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.     

Onset and duration periods of articaine and lidocaine on maxillary infiltration.

OBJECTIVES: The aim of this study was to compare the onset and duration of pulpal anesthesia by maxillary infiltration using 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. METHOD AND MATERIALS: Twenty healthy patients randomly received 1.8 mL of one of the three local anesthetics during operative dentistry procedures of low complexity on three maxillary posterior teeth. Onset and duration were determined using an electric pulp tester. RESULTS: The mean values for pulpal onset were 2.8, 1.6, and 1.4 minutes and for pulpal duration were 39.2, 56.7, and 66.3 minutes, respectively, for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. Statistical analysis by the Kruskal-Wallis nonparametric test showed significant differences with better results (shorter onset and longer duration periods) for both articaine solutions compared with the lidocaine solution. Although 4% articaine with 1:100,000 epinephrine clinically presented the shortest onset and the longest duration periods, there was no statistically significant difference between the articaine solutions. CONCLUSION: Both articaine solutions produced shorter onset and longer duration of pulpal anesthesia by maxillary infiltration than the lidocaine solution did. Statistical analysis did not confirm better clinical results of 4% articaine with 1:100,000 epinephrine than with 4% articaine with 1:200,000 epinephrine.     

A Prospective,Randomized, Double-blind Comparison of 2% Lidocaine With 1:100,000 and 1:50,000 Epinephrine and 3% Mepivacaine for Maxillary Infiltrations

IntroductionThe purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1:100,000 and 1:50,000 epinephrine and 3% mepivacaine in maxillary lateral incisors and first molars.MethodsSixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine at three separate appointments spaced at least 1 week apart. The teeth were pulp tested in 3-minute cycles for a total of 60 minutes.Results and ConclusionsAnesthetic success and the onset of pulpal anesthesia were not significantly different between 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine and 3% mepivacaine for the lateral incisor and first molar. Increasing the epinephrine concentration from 1:100,000 to 1:50,000 in a 2% lidocaine formulation significantly decreased pulpal anesthesia of short duration for the lateral incisor but not the first molar. For both the lateral incisor and first molar, 3% mepivacaine significantly increased pulpal anesthesia of short duration compared with 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine.     

Efficacy of liposome-encapsulated 0.5% ropivacaine in maxillary dental anaesthesia

The aim of this study was to evaluate the effectiveness of liposome-encapsulated ropivacaine (0.5%) in dental anaesthesia. This randomised, double-blind, crossover, four-period treatment study included 40 volunteers who were given 1.8 ml of the following local anaesthetics into the buccal sulcus at the right level of the upper canine: 0.5% ropivacaine; 0.5% ropivacaine with 1:200,000 adrenaline; liposome-encapsulated 0.5% ropivacaine; and 2% lignocaine with 1:100,000 adrenaline. Onset of pulpal anaesthesia; the success of anaesthesia; and the duration of labial, gingival, and pulpal anaesthesia involving the upper right canine and first premolar were evaluated. At the end of each injection, volunteers rated the pain on injection on a visual analogue scale (VAS). Both ropivacaine and adrenaline, and lignocaine with adrenaline, were more successful anaesthetic agents than liposome-encapsulated ropivacaine or plain ropivacaine (p<0.05). There were no significant differences among the anaesthetic preparations in the onset of pulpal anaesthesia. Ropivacaine and adrenaline and lignocaine and adrenaline gave a significantly longer duration of pulpal anaesthesia. VAS showed no significant differences among the groups tested. The results showed that encapsulation of liposome did not improve the anaesthetic efficacy of ropivacaine.     

A double-blind comparison of 0.5% bupivacaine with 1:200,000 epinephrine and 0.5% levobupivacaine with 1:200,000 epinephrine for the inferior alveolar nerve block

This double-blind cross-over study compared the anesthetic success and onset and duration of lip and pulpal anesthesia of 0.5% bupivacaine and levobupivacaine solutions, both with 1:200,000 epinephrine, when administered for inferior alveolar nerve anesthesia. Thirty healthy volunteers were randomly anesthetized using one of the solutions. The inferior canine, second premolar, and molar were tested with electric stimulation. The pulpal anesthetic success rates for bupivacaine and levobupivacaine were 80% and 76.66%, respectively, for molars, 76.66% (both solutions) for premolars, and 70% (both solutions) for canines. At least 250 minutes of pulpal anesthesia was achieved. There were no significant differences between the solutions considering the measured parameters (P > .05). Because of the similar anesthetic behavior of the 2 solutions in this study and the low toxicity related in the literature for levobupivacaine, there is justification for replacing bupivacaine with levobupivacaine for inferior alveolar nerve local anesthesia.     

