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。     

仅行唇颊侧浸润麻醉拔除上颌牙镇痛效果分析

目的讨论拔除上颌恒牙时不给予腭侧麻醉的可行性。方法拔除双侧上颌恒牙的患者63例,进行双侧对照试验,试验组予4%盐酸阿替卡因（含1∶100000肾上腺素）1.7mL唇颊侧前庭沟浸润麻醉,5min后拔牙;对照组颊侧注射同前,同时腭侧追加上述局麻药0.4mL浸润麻醉,5min后拔牙。所有患者麻醉后和拔牙后分别完成注射及拔牙疼痛视觉模拟量表（visual analogue scale,VAS）和语言评价量表（verbal response scale,VRS）测试。结果注射疼痛评价VAS值试验组为（26.3±8.1）mm,对照组为（37.9±6.7）mm,二者差异有统计学意义（P〈0.05）;拔牙疼痛评价VAS值试验组为（15.3±6.9）mm,对照组为（13.3±5.7）mm,两组差异无统计学意义（P〉0.05）,所有患者认为拔牙为“可接受”。结论上颌恒牙拔除行腭侧浸润麻醉给患者带来更多不适,仅行4%盐酸阿替卡因唇颊侧浸润麻醉拔牙的方法可行。     

采用不同麻醉方法拔除上前磨牙的临床对比

目的 比较拔除上前磨牙时采用单牙无痛局部麻醉系统(STA)行牙周韧带(PDL)内注射麻醉和常规金属注射器颊腭双侧局部浸润麻醉在注射及拔牙过程中疼痛情况和麻醉效果.方法 选择100例因为正畸需要拔除双侧上前tEi磨牙的患者为研究对象,随机选择其中一侧作为试验牙,另一侧作为对照牙:实验组应用计算机控制STA进行盐酸阿替卡因PDL内注射麻醉,对照组采用常规金属注射器进行盐酸阿替卡因颊腭双侧局部浸润麻醉.麻醉5 min后进行拔牙手术.利用直观模拟标度尺(VAS)及问卷获得患者麻醉注射及拔牙时的痛觉数据和颊部软组织是否麻木不适数据.结果 实验组和对照组麻醉注射疼痛感觉VAS值分别是(0.4011±0.556)、(4.1038 4±1.512),两组注射疼痛感觉比较差异有统计学意义(P<0.01);而实验组与对照组在麻醉镇痛成功率方面比较差异无统计学意义(P>0.05);实验组只有2%患者有颊侧软组织麻木不适感,而对照组100%患者有颊侧软组织麻木不适感,两者差异有统计学意义(P<0.01).结论 在上前磨牙拔除中.应用STA-PDL注射麻醉可以达到良好的麻醉效果,同时麻醉注射时疼痛轻微,对邻近颊部软组织功能影响小,麻醉药物用量较少.     

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。     

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。     

两种联合局部麻醉法对下颌第一磨牙急性牙髓炎开髓治疗的镇痛效果比较

目的探讨下牙槽神经阻滞麻醉联合颊侧浸润或牙周膜注射对下颌第一磨牙急性牙髓炎开髓治疗的镇痛效果。方法40例下颌第一磨牙急性牙髓炎患者随机分为2组,均予以4%盐酸阿替卡因（含1∶100 000肾上腺素）1.7 mL行下牙槽神经阻滞麻醉,另取0.4 mL相同麻醉剂,A组加行颊侧浸润麻醉,B组加行牙周膜注射。阻滞麻醉后等待5 min并完成疼痛评估,然后行颊侧浸润或牙周膜注射,等待5 min并完成疼痛评估。另一名医生行开髓,作开髓疼痛评估。由牙医助理记录各种注射麻醉及开髓疼痛的视觉模拟量值。结果B组有1例因下牙槽神经阻滞麻醉失败被排除,39例纳入统计分析。2组年龄（t=1.42,P=0.22）、性别（χ2=1.97,P=0.60）、术前疼痛的差异（t=0.93,P=0.71）均无统计学意义。所有患者在下牙槽神经阻滞麻醉起效后行颊侧浸润或牙周膜注射均感到无痛或轻度疼痛。2组下牙槽神经阻滞麻醉疼痛差异无统计学意义（t=0.62,P=0.71）,A组牙周膜注射和B组颊侧浸润疼痛差异无统计学意义（t=1.19,P=0.33）。A组麻醉成功率80.0%（16/20）,B组麻醉成功率为84.2%（16/19）,二者差异无统计学意义（X^2=2.45,P=0.33）。结论 下牙槽神经阻滞麻醉联合颊侧浸润或牙周膜注射应用于下颌第一磨牙急性牙髓炎开髓治疗均可取得较高的麻醉成功率。     

