阿替卡因与利多卡因在活髓牙牙体预备中的效果观察

随着金瓷修复体在临床的广泛应用和患者无痛要求的不断提高,更加安全、高效的局部麻醉剂成为保证活髓牙牙体预备质量的关键因素。笔者自2001年4月～2002年4月应用法国碧兰公司生产的阿替卡因(碧兰麻)在活髓牙牙体预备中取得了满意的疗效,并与2％利多卡因进行比较,报道如下。     

阿替卡因与利多卡因在磨牙牙髓治疗中镇痛效果的比较

目的：研究阿替卡因与利多卡因对牙髓的麻醉效果。方法：对246例病人的382个患牙分别用碧兰麻（40g／L阿替卡因加1：100000的肾上腺素）和20g／L盐酸利多卡因加1：100000的肾上腺素进行局部浸润麻醉，观察牙髓麻醉效果。对麻醉失败者改用阻滞麻醉继续观察。结果：上颌磨牙浸润麻醉，阿替卡因与利多卡因的麻醉效果无差别；下颌磨牙浸润麻醉，阿替卡因的效果略优于利多卡因。但对浸润麻醉失败的病例改用阻滞麻醉后，两者的麻醉效果无明显差别。结论：阿替卡因和利多卡因麻醉的镇痛效果近似，麻醉方式在镇痛中起到更重要的作用。     

活髓牙与去髓牙的牙体脆性比较研究

１５０颗离体牙中，正常活髓牙５０颗。离体干燥牙５０颗，去髓牙５０颗，将其制成含牙釉质和牙本质的牙体硬组织标本，轩于电子万能试验机下测定抗压强度和抗剪切强度。结果表明，三组标本之间，平均抗压强度和抗剪切强度差别无显著性。     

活髓牙与去髓牙的牙体脆性比较研究

150颗离体牙中,正常活伪髓牙50颗。离体干燥牙50颗,去髓牙50颗。将其制成含牙釉质和牙本质的牙体硬组织标本,置于电子万能试验机下测定抗压强度和抗剪切强度。结果表明,三组标本之间,平均抗压强度和抗剪切强度差别无显著性。     

缓解牙体预备后活髓基牙牙本质敏感的方法研究进展

牙体预备后的活髓基牙常出现刺激性酸痛等牙本质敏感症状,虽然目前常用氧化锌丁香油水门汀粘固暂冠的方法安抚、保护牙髓,但其临床效果并不十分理想。因此,如何更有效地安抚、保护牙髓,缓解基牙牙本质敏感受到学者们的关注。本文就此作一综述。     

复方阿替卡因对患儿牙体牙髓病无痛麻醉效果研究

目的分析复方阿替卡因对患儿牙体牙髓病无痛麻醉效果,为临床麻醉提供参考。方法选取治疗牙体牙髓病,需局部麻醉的患儿160例,随机分为观察组和对照组各80例,观察组给予复方阿替卡因局部浸润麻醉,对照组给予利多卡因局部浸润麻醉,分析两组患者麻醉效果。结果观察组麻醉总有效率(97.6%)显著高于对照组(83.7%)(P<0.05),观察组无痛率(80.0%)显著高于对照组(57.5%)(P<0.05),麻醉前后两组患者心率均未出现明显变化(P>0.05)。结论儿童牙体牙髓无痛麻醉中,采用复方阿替卡因麻醉效果显著,能够提高麻醉效果。     

4%阿替卡因与2%利多卡因对上后牙不可复性牙髓炎患者麻醉效果的比较

对40例上颌后牙不可复性牙髓炎患者分组后分别使用4%阿替卡因与2%利多卡因进行颊侧注射麻醉。比较两药在开髓时的麻醉成功率。结果显示阿替卡因与利多卡因组间存在明显差异：4%阿替卡因在上后牙的颊侧注射麻醉中效果优于2%利多卡因。     

左旋布比卡因在活髓牙牙体预备中的麻醉效果

目的：观察左旋布比卡因在活髓牙预备中的麻醉效果及对血压、心率的影响。方法：选择下颌施行烤瓷固定桥修复且基牙为活髓牙病例120例,随机分为两组,每组60例。实验组采用0.5%左旋布比卡因下齿槽神经阻滞麻醉,对照组采用2%利多卡因下齿槽神经阻滞麻醉。以VAS标尺法由患者对牙体预备时疼痛程度进行打分,由口腔医生评价麻醉效果。观测患者在麻药使用前、即刻、10min、20min、30min的血压和心率。结果：VAS评分：左旋布比卡因组0.96±2.21;利多卡因组2.92±2.76,麻醉效果左旋布比卡因组优于利多卡因组,结果具有统计学意义（P〈0.01）。两组麻醉持续时间左旋布比卡因组（4.92±1.52h）明显高于利多卡因组（2.17±0.70h）,P〈0.01。两种麻药起效时间、对血压和心率影响无统计学意义（P〉0.05）。结论：左旋布比卡因是一种长效的、安全的麻醉剂。在无肾上腺素添加的情况下也可维持较长的麻醉时间,适合于不便使用肾上腺素患者耗时较长的牙体预备。     

