Anesthetic efficacy of 1.8 mL versus 3.6 mL of 4% articaine with 1:100,000 epinephrine as a primary buccal infiltration of the mandibular first molar

Introduction

No study has compared 1.8 mL and 3.6 mL 4% articaine with 1:100,000 epinephrine in a mandibular buccal infiltration of the first molar. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 1.8 mL and 3.6 mL 4% articaine with 1:100,000 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 1.8 mL or 3.6 mL 4% articaine with 1:100,000 epinephrine in two separate appointments. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 90 minutes after the injections.

Results

Compared with the 1.8-mL volume of 4% articaine with 1:100,000 epinephrine, the 3.6-mL volume showed a statistically higher success rate (70% vs 50%).

Conclusions

The anesthetic efficacy of 3.6 mL 4% articaine with 1:100,000 epinephrine is better than 1.8 mL of the same anesthetic solution in a primary mandibular buccal infiltration of the first molar. However, the success rate of 70% is not high enough to support its use as a primary injection technique in the mandibular first molar.     

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.     

A prospective, randomized, single-blind comparative evaluation of anesthetic efficacy of posterior superior alveolar nerve blocks, buccal infiltrations, and buccal plus palatal infiltrations in patients with irreversible pulpitis

Introduction

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.

Methods

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.

Results

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%).

Conclusions

None of the tested methods gave 100% anesthetic success rates in maxillary first molars with irreversible pulpitis.     

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.     

Comparison of the Effectiveness of Lidocaine in Permanent Maxillary Teeth Removal Performed with Single Buccal Infiltration Versus Routine Buccal and Palatal Injection

Purpose

For many dental patients, palatal injection proves to be a very traumatic experience. Diverse methods have been suggested to reduce the discomfort of palatal injection. Nevertheless, the reliability of these methods is not obviously evident and they are not found to be universally effective. The desirable method to evade pain during palatal injection is just not to have one. Hence, the present study aims at investigating if lidocaine hydrochloride could provide palatal anesthesia in maxilla when only a buccal infiltration anesthesia is done for teeth extraction.

Patients and Methods

One hundred and fifty patients requiring extraction of maxillary teeth were included in the study. Patients were randomly allotted to two groups, study and control. Patients in study group received a single buccal infiltration of 1.5 mL of lidocaine with epinephrine for extraction of maxillary teeth. Patients in control group received 1.5 mL of buccal and 0.3 mL of palatal infiltration of lidocaine with epinephrine for the extraction. After achieving adequate palatal anesthesia the tooth was extracted with consistent technique. Pain level experienced by the patients during injection procedure and during tooth extraction was rated in an 11-point pain rating scale. Time taken to achieve palatal anesthesia following a single buccal infiltration of anesthetic solution was evaluated by regular pin-prick evaluation of palatal tissues.

Results

The overall success rate of palatal anesthesia achieved with a single buccal infiltration is 81.3 %. The success rate reduced as we proceed from anterior to posterior maxilla. Time taken to achieve successful palatal anesthesia by single buccal infiltration is 7–9 min.

Conclusion

The extraction of permanent maxillary anterior teeth and premolars is possible by depositing local anesthesia to the buccal vestibule of the tooth without palatal supplementation. However, the extraction of permanent maxillary posterior teeth with similar technique would result in fewer success rates suggesting its avoidance.     

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.     

A prospective, randomized, double-blind comparison of bupivacaine and lidocaine for maxillary infiltrations

The purpose of this prospective, randomized, double-blind study was to evaluate the anesthetic efficacy of 1.8 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1.8 mL of 2% lidocaine with 1:100,000 epinephrine in maxillary lateral incisors and first molars. Sixty-five subjects randomly received, in a double-blind manner, two infiltrations at two separate appointments, in a crossover design. The injections consisted of maxillary lateral incisor and first molar infiltrations of 1.8 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1.8 mL 2% lidocaine with 1:100,000 epinephrine. In maxillary lateral incisors, bupivacaine exhibited a significantly lower anesthetic success rate (obtaining two consecutive 80 readings with the pulp tester within 10 minutes) of 78% when compared with a 97% success rate with lidocaine. In maxillary first molars, bupivacaine's onset of pulpal anesthesia (7.7 minutes) was significantly slower than lidocaine (4.3 minutes). Bupivacaine had a lower success rate than lidocaine (64% versus 82%) but there was no significant difference between the two solutions. Neither solution provided pulpal anesthesia for 1 hour.     

