buffered lignocaine, buffered articaine, unbuffered lignocaine and unbuffered articaine in terms of latency (onset of anesthetic effect), duration of anesthetic effect during extraction of mandibular teeth following standard inferior alveolar nerve block. Settings and Design: This study was conducted at Department of Oral and Maxillofacial Surgery, Saveetha University, Chennai from November 2013 to November 2015. Methods and Materials: This study compares the anesthetic efficacy of 4% articaine, 2% lignocaine, 4% buffered articaine and 2% buffered articaine with epinephrine. Onset, duration of anesthetic effect was compared. Statistical analysis used: ANOVA Results: Total number of patients were 272. These patients were equally divided into 4 groups, each group containing 68 patients.THE anova test shows that significant difference between the groups, the mean value shows the group 4 is better than the other 3 groups. Conclusion: We conclude that 4% articaine has faster onset when compared to the other three group. Buffered lignocaine had significantly longer duration when compared to the other groups. This can be explained based on its different chemical structure, liposolubility, increased protein binding ability, diffusion in soft tissue and increased pulpal anesthesia
... Mandibular premolar and molar sites may differ with respect to cortical bone thickness and width of alveolar bone; thereby this difference may affect the success of infiltration approaches. (13) The mechanism of reversible nerve conduction block by articaine is similar to that of other amide local anesthetics. (14) However, articaine is unique among them, because it contains a thiophene group, which increases its lipid solubility. ...
Aim.The aim of this study was to evaluate and compare the anesthetic efficacy of 4%articaine and 2% lidocaine (both with 1:100,000 epinepherine) for buccal andlingual infiltration in patients need implant placement.Materials and methods.Forty patients have edentulus regions posterier to mentalforamen were divided into 4 study groups and received buccal and lingualinfiltration of either 4% articaine or 2% lidocaine. Surgical procedure was begun5 minutes after solution deposition. Success was defined as no or milddiscomfort (VAS recordings) during during pilot hole drill.Results.The success rate for mandibular infiltration to produce anesthesia usingarticaine was 100% in premolar and molar area for the articaine solution andsuccess rate was 80% in preamolar and 30% in molar area. There was highsignificant difference between the articaine and lidocaine solutions (ANOVA P< 0.001).Conclusion. The efficacy of 4% articaine was superior to 2% lidocaine formandibular posterior regoin.
... For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com out to determine its anesthetic efficacy in different concentrations, volumes, techniques of use, comparing it with other available anesthetic agents, especially with 2% lidocaine. Most of these studies were done on mandibular molars, where some studies reported no significant difference in the anesthetic efficacy between 4% articaine and 2% lidocaine when used for the primary inferior alveolar nerve block, intraligamentary injection, supplementary injection, or infiltration injection, [4][5][6][7][8][9][10][11] whereas, other studies have found that 4% articaine is more effective than 2% lidocaine in producing pulpal anesthesia in lower molars. [2,12] Few studies have been done on maxillary molars also, and researchers have found that buccal infiltration alone with 1.7 ml of articaine is sufficient to anesthetize the pulp of molars (100%) and premolars (100%) as compared to 1.7 ml of lidocaine (30% and 80% respectively). ...
Objective:
The purpose of this prospective, randomized study was to evaluate and compare the anesthetic efficacy of 0.8 ml of 4% articaine and 1.6 ml of 2% lidocaine administered through buccal infiltration (submucosal) only in adult male and female patients with irreversible pulpitis of maxillary 1st molar.
Study design:
Two hundred patients with irreversible pulpitis of the maxillary first molar were divided into four study groups and received only buccal infiltration of either 0.8 ml of 4% articaine or 1.6 ml of 2% lidocaine. Endodontic access was begun 7 min after the solution deposition. The success was defined as "no pain (0 mm)" or "weak/mild pain (>0 mm and ≤54 mm)" during access opening, and during the first file insertion till working length.
Results:
The compiled data of the number of failed cases were analyzed by two sample proportion test and of mean pain scores were analyzed by Student's unpaired t-test. P < 0.05 was taken as statistically significant. No significant difference was found in the number of failed cases on using 4% articaine and 2% lidocaine (P > 0.05). Moreover, no significant difference was found in the number of failed cases between the genders in Group I (4% articaine with 1:100,000 epinephrine) and also in Group II (2% lidocaine with 1:80,000 epinephrine). On comparing the mean pain scores of failed cases, it has been found that females experience more pain than males in Group I (not significant) and Group II (significant).
Conclusion:
The efficacy of 4% articaine with 1:100,000 epinephrine has been found to be better than 2% lidocaine with 1:80,000 epinephrine, as only 0.8 ml of 4% articaine with 1:100,000 epinephrine was effectively used as compared to 1.6 ml of 2% lidocaine with 1:80,000 epinephrine. Furthermore, females experience more pain as compared to males.
... Furthermore, BI with 4% articaine shows an improved but inconsistent success rate [12][13][14][15]. It was also found that BI successfully anesthetized maxillary teeth subjected to dental treatment; however, its efficacy was hindered by the thickness of the buccal cortical bone [16]. ...
Background:
Inferior alveolar nerve block (IANB) is known to have a lower success rate for anesthesia in patients with irreversible pulpitis. This calls for supplementary techniques to effectively anesthetize such patients. This systematic review aimed to evaluate the published literature for determining the success rate of anesthesia induction using post-IANB intraligamentary (IL) injection in the mandibular teeth of patients with symptomatic irreversible pulpitis. The review question was, "What is the success rate of IL injection in the mandibular teeth of patients with irreversible pulpitis as a supplementary technique for endodontic treatment?"
Methods:
A thorough search of electronic databases and manual searches were performed. The protocol of the review was framed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and was registered in the International Prospective Register of Ongoing Systematic Reviews (PROSPERO) with a proper criterion for inclusion and exclusion of studies. The included studies were analyzed using the Cochrane Collaboration ''Risk of Bias'' tool. A meta-analysis that included a comparison of primary nerve block and supplemental IL injection was performed. The success rate was evaluated using the combined risk ratio (RR) with a random risk model. A funnel plot was created to measure publication bias.
Results:
After all analyses, four studies were included. In the forest plot representation, RRs were 3.56 (95% CI: 2.86, 4.44), which were in favor of the supplemental IL injections. Statistical heterogeneity was found to be 0%. These values suggest that supplemental IL injections provide better success rates for anesthesia.
Conclusion:
According to the pooled qualitative and quantitative analyses, supplemental IL injections increased anesthetic efficacy.
... In addition to small sample sizes (Berberich et al., 2009;Haas et al., 1990;Visconti et al., 2016), there are several other shortcomings that research papers have missed from the CONSORT check list (Schulz et al., 2010). These include no description of the method of sample size calculation (Gross et al., 2007), no explanation of randomization/implementation (Gross et al., 2007), no report of any possible adverse effects (Gross et al., 2007;Mason et al., 2009;Singla et al., 2015) and reporting no statistical data interpretation in terms of the level of significance (Matthews et al., 2009). ...