拔除上颌牙不施行腭侧注射麻醉的临床研究

目的探讨拔除上颌牙不行腭侧注射麻醉的可行性。方法选择700例需要拔除上颌牙的患者为研究对象,将其随机分为2组,试验组500例,对照组200例。拔牙时试验组患者只行颊侧的局部麻醉;对照组患者采用传统的麻醉方法,比较2组患者的麻醉效果。结果1)试验组患者麻药注射时的疼痛明显小于对照组,其差异有统计学意义(P<0.05);2)试验组患者与对照组患者在拔牙手术时的疼痛无明显的差异(P>0.05)。结论在上颌牙的拔除中只行颊侧的局部麻醉能达到较好的麻醉效果,可以不进行腭侧麻醉。     

阿替卡因在拔牙术中的应用

许多就诊的拔牙患者总是把拔牙治疗与疼痛联系在一起。我们在临床中处理此类患者除语言安慰、诱导外 ,使用了碧兰麻 ,即阿替卡因加肾上腺素 ( 1:10 0 0 0 0 ) ,收到了良好的效果。1　材料与方法2 0 0 0年 5月至 11月间 ,5 3例需要拔牙的患者来我院就诊 ,主观畏痛。其中男 3 0例 ,女 2 3例。年龄 6～ 5 6岁。用含40 ｇ/Ｌ阿替卡因加 1/10 0 0 0 0肾上腺素及配套注射器 ,采取唇(颊 )、腭 (舌 )侧根尖区局部粘膜下浸润麻醉 ,注入量前牙每侧约 0 .5ｍｌ,后牙每侧约 1ｍｌ。注药后 10ｍｉｎ后进行患牙拔除。共拔除患牙 5 8个 ,其中上颌磨牙 (包括…     

不同剂量阿替卡因对不可复性牙髓炎下牙槽神经阻滞麻醉效果的比较

目的:本研究对仅有刺激痛的早期不可复性牙髓炎的患者在下牙槽阻滞麻醉时,比较使用1.7 mL阿替卡因和3.4 mL阿替卡因的麻醉成功率的差异。方法:将76名患者随机分为两组,1.7 mL组和3.4 mL组(两组都为4%阿替卡因与1∶100000的肾上腺素),进行下牙槽阻滞麻醉。根管治疗过程中,使用Heft-Parker视觉模拟量表(VAS)记录患者的疼痛值。对数据进行T检验和卡方检验。结果:72名患者纳入了研究结果,两组的成功率都没有达到100%,组间有显著差异(P<0.001),3.4 mL组有较高的成功率74.4%,1.7 mL组成功率为27.8%。结论:在对下颌第一磨牙进行下牙槽阻滞时,提高阿替卡因的注射剂量可以显著提高麻醉的成功率,但也达不到100%的麻醉成功。     

两种不同下牙槽神经阻滞麻醉方法用于下颌阻生第三磨牙拔除术的对比研究

目的：探讨一种更加有效的下齿槽神经阻滞麻醉的方法。方法：随机选取需翻瓣去骨法拔除下颌阻生第三磨牙患者150例。实验组50例,采用Gow-Gates法阻滞麻醉,对照一组50例,采用下颌支内侧隆突阻滞麻醉,对照二组在采用对照组一的方法注射后保留少量局麻药加用患牙颊侧近远中及舌侧三点浸润麻醉。采用VAS评分法观察疼痛情况。三组病例均使用阿替卡因肾上腺素注射液。结果：与对照一组相比,采用Gow-Gates法阻滞麻醉的病例疼痛明显减轻,但是与对照二组相比,该法没有明显优势。结论：传统的下颌支内侧隆突阻滞麻醉加用局部浸润麻醉可以有效提高下牙槽神经阻滞麻醉的成功率,达到与Gow-Gates阻滞麻醉相同的麻醉效果。     

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.     