布比卡因和阿替卡因用于开髓、拔髓术前麻醉价值的评价

目的评价布比卡因和阿替卡因两种局部注射麻醉剂在开髓、拔髓术中的价值。方法选择因正畸需要将拔除的双侧上颌前磨牙患者40例(80颗牙),左右两侧,一侧为试验组,用0.75%盐酸布比卡因进行局部麻醉,另一侧为对照组,用阿替卡因镇痛效果由患者根据VAS标尺法自评,不良反应评价采用他评。结果布比卡因和阿替卡因镇痛效果分别为95.0%和97.5%;差别不显著;两种方法均未出现不良反应;布比卡因和阿替卡因的零售价分别为1.12元和9.10元。结论布比卡因和阿替卡因都可用于开髓、拔髓术,前者的价格低。     

过氧化氢活髓牙漂白对牙体修复的影响

过氧化氢活髓牙漂白不仅影响修复的粘结强度 ,而且影响多种修复材料的性能和应用。1　过氧化氢活髓牙漂白对修复粘结强度的影响许多研究显示 ,活髓牙采用 350ｍｌ/Ｌ过氧化氢液行诊室内漂白或 10 0ｇ/Ｌ过氧化脲凝胶作家庭漂白时可使复合树脂对釉质的粘结强度降低[1～ 5] 。Ｓｔｏｋｅｓ等[5] 报告采有 350ｍｌ/Ｌ过氧化氢液作釉质漂白 2ｈ ,使复合树脂粘结强度从 16 .2ＭＰａ降至8.4ＭＰａ ,而用 10 0ｇ/Ｌ过氧化脲凝胶作釉质漂白14ｄ ,粘结强度可降至 9.4ＭＰａ ,以上结果均在漂白结束后 4 8ｈ检测得出。而Ｍｕｒｃｈｉｓｏｎ等[6 ] 、Ｊ…     

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.     

The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth

BACKGROUND: The authors conducted a prospective, randomized, double-blind, crossover study comparing the degree of pulpal anesthesia achieved by means of mandibular first molar buccal infiltrations of two anesthetic solutions: 4 percent articaine with 1:100,000 epinephrine and 2 percent lidocaine with 1:100,000 epinephrine. METHODS: Each of 60 blinded adult subjects randomly received two buccal infiltrations at the first molar site: one cartridge of 4 percent articaine with 1:100,000 epinephrine at one appointment and one cartridge of 2 percent lidocaine with 1:100,000 epinephrine at another appointment. The injections were administered during two separate appointments spaced at least one week apart. The authors used an electric pulp tester to assess the first and second molars and the first and second premolars for pulpal anesthesia in three-minute cycles for 60 minutes. They considered anesthesia to be successful when they obtained two consecutive pulp test readings of 80 (meaning the subject evidenced no response at the maximum output on the pulp tester). RESULTS: With the lidocaine formulation, successful pulpal anesthesia ranged from 45 to 67 percent. With the articaine formulation, successful pulpal anesthesia ranged from 75 to 92 percent. There was a significant difference (P < .05) in anesthetic success between the lidocaine and articaine formulations for each of the four teeth. Pulpal anesthesia declined slowly over 60 minutes with both formulations. CONCLUSION AND CLINICAL IMPLICATIONS: For a mandibular buccal infiltration of the first molar, 4 percent articaine with 1:100,000 epinephrine will result in a higher success rate than will 2 percent lidocaine with 1:100,000 epinephrine, but the duration of pulpal anesthesia will decline over 60 minutes with either formulation.     

Clinical efficacy of lidocaine,mepivacaine, and articaine for local infiltration

Aim: To assess and compare the efficacy of single buccal and palatal infiltration of lidocaine, mepivacaine, or articaine with 1:100 000 epinephrine by maxillary anesthetic injection. Methods: A double‐blinded, randomized, clinical trial was conducted with 33 patients undergoing upper premolar extraction. The patients were randomly allocated into one of three groups, according to the local anesthetic agent used: 2% lidocaine, 2% mepivacaine, or 4% articaine, all with 1:100 000 epinephrine, and were blinded to the anesthetic used. The extent of anesthetization, pulpal anesthetization in adjacent teeth, pain on injection, and adverse effects of the anesthetic agents were assessed. Results: The extent of anesthetization produced by 4% articaine (42 mm) was statistically more significant (P ≤ 0.05) than 2% lidocaine (33 mm) and 2% mepivacaine (32.5 mm). The successful anesthetization of adjacent teeth occurred more often in the articaine group than in the lidocaine and mepivacine groups, although not to a statistically‐significant extent. The pain scores for the injections were comparable between the three groups. Conclusions: Local anesthetization using 4% articaine with 1:100 000 epinephrine covers a wider area of soft tissue and adjacent teeth than 2% lidocaine or 2% mepivacaine with 1:100 000 epinephrine, which is sufficient for the extraction of one or two teeth.     