A prospective, randomized, double-blind comparison of bupivacaine 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 0.5% bupivacaine with 1:200,000 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 0.5% bupivacaine with 1:200,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine, at two separate appointments, to 39 subjects. A pulp tester was used to test for anesthesia until two consecutive readings of less than 80 were recorded on at least three of the five experimental teeth. Anesthesia was considered successful when two consecutive 80 readings were obtained within 15 min and the 80 reading was continuously sustained for 60 min. Anesthetic success was significantly improved for all teeth except the first molar with the lidocaine solution. Pulpal anesthesia averaged 4 hr for bupivacaine versus 2 hr and 24 min for lidocaine.     

Anesthetic efficacy of 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine for maxillary infiltrations

The purpose of this prospective, randomized, single-blinded study was to measure the degree of anesthesia obtained with 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine in maxillary infiltrations. Ninety-six adult subjects randomly received infiltrations of 1.8 mL and 3.6 mL of the lidocaine solution at two separate appointments, in a crossover design. Thirty-two lateral incisors, 32 first premolars and 32 first molars were studied in this investigation. Anesthetic success (obtaining two consecutive 80 readings with the electric pulp tester) for the two volumes ranged from 97% to 100%. The onset of pulpal anesthesia was not statistically different between the two volumes. For both volumes, the lateral incisors had a higher percentage of anesthesia of short duration than the first premolar and first molar. The 3.6 mL volume provided a statistically longer duration of pulpal anesthesia for the lateral incisor, first premolar, and first molar.     

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.     

Anesthetic efficacy of a combination palatal and buccal infiltration of the maxillary first molar

Introduction

The purpose of this prospective, randomized, single-blind crossover study was to evaluate the anesthetic efficacy of a combination palatal and buccal infiltration of the maxillary first molar.

Materials and Methods

Using a crossover design, 40 subjects received two sets of maxillary first molar infiltrations at two separate appointments spaced at least 1 week apart. The anesthetic used in this study was 2% lidocaine with 1:100,000 epinephrine. One set of infiltrations consisted of a buccal infiltration of 1.8 mL of anesthetic and a palatal infiltration of 0.5 mL of anesthetic. The other set consisted of a buccal infiltration of 1.8 mL of anesthetic and a mock palatal infiltration. The first molar was pulp tested in 4-minute cycles for a total of 60 minutes. Anesthetic success was defined as no subject response to two consecutive 80 readings with an electric pulp tester.

Results and Conclusions

The success rates were 88% for the buccal infiltration and 95% for the buccal plus palatal infiltration. The difference was not statistically significant. The buccal plus palatal infiltration significantly increased the incidence of pulpal anesthesia from 21 minutes through 57 minutes. Although there was an increased incidence of pulpal anesthesia with the combination buccal plus palatal infiltration, anesthesia was not provided for 60 minutes.     

Pulpal anesthesia dependent on epinephrine dose in 2% lidocaine. A randomized controlled double-blind crossover study.

We studied the discrepancy in the results published on the dependence of the duration of pulpal nerve anesthesia on the concentration of epinephrine in 2% lidocaine. The increase in pain threshold of the pulpal nerve was measured before and after injection of lidocaine alone and lidocaine with epinephrine concentrations of 1:200,000, 1:100,000, or 1:50,000 into the mucobuccal aspect adjacent to the apex of the maxillary right incisor. The study was done in a random manner with a double-blind crossover design. The pulpal nerve was stimulated with negative rectangular electrical pulses of up to -167 V with 100 Hz and a pulse width of 0.6 msec. The results show a relationship between the 1:200,000 and 1:100,000 epinephrine concentrations and the success and duration of anesthesia. The onset of anesthesia was independent of the catecholamine content of the solution.     

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.     

