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Lack of differential effect by Ultracaine (articaine) and Citanest (prilocaine) in infiltration anesthesia
Abstract
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.
... 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.
... [10,11] Labial or lingual infiltration injections with lidocaine are not effective for achieving pulpal anesthesia in mandibular teeth. [12] Adding a labial infiltration of 1.8 ml of 2% lidocaine with 1:100,000 epinephrine to a conventional inferior alveolar nerve block injection increases the success of pulpal anesthesia in mandibular anterior teeth, but not in mandibular molar. [13] On the contrary, an infiltration injection of the mandibular second molar with 4% articaine with 1:200,000 epinephrine successfully achieved pulpal anesthesia in 63% of cases. ...
... [13] On the contrary, an infiltration injection of the mandibular second molar with 4% articaine with 1:200,000 epinephrine successfully achieved pulpal anesthesia in 63% of cases. [12] Perhaps infiltration injection of an articaine solution adjacent to the first molar would be more successful and should be studied experimentally. ...
... Some studies reported a success rate lesser than that reported in this study while using lidocaine. [12] This may be due to testing a different tooth number, i.e., mandibular second molar. The lack of success with lidocaine is because of its lower concentration; this needs to be investigated further. ...
Background:
To compare 4% articaine and 2% lidocaine local anesthetics in achieving pulpal anesthesia of the lower first permanent molar teeth objectively, and to assess and compare lip and lingual mucosa numbness subjectively.
Materials and methods:
All subjects received 1.7 ml of any one anesthetic in the mucobuccal fold adjacent to mandibular first molar teeth; the same individuals received the second infiltration at least 1 week after the first. Later, comparisons for pulpal anesthesia, lip and lingual mucosa numbness between these two anesthetics solutions were made.
Results:
Articaine showed significant results with P = 0.006 in achieving pulpal anesthesia objectively, when compared with lidocaine. Articaine also showed very high significant results subjectively with P = 0.0006 in achieving lip numbness, when compared with lidocaine. But the results in achieving lingual mucosa numbness with articaine subjectively was not significant with P = 0.01, when compared with lidocaine.
Conclusion:
Endodontic and operative treatments are one of the most common oral non-surgical procedures done under local anesthesia. The diversity of anesthetic substances currently available on the market requires dental professionals to assess the drug both by its pharmacokinetic and also by its clinical characteristics during dental treatments. Our study used 4% articaine, which is available in the market, for comparison with 2% lidocaine. Further studies are required to use an equal concentration of solutions to achieve more accurate results.
... When considering the mandibular anterior teeth, labial or lingual infiltration injections alone have not been found to be very effective for pulpal anesthesia (13,16,20,21). Meechan and Kanaa et al. (22) found buccal infiltration (1.8 mL) was more successful (39%) when compared to a combined buccal (0.9 mL) and lingual infiltration (0.9 mL) of 2% lidocaine with 1:100,000 epinephrine in the mandibular first molar (though the difference was not statistically significant). ...
... In 1990 and 1991, Haas et al. (16,20) investigated the claim that anesthesia of mandibular pulpal and lingual soft tissue results following buccal infiltration of the articaine local anesthetic. The authors' aim was to scientifically test these claims by comparing 1.5 mL 4% articaine HCl with 1:200,000 epinephrine to 1.5 mL 4% prilocaine HCl with 1:200,000 epinephrine. ...
... With the success of articaine infiltrations in both pulpal anesthesia and onset (14,18) in the posterior mandible and evidence for greater efficacy in the anterior mandible (16,20), articaine infiltration in the mandibular anterior teeth should be studied further. ...
... No significant difference was found in the anesthetic success rate in some trials where articaine and prilocaine were used for mandibular buccal infiltrations comparing pulpal, buccal or lingual anesthesia for mandibular canines or second molars 49 , or when buccal injections were compared to buccal and lingual injection of articaine in mandibular first molars. Articaine buccal infiltrations have significantly higher anaesthetic success rates than lidocaine in lower first molars 50,51 , premolars and molars and in the mental nerve block for mandibular premolars, canines and lateral incisors 52 . ...
... There were no significant differences in the ability of articaine and lignocaine to achieve pulpal anaesthesia when a periodontal ligament injection was used in mandibular first molars 49 . If we want to provide a pulpal anesthesia for mandibular teeth, we usually use the inferior alveolar nerve block, but in 15 to 20% of the cases, adequate anesthesia is not provided. ...
... Abdulwahab and colleagues 31 found that 4% of articaine is the most effective anesthetic solution as a buccal infiltration for mandibular first molars when compared with other different local anesthetics (2% lidocaine, 0.5% bupivacaine, 4% prilocaine, and 3% mepivacaine). Hass and colleagues 32 reported the success rates of anesthesia for lower second molar using buccal infiltration technique and found that 63% success with 4% articaine while the success rate with 4% prilocaine was 53%. Also, Kanaa and colleagues 33 showed that 4% articaine BI with 1:100,000 epinephrine has a better anesthetic effect than 2% lidocaine with 1:100,000 epinephrine. ...
... The lower success rate of IANB in previous studies may arise due to the presence of individual anatomical variations such as accessory nerves supply to mandibular molars. 32 These nerves are derived from the mylohyoid nerve, which is found in 21% of cases that innervate mandibular molars. 34 While in BI the accessory nerves were anesthetized because of the area of solution deposition, hence increases the success rate. ...
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.
... [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. ...
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.
