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).     

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.     

The significance of needle deflection in success of the inferior alveolar nerve block in patients with irreversible pulpitis

The purpose of this prospective, randomized, blinded study was to compare the anesthetic efficacy of the conventional inferior alveolar nerve block, administered with the needle bevel oriented away from the mandibular ramus, to the bidirectional-needle-rotation technique, administered using the computer-assisted Wand II anesthesia system, in patients diagnosed with irreversible pulpitis. Sixty-four emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a blinded manner, 2.8 ml of 2% lidocaine with 1:100,000 epinephrine using either a conventional inferior alveolar nerve block or a bidirectional-needle-rotational technique using the Wand II injection system. The conventional inferior alveolar nerve block was administered with the needle bevel oriented away from the mandibular ramus so the needle would deflect inward toward the mandibular foramen. The bidirectional-needle-rotation technique was administered by rotating the Wand handpiece assembly in a clockwise-counterclockwise movement (like an endodontic hand file) to minimize needle deflection. Endodontic access was begun 17 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (VAS recordings) on endodontic access or initial instrumentation. The results of this study showed no significant differences (p > 0.05) between the success rates of the two techniques. The conventional inferior alveolar nerve block, with the needle bevel oriented away from the mandibular ramus, had a 50% success rate. The bidirectional-needle-rotation technique with the Wand II had a 56% success rate. Neither technique resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.     

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 the mylohyoid nerve block and combination inferior alveolar nerve block/mylohyoid nerve block.

OBJECTIVE: The purpose of this study was to measure the degree of anesthesia obtained with the mylohyoid nerve block and the combination mylohyoid nerve block/conventional inferior alveolar nerve (IAN) block in mandibular teeth. STUDY DESIGN: With the use of a repeated-measures design, 30 subjects randomly received each of 3 combinations of injections at 3 separate appointments. The combinations were as follows: mylohyoid nerve block (1.8 mL of 2% lidocaine with 1:100,000 epinephrine) + IAN block (3.6 mL of 2% lidocaine with 1:100,000 epinephrine); mock mylohyoid nerve block + IAN block (3.6 mL of 2% lidocaine with 1:100,000 epinephrine); mylohyoid nerve block (1.8 mL of 2% lidocaine with 1:100,000 epinephrine) + mock IAN block. The mylohyoid injections were aided by the use of a peripheral nerve stimulator. Mandibular anterior and posterior teeth were blindly tested with a pulp tester at 4-minute cycles for 60 minutes postinjection. Anesthesia was considered successful when 2 consecutive 80 readings were obtained. RESULTS: One hundred percent of the subjects had lip numbness with the mylohyoid nerve block + IAN block and mock mylohyoid nerve block + IAN block techniques. For these 2 techniques, anesthetic success rates were higher in posterior teeth (73% to 93%) than in anterior teeth (33% to 60%). There were no significant differences (P > .05) between the 2 techniques. The mylohyoid nerve block + mock IAN block technique resulted in a very low success rate (0% to 17%) and was significantly different (P < .05) from the mylohyoid nerve block + IAN block technique. CONCLUSIONS: The results of this study suggest that the mylohyoid nerve block does not by itself predictably provide pulpal anesthesia in mandibular teeth and does not significantly enhance pulpal anesthesia when administered in combination with the IAN block.     

Efficacy of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system

OBJECTIVE: The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of the intraligamentary injection of 4% articaine with 1:100,000 epinephrine and of 2% lidocaine with 1:100,000 epinephrine, administered with computer-controlled local anesthetic delivery system, in mandibular posterior teeth. STUDY DESIGN: Using a crossover design, intraligamentary injections of 1.4 mL of 4% articaine with 1:100,000 epinephrine and of 1.4 mL of 2% lidocaine with 1:100,000 epinephrine were randomly administered with a computer-controlled local anesthetic delivery system, in a double-blind manner on the mesial and distal aspects of a mandibular first molar, at 2 separate appointments to 51 subjects. A pulp tester was used to test for anesthesia, in 2-minute cycles for 60 minutes, of the mandibular first and second molars and second premolar. Anesthesia was considered successful when 2 consecutive 80 readings (highest output) were obtained within 20 minutes. RESULTS: Successful pulpal anesthesia was obtained 86% of the time for the first molar using the articaine solution and 74% of the time using the lidocaine solution. There were no significant differences (P > .05) between the articaine and lidocaine solutions. The mean onset times of pulpal anesthesia for the first molar were 1.3 minutes with articaine solution and 2.2 minutes with lidocaine solution. Duration of pulpal anesthesia for the first molar was 34 minutes for the articaine solution and 31 minutes for the lidocaine solution. CONCLUSION: The efficacy of 4% articaine with 1:100,000 epinephrine was similar to the efficacy of 2% lidocaine with 1:100,000 epinephrine for intraligamentary injections.     

