Can buccal infiltration of articaine replace traditional inferior alveolar nerve block for the treatment of mandibular molars in pediatric patients?: A systematic review and meta-analysis

Background It is unclear if buccal articaine infiltration can be used as an alternative to standard inferior alveolar nerve block (IANB) for treating mandibular molars in pediatric patients. Therefore, this study aimed to pool evidence to compare the efficacy of buccal infiltration of articaine vs IANB with lignocaine for pediatric dental procedures.Material and Methods We searched the PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar databases for randomized controlled trials (RCTs) comparing the two techniques in pediatric patients and reporting the success of anesthesia and/or pain during treatment. PRISMA guidelines were followed.Results Seven RCTs were included. Pooled analysis of five studies indicated no statistically significant difference in the success rates of the two anesthetic techniques (OR: 1.02; 95% CI: 0.13, 7.96; I2=69%, p=0.98). Meta-analysis of data from the four studies demonstrated no statistically significant difference in pain during the procedure with buccal infiltration of articaine or IANB with lignocaine (SMD: 0.62; 95% CI: -1.37, 0.12; I2=88%, p=0.10).Conclusions Evidence suggests that buccal infiltration of articaine is a viable alternative to IANB with lignocaine in pediatric patients for treating mandibular molars. Based on the confidence intervals, there may be a tendency of higher success rates with buccal infiltration of articaine. Key words:Lignocaine, articaine, primary dentition, children, molars.     

Anesthetic Comparisons of 4% Concentrations of Articaine,Lidocaine, and Prilocaine as Primary Buccal Infiltrations of the Mandibular First Molar: A Prospective Randomized,Double-blind Study

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.     

The efficacy and safety of articaine versus lignocaine in dental treatments: A meta-analysis

Objectives

Although articaine has been recommended for providing an improved local anaesthetic effect in patients presenting for dental treatments, a relevant meta-analysis has been lacking. Despite articaine's popularity, there is contradictory evidence to support the claims. The aim of this systematic review was to compare the efficacy and safety of articaine with lignocaine in maxillary and mandibular infiltrations and block anaesthesia in patients presenting for routine dental treatments.

Data sources

The following databases were searched: Cochrane Central, Medline, Embase, and ProQuest Health and Medical Complete. In addition, the metaRegister of the controlled trials database was searched to identify dissertations and ongoing or unpublished trials, and the Australian division of Septodont (the manufacturer of articaine and lignocaine) was contacted. The bibliographies of identified articles were also searched.

Study selection

Inclusion was limited to: (1) randomized controlled trials in patients requiring non-complex routine dental treatments; (2) interventions comparing 4% articaine (1:100,000 epinephrine) with 2% lignocaine (1:100,000 epinephrine) for maxillary and mandibular infiltrations and block anaesthesia; and (3) with principal outcome measures of anaesthetic success, post-injection adverse events or post-injection pain. Trial quality was evaluated by assessing randomization, allocation concealment, blinding, intention to treat analyses and how losses to follow up were addressed. Treatment effects were combined by meta-analysis using the random effects method.

Results

Articaine is more likely than lignocaine to achieve an anaesthetic success in the posterior first molar area with a relative risk for success at 1.31 (95% CI 1.12–1.54, P = 0.0009). There is no difference in post-injection adverse events between articaine and lignocaine with a relative risk of 1.05 (95% CI 0.66–1.65, P = 0.85). However, articaine injection results in a higher pain score as measured by Visual Analogue Scale, than lignocaine at the injection site after anaesthetic reversal with a weighted mean difference of 6.49 (95% CI 0.02–12.96, P = 0.05) decreasing to 1.10 (95% CI 0.18–2.02, P = 0.02) on the third day after injection.