Articaine infiltration for anesthesia of mandibular first molars

A randomized, controlled trial of 31 healthy volunteers compared 4% articaine with 1:100,000 epinephrine buccal infiltration to buccal plus lingual infiltration of the same dose of drug in achieving pulpal anesthesia of mandibular first molar teeth. Data were compared with efficacy of an inferior alveolar nerve block using 2% lidocaine 1:80,000 epinephrine in a cohort of 27 of the volunteers. Anesthesia was determined using electronic pulp testing. Buccal and buccal plus lingual infiltrations of articaine with epinephrine did not differ in efficacy in obtaining pulpal anesthesia for mandibular permanent first molars (p = 0.17). Efficacy of 4% articaine with epinephrine infiltrations for first molar pulp anesthesia was similar to that of an IANB using lidocaine with epinephrine over a 30-minute study period (96 and 80 episodes of no response to maximal stimulation respectively, p = 0.097). Subjective tooth numbness was more common after IANB than buccal infiltration (p = 0.005). The discomfort of buccal infiltration with articaine was volume dependent (p = 0.017) and similar to that of an IANB.     

Comparative evaluation of local infiltration of articaine, articaine plus ketorolac, and dexamethasone on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis

Introduction

The inferior alveolar nerve block (IANB) has a poor success rate in patients with irreversible pulpitis. The purpose of this study was to evaluate the effect of ketorolac and dexamethasone infiltration along with standard IANB on the success rate.

Methods

Ninety-four adult volunteers who were actively experiencing pain participated in this prospective, randomized, double-blind study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive any supplemental infiltrations (control). Twenty-four patients received supplemental buccal infiltration of 4% articaine with 1:100,000 ephinephrine, and 24 patients received supplemental buccal infiltration of 1 mL/4 mg of dexamethasone. It was planned to give supplemental buccal infiltration of 1 mL/30 mg of ketorolac tromethamine in 26 patients, but the first 2 patients experienced severe injection pain after ketorlac infiltration and were excluded from the study. In the subsequent patients, 0.9 mL of 4% articaine was infiltrated before injecting ketorolac. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft-Parker visual analog scale. Success was recorded as none or mild pain.

Results

Statistical analysis was done by using nonparametric χ² tests. Control IANB gave 39% success rate. Buccal infiltration of articaine and articaine plus ketorolac significantly increased the success rate to 54% and 62%, respectively (P < .05). Supplementary dexamethasone infiltration gave 45% success rate, which was insignificant with control IANB.

Conclusions

Articaine and ketorolac infiltration can increase the success rate of IANB in patients with irreversible pulpitis. None of the tested techniques gave 100% success rate.     

A prospective, randomized single-blind study of the anesthetic efficacy of frequency-dependent conduction blockade of the inferior alveolar nerve

Introduction

The purpose of this prospective, randomized single-blind study was to evaluate the degree of pulpal anesthesia obtained with frequency-dependent conduction blockade of the inferior alveolar nerve (IAN).

Methods

Eighty adult volunteers randomly received two IAN blocks: an IAN block followed by continuous electrical stimulation for 3 minutes of the first molar or lateral incisor for six cycles over a time period of 64 minutes; an IAN block followed by mock electrical stimulation using the same cycles. The IAN blocks were administered at two separate appointments spaced at least 1 week apart in a crossover design. An electric pulp tester was used to test for anesthesia of the first molar and lateral incisor. Anesthesia was considered successful when two consecutive 80 readings were obtained within 15 minutes, and the 80 reading was recorded through the 60th minute.

Results

The anesthetic success rate for the stimulated IAN block was 35% and 48% for the lateral incisor and first molar, respectively. For the mock stimulated IAN, success was 18% for the lateral incisor and 62% for the first molar. There was no significant difference between the two IAN block techniques.

Conclusions

We concluded that the stimulation of nerves in the presence of local anesthesia (frequency-dependent nerve block) did not statistically increase the success rate of pulpal anesthesia for an IAN block.     