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.     

Comparison of the buccal injection versus buccal and palatal injection for extraction of permanent maxillary posterior teeth using 4% articaine: a split mouth study

In spite of the development of modern injection techniques, palatal injection is still a painful experience for patients. A plethora of techniques has been tested to reduce this. One such technique that has been claimed to work is administering articaine on the buccal side alone for the extraction of maxillary teeth due to its ability to diffuse through soft and hard tissues more reliably than other local anaesthetics. This split mouth study evaluated the efficacy of 4% articaine with 1:100000 adrenaline to avoid the painful palatal injection for bilateral permanent maxillary tooth extraction in 50 patients. The 100mm 10 point Visual Analog Scale/Wong Baker Facial Pain Scale was used to rate the amount of pain felt on injection, on probing the tissues prior to, or during, extraction, and one hour postoperatively. Although the buccal injection alone resulted in lower pain while injecting the anaesthetic, it did not result in the absence of pain before tooth extraction as has been suggested by various studies. A total of 74% patients required a palatal injection on the study side. We conclude that in most cases, when using a buccal injection alone, one cannot rely on the diffusion of articaine for effective palatal anaesthesia. Despite this, we suggest that as an initial option in young patients, the operator can consider avoiding the painful palatal injection by the use of articaine to prevent aversion to dental treatment. Postoperatively, the difference in pain levels was not statistically significant and no patient showed signs of lesions at the injection sites.     

Comparison of the efficacy of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 buccal infiltration for single maxillary molar extraction: a double-blind,randomised, clinical trial

The present study was designed to compare the efficiency of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 in providing adequate anaesthesia for maxillary molar extraction with buccal infiltration only. In this randomised, double-blind clinical trial, 139 patients who needed maxillary molars extracting were enrolled. Individuals were randomly divided into two groups of 2% lidocaine with epinephrine 1:100,000 treated by buccal infiltration without palatal injection and 4% articaine with epinephrine 1:100,000 treated with the same method. Then, teeth were extracted and the pain assessed. During the extraction of teeth, 90.63% of patients in the lidocaine-treated group and 36% of patients in the articaine-treated group experienced pain (p<0.0001). In other words, the rates of successful anaesthesia with lidocaine and articaine buccal infiltration were 9.38% and 64%, respectively. Despite the better performance of articaine, it seems that some factors such as bone thickness and anatomical variations among individuals, besides the condition of the tooth, affects articaine’s level of efficiency in each case.     

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.     

Effectiveness of various modes of computerized delivery of local anesthesia in primary maxillary molars

PURPOSE: The purpose of this study was to compare the effectiveness of infiltration and intrasulcular injection, delivered by a computerized delivery system (CDS), to primary maxillary molars. METHODS: The study population consisted of 178 children (2-14 years old) who received local infiltration (buccal and palatal) or intrasulcular injection to primary maxillary molars with the use of a CDS. Behavior was managed using: (1) behavioral management techniques; (2) N2O inhalation; or (3) sedation. Measured dependent variables included the: (1) child's subjective perception of well-being before and immediately after anesthesia (scale = 0-100); (2) child's pain behavior during anesthesia, as measured by Children's Hospital of Eastern Ontario pain scale (CHEOPS; range = 4-13); and (3) effectiveness of anesthesia during dental treatment. RESULTS: Low stress levels were shown for most children before and immediately after anesthesia (range = 12-23). The CHEOPS rating for pain-distractive behavior associated with palatal and buccal infiltration and intrasulcular anesthesia by CDS was similar (6.0 +/- 1.9, 5.8 +/- 1.7, and 5.9 +/- 1.6, respectively). Children treated under sedation, compared to behavioral management techniques, showed higher CHEOPS scores (P = .004). The effectiveness of anesthesia using a CDS (infiltration and intrasulcular) had a downward trend, but was not significantly different for restoration (91%), pulpotomy and preformed crowns (79%), or extraction (74%; mean = 86%). There was no significant difference between infiltration and intrasulcular effectiveness or for age, gender, or tooth location (primary maxillary first vs second molars). CONCLUSIONS: CDS caused low levels of stress and pain reaction after palatal infiltration equal to that for buccal infiltration. All procedures achieved anesthesia effectiveness (86%), with no differences between primary maxillary first and second molars.