Conclusion

The results of this systematic review provide support for the argument that articaine is more effective than lignocaine in providing anaesthetic success in the first molar region for routine dental procedures. In addition, both drugs appear to have similar adverse effect profiles. The clinical impact of articaine's higher post-injection pain scores than lignocaine is negligible. Hence, articaine is a superior anaesthetic to lignocaine for use in routine dental procedures. Use in children under 4 years of age is not recommended, since no data exists to support such usage.     

Addition of epidermal growth factor receptor inhibitors to standard chemotherapy increases survival of advanced head and neck squamous cell carcinoma patients: A systematic review and meta-analysis

Head and neck squamous cell carcinoma (HNSCC) is among the common tumors associated with high mortality. The aim of our meta-analysis was to determine how additional anti-epidermal growth factor receptor (EGFR) therapy to standard chemotherapy affects the progression-free (PFS) and overall survival (OS) of the patients, besides the most common side effects. We used CENTRAL, MEDLINE, and Embase databases until October 26, 2020, and included 13 eligible randomized controlled trials in our systematic research. The pooled hazard ratios (HR) for the main outcomes from the original data were estimated and for the other dichotomous outcomes, odds ratios (ORs) with their 95% confidence intervals (CI) were calculated. Addition of EGFR inhibitors to conventional chemotherapy significantly decreased the death and disease progression (for PFS HR: 0.68, 95% CI: 0.55–0.81, I² = 65.5%, p = 0.005) and mortality (for OS HR: 0.83, 95% CI: 0.72–0.94, I² = 42.3%, p = 0.076). In the EGFR inhibitor group, we revealed an increased chance of the over Grade 3 skin rashes (OR: 4.86; 95% CI: 1.52–15.49, I² = 2.3%, p = 0.407), and all Grade skin rashes (OR: 18.32, 95% CI: 8.07–41.60, I² = 56.6%, p = 0.032). Despite their unwanted dermatological side effects, the addition of EGFR inhibitors is recommended to be included in advanced HNSCC therapy.     

The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: a meta-analysis

BackgroundThe authors evaluated published evidence from controlled clinical trials regarding the efficacy of two local anesthetic solutions in providing successful pulpal anesthesia.MethodsThe authors searched MEDLINE and Embase databases to identify peer-reviewed randomized controlled trials in which researchers directly compared articaine and lidocaine local anesthetic solutions in adult participants. They extracted study characteristics and outcomes data as a basis for meta-analysis. They completed subgroup analyses for both infiltration and mandibular inferior alveolar block anesthetic techniques.ResultsArticaine solutions had a probability of achieving anesthetic success superior to that of lidocaine, with an odds ratio of 2.44 (95 percent confidence interval [CI], 1.59–3.76; P < .0001). The greater odds ratio for articaine increased to 3.81 (95 percent CI, 2.71–5.36; P < .00001) when the authors analyzed only infiltration data. There was weaker, but still significant, evidence of articaine’s being superior to lidocaine for mandibular block anesthesia, with an odds ratio of 1.57 (95 percent CI, 1.12–2.21; P = .009), and no difference when the authors considered only symptomatic teeth.Clinical ImplicationsResearch evidence supports using articaine versus lidocaine for achieving pulpal anesthesia when the infiltration mode of administration is used. It is premature to recommend articaine for mandibular block anesthesia in cases involving irreversible pulpitis.     

Efficacy of local anaesthetic solutions on the success of inferior alveolar nerve block in patients with irreversible pulpitis: a systematic review and network meta‐analysis of randomized clinical trials