Aim:
To review variables and management techniques that may affect anaesthesia failure during root canal treatment and methods of overcoming anaesthesia failure.
Methodology:
The PubMed and Cochran databases were searched for evidence-based investigations regarding pain during needle insertion, pain on injection, efficacy of the anaesthetic solutions and anaesthesia techniques, and premedication.
Results:
Variables such as 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. However, there are several concerns regarding the methodology of investigations that have evaluated anaesthesia success rates.
Conclusion:
Several variables may influence anaesthesia success rates. There are conditions that may help to predict a patient's pain during endodontic procedures. 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 techniques before or during the treatment. However, investigators need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.
... Hass et al. also described the reading of 80 on the pulp tester as the criteria for pulpal anaesthesia in accordance to above studies. 13 We however, in our study did not achieve this reading in both the solutions groups. Difficulty of extraction was assessed by the surgeon. ...
BACKGROUND Local anaesthetics helps in preventing pain during surgical and dental procedures by blocking the peripheral nerves. The primary objective of this investigation was to compare and evaluate 4 % articaine hydrochloride (with 1 : 100000 adrenaline) and 2 % lignocaine hydrochloride (with 1 : 80000 adrenaline) in terms of pulpal anaesthesia, volume of anaesthetic solution administered, need of re-anaesthesia and difficulty of extraction during orthodontic extraction of maxillary first premolars. METHODS This prospective randomized, double-blinded study was conducted on 43 patients of less than 40 years of age requiring bilateral maxillary first premolar extractions for orthodontic purposes. Each patient was randomly assigned to receive either 2 % lignocaine hydrochloride or 4 % articaine hydrochloride for premolar extraction of one side and other solution was administered for premolar extraction of contralateral side spaced 1 to 3 weeks apart. In each patient, the difference in pulpal anaesthesia, volume of anaesthetic solution administered, need of re-anaesthesia, difficulty of extraction and duration of anaesthesia was assessed on administration of lignocaine hydrochloride and articaine hydrochloride. RESULTS Statistically significant difference in pulpal anaesthesia levels was found when the articaine and lignocaine groups (P > 0.05) were compared, with a higher mean pulpal anaesthesia among the articaine group. There was no difference in volume of anaesthetic solution administered on buccal and palatal side among the articaine and lignocaine groups. Only 2.3 % of patients in both the groups required re-anaesthesia on the buccal side. There was no significant difference in difficulty of extraction in both the groups. The articaine group had a longer mean duration of anaesthesia as compared to the lignocaine group which was highly significant. CONCLUSIONS Articaine may be used to replace lignocaine in orthodontic extraction of maxillary premolars with clinical advantages like higher pulpal anaesthesia and longer duration of anaesthesia. KEY WORDS Local Anaesthetic, Lignocaine Hydrochloride, Articaine Hydrochloride, Orthodontic Extraction, Prospective Study, Double-Blinded Study.
... The procedures of posterior teeth of mandible are best performed by anesthetizing the inferior alveolar nerve. The thick buccal cortical plate of posterior mandible does not permit the penetration of local anaesthesia administered by buccal infiltration, and so inferior nerve block is used to anaesthetize the main trunk of nerve 10 . ...
Almost all minor oral surgical procedures can be performed effectively if patient is relaxed and comfortable. One of the contributing factor for patient comfort is effective pain control. This can be achieved pre and per-operatively by various local anaesthetic techniques. Infiltration techniques are commonly employed in all maxillary and mandibular teeth whereas mandibular posterior teeth requires a nerve block. In certain cases, these techniques fails or provide inadequate anaesthesia, for example, teeth associated with periapical pathology. Therefore, we conducted a study to determine effectiveness of infiltration and block techniques as well as when supplemented by intra-ligament injection for anaesthesia in periapical infected teeth. Keywords: anaesthesia, infiltration technique, block technique, intraligamental technique, periapical pathology.
... The pharmacological characteristics of this anaesthetic are responsible for its main advantages with respect to other local anaesthetics and include substitution of the aromatic ring with a thiopenic ring that increases the liposolubility of the drug as well as its potency [23,40]. Articaine is the only amide local anaesthetic agent containing an ester group in its molecular structure [12]. The clinical advantages of Articaine include the duration of its anaesthetic effort -only surpassed by ultra long acting anaesthetics and its superior diffusion through Bony tissue [54]. ...
... Although infiltration alone suffices the purpose in the maxillary quadrants, the same is not possible for the mandibular region because of the thick cortical plates [27]. However, it can serve as a supplemental mode of anesthesia in IANB [28][29][30][31][32]. ...
Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review
aimed at evaluating the success of buccal/lingual infiltrations administered with a primary inferior alveolar nerve
block (IANB) injection or as a supplemental injection after the failure of the primary injection in symptomatic
and asymptomatic patients with irreversible pulpitis in human mandibular molars. The review question was “What
will be the success of primary and supplemental infiltration injection in the endodontic treatment of patients
with irreversible pulpitis in human mandibular molars?” We searched electronic databases, including Pubmed,
Scopus, and Ebsco host and we did a comprehensive manual search. The review protocol was framed according
to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We included
clinical studies that evaluated and compared the anesthetic outcomes of primary IANB with primary and/or
supplementary infiltration injections. Standard evaluation of the included studies was performed and suitable
data and inferences were assessed. Twenty-six studies were included, of which 13 were selected for the meta-analysis.
In the forest plot representation of the studies evaluating infiltrations, the combined risk ratio (RR) was 1.88
(95% CI: 1.49, 2.37), in favor of the secondary infiltrations with a statistical heterogeneity of 77%. The forest
plot analysis for studies comparing primary IANB + infiltration versus primary IANB alone showed a low
heterogeneity (0%). The included studies had similar RRs and the combined RR was 1.84 (95% CI: 1.44, 2.34).
These findings suggest that supplemental infiltrations given along with a primary IANB provide a better success
rate. L’Abbe plots were generated to measure the statistical heterogeneity among the studies. Trial sequential
analysis suggested that the number of patients included in the analysis was adequate. Based on the qualitative
and quantitative analyses, we concluded that the infiltration technique, either as a primary injection or as a
supplementary injection, given after the failure of primary IANB, increases the overall anesthetic efficacy.
... Buccal infiltration anesthesia is a common treatment approach to obtain pulpal anesthesia for maxillary teeth and has been shown to provide a success rate of 72 to 100% in healthy pulps [1][2][3]. The advantages of infiltration anesthesia are simple technique which is easy to master and when successful, anesthetizes all nerve endings in the area of deposition independent of the nerve source [4]. ...