Anesthetic efficacy of ropivacaine in maxillary anterior infiltration

OBJECTIVE: The purpose of this prospective, randomized double-blind study was to evaluate and compare the anesthetic efficacy of 0.5% ropivacaine with 1:200,000 epinephrine, of 0.5% ropivacaine, and of 0.5% bupivacaine with 1:200,000 epinephrine in maxillary lateral incisor infiltrations. STUDY DESIGN: Forty subjects randomly received, in a double-blind manner, 3 infiltrations at 3 separate appointments, in a repeated-measures design. The injections consisted of an infiltration of 1.8 mL of 0.5% ropivacaine plain, an infiltration of 1.8 mL of 0.5% ropivacaine with 1:200,000 epinephrine, and an infiltration of 1.8 mL of 0.5% bupivacaine with 1:200,000 epinephrine (control solution). The maxillary lateral incisor pulpal anesthesia was evaluated with an electric pulp tester at 2-minute cycles for 90 minutes after injection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Anesthesia was considered successful when 2 consecutive 80 readings were obtained. The duration of pulpal anesthesia was recorded as the last 80 reading. RESULTS: One hundred percent of the subjects had lip numbness with all solutions. The anesthetic success rates for ropivacaine plain, ropivacaine with epinephrine, and bupivacaine with epinephrine were 68%, 75%, and 80%, respectively. There were no significant differences (P >.05) among the solutions. The duration of pulpal anesthesia (80 readings) for ropivacaine plain, ropivacaine with epinephrine, and bupivacaine with epinephrine was 13 minutes, 33 minutes, and 33 minutes, respectively. Ropivacaine plain had a significantly shorter duration of pulpal anesthesia than ropivacaine with epinephrine. CONCLUSIONS: We concluded that 0.5% ropivacaine with 1:200,000 epinephrine was equivalent to 0.5% bupivacaine with 1:200,000 epinephrine in pharmacologic action. The duration of pulpal anesthesia was less for ropivacaine without epinephrine. Ropivacaine with epinephrine has the potential to replace bupivacaine with epinephrine in clinical dental practice because of the decreased potential for cardiac and central nervous system toxicity.     

Comparison of onset and duration of action of soft tissue and pulpal anesthesia with three volumes of 4% articaine with 1:100,000 epinephrine in maxillary infiltration anesthesia

Purpose

This randomized double-blind investigation was conducted to compare the onset and duration of action of soft tissue and pulpal anesthesia with three volumes of 4% articaine with 1:100,000 epinephrine in maxillary infiltration anesthesia. The injection discomfort associated with three volumes of infiltration anesthesia was also assessed.

Materials and methods

A total of 10 subjects received 0.6?mL (group 1), 0.9?mL (group 2), and 1.2?mL (group 3) of the anesthetic buccal to the upper canine. Test teeth were assessed with electrical stimulation to determine onset and duration of pulpal anesthesia. Soft tissue anesthesia was assessed by pin-prick test, and injection discomfort was assessed using a visual analogue scale. The statistical analysis of the data recorded was carried out with one-way ANOVA and post-hoc tests.

Results

The 1.2-mL dose induced faster onset of pulpal anesthesia, a higher success rate, and a longer duration of soft tissue/pulpal anesthesia than was achieved with 0.6?mL (P?Conclusion Maxillary infiltration anesthesia with articaine and epinephrine has a faster onset, a greater success rate, and a longer duration when a volume of 1.2?mL is used than when volumes less than 1.0?mL are used. Palatal tissues were anesthetized with the highest concentration (1.2?mL) in our study (30% of cases).     

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).     

Extraction of Permanent Maxillary Teeth by Only Buccal Infiltration of Articaine

Objective

The aim of this study is to demonstrate whether articaine hydrochloride administered alone as a single buccal infiltration in maxillary tooth removal, can provide favourable palatal anesthesia as compared to buccal and palatal injection of lidocaine.

Study Design

The study population consisted of 30 patients who were undergoing orthodontic treatment, and who required bilateral extraction of maxillary permanent premolars as per their orthodontic treatment plan. On the experimental side, 4 % articaine/HCl was injected into the buccal vestibule of the tooth to be extracted. On the control side, 2 % lignocaine HCl was injected both into the buccal and the palatal side of the tooth to be extracted. Following tooth extraction all patients completed a 100-mm visual analogue scale (VAS) and faces pain scale (FPS) to rate the pain on extraction.

Results

According to the VAS and FPS scores, the pain on extraction between buccal infiltration of articaine and the routine buccal and palatal infiltration of lignocaine was statistically insignificant.

Conclusions

The routine use of a palatal injection for the removal of permanent maxillary premolar teeth may not be required when articaine/HCl is used as the local anesthetic.     

Comparative Evaluation of the Efficacy of 2% Lidocaine Containing 1:200,000 Epinephrine with and without Hyaluronidase (75 IU) in Patients with Irreversible Pulpitis

Introductions

The purpose of this study was to determine the anesthetic efficacy of lidocaine containing epinephrine compared with lidocaine containing epinephrine plus hyaluronidase (75 IU) when performing an inferior alveolar nerve block.