The management of pain during root canal treatment is important. The aim of this systematic review and network meta‐analysis was to identify the anaesthetic solution that would provide the best pulpal anaesthesia for inferior alveolar nerve blocks (IANB) treating mandibular teeth with irreversible pulpitis. Two electronic databases (PubMed and Scopus) were searched to identify studies up to October 2018. Randomized clinical trials comparing at least two anaesthetic solutions (lidocaine (lignocaine), articaine, bupivacaine, prilocaine or mepivacaine) used for IANB for treatment of irreversible pulpitis were included. The revised Cochrane risk of bias tool for randomized trials was used to assess the quality of the included studies. Pairwise meta‐analysis, network meta‐analysis using a random‐effects model, and SUCRA ranking were performed. The network meta‐analysis estimated the probability of each treatment performing best. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. In total, 11 studies (n = 750) were included in the meta‐analysis. The network meta‐analysis revealed that only mepivacaine significantly increased the success rate of IANB compared to lidocaine (RR, 1.42 [95% CI 1.04–1.95]). However, no significant differences in the success rate of IANB were observed between mepivacaine and other anaesthetic agents (articaine and bupivacaine). Of all anaesthetic agents, mepivacaine (SUCRA = 0.81) ranked first in increasing the success rate of IANB, followed by prilocaine (SUCRA = 0.62), articaine (SUCRA = 0.54), bupivacaine (SUCRA = 0.41) and lidocaine (SUCRA = 0.13). The overall quality of evidence was very low to moderate. In conclusion, based on the evidence from the randomized clinical trials included in this review, mepivacaine with epinephrine demonstrated the highest probability of providing effective pulpal anaesthesia using IANB for teeth with irreversible pulpitis compared to prilocaine, articaine, bupivacaine and lidocaine. Further, high‐quality clinical trials are needed to support the conclusion of this review.     

Efficacy of Lycopene in the Treatment of Oral Submucous Fibrosis: A Meta-analysis of Randomized Controlled Trials

ObjectivesThe aim of this meta-analysis was to systematically evaluate the efficacy of lycopene in improving maximum mouth opening and other clinical symptoms in patients with oral submucous fibrosis (OSF).MethodsWe searched 5 databases: PubMed, Web of Science, Embase, The Cochrane Library, and EBSCO. Randomized controlled trials were collected to evaluate the efficacy of lycopene in the treatment of OSF. Each database was searched from inception to April 30, 2019. The RevMan 5.3 software was used for this meta-analysis.ResultsThe included studies were 7 randomized controlled trials involving 758 patients with OSF. The results of this meta-analysis showed that lycopene was significantly more effective in improving maximum mouth opening in OSF patients than placebo treatment (mean difference [MD]: 3.15; 95% confidence interval [CI]: 2.19-4.10, P < .0001, I² = 0%). Compared with control groups, lycopene could significantly increase the maximum mouth opening in patients with OSF after 1 month of treatment (MD, 2.40; 95% CI, 2.22-2.58; P = .91; I² = 0%), 2 months of treatment (MD, 3.19; 95% CI, 2.87-3.51; P = .93; I² = 0%), and 3 months of treatment (MD, 4.89; 95% CI, 4.51-5.28; P = .86; I² = 0%). However, no significant difference was found in alleviation of burning sensation after 1 month (risk ratio [RR], 1.04; 95% CI, 0.89-1.23; P = .73; I² = 0%), 2 months (RR, 0.98; 95% CI, 0.73-1.31; P = .69; I² = 0%), and 3 months of treatment (RR, 0.84; 95% CI, 0.47-1.52; P = .81; I² = 0%); tongue protrusion (MD, −1.59; 95% CI, −4.15 to 0.97; P = .12; I² = 58%); and pain associated with the lesion after 1 month (RR, 1.05; 95% CI, 0.92-1.21; P = .77; I² = 0%), 2 months (RR, 0.95; 95% CI, 0.75-1.19; P = .35; I² = 0%), and 3 months (RR, 0.95; 95% CI, 0.68-1.33; P = .14; I² = 51%) in patients with OSF between lycopene and control groups.ConclusionsThe results of this meta-analysis showed that lycopene is more effective for improving symptoms of maximum mouth opening than placebo groups and control groups, but there were no significant differences in burning sensation, pain associated with lesion, and tongue protrusion in patients with OSF compared with control groups.     