A comparison of ropivacaine and lidocaine with epinephrine for intraligamentary anesthesia

OBJECTIVE: The purpose of this study was to compare the efficacy of 2 different concentrations of ropivacaine with lidocaine containing epinephrine for intraligamentary anesthesia. STUDY DESIGN: Ethical approval was obtained and a randomized, double-blind, cross-over volunteer investigation was conducted. Twenty-four volunteers had intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine, 0.75% ropivacaine, or 1% ropivacaine at the upper lateral incisor and lower first bicuspid teeth. The response of the test teeth to electrical pulp testing and the reaction of the gingiva to sharp probing were assessed up to 29 minutes after injection. Injection discomfort and side effects were also recorded. Data were analyzed by using the chi-square test and analysis of variance. RESULTS: Lidocaine with epinephrine was more successful than the ropivacaine solutions in obtaining pulpal anesthesia (chi-square = 12; P <.002) and produced longer-lasting pulpal (F = 21; P <.001) and soft tissue (F = 16; P <.001) anesthesia. Injection discomfort and incidence of side effects were similar between solutions, and none produced serious adverse effects. CONCLUSION: Lidocaine with epinephrine is more effective than ropivacaine as an intraligamentary anesthetic.     

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.     

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.     

A Prospective,Randomized, Double-blind Comparison of the Anesthetic Efficacy of Two Percent Lidocaine with 1:100,000 and 1:50,000 Epinephrine and Three Percent Mepivacaine in the Intraoral,Infraorbital Nerve Block

IntroductionThe purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine in the intraoral, infraorbital nerve block.MethodsForty subjects randomly received intraoral, infraorbital nerve blocks by using a cartridge of 2% lidocaine with 1:100,000 or 1:50,000 epinephrine and a cartridge of 3% mepivacaine at 3 separate appointments spaced at least 1 week apart. The anteriors, premolars, and first molar were pulp tested in 4-minute cycles for a total of 60 minutes.Results and ConclusionsThe intraoral, infraorbital nerve block was ineffective in providing profound pulpal anesthesia of the maxillary central incisor, lateral incisor, and first molar. Successful pulpal anesthesia of the canine and first and second premolars ranged from 75%–92% by using 2% lidocaine with 1:100,000 and 1:50,000 epinephrine. However, pulpal anesthesia did not last for 60 minutes. The use of 3% mepivacaine provided a shorter duration of anesthesia than the lidocaine formulations with epinephrine in the canines and premolars.     

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).     

Anesthetic Efficacy of Supplemental Buccal and Lingual Infiltrations of Articaine and Lidocaine after an Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis

IntroductionThe success rate of inferior alveolar nerve block (IANB) decreases in patients with irreversible pulpitis. It was hypothesized that supplemental infiltration of lidocaine and articaine may improve the success rates.MethodsEighty-four adult volunteers, actively experiencing pain, participated in this prospective, randomized, double-blinded study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive supplemental infiltrations (control). Thirty patients received supplemental buccal and lingual infiltrations of 2% articaine with 1:200,000 epinephrine, and 30 patients received buccal and lingual infiltrations of 2% lidocaine with 1:200,000 epinephrine at 2 minutes after the IANB. 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.ResultsStatistical analysis using nonparametric McNemer tests showed that supplemental buccal and lingual infiltration of 2% lidocaine with 1:200,000 epinephrine or 4% articaine with 1:200,000 epinephrine improved the success rate from 33% to 47% and 67%, respectively. Also the success rate with 4% articaine with 1:200,000 epinephrine was significantly more than 2% lidocaine with 1:200,000 epinephrine (p < 0.05).ConclusionsAlthough supplemental buccal and lingual infiltrations of 4% articaine or 2% lidocaine increased the success rate of the inferior alveolar nerve block in patients with irreversible pulpitis, none of the techniques provided acceptable success rates.     

A randomized anesthethic potency comparison between ropivacaine and bupivacaine on the perioperative regional anesthesia in lower third molar surgery