... 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. ...
... 63 The intraosseous injection seems to raise the success rate to a reliable extent as shown in some previous studies. 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. ...
... Numerous studies compared the safety and/or efficacy of articaine to other local anesthetics [5,[36][37][38][39][40]. Some authors showed that articaine is significantly more effective [38,39,[41][42][43][44][45], whereas others reported no significant differences [12,40,42,[46][47][48]. ...
... Numerous studies compared the safety and/or efficacy of articaine to other local anesthetics [5,[36][37][38][39][40]. Some authors showed that articaine is significantly more effective [38,39,[41][42][43][44][45], whereas others reported no significant differences [12,40,42,[46][47][48]. Nevertheless, no study showed that articaine is inferior when compared to other dental local anesthetics. ...
Objectives
The purpose of this clinical prospective, randomized, double-blind trial was to compare the anesthetic efficacy of 2 % articaine and 4 % articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth.
Materials and methods
In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2 % articaine (group I) and, in 52 cases, 4 % articaine (group II) was administered. The primary objective was to analyze the differences of anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min)), as well as in length of soft tissue anesthesia (min), were evaluated. Additionally, the need of a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analyzed.
Results
Anesthesia was sufficient for dental extractions in both groups without significant differences (p = 0.201). The onset of anesthesia did not differ significantly (p = 0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9 vs. 4 h; p < 0.001). There was no significant difference in the need for a second injection (p = 0.359), in injection pain (p = 0.386), as well as in pain during (p = 0.287) or after treatment (p = 0.121). In both groups, no complications were seen.
Conclusions
The local anesthetic effect of the 4 % articaine solution is not significantly better when compared to 2 % articaine.
Clinical relevance
For mandibular tooth extraction, articaine 2 % may be used as alternative as well.
... Key Words: Anesthesia; Mannitol; Lidocaine; Infiltration; Maxillary. P revious studies [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] have evaluated the success (ie, never achieving 1 or 2 consecutive 80 readings with the electric pulp tester) of maxillary infiltrations. When a volume of 1.8 mL or less was used with various anesthetic formulations, pulpal anesthetic success ranged from 62% to 100%. ...
... When a volume of 1.8 mL or less was used with various anesthetic formulations, pulpal anesthetic success ranged from 62% to 100%. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Therefore, an infiltration injection may not always be 100% successful because of individual variations in response to the drug administered, operator differences, and variations in anatomy as well as tooth position. ...
Abstract The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of lidocaine with epinephrine compared to lidocaine with epinephrine plus 0.5 M mannitol in maxillary lateral incisor infiltrations. Forty-one subjects randomly received 2 maxillary lateral infiltrations consisting of a 1.84-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (control solution) and a 2.90-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) in 2 separate appointments spaced at least 1 week apart. The maxillary lateral incisor was blindly electric pulp-tested in 2-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (a reading of 80) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all pulpal anesthesia readings (at output of 80) over the 60-minute test period. Pain during solution deposition and postoperative pain were also measured. The results demonstrated that a 2.90-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) was not statistically significantly superior to a 1.84-mL solution of 36.8 mg lidocaine with 18.4 μg epinephrine. The pain of solution deposition was lower with the lidocaine/mannitol formulation. Postoperative pain was not statistically significantly different between the lidocaine/mannitol formulation and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to a lidocaine with epinephrine formulation was not significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol in the maxillary lateral incisor.
... 27 No significant differences between prilocaine and articaine were found in onset time and anaesthetic duration 28 or in the ability of the two LAs to induce pulpal, buccal or palatal tissue anaesthesia in maxillary canines 29 or second molars. 30 Trials comparing mandibular buccal infiltrations have found no significant difference in anaesthetic success rate for pulpal, buccal or lingual tissue for mandibular canines 29 or mandibular second molars 30 when articaine and prilocaine were used, or when buccal infiltrations were compared to buccal and lingual infiltrations of articaine in mandibular first molars. 31 Alternatively, articaine buccal infiltrations have had significantly higher anaesthetic success rates than lignocaine in mandibular first molars, 32,33 mandibular premolars and molars 34 and in the incisive/mental nerve block for mandibular premolars, canines and lateral incisors. ...
... 27 No significant differences between prilocaine and articaine were found in onset time and anaesthetic duration 28 or in the ability of the two LAs to induce pulpal, buccal or palatal tissue anaesthesia in maxillary canines 29 or second molars. 30 Trials comparing mandibular buccal infiltrations have found no significant difference in anaesthetic success rate for pulpal, buccal or lingual tissue for mandibular canines 29 or mandibular second molars 30 when articaine and prilocaine were used, or when buccal infiltrations were compared to buccal and lingual infiltrations of articaine in mandibular first molars. 31 Alternatively, articaine buccal infiltrations have had significantly higher anaesthetic success rates than lignocaine in mandibular first molars, 32,33 mandibular premolars and molars 34 and in the incisive/mental nerve block for mandibular premolars, canines and lateral incisors. ...
Articaine is one of the most recent local anaesthetic drugs made available to dentists worldwide. Anecdotal reports advocate its superiority over other common local anaesthetic agents and controversy exists concerning its clinical safety. This article reviews the current literature on articaine use in dentistry specifically addressing the issues of efficacy and safety.
... 7 However, there are numerous studies showing equal anesthetic efficiency of the Lidocaine and the Articaine. 11,23,24,25 Results of the study ensure that Articaine has good anesthetic efficacy in cases of irreversible pulpitis (symptomatic) in the mandibular molars. ...