Anesthetic efficacy of 4% Articaine with 1:100,000 epinephrine versus 4% articaine with 1:200,000 epinephrine as a primary buccal infiltration in the mandibular first molar

Introduction

No study has compared 4% articaine with 1:100,000 epinephrine with 4% articaine with 1:200,000 epinephrine in a mandibular buccal infiltration of the first molar. The authors conducted a prospective, randomized, double-blind, crossover study comparing the degree of pulpal anesthesia obtained with 4% articaine with 1:100,000 epinephrine and 4% articaine with 1:200,000 epinephrine as a primary infiltration in the mandibular first molar.

Methods

Eighty-six asymptomatic adult subjects randomly received a primary mandibular buccal first molar infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine and a cartridge of 4% articaine with 1:200,000 epinephrine in 2 separate appointments. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 60 minutes after the injections.

Results

The two 4% articaine formulations showed no statistically significant difference when comparing anesthetic success, onset of anesthesia, or incidence of pulpal anesthesia.

Conclusions

The anesthetic efficacy of 4% articaine with 1:200,000 epinephrine is comparable to 4% articaine with 1:100,000 epinephrine in a primary mandibular buccal infiltration of the first molar.     

Which antibiotic regimen prevents implant failure or infection after dental implant surgery? A systematic review and meta-analysis

ObjectiveTo assess which antibiotic regimen prevents dental implant failures or postoperative infections following dental implant placement.Materials and methodsSystematic review and meta-analysis. Data sources: Pubmed, Cochrane, Science Direct, and EMBASE via OVID were searched up to August 2017. Only randomized controlled clinical trials (RCT) using antibiotics were included. Outcome measures were set on dental implant failures or postoperative infection incidence after dental implant surgery. Three reviewers independently undertook risk of bias assessment and data extraction. Stratified meta-analyses of binary data using fixed-effects models were performed using Stata 14.0. The risk ratio (RR) and 95% confidence interval (CI) were estimated.ResultsNine articles were included corresponding to 15 RCTs. All RCTs tested only oral amoxicillin. Implant-failure analysis: overall RR = 0.53 (P = .005, 95% CI: 0.34–0.82) and overall NNT = 55 (95% CI, 33–167). Single-dose oral amoxicillin preoperatively (SDOAP) is beneficial (RR = 0.50, CI: 0.29–0.86. P = .012), when compared to postoperative oral amoxicillin (POA): RR = 0.60, CI: 0.28–1.30. P = .197. Postoperative-infection analysis: overall RR = 0.76 (P = 0.250, 95% CI: 0.47–1.22). Neither SDOAP (RR = 0.82, CI = 0.46–1.45, P = .488) nor POA (RR = 0.64, CI = 0.27–1.51, P = .309) are beneficial. I² = 0.0%, chi-squared tests P ≈ 1.ConclusionOnly SDOAP is effective and efficacious at preventing implant failures, but it was not significant for postoperative infections following dental implant surgeries.     

Efficacy of Articaine versus Lidocaine as a Supplemental Buccal Infiltration in Mandibular Molars with Irreversible Pulpitis: A Prospective,Randomized, Double-blind Study

Introduction

Profound pulpal anesthesia in mandibular molars with irreversible pulpitis (IP) is often difficult to obtain and often requires supplemental injections after an ineffective inferior alveolar nerve block (IANB). The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental buccal infiltrations (BIs) after an ineffective IANB in mandibular molars with IP. In addition, the use of articaine for IANB and intraosseous injections was investigated.

Methods

One hundred emergency patients diagnosed with IP of a mandibular molar were selected and received an IANB with 4% articaine. All injections were 1.7 mL with 1:100,000 epinephrine. All patients reported profound lip numbness after IANB. Patients with ineffective IANB (positive pulpal response to cold or pain on access) randomly received 4% articaine or 2% lidocaine as a supplemental BI. Endodontic access was initiated 5 minutes after deposition of the infiltration solution. Success was defined as no pain or no more than mild pain during endodontic access and instrumentation as measured on a visual analogue scale.