The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks

OBJECTIVE: The degree of pulpal anesthesia obtained with an ultrasound-assisted inferior alveolar nerve block was compared to that obtained with a conventional inferior alveolar nerve block for mandibular teeth to determine whether needle placement assisted by ultrasound results in more successful anesthesia. STUDY DESIGN: Through use of a repeated-measures design, each of 40 subjects randomly received an ultrasound-assisted inferior alveolar nerve block and a conventional inferior alveolar nerve block at 2 separate appointments. Mandibular anterior and posterior teeth were blindly tested by means of a pulp tester at 4-minute cycles for 60 minutes postinjection. Anesthesia was considered successful when 2 consecutive readings of 80 were obtained. RESULTS: One hundred percent of the subjects had profound lip numbness with both the ultrasound-assisted inferior alveolar nerve block and the conventional inferior alveolar nerve block. For these 2 techniques, anesthetic success rates for individual teeth ranged from 38% to 92%. There were no significant differences (P > .05) between the 2 techniques. CONCLUSIONS: It was concluded that accurate needle placement with ultrasound for the inferior alveolar nerve block did not result in more successful pulpal anesthesia in the mandible. Therefore, accuracy of needle placement is not the primary reason for pulpal anesthetic failure with this block.     

An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars

We compared the anesthetic efficacy of inferior alveolar nerve blocks (IANBs) with that of buccal infiltrations (BIs) in mandibular first molars. Using a crossover design, all subjects received a standard IANB or a BI of 1.7 mL of 4% articaine with 1:100,000 adrenaline (Septanest; Septodont, Saint-Maru-des-Fosses, France) on two appointments separated by at least 1 week. Pulpal anesthesia was determined by using an electric pulp tester. Electric pulp testing was repeated at 5, 8, 11, 15, 20, 25, and 30 minutes after the injections. Anesthesia was considered successful if the subject did not respond to the maximum output of the pulp tester at two or more consecutive time points. Fifty-four percent of the BI and 43% of the IANB were successful; the difference was not significant (p = 0.34). The onset of pulpal anesthesia was significantly faster with BI (p = 0.03). In conclusion, BI with 4% articaine for mandibular first molars can be a useful alternative for clinicians because compared with IANB it has a faster onset and a similar success rate.     

A comparison of the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block

BackgroundThe efficacy of the extraoral infraorbital nerve block has not been studied sufficiently to ensure its appropriate clinical use. To compare the local anesthetic efficacy of the extraoral versus the intraoral infraorbital nerve block, the authors conducted a prospective, randomized crossover study.MethodsForty adult participants randomly received extraoral infraorbital nerve blocks of 1.8 milliliters of 2 percent lidocaine with 1:100,000 epinephrine at one appointment and intraoral infraorbital nerve blocks of 1.8 mL of 2 percent lidocaine with 1:100,000 epinephrine at another appointment in a crossover design. After administering the injections, the authors used an electric pulp tester to assess the maxillary central and lateral incisors, canine, premolars and first molar for pulpal anesthesia in four-minute cycles for 60 minutes. They considered anesthesia to be successful when the participant had no response to two consecutive 80 readings (the maximum output) with the electric pulp tester.ConclusionsThe authors found that the extraoral and intraoral infraorbital nerve blocks were ineffective in providing profound pulpal anesthesia of the maxillary central incisor (15 percent success rate) and lateral incisor (22 percent success rate). The pulpal anesthesia success rate was 92 percent for the canine for both types of nerve blocks, 80 to 90 percent for first and second premolars and 65 to 70 percent for the first molar, with no significant differences (P < .05) between the two nerve blocks. Pulpal anesthesia did not last for an hour in any of the teeth. Needle insertion pain and postoperative sequelae were more common after the extraoral infraorbital nerve block was administered.Clinical ImplicationsBoth nerve blocks would be ineffective in the central and lateral incisors. Both nerve blocks would be somewhat successful in the canine and premolars but not in the first molar.     

A comparison of two intraosseous anesthetic techniques in mandibular posterior teeth