Type of study
Original Research.
Aims
To comparatively evaluate the effect of different premedication agents on the efficacy of 4% Articaine in teeth with symptomatic irreversible pulpitis.
Materials and methods
The primary objective of our study is to evaluate the effect of premedication agents on efficacy of Articaine as an oral anesthetic. Our secondary objective is to comparatively evaluate the efficacy of Diclofenac patch, Ibuprofen tablet, Paracetamol tablet and Placebo as a premedication agent. Patients with 25–40 years age, no systemic disease, no history of medication for that complaint, with pain on Heft Parker Visual Analog Scale between 55 mm and 170 mm (VAS), no tenderness on percussion, cold test and EPT negative- Positive, giving proper consent, coming to the Department of Conservative Dentistry and Endodontics were allowed to participate. The exclusion criteria include the following- Non-vital teeth, pregnant and lactating women, allergic to Articaine and NSAIDs, active systemic disease, immune-compromised patients, taken analgesics in last 24 h, root fractures, restoration extending to pulp¹⁰ and periapical pathologies (except periodontal ligament widening).
Preoperatively pain was recorded using Heft Parker VAS (Visual Analog Scale). Cold testing, palpation, percussion and EPT were carried out. 40 patients having symptomatic irreversible pulpitis were randomly divided into 4 groups: group 1 Placebo (n = 10), group 2-Diclofenac patch (n = 10), group-3 Ibuprofen tablets (n = 10), group 4-Paracetamol tablets (n = 10). After 1 h of premedication, all patients were administered IANB injection using 4% Articaine (Septanest with adrenaline 1/100000, Septodont, France) containing epinephrine 1:100000. 15 mins after administration of IANB, patients were asked about symptomatic numbness and was tested with Endo frost and EPT and Outcome was recorded. If lip numbness was present, Electric Pulp Testing and Cold Test give negative result then endodontic access opening was performed and pain was recorded using visual analog scale. The study was conducted for a period of 1.5 years.
Results
During the access cavity preparation only 1 subject in the Group III reported pain while in other groups none of the subjects reported pain of any type. When the intergroup comparison was made of intensity of pain 15 min after LA and during access cavity preparation, the difference between the groups was statistically non-significant when analyzed using One Way ANOVA. The intragroup comparison between three time intervals revealed significant reduction in the pain scores from the pre-treatment levels in all the four groups.
Conclusions
The results of the study showed that there is no significant effect of different premedication agents on the efficacy of 4% Articaine in teeth with symptomatic irreversible pulpitis.
... 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.
... 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.
... 76 As for other injection methods, Haas also believed that there was no significant difference in the success rate of anesthesia between 4% prilocaine and 4% articaine in BI of the maxillary second molars and canines. 79,80 Although the anesthetic efficacy of prilocaine is similar to that of lidocaine and articaine, Brown and Ward et al. have proved that prilocaine had a short anesthetic duration of anesthesia and belonged to short acting LA agent, 81 due to the fact that they thought prilocaine was rarely used with adrenaline, which shortened the duration of drug efficacy. Some scholars have hold a view that patients should receive an injection of prilocaine with felypressin to prolong the duration of anesthesia. ...
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.
... Dovepress Dovepress 1324 al-shayyab relatively porous maxillary bone and its thin bony cortex. 1,7 However, local infiltration techniques show great variation in success rates 8,9 and pain scores during administration of anesthetic injections for maxillary teeth. 6 This variation has been explained by anatomical deviations in the bone surrounding maxillary teeth and individual variations in response to the anesthetic agent administered. ...
Aim
The aim of this study was to evaluate the efficacy of, and patients’ subjective responses to, periodontal ligament (PDL) anesthetic injection compared to traditional local-anesthetic infiltration injection for the nonsurgical extraction of one posterior maxillary permanent tooth.
Materials and methods
All patients scheduled for nonsurgical symmetrical maxillary posterior permanent tooth extraction in the Department of Oral and Maxillofacial Surgery at the University of Jordan Hospital, Amman, Jordan over a 7-month period were invited to participate in this prospective randomized double-blinded split-mouth study. Every patient received the recommended volume of 2% lidocaine with 1:100,000 epinephrine for PDL injection on the experimental side and for local infiltration on the control side. A visual analog scale (VAS) and verbal rating scale (VRS) were used to describe pain felt during injection and extraction, respectively. Statistical significance was based on probability values <0.05 and measured using χ² and Student t-tests and nonparametric Mann–Whitney and Kruskal–Wallis tests.
Results
Of the 73 patients eligible for this study, 55 met the inclusion criteria: 32 males and 23 females, with a mean age of 34.87±14.93 years. Differences in VAS scores and VRS data between the two techniques were statistically significant (P<0.001) and in favor of the infiltration injection.
Conclusion
The PDL injection may not be the alternative anesthetic technique of choice to routine local infiltration for the nonsurgical extraction of one posterior maxillary permanent tooth.
... The reasons for this may be the individual anatomical nature, such as the increased thickness of the buccal lamella in the region of the second molar, more lingual position of the mandibular canal, as well as the fact that the anaesthetic was applied proximal to the mentioned tooth. Haas at al [25] reported that there was no difference in achieving pulp anaesthesia in mandibular teeth between 4% articaine and 4% prilocaine, both with adrenaline 1: 200 000. When it comes to the second lower molar, they noted the success in achieving the pulp anaesthesia after LIA in 63% (12/19) of patients when articaine was used, and 53% (10/19) after 4% prilocaine. ...