Results

Seventy-four patients failed to achieve pulpal anesthesia after IANB with 4% articaine, resulting in IANB success rate of 26%. Success rates for supplemental BIs were 62% for articaine and 37% for lidocaine (P < .05). This effect was most pronounced in second molars (P < .05).

Conclusions

Supplemental BI with articaine was significantly more effective than lidocaine. The IANB success rate of 4% articaine confirmed published data.     

Effect of waterpipe smoking on peri‐implant health: A systematic review and meta‐analysis

The aim of the present review was to evaluate the effect of waterpipe smoking (WS) on clinical peri‐implant inflammatory parameters compared to non‐smokers (NS) with dental implants. Literature searches were performed using bibliographic databases up to May 2018. Primary outcomes included peri‐implant bone loss (PIBL), while secondary outcomes were probing depth (PD), plaque index, and bleeding on probing. Relative risk (RR) and 95% confidence intervals (CI) for each PIBL and PD were estimated by a random‐effect model. Four retrospective case‐control studies were included in the qualitative and quantitative syntheses. All of the included studies showed statistically‐significantly worse peri‐implant outcomes in WS compared to NS. Considering the effects of WS on peri‐implant parameters, significant heterogeneity for PIBL (Q‐value = 34.21, P < 0.0001, I² = 94.16%) and PD (Q‐value = 51.97, P < 0.0001, I² = 96.15%) was observed between both groups. The overall RR for PIBL (RR = 3.32, 95% CI = 1.01‐3.97, P = 0.001) and PD (RR = 3.40, 95% CI = 1.91‐7.17, P = 0.001) were significant between WS and NS groups. WS has detrimental effect on peri‐implant health. Clinicians should instruct and advise patients about poor prognosis and peri‐implant diseases caused by WS.     

A comparison of articaine 4% and lignocaine 2% in block and infiltration analgesia in children

Background: Articaine administered through buccal infiltration (BI) has been suggested as providing adequate posterior mandibular analgesia. This study compared the efficacy of articaine 4% with 1:100 000 adrenaline (test) and lignocaine 2% with 1:80 000 adrenaline (control), delivered either through an inferior alveolar nerve block (IANB) or BI for routine restorative procedures in mandibular posterior teeth among children. Methods: Children enrolled within the Western Australian School Dental Service and in need of restorative care on contralateral mandibular posterior teeth were eligible. Consenting children were randomly allocated to test and control techniques, and to type of local anaesthetic. Using the faces pain scale, pain reports from analgesia administration and from dental treatment were elicited. Analgesia success and pain reports were compared by anaesthetic technique and type. Results: Fifty‐seven children were recruited into the study; 29 allocated to IANB. Analgesia success for IANB 100%; BI 67%; p < 0.001. Analgesia success for BI with articaine 71%; lignocaine 64%, p > 0.05. Analgesia success was associated with fewer reports of painful dental treatment, p = 0.005. Conclusions: There was higher success and less painful treatment with IANB. There was no statistically significant difference in local analgesia success between articaine and lignocaine when delivered via BI.     

Is mepivacaine as effective as lidocaine during inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis? A systematic review and meta‐analysis

This study aimed to compare the effectiveness of mepivacaine and lidocaine for pulpal anaesthesia and pain control when administered via an inferior alveolar nerve block during the root canal treatment of mandibular molars in patients with symptomatic irreversible pulpitis. A research protocol was developed and registered in PROSPERO. The systematic search was conducted during May 2017 in eight databases. The studies were selected based on inclusion and exclusion criteria. Two examiners analysed the sample independently, decided the eligibility for inclusion and classified the articles according to their quality. Statistical analysis was performed with Mantel‐Haenszel and I‐square (I²) tests considering a confidence interval of 95%. The initial sample consisted of 1130 articles, out of which four were eligible. The articles were published between 1993 and 2016. For both pulpal anaesthesia and pain control, there was no significant difference between mepivacaine and lidocaine (P = 0.843, I² = 0%, and P = 0.183, I² = 21.1%, respectively). Mepivacaine and lidocaine were similarly effective for pulpal anaesthesia and pain control after inferior alveolar nerve blocks for root canal treatment.     