BackgroundPerioperative pain control by means of local anesthesia is an intrinsic part of surgical practice.AimTo evaluate the anesthetic potencies between ropivacaine and bupivacaine in the surgery of mandibular horizontally impacted teeth.Material and methodOutpatients of both sexes, in the age range from 18 to 70 yrs. of age (mean age: 26.48 ± 3.66), participated in this clinical study. After mandibular conduction anesthesia of 0.75% ropivacaine in group I, 0.5% bupivacaine in group II, and 2% lidocaine with 1:100000 epinephrine in group III, the following anesthetics variables were measured: quality of anesthesia score (QAS), success rate of local anesthesia (SLA), onset time of anesthesia (OT), duration of anesthesia (DA), intensity of intraoperative pain (IIP) (VAS scale in mm). Blood pressure, and pulse were measured.ResultsNinety patients, divided into three equal groups, were enrolled for the study. Ropivacaine gained statistically significant (p < 0.05) variables: QAS of 1.77 ± 0.68 and IIP was 18.90 ± 6.11 mm (p < 0.05). The SLA of the achieved local anesthesia was 96.6%, 93.3% and, 86.6% for ropivacaine, lidocaine with epinephrine 1:100000, and bupivacaine groups, respectively. OT was 151.50 ± 80.93, 168.27 ± 79.73, and 89.80 ± 27.91 sec, for groups I, II and III, respectively. The DA for ropivacaine was 412.17 ± 110.04 min, while the one for bupivacaine and lidocaine with epinephrine 1:100000 was 376.30 ± 98.51 min., and 216.13 ± 47.69 min., respectively. Hemodynamic parameters were insignificant to cause side effects.Conclusion0.75% ropivacaine provided successful local anesthesia in 96.6% of the patients, better quality and onset of anesthesia with the duration of anesthesia of 412.17 ± 110.04 min and lower intraoperative pain than in the case of 0.5% bupivacaine and 2% lidocaine with epinephrine.     

Comparative clinical evaluation of different epinephrine concentrations in 4 % articaine for dental local infiltration anesthesia

Objectives

The aims of this study were to compare and evaluate the clinical anesthetic efficacy of five 4 % articaine solutions with and without epinephrine in pulpal anesthesia after infiltration.

Materials and methods

In a randomized, double-blinded, crossover study, ten volunteers received local anesthesia infiltration in the maxillary right central incisor with five different solutions (4 % articaine?+?epinephrine 1:100,000, + epinephrine 1:200,000, + epinephrine 1:300,000, + epinephrine 1:400,000, without epinephrine). Electronic pulp tester was used to calculate the onset, utilization time, time to recede, and the surface integral under the time–effect curve. Additionally, cardiovascular parameters and post-experimental soft tissue anesthesia were examined.

Results

Onset as well as time to recede was not influenced by the epinephrine concentration. When using the epinephrine-free agent, time to recede was significantly shorter. Upon decreasing epinephrine concentration, duration of pulpal anesthesia and total anesthetic efficacy declined. The shortest time of anesthesia and lowest anesthetic efficacy were seen for the solution without epinephrine. No association was found between the local anesthetic drug and cardiovascular parameters. Soft tissue anesthesia was significantly shorter without epinephrine.

Conclusions

This study shows the substantial benefits of vasoconstrictors in dental infiltration anesthesia. These findings were reflected by means of prolonged and deeper therapeutic effect in a dose-dependent manner.

Clinical relevance

Even when utilizing agents with reduced amount of epinephrine, a safe anesthesia is possible. The epinephrine-free solutions resulted in a distinct limitation of utilization time and efficacy.     

Ropivacaine for dental anesthesia: a dose-finding study.

PURPOSE: The purpose of this study was to determine the optimal concentration and volumes of ropivacaine for dental anesthesia as regards onset and duration of action. SUBJECTS AND METHODS: Thirty healthy individuals with a mean age of 32 years participated in the study on a voluntary basis. All subjects received a ropivacaine injection in 1 of 3 randomized concentrations (2.0, 5.0, or 7.5 mg/mL) for infiltration anesthesia and mandibular nerve block in a double-blind manner. The onset time and duration of anesthesia were assessed by electric pulp test, pinprick test of the gingiva, and presence of feeling of numbness of the lip. RESULTS: Regardless of dose, only 5 patients received pulpal anesthesia after infiltration, but all 3 concentrations anesthetized the gingiva and upper lip. The onset of pulpal anesthesia occurred less than 5 minutes after injection and lasted for 4 to 58 minutes. Pinprick anesthesia lasted for 8 to 48 minutes, and numbness of the upper lip lasted 1 to 4 hours. The effectiveness of the mandibular nerve block with regard to pulpal anesthesia was dose dependent. Only ropivacaine at 7.5 mg/mL produced sufficient anesthesia. The onset of pulpal anesthesia occurred less than 10 minutes after injection and lasted for 2 to 6 hours. Pinprick anesthesia lasted for 3 to 6 hours and numbness of the lower lip lasted for 5 to 9 hours. CONCLUSION: This study shows that ropivacaine could be useful as a local anesthetic for mandibular nerve block in dentistry and that the very long duration of both pulpal and soft tissue anesthesia may be favorable in reducing postoperative pain.