Introduction. The aim of this study was to compare anaesthetic efficacy of two techniques - infiltration local anaesthesia in the posterior segment of the mandible, and inferior alveolar block, using 4% articaine with 1:100.000 adrenaline - and to note possible differences in haemodynamic parameters caused by these two techniques. Methods. Sixty pre-informed patients were divided into two study groups. Both groups received 1.8 ml of the same anaesthetic solution, 4% articaine with adrenaline 1:100.000, with two different techniques of local anaesthesia. The first group received local infiltration anaesthesia (LIA) in projection of root apex of the first lower molar; the second group received the inferior alveolar nerve block (IAB). The examined parameters were: changes in tooth sensitivity after 5 and 30 minutes in relation to the value recorded before administering the anaesthetics, onset of anaesthesia, width of anaesthetic field, and duration of anaesthesia. Also, the impact of the applied techniques on cardiovascular parameters was noticed. Results. LIA group had a statistically significant decrease in sensitivity 5 minutes after application local anaesthetic. The decreasing trend continued between 5 and 30 minutes, although without statistical significance. There was no statistically significant difference in sensitivity changes between two groups for the first molar and the first and second premolars. However, there was a statistically significant difference in duration of local anaesthesia in favour of the IAB, while the width of anaesthetic fields was significantly higher after LIA. Significant changes in hemodynamic parameters were not recorded within the two groups. Conclusion. The effect of LIA, on tooth sensitivity of premolars and first molar is quite satisfactory. Iwas more effective for canine and second molar. None of the tested techniques had any significant effect on the cardiovascular parameters.
... The ability of articaine infiltrations to secure pulp anesthesia in mandibular molars, [1] and the superiority of However, no trail in the literature has ever investigated the influence of articaine and mepivacaine buccal infiltration following 2% mepivacaine IANB. The aim of this study is to assess the depth of local anesthesia in healthy adult volunteers' first molar teeth when buccal infiltration of 2% mepivacaine with adrenaline (1:100,000) and 4% articaine with adrenaline (1:100,000) were supplemented to 2% mepivacaine and adrenaline (1:100,000) local anesthetic solution. ...
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.
... Uma escala visual analógica de faces foi utilizada para avaliar a sensibilidade dolorosa durante o estudo 14 em que o auxiliar mostrava para o paciente a escala e pedia para o mesmo indicar a sensação de dor em escores que variavam de 0 a 5, em que o zero indicava ausência de dor, 1 e 2 dor leve, 3 e 4 dor moderada e 5 indicava dor severa. Esta escala foi utilizada no momento de triagem e seleção do paciente, sendo feita a sondagem das unidades comprometidas e apenas aquelas que apresentavam escore de dor 5 foram incluídas na amostra. ...
... Nevertheless, infiltration injection is not always 100% successful. Success is reported to range from 50 to 100% in maxillary teeth [12,13,14]. ...
Various adjuncts have been utilized with lignocaine to decrement tourniquet pain and prolong postoperative analgesia and its efficacy
during dental extraction and various other restorative procedures in dentistry. An obligatory part of the dental process is to sanction a
patient to feel comfortable and pain-free during operational and remedial dental procedures. The most popular local anaesthetic injection
for lower teeth is the inferior alveolar nerve (IAN) block. Instead of this the percentage of ineffectiveness is higher is inferior alveolar nerve
block as compared to other local anaesthetic nerve block. The goal of cumulating different drugs is to engender the best therapeutic
effects with the fewest or no unpropitious effects. There are fewer researches and evidence present which recommend and promote the
application and effectiveness of mannitol other than in the administration in decreasing raised intracranial pressure. It is paramount to
know how the drug interacts with each other to minimize the unexpected or perilous effects.
... Uma escala visual analógica de faces foi utilizada para avaliar a sensibilidade dolorosa durante o estudo 14 em que o auxiliar mostrava para o paciente a escala e pedia para o mesmo indicar a sensação de dor em escores que variavam de 0 a 5, em que o zero indicava ausência de dor, 1 e 2 dor leve, 3 e 4 dor moderada e 5 indicava dor severa. Esta escala foi utilizada no momento de triagem e seleção do paciente, sendo feita a sondagem das unidades comprometidas e apenas aquelas que apresentavam escore de dor 5 foram incluídas na amostra. ...
Objective: To evaluate the anesthetic efficacy and the need for additional intraligamentary anesthesia in patients with advanced chronic periodontitis after anesthesic block for inferior alveolar nerve, lingual and buccal using two different anesthesics. Method: We selected 30 patients with advanced chronic periodontitis and with indication for extraction of at least two lower teeth, one on each side of the mandible. 60 anesthesic blocks performed in two sessions with one week between sessions: 30 blocks of articaine 4% with epinephrine 1:100,000 and 30 blocks of lidocaine 2% with epinephrine 1:100,000. The pain was measured using a faces analogue scale in which patients rated the pain felt in scores ranging from 0 (no pain) to 5 (hard pain) and, scores higher than 2 in moment post anesthesia, indicated the need for intraligamentary supplementary anesthesia. The statistical test of Mann-Whitney was used to compare the anesthetic efficacy and the need for additional anesthesia and the results were considered statistically significant when p < 0.05. Results: When comparing the success of the two anesthetic solutions, there was a significant statistically difference (p = 0.0337), as well as the need additional anesthesic technique (intraligamentary anesthesia), where only 16.7% of patients anesthetized with articaine needed to supplement anesthesia. With lidocaine that percentage increased to 46.7%, showing the superiority of articaine 4% with epinephrine 1:100,000. Conclusion: The articaine 4% with epinephrine 1:100,000 was better than the lidocaine 2% with epinephrine 1:100,000 in both item anesthetic success as in need of additional intraligamentary anesthesia.