Efficacy of Articaine versus Lidocaine in Supplemental Infiltration for Mandibular First versus Second Molars with Irreversible Pulpitis: A Prospective,Randomized, Double-blind Clinical Trial

Introduction

Profound pulpal anesthesia is difficult to achieve in mandibular molars with irreversible pulpitis (IP). However, there are no published randomized controlled clinical trials comparing the success of supplemental buccal infiltration (BI) in mandibular first versus second molars with IP. The purpose of this prospective, randomized, double-blind study was to compare the efficacy of 4% articaine with 2% lidocaine for supplemental BIs in mandibular first versus second molars with IP after a failed inferior alveolar nerve block (IANB). This study's sample was combined with data from a previous trial.

Efficacy and Safety of Pulpal Anesthesia Strategies during Endodontic Treatment of Permanent Mandibular Molars with Symptomatic Irreversible Pulpitis: A Systematic Review and Network Meta-analysis

IntroductionSeveral 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.MethodsMEDLINE, 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.ResultsThirty-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.ConclusionsVery 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.     

EFFICACY OF 4% ARTICAINE BUCCAL INFILTRATION VERSUS INFERIOR ALVEOLAR NERVE BLOCK FOR MANDIBULAR MOLARS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Objectives:To compare the anesthetic efficacy of buccal infiltration (BI) using 4% articaine vs 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 vs 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 assessment tool. Studies were quantitatively assessed using fixed or random effect models.Results:Out of 756 articles, 5 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 = .08]. Similarly, there was non-significant difference when compared to 4% articaine IANB [RD:-0.01 (95% CI, -0.13 to 0.11; P = .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 = .27]. Regarding quality assessment, 3 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.     

Oral Candida carriage in smokers and tobacco users: A systematic review and meta-analysis of observational studies

ObjectiveTo synthesize evidence from observational studies that evaluated the association between smoking and smokeless tobacco with oral Candida carriage.MethodsFollowing the PRISMA guidelines, we searched through PubMed/MEDLINE, Web of Science, Embase, and Scopus without restrictions until April 2020 for studies that assessed this association. Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed by two independent authors using the Newcastle-Ottawa Scale. A fixed-effect meta-analysis was performed due to insignificant heterogeneity between studies.ResultsWe identified 14 studies that were eligible for inclusion in this review. The pooled odds ratio (OR; six studies) for Candida carriage among smokers and non-smokers was 2.15 (95% confidence interval [CI]: 1.47, 3.14; I² = 8%; P < 0.0001). The OR (five studies) for Candida carriage among smokeless tobacco users and non-users was 1.77 (95% CI: 1.29, 2.44; I² = 46%; P = 0.0004).ConclusionOur findings suggest a significant relationship between smoking/smokeless tobacco users and oral Candida carriage. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or the result of some unmeasured confounding variables. Therefore, continued efforts to measure the association between smoking and oral Candida carriage are required.     

Effect of platelet-rich fibrin on the control of alveolar osteitis,pain, trismus,soft tissue healing,and swelling following mandibular third molar surgery: an updated systematic review and meta-analysis