BACKGROUND: A number of studies have evaluated the Stabident (Fairfax Dental, Miami) intraosseous anesthesia technique. A second intraosseous technique--the X-tip system (X-tip Technologies, Lakewood, N.J.)--has been introduced, but no scientific studies have yet compared its effectiveness to that of the Stabident system. The authors undertook a study to compare the two systems' anesthetic outcomes in primary intraosseous injections in mandibular posterior teeth. METHODS: The authors, using a crossover design, randomly administered a primary Stabident intraosseous injection and a primary X-tip intraosseous injection, at two separate appointments, to 41 subjects. Subjects were asked if they perceived an increase in heart rate with the intraosseous injections. The research team blind-tested each subject's first molar, second molar and second premolar with a pulp tester at two-minute cycles for 60 minutes after the injection. Anesthesia was considered successful when two consecutive pulp tester readings of 80 were obtained. RESULTS: Anesthetic success rates for the Stabident technique and the X-tip technique, respectively, were 93 percent and 93 percent for the first molar; 95 percent and 95 percent for the second molar; and 81 percent and 83 percent for the second premolar, with no significant differences (P > .05) between the two techniques. For both intraosseous techniques, onset of pulpal anesthesia occurred within the first two minutes, but the duration of anesthesia declined steadily over the 60 minutes. Eighty-five percent of the subjects had a perceived increase in heart rate with the Stabident injection and 93 percent with the X-tip injection, with no significant differences (P > .05) between the techniques. CONCLUSIONS AND CLINICAL IMPLICATIONS: The two primary intraosseous injection techniques were similar regarding anesthetic success, onset, duration and perceived heart rate increases.     

Anesthetic efficacy of the palatal-anterior superior alveolar injection

BACKGROUND: A single palatal-anterior superior alveolar, or P-ASA, injection has been reported to provide pulpal anesthesia of the four maxillary incisors and usually the canines. The authors conducted a prospective, randomized, double-blind study to compare the anesthetic efficacy of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine using a computer-assisted injection system to administer the P-ASA injection. MATERIALS AND METHODS: In a double-blind manner, the authors used a crossover design to administer randomly P-ASA injections of 1.4 milliliters of the lidocaine solution and 1.4 mL of the mepivacaine solution using the computer-assisted injection system at two appointments to 40 subjects. They used a pulp tester to test for anesthesia of the central incisors, lateral incisors and canines in four-minute cycles for 72 minutes. Anesthesia was considered successful when two consecutive maximum readings (80 readings) with the pulp tester were obtained. RESULTS: For the lidocaine solution, successful pulpal anesthesia ranged from 32 to 58 percent for the six anterior teeth. For the mepivacaine solution, successful pulpal anesthesia ranged from 22 to 38 percent. Except for the left canine, the lidocaine solution was significantly more likely to result in pulpal anesthesia than the use of the mepivacaine solution. The duration of pulpal anesthesia, for both solutions, declined steadily over 72 minutes. CONCLUSIONS AND CLINICAL IMPLICATIONS: Using the computer-assisted injection system for the P-ASA injection, we concluded that the rather modest-to-low success rates of the lidocaine and mepivacaine solutions would not ensure predictable pulpal anesthesia of the four maxillary incisors and the canines.     

Articaine for Supplemental Buccal Mandibular Infiltration Anesthesia in Patients with Irreversible Pulpitis When the Inferior Alveolar Nerve Block Fails

The purpose of this prospective study was to determine the anesthetic efficacy of the supplemental buccal infiltration injection of a cartridge of 4% articaine with 1:100,000 epinephrine in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve (IAN) block failed. Fifty-five emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an IAN block and had moderate to severe pain on endodontic access. An infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine was administered buccal to the tooth requiring endodontic treatment. Success of the infiltration injection was defined as no pain or mild pain on endodontic access or instrumentation. The results showed that anesthetic success was obtained in 58% of the mandibular posterior teeth. We can conclude that when the IAN block fails to provide profound pulpal anesthesia, the supplemental buccal infiltration injection of a cartridge of 4% articaine with 1:100,000 epinephrine would be successful 58% of the time for mandibular posterior teeth in patients presenting with irreversible pulpitis. Unfortunately, the modest success rate would not provide predictable pulpal anesthesia for all patients requiring profound anesthesia.     

Comparison of the anesthetic efficacy of the conventional inferior alveolar, Gow-Gates, and Vazirani-Akinosi techniques

The purpose of this prospective, randomized study was to compare the degree of pulpal anesthesia obtained with the conventional inferior alveolar, the Gow-Gates, and the Vazirani-Akinosi techniques in vital, asymptomatic teeth. With a crossover design, 40 subjects received all 3 techniques in a random manner by using 3.6 mL of 2% lidocaine with 1:100,000 epinephrine at 3 separate appointments. An electric pulp tester was used to test for anesthesia in 3-minute cycles for 60 minutes of the first molars, first premolars, and lateral incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained through the 60th minute. The ranges of successful anesthesia were as follows: inferior alveolar technique, 25%-62%; Gow-Gates technique, 16%-44%; and for the Vazirani-Akinosi technique, 13%-50%. There was no significant difference (P > .05) in success among the 3 techniques. However, the Gow-Gates and Vazirani-Akinosi techniques resulted in a statistically slower onset of pulpal anesthesia than the inferior alveolar nerve block. We concluded that in vital, asymptomatic teeth and for the subjects who achieved lip numbness, the conventional inferior alveolar nerve block is similar to the Gow-Gates and Vazirani-Akinosi techniques regarding anesthetic success but has a faster onset of pulpal anesthesia.     