... One study 22 showed that mandibular buccal infiltration with 4% articaine with 1:100 000 adrenaline was more effective in obtaining molar pulpal anaesthesia than a similar injection of 2% lidocaine with 1:100 000 adrenaline. This may be the result of the increased concentration of local anaesthetic drug as an earlier investigation showed no difference in efficacy following mandibular buccal infiltration between 4% articaine and 4% prilocaine 23 . A point of interest is that, as far as anaesthesia of the lower first molar is concerned, the infiltration of 4% articaine produced equivalent success to inferior alveolar nerve block with 2% lidocaine in a similar study population 24 . ...
This article describes current concepts in the mechanism of action of local anaesthetic drugs and discusses recent advances in the equipment and drugs that may be used to provide intra-oral anaesthesia.
Background
Uncertainty exists regarding the pain scores and the success rate of intraligamentary anesthesia compared to other infiltration anesthesia. Based on the conditions of clinical anesthesia techniques, we conducted a systematic review and meta-analysis to compare the efficacy of intraligamentary anesthesia with other infiltration anesthesia.
Methods
The search was carried out in PubMed Central, Cochrane Central Register of Controlled Trials, MEDLINE (via OVID), Embase (via OVID), and Scopus from the inception to March 26, 2023.
Results
Seven eligible randomized controlled trials were included in the meta-analysis. The results indicated no significant difference in the success rate (RR = 0.96; 95% CI [0.81–1.14]; p = 0.65; I ² = 73%) and visual analog scale (VAS) during dental procedures (MD = 3.81; 95% CI [−0.54–8.16]; p = 0.09; I ² = 97%) between intraligamentary anesthesia and other infiltration anesthesia. However, intraligamentary anesthesia exhibited a higher VAS score during injection than other infiltration anesthesia (MD = 8.83; 95% CI [4.86–12.79]; p < 0.0001; I ² = 90%). A subgroup analysis according to infiltration techniques showed that supraperiosteal anesthesia had a lower VAS score during dental procedures than intraligamentary anesthesia.
Conclusions
Intraligamentary anesthesia and other infiltration anesthesias have the same success rate and pain during dental procedures. However, the pain during injection of intraligamentary anesthesia is heavier than that of other infiltration anesthesia.
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.
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.
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'.
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.
Dexmedetomidine is an alpha 2 adrenergic receptor agonist, even ten times more selective than clonidine. It is a very versatile drug in
anaesthesia practice, finding place in increasing number of clinical scenarios and is no more limited to intensive care unit (ICU) sedation.
It is analgesic, has anaesthetic sparing effect, sympatholytic property, useful in other procedural sedation and also has cardiovascular
stabilizing property. It reduces delirium and preserves respiratory function which adds benefits to its uses. The aim of this review is to
make awareness of its role in present anaesthesia and discuss its limitations at the same time.
Introduction:
Studies have shown the superiority of 4% articaine with 1:100,000 epinephrine over 2% lidocaine with 1:100,000 epinephrine when used as a primary buccal infiltration of the mandibular first molar. A study using other 4% anesthetic formulations may help determine the role of concentration in the increased efficacy of 4% articaine. The authors conducted a prospective randomized, double-blind, crossover study comparing the pulpal anesthesia obtained with 4% concentrations of articaine, lidocaine, and prilocaine formulations as primary buccal infiltrations of the mandibular first molar.
Methods:
Sixty asymptomatic adult subjects randomly received a primary mandibular buccal first molar infiltration of 1.8 mL 4% articaine with 1:100,000 epinephrine, 4% lidocaine with 1:100,000 epinephrine, and 4% prilocaine with 1:200,000 epinephrine in 3 separate appointments. An electric pulp tester was used to test the first molar for anesthesia in 3-minute cycles for 60 minutes after the infiltrations. Successful anesthesia was defined as 2 consecutive 80/80 readings.
Results:
The success rate for the 4% articaine formulation was 55%, 33% for the 4% lidocaine formulation, and 32% for the 4% prilocaine formulation. There was a significant difference between articaine and both lidocaine (P = .0071) and prilocaine (P = .0187) formulations.
Conclusions:
A 4% articaine formulation was statistically better than both 4% lidocaine and 4% prilocaine formulations for buccal infiltration of the mandibular first molar in asymptomatic mandibular first molars. However, the success rate of 55% is not high enough to support its use as a primary buccal infiltration technique in the mandibular first molar.
Local anesthetics are administered every day in the practice of dentistry. Since there are quite a number of solutions on the market today, a dentist should be able to select the most one for every patient and each procedure. During the last few years Articaine has been strongly promoted. We have tried to compare Articaine and Lidocaine in a clinical setting. The omnipresence of local anesthetics in dentistry makes this class of drugs the most used in practice. For the five last decades, several local anesthetics came to the fore on the market, bringing more latitude to the dentist who now has the advisability to choose which anesthetic solution is adapted to meet a precise clinical situation. On the other hand, knowing the growing number of anesthetic formulas available, it is becoming more difficult to choose since it is not easy to remain current in this field of dental medicine. Certain myths or beliefs circulate among the dental profession people and this information, often unfounded, tends to keep an important place at the time of the decision-making which anesthetic way the dentist will follow. This article is a literature review on certain nebulous points surrounding the local anesthetics used in cabinet, hoping to make it possible for professional people to do more judicious choices on the scientific knowledge based, known and accepted by the dental profession at present.