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 methodsFifteen 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.ResultsArticaine (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 relevanceSingle 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.
... However, this block anesthesia technique challenges clinicians because it is complex in terms of its application and may cause complications such as hematoma and trismus. Additionally, the standard IANB anesthesia has a high failure rate in terms of anesthetic effectiveness [3], its anesthetic success in healthy mandibular molars is around 70%, and this rate decreases to 20% in inflammatory conditions, such as irreversible pulpitis [4,5]. Infiltration anesthesia which is another technique used on both jaws is a simpler technique and less painful for the patient, as well as having lower complication rates than IANB anesthesia. ...
Objectives
The issue of needing additional lingual injection in extractions of mandibular premolar and incisors is still not clarified. The aim of this study is to investigate whether it is necessary to perform lingual injection in addition to buccal infiltration anesthesia in mandibular incisors and premolar teeth extractions.
Materials and methods
Sixty-six patients who admitted to our clinic for the removal of bilateral mandibular anterior teeth were included in the present study. Patients were divided into two groups. The experimental group received only 1.5 ml of 2% lidocaine with 1:80,000 epinephrine by injection into the buccal vestibule of the tooth. The control group received 1.5 ml of 2% lidocaine with 1:80,000 epinephrine by buccal injection into the buccal side and 0.3 ml same lidocaine solution injected into the lingual side of the tooth. After 5 min, tooth was extracted and each patient was asked to record the intensity of injection and extraction pain by 0–100 mm and a 10-point Visual Analogue Scale (VAS) and six-pointed Face Pain Scale (FPS).
Results
The injection pain scores were significantly higher in terms of the VAS 0–10 point and 0–100 mm and FPS in the control group to which additional lingual injections were applied than the experimental group (p < 0.05). No statistically significant differences were found in all three scales between the groups in terms of extraction pain (p > 0.05). The mean extraction pain scores were lower in the experimental group according to the three scales. No additional anesthetic injection and post-operative complications were observed in all patients.
Conclusions
The extraction of mandibular incisors and premolar teeth can only be done with only the buccal infiltration.
Clinical relevance
In the extraction of mandibular anterior teeth, it can be performed with less anesthetic amount without the need for an additional lingual injection.
... Dental researchers are still looking for the optimal local anaesthetic agent which can produce the rapid onset and longer duration [3,4]. The literature has no enough evidence about the superiority of 4% articaine contemporary local anaesthetic drug over 2% mepivacaine [5][6][7]. Lugman et al. [8] reported that the buccal infiltration with a single articaine injection and lignocaine buccal and palatal infiltration were equally effective for maxillary exodontia. Articaine is different from other amide local anaesthetic because it contains a thiophene ring. ...
ABSTRACT
Objectives: To investigate the potency and speed of action of 4% articaine and 2% mepivacaine for maxillary teeth extractions.
Material and Methods: Ninety-four patients, aged between 16 to 70 years old, were recruited in this study. Two regimens were randomly administered over one visit. Patients of treatment group 1 received mepivacaine 2% with 1:100,000 adrenaline, whereas treatment group 2 - articaine 4% with 1:100,000 adrenaline. The onset time of pulp anaesthesia for maxillary teeth indicated for extraction was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out.
Results: In this study, 85 patients had successful local anaesthetic followed by extraction within the study duration time (10 min). However, 5 patients had failed dental extraction (4 in mepivacaine group and 1 in articaine group). Patients in the articaine buccal infiltration group recorded faster onset time of action regarding anaesthesia and teeth extraction than patients in mepivacaine buccal infiltration group (P = 0.03).
Conclusions: Articaine is an effective anaesthetic with a rapid onset, comparable to mepivacaine in infiltrative techniques used for maxillary teeth extraction. However, articaine has clinically achieved faster dental anaesthesia and earlier teeth extraction than mepivacaine. So, articaine can be the local anaesthetic of first choice in oral surgery.
... Furthermore, articaine can penetrate the cortical bone, and it could be used in the mandibular molar region. [4,8,[17][18][19][20][21][22][23][24][25][26] For these reasons, Ultracain DS Forte (Hoechst AG, Mainz, Germany) anesthetic solution containing 4% articaine and epinephrine (1:100.000) was used in the present study. ...
Purpose:
The purpose of this study is to compare the success rates of inferior alveolar nerve block (IANB) and buccal infiltration anesthesia of mandibular second premolar with irreversible pulpitis and to evaluate the level of patient discomfort with these methods.
Matherials and methods:
Forty patients, who had irreversible pulpitis in the mandibular 2ndpremolar teeth, were included in the study. Patients were randomly distributed in two groups. In one group IANB, in the other group buccal infiltration anesthesia were performed. The efficacy of these two different anesthesia techniques on the related teeth was investigated with the Heft-Parker visual analog scale. In addition, with a pulse oximetry device, the changes in the patients' heart rates were compared between the groups. The obtained data were evaluated statistically.
Results:
Both anesthesia techniques reduced the pain significantly in patients before the administration (P < 0.05), but there was no significant difference among the groups regarding the pain control and success rates of anesthesia (P > 0.05). Both of the anesthesia techniques increased the heart rate (P < 0.05). The increase in the heart rate of the patients was significantly higher in the buccal infiltration anesthesia group than the other anesthesia group (P < 0.05).
Conclusion:
Within the limitation of this in vivo study, there was no difference between the efficacies of the buccal infiltration anesthesia and IANB anesthesia in the mandibular 2ndpremolar teeth with irreversible pulpitis. Buccal infiltration anesthesia caused more discomfort in the patients compared with the IANB during the administration.
... However, in our study, articaine was used for infiltration unlike their study where articaine was used as an inferior alveolar nerve block. [12] Clinical trials comparing the time of onset of clinical anesthesia and the duration and depth of anesthesia have shown that 4% articaine provides significantly shorter time of anesthesia as well as greater consistency than 2% articaine. [13][14][15][16] Toxicity of 4% articaine as compared to lowered concentrations was found to be nonsignificant. ...
... McLean et al. [6] reported 3% mepivacaine as equivalent to other anaesthetic solutions for achieving pulpal anaesthesia. Haas et al. [7] found a higher success rate with articaine in obtaining pulpal anesthesia than prilocaine. ...
Aims: To analyse the existing literature on the effectiveness of various injectable amide local anaesthetic agents for children undergoing routine dental treatment.Design: A systematic search was carried out for the databases of PubMed, Central, LILACS, Science direct, Metapress and SIGLE to identify clinical trials published on the effectiveness of injectable amide local anaesthetic agents in dental journals from the inception of the databases up to July 2015. Results: The systematic search gave nine studies.Four of out seven studies found articaine to more effective. No significant difference in anaesthetic effectiveness of the agents were found in seven studies. One study reported significant difference in the anaesthetic effectiveness in favour to articaine. Two studies reported articaine to have longer duration of action.Conclusion: With the available evidence, this review may suggest that articaineis an effective amide anesthetic agent. Lignocaine is most effective at 2% concentration. Prilocaine and mepivacaine show comparable effectiveness. As eight of the studies have high risk of bias, there is a greater need for well-designed randomized controlled studies to beconducted to assess
Local Anesthetic Used for Dental Treatment in Children- Systematic Review. Available from: https://www.researchgate.net/publication/294107525_Local_Anesthetic_Used_for_Dental_Treatment_in_Children-_Systematic_Review [accessed Jul 27, 2017].