The purpose of this study was to estimate the effect of platelet-rich fibrin (PRF) on the control of alveolar osteitis (AO), pain, trismus, soft tissue healing, and swelling following mandibular third molar surgery. A comprehensive search of the literature was conducted through PubMed, Embase, Web of Science, and Cochrane Library up to May 2019. Randomized controlled studies conforming to the inclusion criteria were included. The record screening and data extraction were conducted by two authors independently. The risk of bias assessment was performed according to the guidelines recommended by the Cochrane Collaboration. The quantitative analysis was performed using RevMan version 5.3. Nineteen studies were included in the systematic review and 17 studies were eligible for the meta-analysis. The use of PRF significantly reduced the incidence of AO and postoperative pain when compared to the controls (AO: relative risk 0.43, 95% confidence interval (CI) 0.28 to 0.65, Z = 3.90, P < 0.0001 (I² = 0%); pain: day 1, standardized mean difference (SMD) ?1.12, 95% CI ?1.87 to ?0.37, Z = 2.93, P = 0.003 (I² = 95%); day 3, SMD ?0.93, 95% CI ?1.48 to ?0.38, Z = 3.30, P = 0.001 (I² = 92%); day 7, SMD ?1.84, 95% CI ?2.98 to ?0.71, Z = 3.19, P = 0.001 (I² = 97%)). Additionally, the result showed a better soft tissue healing when PRF was used (mean difference ?0.63, 95% CI ?1.08 to ?0.18, Z = 2.76, P = 0.006 (I² = 90%)). The use of PRF reduced the incidence of AO and postoperative pain following third molar surgery. Furthermore, PRF may also improve the postoperative soft tissue healing.     

Prophylactic antibiotic regimen and dental implant failure: a meta‐analysis

The aim of this meta‐analysis was to investigate whether there are any positive effects of prophylactic antibiotic regimen on implant failure rates and post‐operative infection when performing dental implant treatment in healthy individuals. An electronic search without time or language restrictions was undertaken in March 2014. Eligibility criteria included clinical human studies, either randomised or not. The search strategy resulted in 14 publications. The I² statistic was used to express the percentage of the total variation across studies due to heterogeneity. The inverse variance method was used with a fixed‐ or random‐effects model, depending on the heterogeneity. The estimates of relative effect were expressed in risk ratio (RR) with 95% confidence interval. Six studies were judged to be at high risk of bias, whereas one study was considered at moderate risk, and six studies were considered at low risk of bias. The test for overall effect showed that the difference between the procedures (use versus non‐use of antibiotics) significantly affected the implant failure rates (P = 0·0002), with a RR of 0·55 (95% CI 0·41–0·75). The number needed to treat (NNT) to prevent one patient having an implant failure was 50 (95% CI 33–100). There were no apparent significant effects of prophylactic antibiotics on the occurrence of post‐operative infections in healthy patients receiving implants (P = 0·520). A sensitivity analysis did not reveal difference when studies judged as having high risk of bias were not considered. The results have to be interpreted with caution due to the presence of several confounding factors in the included studies.     

Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars

Aim

The aim of this study is to assess the efficacy of 4% articaine with 1:100,000 adrenaline given as buccal and lingual infiltration in adult patients undergoing erupted mandibular first and second molar teeth extraction versus inferior alveolar nerve block technique using 2% lignocaine with 1:80,000 adrenaline.

Materials and methods

A total of 100 patients undergoing extraction of mandibular posterior teeth were divided into two equally matched groups for the study, out of which 50 patients were given 4% articaine with 1:100,000 adrenaline as buccal and lingual infiltration and 50 patients were given 2% lignocaine with 1:80,000 adrenaline using classic direct inferior alveolar nerve block with lingual and buccal nerve block. Efficacy of anesthesia was determined using a numeric analog scale (NAS) ranging from 0 indicating no pain to 10 indicating the worst pain imaginable. The NAS was taken by a different operator to avoid bias.

Results

The pain scores in both groups were analyzed using the Mann–Whitney U test, and a p value of 0.338 was obtained which is not statistically significant. Hence, no significant difference in the pain score was established between both groups. The adverse effects of both the local anesthetics if any were noted.

Conclusion

From this study, we concluded that the use of 4% articaine with 1:100,000 adrenaline is as effective as inferior alveolar nerve block with lignocaine but without the risk of attendant adverse effects of inferior alveolar nerve block technique.