Aim:
To evaluate the efficacy of a single buccal infitration using 4% articaine hydrochloride (HCl) with 1 : 100,000 epinephrine or 4% articaine HCl with 1 : 100 000 epinephrine bitartrate for obtaining adequate pulpal anaesthesia in the palatal roots of maxillary first molars associated with irreversible pulpitis.
Methodology:
In this single-blind randomized clinical trial, fifty subjects were randomly allocated to receive maxillary buccal injections of 1.5 mL 4% articaine with 1 : 100,000 epinephrine (n = 25) or 1.5 mL 4% articaine with 1 : 100,000 epinephrine bitartrate (n = 25). Visual analogue scale (VAS) scores and pulse rate measurements were recorded during access cavity preparation and initial file placement into the mesiobuccal, distobuccal and palatal canals. Data were analysed using Duncan and t-tests.
Results:
There was no significant difference between the two anaesthetic solutions regarding the VAS scores and pulse rate measurements during endodontic procedures. The mean VAS ratings of the 50 patients during file placement into the palatal canals were significantly higher compared with the other three root canal procedures (P < 0.0001). The heart rates during negotiation of palatal canals were significantly higher than when negotiating the mesiobuccal and distobuccal canals (P < 0.0001).
Conclusion:
Single buccal infiltration did not achieve adequate pulpal anaesthesia in the palatal root canal of the maxillary first molars associated with irreversible pulpitis.
Objectives:
The aim of this systematic review is to investigate the effect of an additional lingual infiltration on the pulpal anesthesia of mandibular teeth.
Method and materials:
Prospective clinical trials were searched from Medline, EMBASE, Cochrane Library, Pubmed, SCI, and the China National Knowledge Infrastructure. Papers that met the inclusion criteria were accepted. Data was extracted by two investigators using a designed extraction form. The anesthetic efficacy of an additional lingual infiltration on the pulpal anesthesia of mandibular teeth was analyzed.
Results:
Seven prospective randomized controlled trials were included. All subjects of these studies were volunteers with healthy pulps, without patients with pulpitis. Compared to buccal infiltration alone, an additional lingual infiltration following buccal infiltration is more likely to achieve a successful pulpal anesthesia in the mandibular incisor area, with a relative risk for success of 2.00 [1.08, 3.72] for 2% lidocaine and 1.32 [1.15, 1.51] for 4% articaine. For mandibular canines and premolars, the additional lingual infiltration following inferior alveolar nerve block did not enhance the anesthetic efficacy. In the mandibular molar area, no significant difference was found after an additional lingual infiltration with either 2% lidocaine or 4% articaine.
Conclusion:
An additional lingual infiltration following buccal infiltration can enhance the anesthetic efficacy compared with buccal infiltration alone in the mandibular incisor area. For mandibular canines, premolars, and molars, an additional lingual infiltration is not recommended, since no data exist to support such usage. Lingual infiltration of articaine in the mandibular teeth with pulpitis should be studied further.
Profound pulpal anesthesia in posterior mandibular teeth with irreversible pulpitis usually requires administering an inferior alveolar nerve block (IANB) plus other supplemental injections. The purpose of this prospective, randomized, double-blind study was to compare the anesthetic success rate of buccal infiltration injections of articaine and lidocaine when supplemented with an IANB.
One hundred twenty-five emergency patients who had their first or second mandibular molar diagnosed with irreversible pulpitis participated in the study and received the IANB by using either 2% lidocaine with 1:100,000 epinephrine or 4% articaine with 1:100,000 epinephrine. One hundred two of the patients reported moderate-to-severe pain upon initiation of their endodontic treatment or through filing of their tooth canals and received supplemental buccal infiltration injections by using the same anesthetic that the IANB had been performed. After the block or the supplemental buccal infiltration injections, success was achieved with no or mild pain during instrumentation of the tooth canals.
The success rate after the administration of the infiltration injections after an incomplete IANB by using lidocaine was 29%, whereas by using articaine it was 71% (P < .001). No statistical differences were detected in the success rates between the 2 anesthetics after the block injections.
Supplementing an incomplete articaine IANB with articaine infiltration raises the anesthetic success more effectively compared with lidocaine in mandibular molars with irreversible pulpitis.
The purpose of the following paper is to discuss problems with mandibular anesthesia, the success of intraosseous anesthesia, and the clinical management of endodontic anesthesia.
The purpose of this study was to evaluate and compare the anesthetic efficacy of posterior superior alveolar (PSA) nerve blocks, buccal infiltrations, and buccal plus palatal infiltrations with 2% lidocaine with 1:200,000 epinephrine in maxillary first molars with irreversible pulpitis.
Ninety-four adult patients participated in this prospective, randomized, single-blinded study. The patients were divided into 3 treatment groups on a random basis. Twenty-eight patients received a PSA nerve block, 33 patients received buccal infiltrations, and 33 patients received buccal plus palatal infiltrations with 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated 15 minutes after injection. Pain during treatment was recorded using a Heft-Parker visual analog scale. Success was recorded as "none" or "mild" pain.