... About 4% solutions of prilocaine or articaine [39] may not be the only reason for the differences observed since 4% articaine was not superior to 2% articaine in one study. [29] The thiophene ring of articaine may be considered as additional co-factor for articaine's superiority [17] increasing its liposolubility. ...
Aims:
A crossover double-blind, randomized study was designed to explore the efficacy of 2% mepivacaine with 1:100,000 adrenaline buccal infiltration and 4% articaine with 1:100,000 adrenaline buccal infiltration following 2% mepivacaine with 1:100,000 adrenaline inferior alveolar nerve block (IANB) for testing pulp anesthesia of mandibular first molar teeth in adult volunteers.
Materials and methods:
A total of 23 healthy adult volunteers received two regimens with at least 1-week apart; one with 4% articaine buccal infiltration and 2% mepivacaine IANB (articaine regimen) and another with 2% mepivacaine buccal infiltration supplemented to 2% mepivacaine IANB (mepivacaine regimen). Pulp testing of first molar tooth was electronically measured twice at baseline, then at intervals of 2 min for the first 10 min, then every 5 min until 45 min postinjection. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation were obtained within 10 min and continuously sustained for 45 min postinjection.
Results:
In total, the number of no sensations to maximum pulp testing for first molar teeth were significantly higher after articaine regimen than mepivacaine during 45 min postinjection (267 vs. 250 episodes, respectively, P < 0.001), however, both articaine and mepivacaine buccal infiltrations are equally effective in securing anesthetic success for first molar pulp anesthesia when supplemented to mepivacaine IANB injections (P > 0.05). Interestingly, volunteers in the articaine regimen provided faster onset and longer duration (means 2.78 min, 42.22 min, respectively) than mepivacaine regimen (means 4.26 min, 40.74 min, respectively) for first molar pulp anesthesia (P < 0.001).
Conclusions:
Supplementary mepivacaine and articaine buccal infiltrations produced similar successful first molar pulp anesthesia following mepivacaine IANB injections in volunteers. Articaine buccal infiltration produced faster onset and longer duration than mepivacaine buccal infiltration following mepivacaine IANB injections.
... However in mandibular teeth due to the thickness of buccal cortical bone buccal infiltration technique is not as effective as nerve block techniques. [11] Pulpal anesthesia of posterior mandibular teeth with irreversible pulpitis is most frequently achieved by the inferior alveolar nerve block (IANB) injection technique. However, sometimes it does not produce desired anesthesia. ...
To systematically review the anesthetic success rates of inferior alveolar nerve block (IANB) injection technique alone with that of combination of IANB and supplemental infiltration (SI) technique when used for pulpal anesthesia of mandibular posterior teeth with irreversible pulpitis during endodontic treatment.
The study follows a longitudinal study design involving original research.
Electronic databases were systematically searched for randomized controlled clinical studies. Studies were selected by predefined inclusion and exclusion criteria.
The statistical analysis used was based on the results of the original research. All the included studies showed that there is the difference in the values comparing the two techniques, but the data are not statistically significantly different.
Based on this review, the better anesthetic efficacy of the SI was observed.
The use of local anesthetics in dentistry is crucial for pain control. Their efficacy may be related to multiple factors, including gender, the clinical status of the patient, anatomical factors, the type of anesthetic, premedication treatment, and the experience of the professional. Aim: The objective of this study was to analyze whether premedication or the degree of patient anxiety influences the anesthetic efficacy of 4% articaine with epinephrine 1:100,000 and 0.5% bupivacaine with epinephrine 1:100,000 in patients undergoing root canal treatment for symptomatic irreversible pulpitis in the upper and lower molars. The null hypothesis (H0) of this study was that articaine and bupivacaine would have a similar anesthetic efficacy when used during the treatment of symptomatic irreversible pulpitis of the posterior mandibular and maxillary teeth, independent of non-steroidal anti-inflammatory drugs (NSAIDs) premedication or the patient’s anxiety levels. Methods: A total of 140 patients presenting with pulpitis in the upper and lower molars were randomly assigned to one of two anesthetics: articaine or bupivacaine. Before root canal treatment, patients completed the Modified Corah Dental Anxiety Scale (MDAS) and a Visual Analog Scale (VAS) for pain intensity. Inferior alveolar nerve block was performed for the lower molars and buccal infiltration for the upper molars, and the anesthetic efficacy was verified by the Endo Coldspray® test. During the procedure, the patients’ heart rate and oxygen saturation were monitored using a pulse oximeter. The patients reported their pain levels using a VAS twenty-four hours postoperatively. Results: High levels of dental anxiety were significantly associated with higher pain scores (p = 0.000) for both groups. The hemodynamic changes during treatment remained within normal limits. The need for anesthetic reinforcement was higher in the bupivacaine group (p = 0.004). The patients in both groups reported low-intensity postoperative pain, although the pain level was slightly lower in the bupivacaine group. Conclusions: The anesthetic efficacy of articaine and bupivacaine in patients with irreversible pulpitis did not appear to be influenced by the degree of anxiety or the intake of AINEs as premedication. The intrinsic anesthetic efficacy was higher for articaine, which required less reinforcement than bupivacaine. Comparing the results obtained when performing buccal infiltration and inferior alveolar nerve block further highlighted the differences between the two anesthetics; these differences were more pronounced in the bupivacaine group, leading to rejection of the null hypothesis proposed at the beginning of the study.
Aims and background
Local anesthetics play a crucial role in pain management in pediatric dentistry, where anxiety and fear are common among young patients. This study aimed to compare the anesthetic efficacy of 2% lignocaine with a 20-gauge needle in an inferior alveolar nerve block (IANB) and 4% articaine with a 24-gauge needle in a buccal nerve block (BNB) during the extraction of dentoalveolar abscesses in children aged 5–11 years.
Materials and methods
A 12-month randomized controlled trial involving 100 healthy children was conducted following ethical standards. Patients were assigned to receive either lignocaine or articaine anesthesia. Pain assessments were conducted using the Wong–Baker Faces Pain Rating Scale (W–BFRS) and visual analog scale (VAS). Postoperative follow-ups were performed to evaluate pain, biting incidents, and numbness duration.