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 comparison of articaine and lidocaine for inferior alveolar nerve blocks

The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks. Using a crossover design, inferior alveolar nerve blocks were randomly administered, in a double-blind manner, using 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine, at two separate appointments, to 57 subjects. A pulp tester was used to test for anesthesia, in 4-min cycles for 60 min, of the molars, premolars, central, and lateral incisors. Anesthesia was considered successful when two consecutive 80 readings were obtained within 15 min and the 80 reading was continuously sustained for 60 min. Using the articaine solution, successful pulpal anesthesia ranged from 4 to 54% from the central incisor to the second molar. Using the lidocaine solution, successful pulpal anesthesia ranged from 2 to 48%. There was no significant difference (p > 0.05) between the articaine and lidocaine solutions. We concluded that 4% articaine with 1:100,000 epinephrine was similar to 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks.     

Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection

The purpose of this prospective, randomized, single-blinded study was to determine the anesthetic efficacy of a repeated intraosseous injection given 30 minutes after a primary intraosseous injection. Using a crossover design, 55 subjects randomly received a primary X-tip intraosseous injection (Dentsply Inc, York, PA) of 1.4 mL of 2% lidocaine with epinephrine (using the Wand; Milestone Scientific, Deerfield, IL) and a repeated intraosseous or mock injection at 30 minutes in two appointments. The first molar and adjacent teeth were pulp tested every 2 minutes for a total of 120 minutes. Success was defined as obtaining two consecutive 80 readings with the electric pulp tester. Success of the initial intraosseous injection was 100% for the first molar. The repeated intraosseous injection mimicked the initial intraosseous injection in terms of pulpal anesthesia and statistically provided another 15 minutes of pulpal anesthesia. In conclusion, using the methodology presented, repeating the intraosseous injection 30 minutes after an initial intraosseous injection will provide an additional 15 minutes of pulpal anesthesia.     

Reaction of children to dental injection with 27- or 30-gauge needles

AIM: The purpose of this study was to assess children's reaction while receiving dental local anaesthesia with a 27- and a 30-gauge needle and to record their sensation. METHODS: Ninety-five children (43 boys and 52 girls) participated in this study. A random crossover design was used so that each child served as his or her own control, receiving each treatment on the opposite sides of the same arch (right vs. left). Each patient received an injection either with a 27- or 30-gauge needle during the first visit and during the second visit with the other needle. Objective and subjective evaluation were performed. RESULTS: Children's reactions to maxillary buccal infiltration either with a 27- or 30-gauge needle were similar. Significantly more children cried while receiving mandibular block injection with a 27-gauge needle than they did when receiving the injection with a 30-gauge needle (P = 0.002). According to subjective evaluation, most children rated both injections as a positive, non-painful experience. CONCLUSIONS: Mandibular block is less unpleasant, and children cry less when administered with a 30-gauge needle than they do when it is delivered with a 27-gauge needle. No difference in crying during injection is observed when maxillary infiltration is provided with 27- or 30-gauge needles.     

Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study

This randomized crossover double-blind trial compared the efficacy of buccal infiltration with 4% articaine and 2% lidocaine (both with 1:100,000 epinephrine) in securing mandibular first molar pulp anesthesia. Injections were given at least 1 week apart in 31 healthy adult volunteers. Electronic pulp testing was undertaken at baseline and at 2 minute intervals until 30 minutes postinjection. A successful outcome was recorded in the absence of pulp sensation on two consecutive maximal pulp tester stimulations (80 muA). 64.5% of articaine and 38.7% of lidocaine infiltrations were successful (p = 0.008). Articaine infiltration produced significantly more episodes of no response to maximum stimulation in first molars than lidocaine (236 and 129, respectively, p < 0.001). Mandibular buccal infiltration is more effective with 4% articaine with epinephrine compared to 2% lidocaine with epinephrine. Both injections were associated with mild discomfort.     

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.     

碧兰麻对牙髓麻醉效果的临床验证

目的 验证碧兰麻对牙髓麻醉的效果及安全性。方法 对３１例患者的３３颗患牙进行局部粘膜下浸润麻醉电测牙髓活力反应及治疗中检测牙髓麻醉效果,观察副作用。结果 上颌牙齿及下颌前牙牙髓麻醉完全及良好率为１００％;下颌后牙牙髓麻醉完全及良好率为３５．７％;对血压、心率无影响;未发生副作用。结论 碧兰麻是一种安全、有效的口腔科专用的局部麻醉剂,它可替代传统的传导麻醉。