Methods

Patients complaining of pain in the mandibular posterior teeth were selected. Based on their chief complaint, proper clinical and radiographic examinations were performed. Among them, 40 subjects diagnosed with irreversible pulpitis were selected. The inferior alveolar nerve block was induced using 3 mL 2% lidocaine with epinephrine. Hyaluronidase (75 IU) or a placebo was injected 30 minutes after the beginning of pulpal anesthesia (randomized and double-blind trial). The duration of the effect in the pulpal and gingival tissues was evaluated by the response to painful electrical stimuli applied to the adjacent premolar and by mechanical stimuli (pinprick) to the buccal gingiva, respectively.

Results

In both pulpal and gingival tissues, the duration of the anesthetic effects with hyaluronidase was longer than with placebo.

Conclusions

Hyaluronidase increased the duration of the effects of lidocaine in inferior alveolar nerve blocks.     

Anesthetic Efficacy of Intranasal 3% Tetracaine plus 0.05% Oxymetazoline (Kovanaze) in Maxillary Teeth

Introduction

Needle-free anesthetic delivery is a promising alternative to traditional anesthetic routes of administration. The purpose of this study was to determine the patient preference for and pulpal anesthetic efficacy of a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray in maxillary lateral incisors and first premolars.

Comparison of pulpal anesthesia and cardiovascular parameters with lidocaine with epinephrine and lidocaine with clonidine after maxillary infiltration in type 2 diabetic volunteers

Objectives

The pulpal anesthetic and cardiovascular parameters obtained by 2 % lidocaine with epinephrine (LE; 1:80,000) or clonidine (LC; 15 mcg/ml) were studied in diabetes mellitus (DM) type 2 and healthy volunteers (72), after maxillary infiltration anesthesia.

Materials and methods

Onset and duration of pulpal anesthesia were measured by electric pulp tester; vasoconstrictive effect of used local anesthetic mixtures by laser Doppler flowmetry (LDF) through pulpal blood flow (PBF); systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were registered by electrocardiogram monitoring.

Results

Onset of pulpal anesthesia was shorter for LC than for LE in healthy, while it was not different in diabetic participants; duration of pulpal anesthesia was significantly longer in type 2 diabetic participants, regardless of used anesthetic mixture. Significant reduction of PBF with LE was observed during 45 min in healthy and 60 min in diabetic participants, while with LC such reduction was observed during 45 min in both groups. LE caused a significant increase of SBP in the 5th and 15th minutes in diabetic versus healthy participants, while LC decreased SBP from the 10th to 60th minutes in healthy versus diabetic participants.

Conclusions

DM type 2 influences duration of maxillary infiltration anesthesia obtained with LE and LC, and systolic blood pressure during LE anesthesia.

Clinical relevance

The obtained results provide elements for future protocols concerning intraoral local anesthesia in DM type 2 patients.

     

仅用阿替卡因颊侧浸润麻醉拔除上颌第三磨牙的临床对照研究

目的：评价上颌第三磨牙拔除术中阿替卡因颊侧浸润注射对腭侧软组织的麻醉作用，讨论常规腭侧浸润麻醉注射是否必须。方法：28例拔除双侧上颌第三磨牙患者，每位患者作为其自身对照。对照侧利用盐酸阿替卡因行颊侧浸润麻醉及腭侧浸润麻醉，实验侧仅行颊侧浸润麻醉。注射3min后常规方法拔除患牙。利用100mm直观模拟标度尺（VAS）及问卷调查获得患者拔牙时的痛觉数据。结果：实验侧和对照侧的疼痛感觉（VAS值）没有显著性差异（P〉0．05），拔牙过程中的疼痛均可接受。结论：仅用阿替卡因颊侧浸润麻醉可顺利拔除上颌第三磨牙，无需常规腭侧浸润麻醉，从而避免腭侧注射的疼痛不适。     

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.     

Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: a prospective randomized double-blind clinical trial

Introduction

The study was designed as a randomized double-blind trial to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in inferior alveolar nerve block (IANB) and infiltration anesthetic techniques to anesthetize mandibular molars with irreversible pulpitis.

Methods

The study was composed of 2 test arms and 1 control arm. Subjects in the test arms received either a standard IANB or a buccal infiltration (B Infil) of 4% articaine with 1:100,000 epinephrine, whereas the subjects in the control arm received a standard IANB of 2% lidocaine with 1:100,000 epinephrine. Subject’s self-reported pain response was recorded on Heft Parker Visual Analogue Scale after local anesthetic administration during access preparation and pulp extirpation.

Results

For statistical analysis Pearson χ², Student's paired t test, 1-way analysis of variance, and Friedman tests showed no significant difference in success rates among the 3 arms of the trial.

Conclusions

Although B Infil and IANB of 4% articaine were equally effective, B Infil can be considered a viable alterative in IANB for pulpal anesthesia in mandibular molars with irreversible pulpitis.