Results
The study demonstrated a strong positive correlation between W–BFRS and VAS ratings, indicating effective pain assessment. While both techniques showed efficacy, the BNB + local infiltration (LI) technique exhibited lower rates of reanesthesia and discomfort compared to IANB + LI. Follow-up assessments revealed shorter numbness duration and reduced biting incidents with the BNB + LI technique.
Conclusion
This study underscores the importance of considering patient comfort and experience when selecting anesthesia techniques in pediatric dentistry. Articaine emerges as a favorable option, offering improved pain management and patient satisfaction compared to lignocaine. Both the IANB + LI and BNB + LI techniques are viable options, with the choice influenced by adverse events and patient preferences. This research contributes valuable insights into optimizing pain management for pediatric dental procedures, particularly in cases of dentoalveolar abscesses.
How to cite this article
Sharma J, Sharma N, Gera D, et al. Comparative Evaluation of Clinical Anesthetic Efficacy of 4% Articaine with 24-Gauge Needle in Buccal Nerve Block Compared to 2% Lignocaine with 20-Gauge Needle in Inferior Alveolar Nerve Block in Children with Dentoalveolar Abscess. Int J Clin Pediatr Dent 2024;17(11):1236–1240.
In 1979, the International Association for the Study of Pain (IASP) defined pain as an unpleasant subjective feeling and emotional experience associated with tissue damage or potential tissue damage. Pain is another vital sign besides the four vital signs, namely, temperature, pulse, breathing, and blood pressure. The ability of pain management will influence patients’ evaluations of doctors. Pain will cause negative emotions such as anxiety which end up in a vicious cycle of “anxiety-pain-anxiety,” increase heart rate and blood pressure, reduce insulin secretion, result in a rise of blood sugar, lower the threshold toward noxious stimulation, put the body in a high decomposition state and negative nitrogen balance, disturb the immune mechanism, and, finally, induce many adverse reactions. At the beginning of the twenty-first century, scholars from various countries put forward Comfortable Dentistry and made a series of novel attempts in improving the clinical environment, shielding the treatment noise, carrying out painless dental treatment, and adopting minimally invasive treatment, which has gained fabulous effect in clinic. Dental anxiety (DA) is a common psychological disorder in dental treatment. The formation of DA is often related to the unpleasant treatment experienced in childhood. The fear of pain is an important reason why many patients are unwilling to seek for medical treatment.
Objectives
: To compare the anesthetic efficacy of buccal infiltration (BI) using 4% articaine versus 4% articaine or 2% lidocaine inferior alveolar nerve block (IANB) for mandibular molars with symptomatic irreversible pulpitis.
Methods
: PubMed, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov were searched using MESH terms and specific keywords. Included articles were Randomized Clinical Trials (RCTs), which compared 4% articaine BI versus conventional IANB in terms of the efficacy of pulpal anesthesia and success rate. The quality assessment of included studies was done according to the Cochrane risk of bias (ROB) assessment tool. Studies were quantitatively assessed using fixed or random effect models.
Results
: Out of 756 articles, five RCT studies were included with a total number of 500 patients: 231 in 4% articaine BI group, 150 in 2% lidocaine IANB group, and 119 in 4% articaine IANB group. Our meta-analysis results showed that patients anesthetized with 4% articaine BI had a similar success rate compared to 2% lidocaine IANB [pooled RD: 0.14 (95% CI, -0.01 to 0.29); P= 0.08]. Similarly, there was non-significant difference when compared to 4% articaine IANB [RD:-0.01 (95% CI, -0.13 to 0.11; P= 0.86)]. Patients anesthetized with 4 % articaine BI presented comparable pain scores compared to IANB (4% articaine or 2% lidocaine) [pooled MD: -0.14 (95% CI, -0.38 to 0.11); P= 0.27]. Regarding quality assessment, three studies were considered to have a low risk of bias, one study has an unclear risk of bias, and one study has a high risk of bias.
Conclusion
: 4% articaine BI showed comparable results in terms of pain relief and success rate in comparison with 2% lidocaine IANB or 4% articaine IANB. However, due to the limited number and small sample size of included studies, these findings should be considered carefully, and further studies are required to confirm our findings.
Local anesthesia (LA) is the most important pain management process in oral and maxillofacial surgery. Safe and effective LA not only enable patients to obtain high-quality treatment, but also relieve the anxiety of patients when they come to the clinic. The choices of local anesthetic and injection methods determine the success of LA to a great extent. At present, in most countries or regions, common local anesthetics used in oral and maxillofacial surgery belong to amides and they are injected into patients' body mainly through block or infiltration anesthesia. In addition, the operators' technique level, patient's subjective psychology and anatomical variation of maxillofacial structure also have a strong influence on LA in dental clinic. Due to the existence of above factors, the worldwide success rates of LA in oral and maxillofacial surgery is very different. There are no specific LA methods that ensure 100% successful LA rates. Fortunately, the development of new local anesthetic and injection technology are providing us with new ideas to solve this problem. This review mainly report the new research progress on LA in oral and maxillofacial surgery in recent decades and help clinicians with dental LA operation.
Various anaesthetic agents have been used in dentistry for the extraction of teeth. The most common used local anaesthetic agent is lidocaine hydrochloride. Recently articaine hydrochloride came into existence because of its versatile properties and longer duration of action. Due to lack of study of effects of articaine on various systems, the present study is aimed to compare the anaesthetic efficacy of articaine and lidocaine with adrenaline during extraction of mandibular molars.
Total of 100 patients were randomly divided into two groups (50 each) and clinical parameters like onset and duration of anaesthesia, blood pressure, oxygen saturation, pulse rate and pain perception using visual analogue scale were recorded at different time intervals. The statistical analysis was performed using SPSS package version 22.0. Mean and standard deviations, frequency distribution analysis, Chi-square test were performed for calculating variables and ‘p’< 0.05 was considered significant.
Statistical significant difference was obtained regarding mean time of onset of anaesthesia (‘p’<0.001), mean duration of the anaesthetic effect (‘p’<0.001) and pain perception for articaine group. Non significant results were obtained for blood pressure, oxygen saturation and pulse rate. During the deposition of articaine patients observed less pain as compared to lidocaine.
Articaine hydrochloride helped in achieving increased anaesthetic success in dental applications than lidocaine hydrochloride in terms of fast time of onset, longer time of duration, less pain during the deposition of articaine which were attributed to the greater diffusing property of it.
Background: This study aims to compare the anesthetic efficacy, postoperative pain, hemorrhage & dry sock incidence of articaine 4% versus lidocaine 2% in inferior alveolar nerve block during impacted lower third molar surgery.