Statistical analysis using nonparametric chi-square tests revealed that there was no statistical difference between the anesthetic success of PSA nerve blocks (64%), buccal infiltrations (54%), and buccal plus palatal infiltrations (70%).
None of the tested methods gave 100% anesthetic success rates in maxillary first molars with irreversible pulpitis.
The author describes the use of the infiltration anesthetic technique to anesthetize mandibular teeth in adults and explores its mechanism of action.
The author reviewed articles describing randomized controlled trials of the mandibular infiltration anesthetic technique in healthy participants.
The author found that using the mandibular infiltration anesthetic technique can produce anesthesia in adult mandibular teeth. The success was dose dependent and the choice of anesthetic solution was significant; 4 percent articaine with 1:100,000 epinephrine was more effective than 2 percent lidocaine with 1:100,000 epinephrine. Combining buccal and lingual infiltrations increased success in the mandibular incisor region. The success of the mechanism of infiltration of anesthetic at the mandibular first molar appeared to depend on the mental foramen.
The mandibular infiltration anesthetic technique is an effective method of anesthetizing mandibular incisors. Four percent articaine with epinephrine appears to be the preferred solution.
The choice of anesthetic solution is important when using the infiltration anesthetic technique in the adult mandible.
The purpose of this prospective, randomized, single-blind crossover study was to evaluate the anesthetic efficacy of a combination palatal and buccal infiltration of the maxillary first molar.
Using a crossover design, 40 subjects received two sets of maxillary first molar infiltrations at two separate appointments spaced at least 1 week apart. The anesthetic used in this study was 2% lidocaine with 1:100,000 epinephrine. One set of infiltrations consisted of a buccal infiltration of 1.8 mL of anesthetic and a palatal infiltration of 0.5 mL of anesthetic. The other set consisted of a buccal infiltration of 1.8 mL of anesthetic and a mock palatal infiltration. The first molar was pulp tested in 4-minute cycles for a total of 60 minutes. Anesthetic success was defined as no subject response to two consecutive 80 readings with an electric pulp tester.
The success rates were 88% for the buccal infiltration and 95% for the buccal plus palatal infiltration. The difference was not statistically significant. The buccal plus palatal infiltration significantly increased the incidence of pulpal anesthesia from 21 minutes through 57 minutes. Although there was an increased incidence of pulpal anesthesia with the combination buccal plus palatal infiltration, anesthesia was not provided for 60 minutes.
The purpose of this prospective, randomized, double-blind crossover study was to compare the anesthetic efficacy of 2% mepivacaine with 1 : 20,000 levonordefrin versus 2% lidocaine with 1 : 100,000 epinephrine in maxillary central incisors and first molars. Sixty subjects randomly received, in a double-blind manner, maxillary central incisor and first molar infiltrations of 1.8 mL of 2% mepivacaine with 1 : 20,000 levonordefrin and 1.8 mL of 2% lidocaine with 1 : 100,000 epinephrine at 2 separate appointments spaced at least 1 week apart. The teeth were electric pulp tested in 2-minute cycles for a total of 60 minutes. Anesthetic success (obtaining 2 consecutive 80 readings with the electric pulp tester within 10 minutes) was not significantly different between 2% mepivacaine with 1 : 20,000 levonordefrin and 2% lidocaine with 1 : 100,000 epinephrine for the central incisor and first molar. However, neither anesthetic agent provided an hour of pulpal anesthesia.
Infiltration is preferred to regional block techniques in the maxilla as the former offers a number of advantages. This paper considers the evidence for the efficacy of infiltration anesthesia in the mandible in the adult dentition, both as a primary and as a supplemental method.
The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1:100,000 epinephrine, 4% prilocaine with 1:200,000 epinephrine, and 4% prilocaine in maxillary lateral incisors and first molars. Sixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine, 1.8 mL of 4% prilocaine with 1:200,000 epinephrine, and 1.8 mL of 4% prilocaine, at 3 separate appointments spaced at least 1 week apart. The teeth were pulp-tested in 3-minute cycles for a total of 60 minutes. Anesthetic success (ie, obtaining 2 consecutive 80 readings with the electric pulp tester) and onset of pulpal anesthesia were not significantly different between 2% lidocaine with 1:100,000 epinephrine, 4% prilocaine with 1:200,000 epinephrine, and 4% prilocaine for the lateral incisor and first molar. For both lateral incisor and first molar, 4% prilocaine with 1:200,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine were equivalent for incidence of pulpal anesthesia. However, neither anesthetic agent provided an hour of pulpal anesthesia. For both lateral incisor and first molar, 4% prilocaine provided a significantly shorter duration of pulpal anesthesia compared with 2% lidocaine with 1:100,000 epinephrine and 4% prilocaine with 1:200,000 epinephrine.
The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine the effect of the administration of preoperative ibuprofen on the success of the inferior alveolar nerve block (IAN) in patients with irreversible pulpitis.
One hundred endodontic emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, identical capsules of either 800 mg ibuprofen or placebo 45 minutes before the administration of a conventional IAN block. Access was begun 15 minutes after completion of the IAN block, and all patients had profound lip numbness. Success was defined as no or mild pain (visual analogue scale recordings) on access or initial instrumentation.