必兰浸润麻醉与利多卡因阻滞麻醉在下颌阻生齿微创拔牙术中的临床对照研究

目的 比较必兰浸润麻醉与利多卡因阻滞麻醉法在下颌第三磨牙阻生齿微创拔牙术中的疗效.方法 选择双侧阻生齿拔除患者104名,在同一患者双侧下颌分别行必兰浸润麻醉或2%利多卡因阻滞麻醉,并行高速涡轮机微创拔牙,比较2组的麻醉显效率、麻醉显效时间、术中疼痛程度和术前后收缩压差及无痛持续时间,按配对样本t检验法行统计分析.结果 ...     

牙科治疗用阿替卡因或甲哌卡因局麻的效果

目的：比较阿替卡因和甲哌卡因在牙科治疗中的局麻效果及安全性。方法：将需要在牙体、牙周、修复和外科拔牙治疗中采用局部麻醉的病人各60例随机分成甲、乙两组，分别采用阿替卡因、甲哌卡因进行局部麻醉，监测麻醉前后病人的血压和心率，用疼痛行为法和视觉模拟疼痛法（VAS评分法）进行疼痛评分并记录局麻副作用。结果：两种麻药安全性好，在不同牙科治疗时阿替卡因的平均评分值低于甲哌卡因，但尚无明显统计学差异。结论：采用阿替卡因、甲哌卡因局麻下进行牙科治疗，效果相近，安全可靠，建议推广使用。     

碳酸利多卡因在口腔颌面外科的临床应用研究

目的观察碳酸利多卡因和盐酸利多卡因用于口腔颌面外科局部麻醉的效果。方法200例按照美国麻醉师协会(ASA)分级为Ⅰ~Ⅱ级择期手术患者,随机分为盐酸利多卡因组(A)100例,碳酸利多卡因组(B)100例。分别观察起效时间、阻滞完全时间、首剂量维持时间、阻滞范围、麻醉效果、不良反应及麻醉前后血压、心率、呼吸、心电图(ECG)和血氧饱和度。结果碳酸利多卡因组的起效时间、阻滞完全时间较盐酸利多卡因组明显缩短,首剂量维持时间、阻滞范围无明显差异,但碳酸利多卡因首剂量维持时间有延长趋势。两组麻醉前后的血压、心率、呼吸、ECG和血氧饱和度均无明显变化。无明显不良反应。结论碳酸利多卡因与盐酸利多卡因相比,起效快,阻滞作用强、阻滞完全时间明显缩短,不良反应小。     

Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block

BACKGROUND: The authors conducted a prospective, randomized, double-blind, crossover study comparing the degree of pulpal anesthesia achieved by means of mandibular first molar buccal infiltrations of two anesthetic solutions: 4 percent articaine with 1:100,000 epinephrine and 2 percent lidocaine with 1:100,000 epinephrine after an inferior alveolar nerve (IAN) block with the use of 4 percent articaine with 1:100,000 epinephrine. METHODS: Seventy-three blinded adult subjects randomly received buccal infiltrations at the first molar site with a cartridge of 4 percent articaine with 1:100,000 epinephrine at one appointment and a cartridge of 2 percent lidocaine with 1:100,000 epinephrine at another appointment after receiving a standard IAN block with the use of 4 percent articaine with 1:100,000 epinephrine in a crossover design. After the injections, the authors used an electric pulp tester to test the first molar for anesthesia in three-minute cycles for 60 minutes. They considered anesthesia to be successful when two consecutive 80 readings were obtained within 10 minutes of the IAN block and infiltration injection, and the 80 reading was sustained continuously through the 60th minute. RESULTS: The authors found that with the use of the 4 percent articaine formulation, successful pulpal anesthesia occurred 88 percent of the time for the first molar. With the 2 percent lidocaine formulation, successful pulpal anesthesia occurred 71 percent of the time. The results show a significant difference (P < .05) between the articaine and lidocaine formulations. CONCLUSION AND CLINICAL IMPLICATIONS: For a mandibular buccal infiltration of the first molar after a standard IAN block, 4 percent articaine with 1:100,000 epinephrine resulted in a higher success rate (88 percent) than did 2 percent lidocaine with 1:100,000 epinephrine (71 percent success rate).