Materials and Methods: A prospective randomized study was conducted on 20 subjects planned for elective surgical removal of bilateral impacted mandibular with similar difficulty indices. A single operator performed all surgeries on basis using 4% articaine or 2% lidocaine as an anesthetic agent and with the same concentration of vasoconstrictor (epinephrine 1:100,1000). Latency, duration of anesthetic effect, intra and post surgical pain experiences, hemorrhage & dry socket occurrences were evaluated with respect to the type of anesthetia. A visual analog scale was used to score pain. Data were analyzed by descriptive statistics, repeated measures ANOVA, Wilcoxon and McNemar’s test (α=0.05).
Results: Latency, Intra & Postoperative pain and hemorrhage showed clinical differences in favor of articaine, though statistical significance was not reached. In turn, the mean duration of anesthetic for articain was much extended and showed statistically significant difference. Dry socket incidence consisted of two occurrences (5%) and those two only occurred in Lidocain group.
Conclusion: Although 4% articaine offers better pharmacological performance than 2% lidocaine, both articaine and lidocaine have demonstrated adequate, negligible differences and acceptable clinical profiles. For this reason, their use in oral surgery should remain of the professional preference who will evaluate their use base on the necessary surgical time.
Introduction:
Several strategies have been investigated for achieving successful pulpal anesthesia during endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. However, comprehensive evaluation and identification of the most efficacious and safe intervention are lacking. We aimed to determine this using network meta-analysis.
Methods:
MEDLINE, Embase, Cochrane Central, CINAHL, and Scopus databases were searched. Study selection and data extraction were performed in duplicate. Eligible randomized controlled trials were meta-analyzed to estimate the treatment effects (odd ratios [ORs]; 95% credible interval (CrI) and surface under the cumulative ranking curve (SUCRA)]. CINeMA software (University of Bern, Bern, Switzerland) was used to assess the quality of results.
Results:
Thirty-seven interventions from 46 studies were identified. Compared with the common practice of an inferior alveolar nerve block with 2% lidocaine, a supplemental intraosseous injection was ranked the most efficacious with very low to moderate confidence (2% lidocaine + preoperative nonsteroidal anti-inflammatory drugs [NSAIDs] + acetaminophen [OR = 74; 95% CrI, 15-470; SUCRA = 97%], 2% lidocaine + preoperative NSAIDs [OR = 46; 95% CrI, 8-420; SUCRA = 94%], 2% lidocaine [OR = 33; 95% CrI, 14-80; SUCRA = 93%], 2% lidocaine + preoperative opioids + acetaminophen [OR = 20; 95% CrI, 4.4-98; SUCRA = 86%], and 4% articaine [OR = 20; 95% CrI, 6.3-96; SUCRA = 87%]) followed by supplemental buccal and lingual infiltrations using 4% articaine + preoperative NSAIDs (OR = 18; 95% CrI, 6-56; SUCRA = 86%; very low confidence). No major safety concerns were reported.
Conclusions:
Very low- to moderate-quality evidence suggests intraosseous injection using 2% lidocaine with 1:100,000 epinephrine or 4% articaine with 1:100,000 epinephrine or buccal and lingual infiltrations of 4% articaine with 1:100,000 epinephrine are superior strategies to achieve pulpal anesthesia during endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Preoperative NSAIDs or opioids with or without acetaminophen may increase the efficacy of these injections.
The purpose of this study was to determine anesthetic success in adjacent teeth following a primary infiltration of the maxillary lateral incisor and first molar using 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Three hundred eight asymptomatic subjects received an infiltration of a cartridge of 2% lidocaine with 1:100,000 epinephrine over the maxillary lateral incisor (163 subjects) or first molar (145 subjects). Pulpal anesthesia of the injected tooth and adjacent mesial and distal teeth was monitored with the electric pulp tester in 2-minute cycles for a total of 60 minutes. No response from the subject at the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Comparisons of the odds of pulpal anesthesia (defined as an 80/80 response to electric pulp testing over 60 minutes) between the experimentally injected tooth and adjacent teeth were analyzed using mixed-models, repeated-measures logistic regression. When compared with the lateral incisor infiltration, the adjacent mesial tooth (central incisor) and distal tooth (canine) achieved statistically lower anesthetic success. When compared with the first molar, the mesial tooth (second premolar) did not differ statistically. However, significant differences were shown between the first molar and the second molar, with the distal tooth (second molar) achieving a statistically higher rate of pulpal anesthesia, which was related to a better duration of anesthesia. For asymptomatic patients, local anesthesia of the adjacent mesial (central incisor) and distal (canine) teeth to the infiltrated lateral incisor had lower pulpal anesthetic success. Because standard infiltration anesthesia of the lateral incisor is of short duration, repeating the infiltration at 30 minutes will result in a high incidence of pulpal anesthesia for 60 minutes. Local anesthesia of the adjacent distal tooth to the first molar (second molar) had a statistically higher rate of total pulpal anesthesia than the infiltrated first molar due to the longer duration of pulpal anesthesia. However, if pulpal anesthesia is required for 60 minutes in the first and second molars, the clinician may need to add an additional infiltration to ensure anesthesia.
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.
Objective
The objective of this meta-analysis was to assess the operation success rates of extracting maxillary teeth without palatal injection.
Study Design
PubMed, Cochrane Library, Embase, SinoMed and the references of the identified full-text articles were searched for relevant studies published until June 2017 that met the eligibility criteria. Experimental data were combined by meta-analysis using RevMan 5.3 soft- ware.
Results
7 randomized controlled trials were included in this meta-analysis. Compared with the control groups (were given the combination of buccal and palatal anesthesia recommended by the textbook, also known as routine Infiltration anesthesia), experimental group (single buccal anesthesia) for the removal of maxillary permanent teeth at conventional doses, which resulted in a reduction in the success rate (OR = 0.14, 95% CI = 0.07–0.27, P < 0.00001).
Conclusions
The results revealed that the success rate of the removal of the maxillary permanent teeth has undoubtedly been reduced by the lack of palatal injections. However, larger and higher quality tests are needed to confirm and optimize the effect of this anesthetic procedure.
Aims:
To review the literature, to investigate whether there was aconsensus on what encompasses over-sedation, and to determine the guidance employed for the administration of flumazenil.
Methods:
A literature search was performed following which a self-designed questionnaire was emailed to 14 sedation leads within UK Dental Hospitals.
Results:
10 documents in the literature review met the inclusion criteria. In their definitions of over-sedation, loss of consciousness and respiratory depression were the main terms used; but a variety of terms were also seen, indicating a lack of agreement. Fourteen dental institutes were contacted of which nine (64%) responded. Thirty-seven per cent of sedation leads who responded stated they were unaware of a definition for over-sedation. Seventy-seven percent stated that when flumazenil was used this was recorded in a drugs book, with a broad range of justifications given.
Conclusion:
This study shows that there is a lack of uniformity both from clinicians and the literature, in what encompasses over-sedation. This makes formulating an accepted definition of over-sedation difficult. In order to ensure accurate reporting, monitoring and auditing of such events, a clear definition for over-sedation is required and can be used to provide clarity when flumazenil is to be administered.