The success rate for the IAN block was 41% with ibuprofen and 35% with placebo, with no significant difference (P=.57) between the 2 groups. For mandibular posterior teeth, a dose of 800 mg of ibuprofen given 45 minutes before the administration of the IAN block did not result in a statistically significant increase in anesthetic success in patients with irreversible pulpitis.
Previous studies have shown declining rates of pulpal anesthesia over 60 minutes when a cartridge of 4% articaine is used with 1:100,000 epinephrine for buccal infiltration in the mandibular first molar. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 2 sets of mandibular first molar buccal infiltrations, given in 2 separate appointments, to 86 adult subjects: an initial infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine plus a repeated infiltration of the same anesthetic and dose given 25 minutes following the initial infiltration versus an initial infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine plus a mock repeated infiltration given 25 minutes following the initial infiltration. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 112 minutes after the injections. The repeated infiltration significantly improved pulpal anesthesia from 28 minutes through 109 minutes in the mandibular first molar. A repeated infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine given 25 minutes after an initial infiltration of the same type and dose of anesthetic significantly improved the duration of pulpal anesthesia, when compared with only an initial buccal infiltration, in the mandibular first molar.
The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine in the intraoral, infraorbital nerve block.
Forty subjects randomly received intraoral, infraorbital nerve blocks by using a cartridge of 2% lidocaine with 1:100,000 or 1:50,000 epinephrine and a cartridge of 3% mepivacaine at 3 separate appointments spaced at least 1 week apart. The anteriors, premolars, and first molar were pulp tested in 4-minute cycles for a total of 60 minutes.
The intraoral, infraorbital nerve block was ineffective in providing profound pulpal anesthesia of the maxillary central incisor, lateral incisor, and first molar. Successful pulpal anesthesia of the canine and first and second premolars ranged from 75%-92% by using 2% lidocaine with 1:100,000 and 1:50,000 epinephrine. However, pulpal anesthesia did not last for 60 minutes. The use of 3% mepivacaine provided a shorter duration of anesthesia than the lidocaine formulations with epinephrine in the canines and premolars.
The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1:100,000 and 1:50,000 epinephrine and 3% mepivacaine in maxillary lateral incisors and first molars.
Sixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine at three separate appointments spaced at least 1 week apart. The teeth were pulp tested in 3-minute cycles for a total of 60 minutes.
Anesthetic success and the onset of pulpal anesthesia were not significantly different between 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine and 3% mepivacaine for the lateral incisor and first molar. Increasing the epinephrine concentration from 1:100,000 to 1:50,000 in a 2% lidocaine formulation significantly decreased pulpal anesthesia of short duration for the lateral incisor but not the first molar. For both the lateral incisor and first molar, 3% mepivacaine significantly increased pulpal anesthesia of short duration compared with 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine.
The authors conducted a randomized, double-blind clinical trial to evaluate pulpal anesthesia achieved after mandibular infiltration of five commonly marketed dental local anesthetic formulations as compared with a control formulation of lidocaine with epinephrine.
The authors evaluated 2 percent lidocaine with 1:100,000 epinephrine (L100) against 4 percent articaine with 1:100,000 epinephrine (A100), 4 percent articaine with 1:200,000 epinephrine (A200), 4 percent prilocaine with 1:200,000 epinephrine (P200), 3 percent mepivacaine without vasoconstrictor (Mw/o) and 0.5 percent bupivacaine with 1:200,000 epinephrine (B200). This repeated-treatment trial involved 18 healthy participants. The investigators administered mandibular infiltration injections (six sessions per participant) of 0.9 milliliters of anesthetic into the buccal fold adjacent to the distal root of the mandibular first molar. The authors determined anesthetic efficacy across a 20-minute period by measuring changes in sensory threshold to electrical pulp test (EPT) stimulation.
Twelve female and six male participants (mean age, 24.9 years; range, 18-53 years) completed the study. The maximum mean increase from baseline of EPT measurements for the six formulations were 43.5 percent for L100, 44.8 percent for B200, 51.2 percent for P200, 66.9 percent for A200, 68.3 percent for Mw/o and 77.3 percent for A100 (A100 versus L100, P = .029). Adverse reactions were minor and not formulation dependent.
The authors found that mandibular infiltration with 0.9 mL of the tested dental anesthetics could induce only partial pulpal anesthesia, a level likely to be inadequate for most dental procedures. When compared with L100, only the A100 induced statistically greater pulpal anesthesia after mandibular buccal infiltration.
Previous studies have shown declining rates of pulpal anesthesia over 60-minute periods in patients who have received 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine in the maxillary lateral incisor.
The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained in 40 adult subjects with two sets of maxillary lateral incisor infiltrations, given in two separate appointments: an initial infiltration of 1.8 mL of 2 percent lidocaine with 1:100,000 epinephrine plus a repeated infiltration of the same anesthetic and dose given 30 minutes after the initial infiltration, and an initial infiltration of 1.8 mL of 2 percent lidocaine with 1:100,000 epinephrine plus a mock repeated infiltration given 30 minutes after the initial infiltration. The authors used an electric pulp tester to test the lateral incisor for anesthesia in two-minute cycles for 90 minutes after the injection.
The repeated infiltration improved pulpal anesthesia significantly in the maxillary lateral incisor in the period from 37 through 90 minutes postinjection.
A repeated infiltration of 1.8 mL of 2 percent lidocaine with 1:100,000 epinephrine given 30 minutes after the initial infiltration significantly improved the duration of pulpal anesthesia in the maxillary lateral incisor.
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