Sedation is frequently desired to facilitate dental procedures in uncooperative paediatric patients. Oromucosal Midazolam sedation is a popular choice among paediatric dentists world wide due to its many advantages such as ease of administration, good efficacy, presence of reversal agents and a wide margin of safety. On the other hand, many investigators have reported that midazolam sedation may not be successful for carrying out all types of dental procedures. This may be attributed to diverse nature of various treatment plans coupled with the extent of behavioural changes in the child and operator's experience. Due to the heterogeneity involved in treatment of paediatric dental procedures, the specific indications for oral midazolam use that ensure its success rate, probably need to be defined. This may enable the clinicians to have a convenient and quicker option for managing the cases rather than facing sedation failure or at times, ending up giving general anaesthetics. This article therefore brings forth the possible causes of midazolam sedation failure and proposes a 'case selection criterion'.
Purpose:
The injection of a local anesthetic before tooth extraction is always associated with pain, and palatal anesthesia is the most painful type of injection for the patient. The specific aims of the study were to evaluate "pain control" using 4% articaine without palatal injection and to compare adequate anesthesia and pain control in the anterior and posterior regions of the maxilla.
Materials and methods:
This prospective controlled study followed a split-mouth protocol, in which patients served as their own control. Forty-eight patients who needed routine extraction of permanent maxillary anterior and posterior teeth were referred. After an injection of 4% articaine and a 5-minute wait, 1 posterior tooth and 1 anterior tooth were extracted using standard techniques. The patient's perception of pain was assessed using a visual analog scale and a verbal rating scale after each injection and extraction. Statistical analysis consisted of descriptive statistics, paired-sample t test, and independent-samples t test to determine whether differences were statistically significant (P < .05).
Results:
In total, 48 anterior and 48 posterior teeth were extracted from 48 patients. Extraction of maxillary teeth was possible without an additional palatal injection for 87 teeth (90.6%), whereas only 9 teeth (9.4%) needed an additional palatal injection to complete the extraction. Of the total number of patients, 90% reported that the pain caused by tooth extraction in the anterior and posterior regions of the maxilla was mild. None of the patients rated the pain of extraction in the maxilla as severe.
Conclusion:
There was no difference in pain perception when extracting anterior and posterior teeth. Of the total number of teeth, 90.6% were extracted without the need for palatal injection. In this study, extraction of erupted maxillary teeth using 4% articaine without manipulation of the palatal mucosa obviated palatal infiltration during extraction. Articaine anesthesia provides adequate palatal anesthesia for maxillary teeth extraction in the anterior and posterior regions without the need for a palatal block.
Allergic cross-reactivity between propofol and food is frequently considered as a risk factor for perioperative allergic hypersensitivity reactions and anaphylaxis during dental anaesthesia and sedation. Better understanding of of this cross-reactivity is important to providing safe care. There are, however, conflicting assumptions about anaphylactic reactions to propofol in patients reporting allergy to certain type of the food. Egg and/or soya allergy are often cited as contraindications to propofol administration but the evidence remains unclear. The main goal of this article is to review the available advice and evidence about the cross-reactivity between propofol and foods. A literature search was undertaken. The current published evidence does not elucidate that propofol allergy and food allergies are linked directly, but this drug should be used with caution in atopic patients with allergies to egg and/or soya bean oil. Clinical audit projects may gather data on anaphylactic events during anaesthesia and may aid the profession in this dilemma.
This double-masked, parallel-design, clinical trial assessed whether a combination nasal spray (K305; 3% tetracaine hydrochloride and 0.05% oxymetazoline hydrochloride) compared with a tetracaine-only spray and a placebo spray would be safer and superior in producing local anesthesia sufficient to complete a direct restorative procedure in maxillary nonmolar teeth.
In recent times there has been raised interest regarding the use of articaine hydrochloride as a dental local anaesthetic solution. The use of articaine hydrochloride as a dental local anaesthetic agent has been reported to be safe and effective. Paraesthesia is a rare but unwanted adverse effect attributed to the use of this local anaesthetic in dentistry, particularly following the administration of a nerve block injection. There is no evidence to support the opinion that the use of articaine carries a greater associated risk of paraesthesia than with the use of any other local anaesthetic.
Clinical Relevance: The aim of this article is to review the relative merits of articaine hydrochloride against its documented potential drawbacks. The article will also aim to update readers on the use of articaine hydrochloride for local analgesia in dentistry, including the pharmacology, efficacy and safety concerns (including the risks of nerve paraesthesia) commonly associated with the administration of this agent.
A retrospective survey reports the use of articaine hydrochloride as an anesthetic in children under 4 years of age. Data was collected by a record audit in two pediatric dentistry offices. Articaine anesthetic was administered to 211 patients, 29 having additional administrations of the agent. In some instances, the dosages exceeded the recommended concentrations for older children. No adverse systemic adverse reactions were noted on the charts or known to the clinicians. The present report provides initial evidence for the use of articaine in children under 4 years of age.
The combination of 4 per cent carticaine 5 mug per milliliter with epinephrine is an effective agent acting in the standard lidocaine-epinephrine-mepivacaine-epinephrine range. Like lidocaine, it is of no clinical value without the addition of epinephrine and its vasodilator properties are greater than those of mepivacaine or prilocaine. Its onset time is reasonably rapid, its duration and extent are satisfactory for clinical purposes, and no toxic reactions were noted in the 100 injections given. However, its predictability for +4 anesthesia is poor, and there is wide variation in the onset time. Finally, the success rate compared with that for lidocaine, mepivacaine, or prilocaine for the same dosage and areas, with the use of the same criteria, is not good enough in my opinion to qualify carticaine as a general-purpose anesthetic on a par with standard lidocaine.
Carticaine, a new local anesthetic of the amide type, differs from those previously known in that it contains a thiophene ring. The physico-chemical properties of the compound, its pharmacology and its toxicology are reviewed from the litererture. A controlled, double-blind investigation in which carticaine was compared with lidocaine for the purpose of throwing light on the effect of the new local anesthetic in epidural analgesia is presented. Carticaine and lidocaine 2% with adrenaline 1:200 000 were used in the investigation. It was not possible to show any stastically significant difference as regards latency, spread, duration, or motor blockade obtained with the two substances. Marked differences in the type of side effects or their frequency were not noted. From this investigation and a scrutiny of the published clinical studies on the effect of carticaine, it is concluded that its clinical properties are comparable to those of lidocaine.
Carticaine and prilocaine (without adrenaline) in epidural anaesthesia were compared in a double blind study. Carticaine and prilocaine were used in 2 % concentration without adrenaline. The latency time was not significantly different, but carticaine was a shorter acting local anaesthetic. The motor block in both series was similar. Carticaine is a good and reliable analgesic in short operations but in operations longer than one and a half hours catheter technique, adrenaline addition or local anaesthetics of longer duration ought to be used.
The effects of Lidocaine and the new local anaesthetic carticaine in spinal anaesthesia were compared in a double blind study in 120 elderly male patients scheduled for small urological procedures. The variables investigated were: analgesia examined by pin prick method, loss of tactile sensation, motor block, and skin temperature on the big toe. Both local anaesthetics seem to act similarly, but the loss of tactile sensation and motor block began somewhat earlier with carticaine. The differences have hardly any clinical significance. The incidence of hypotension and postanaesthetic headache was similar in each group.
The actions of carticaine 1% and mepivacaine 1% in peripheral nerve block were investigated in double-blind study. Bilateral ulnar nerve blocks were performed in 14 healthy subjects (age range 20-30 years), and latency, duration, and intensity of anaesthesia were quantitatively determined. There were no differences in latency of nerve block, but a significant difference in the duration of effect: Mepivacaine acted for nearly twice as long as Carticaine. In addition, several incomplete blocks were noted with Carticaine. On the basis of these results mepivacaine is preferred in peripheral nerve block because of its longer and more reliable action.
For objectifying clinical experience, we measured and compared experimental stimulus thresholds with Ultracain 4% and Xylocain 2% in the upper and lower jaws in double blind tests. By means of electronically controlled rectangular impulses the latent period, depth and duration of anesthesia were registered. Relevant differences were found for plexus anesthesia in the lower jaw. The Ultracain preparation is characterized by a high capacity of bone penetration.
It has been claimed that anaesthesia of mandibular pulpal and lingual soft tissue, as well as maxillary palatal soft tissue, results following buccal infiltration of the local anaesthetic Ultracaine (articaine HC1). However, this has never been scientifically proven and the aim of this investigation was to test these claims by comparing articaine to a standard anaesthetic, Citanest (prilocaine HC1). In order to study this, a double blind, randomized trial was conducted in healthy adult volunteers. In these subjects, the ability to induce maxillary and mandibular anaesthesia following buccal infiltration with articaine (as compared to prilocaine given contralaterally), was determined by measuring sensation to electrical stimulation at the tooth, buccal and lingual soft tissue at each of the four non-carious, non-restored, second molars. Results showed that there were no statistically significant differences between articaine and prilocaine in their ability to induce anaesthesia for any tissue at any of the six sites (p greater than 0.05) as determined by chi-square analysis. Analysis of effect on sensation for 25 minutes post-administration also failed to demonstrate a difference between the two drugs. Therefore, these data are not consistent with superior anaesthesia efficacy by articaine at any site, including the mandibular pulpal, lingual or maxillary palatal tissues, in the second molars studied.
This study utilizes healthy volunteers to determine, via electronic pulp tester, such basic clinical parameters as time of onset and duration of action for an infiltration and mandibular block utilizing the recently available local anesthetic preparation, 2 per cent lidocaine with 1:200,000 epinephrine (Octocaine 200). This study showed Octocaine 200 to be both safe and efficacious, producing times of onset and duration within the clinically useful range. The rationale for vasoconstrictor use in dentistry is also reviewed.
The feasibility of 1.5% carticaine, an amide-type local anaesthetic agent, for epidural anaesthesia for Caesarean section was studied in 15 parturients. As a control, epidural anaesthesia in 15 parturients was done with 0.5% bupivacaine. The quality of anaesthesia before delivery was good in both groups. One additional dose of carticaine had to be given after delivery in order for the anaesthesia to last until the end of the operation. Apgar-scores, maternal and fetal pH and blood-gas values were similar in both groups. Maternal arterial serum concentration of bupivacaine at the time of delivery was 1.25 microgram/ml, while that of carticaine was only 0.48 microgram/ml. The lower serum concentration of carticaine is due to its rapid metabolization. The ratio of the unmetabolized drug to that of the metabolite found in maternal serum at the time of delivery was 0.75. Umbilical venous-maternal arterial serum concentration ratio in bupivacaine patients was 0.28 and in carticaine patients 0.32. The results suggest that carticaine is a feasible drug for Caesarean section.
Carticaine, formerly known as Hoe 40045, is a new local analgesic which has been subjected to a series of experiments in human volunteers using electrical stimulation to assess the effect. Six solutions of different strengths and vasoconstrictor additions, including two control solutions (mepivacaine) were tested. Vitality tests were performed at regular intervals with a Bofors pulp tester. Carticaine in 2% and 3% solutions with an adrenalin content of 3.3, 5 and 10 μg/ml showed excellent frequency of analgesia and a relatively long lasting effect. It was especially notable that carticaine without vasoconstrictor was not able to produce reliable analgesia, while only a minute amount of adrenalin (3.3 μg/ml) improved the parameters radically. From comparison with other results on carticaine it is suggested that 2% solutions probably are sufficient for dental and oral surgical procedures when adrenalin in concentrations of 3.3, 5 or 10 μg/ml is added.
Unlike other clinically used local anesthetics, carticaine contains a thiophene ring. Current voltage relations of peak sodium current INa and steady state potassium current IK were measured in voltage clamp experiments on the node of Ranvier of Rana esculenta. The dependence of the maximum sodium conductance on external concnetration of carticaine is described by an apparent dissociation constant KNa = 0.065 mM at pH = 7.3. An apparent dissociation constant KK = 0.147 mM at pH = 7.3 was calculated on the basis of the action of carticaine on the maximum potassium conductance. Similar to other amine local anesthetics, carticaine blocks sodium channels at a lower concentration than potassium channels, but lower concentrations of the thiophene derivative than of the benzene derivatives are needed to block the ionic channels. The partition coefficients in-octanol/Soerensen buffer at pH = 7.35 follow the sequence lidocaine (46) more than carticaine (17) more than procaine (2). Therefore, the action of these local anesthetics on sodium channels and potassium channels seems not to follow mere lipid solubility properties of the neutral drug. Increasing the pH from 6.3 to 8.3 favoured the neutral drug form and enhanced the block of both ionic channels but the relative reduction of the ionic currents was larger for potassium currents.
In a double blind study, using supraclavicular plexus blockade as a model, the latency and diffusion of carticaine in comparison with mepivacain was investigated. Up to 16 min after first eliciting paraesthesiae and injection somewhat more plexus blocks were complete with carticain than with mepivacaine. This difference was statistically valid only for motor block and not for sensory block. However, the relative proportion of complete motor and sensory block increased with mepivacain after 16 min and surpassed the results for carticaine. This difference is statistically significant for sensory block and for sensory and motor block combined. It is also valid for the results up to 30 min. The failure rate was significantly higher for carticaine than for mepivacaine. From these results the course and the failures are attributed to a poorer diffusion of carticaine.
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