急性牙髓炎应用无痛局麻仪进行牙周膜麻醉的临床评价

目的：病例应用无痛局麻注射仪对神经阻滞麻醉失败病例进行牙周膜注射的疼痛程度及注射效果进行评价。方法：本组90例,采用无痛局麻注射仪进行牙周膜麻醉,与传统的手推式加压牙周膜麻醉对比。结果：应用无痛局麻注射仪进行牙周膜麻醉时,注射时疼痛程度明显小于手推式加压麻醉法。牙髓治疗时的麻醉效果两者无明显差别。但前者的成功率高于后者。阿替卡因注射时镇痛效果明显优于利多卡因,并且麻醉效果更好。     

STATM韧带内注射对急性牙髓炎诊断和治疗的作用探讨

目的:观察STATM系统韧带内注射在急性牙髓炎定位诊断中的作用。方法:将96例急性牙髓炎或慢性牙髓炎急性发作的患者,采用单纯随机法分为试验组和对照组。试验组(n=48)采用STATM系统韧带内注射麻醉下确诊后开髓、拔髓;对照组(n=48)采用常规中空注射器抽取相同麻醉药手持推注局部浸润或阻滞麻醉确诊后,同样进行开髓、拔髓,记录确诊、麻药起效、失效时间;麻药用量。请患者自行评估疼痛程度。结果:试验组的确诊时间、麻药生效及失效时间、麻药用量明显少于对照组(P<0.05),麻药注射过程中试验组疼痛明显轻于对照组(P<0.05),上颌牙及下颌前牙、下颌前磨牙开髓、拔髓中的镇痛效果试验组与对照组无显著差异(P>0.05);下颌磨牙开髓、拔髓中的镇痛效果试验组与对照组有显著差异(P<0.05)。结论:STATM系统韧带内注射在急性牙髓炎诊断及治疗中,有较好的临床应用价值。尤其在定位患牙和下颌磨牙镇痛中,能发挥明显的作用。     

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.     

Anesthetic efficacy of the supplemental X-tip intraosseous injection in patients with irreversible pulpitis

The purpose of this study was to determine the anesthetic efficacy of the supplemental intraosseous injection, using the X-tip system in an apical location, in mandibular posterior teeth diagnosed with irreversible pulpitis when the conventional inferior alveolar nerve block failed. Thirty-three emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain on endodontic access. The X-tip system was used to administer 1.8 ml of 2% lidocaine with 1:100,000 epinephrine. The X-tip injection site was 3- to 7-mm apical to the mucogingival junction of the affected tooth. Success of the X-tip intraosseous injection was defined as none or mild pain on endodontic access or initial instrumentation. The results of this study demonstrated that 6 of 33 (18%) X-tip injections resulted in backflow of anesthetic solution into the oral cavity; none were successful in obtaining anesthesia. Twenty-seven of the remaining 33 X-tip injections (82%) were successful. We conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the X-tip system, when used in an apical location and when there was no backflow of the anesthetic solution into the oral cavity, was successful in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.     

Anesthetic efficacy of the supplemental intraosseous injection for teeth with irreversible pulpitis

The purpose of this study was to determine the efficacy of a supplemental intraosseous injection (IOI) of 2% lidocaine with 1:100,000 epinephrine using the Stabident device, after conventional anesthetic methods had failed. Patients who experienced pain during endodontic access and required a supplemental IOI using 0.45 to 0.90 ml of the local anesthetic were identified. All 37 of the patients treated had teeth diagnosed with irreversible pulpitis. Thirty-four of the teeth were mandibular posterior teeth, 2 were maxillary posterior teeth, and 1 was a maxillary anterior tooth. Patients with maxillary teeth had received infiltration anesthesia, and those with mandibular teeth had received an inferior alveolar nerve block in conjunction with long buccal infiltration. A minimum of 3.6 ml of local anesthetic was used with the conventional techniques. Modified visual analogue scales, coupled with operator evaluations, were used to measure success. The Stabident IOI was an effective supplemental anesthetic technique in 89% (+/- 5.1) or 33/37 patients evaluated. The 95% confidence interval was 74 to 97%. The IOI was successful in 91% (+/- 4.9) of the mandibular posterior teeth (31/34), and 67% of the maxillary teeth (2/3).     

Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis

Objective. To determine the efficacy of a supplemental intraosseous injection of 3% mepivacaine in mandibular posterior teeth with irreversible pulpitis. Intraosseous injection pain, subjective heart rate increase, and pain ratings during endodontic treatment were also assessed.Study Design. Forty-eight patients with irreversible pulpitis received conventional inferior alveolar nerve blocks. Electric pulp testing was used to determine pulpal anesthesia. Patients who were positive to the pulp testing, or negative to pulp testing but felt pain during endodontic treatment, received an intraosseous injection of 1.8 ml of 3% mepivacaine. A second intraosseous injection of 3% mepivacaine (1.8 ml) was given if the first injection was unsuccessful.Results. Seventy-five percent of patients required an initial intraosseous injection because of failure to gain pulpal anesthesia. The inferior alveolar block was 25% successful; the first intraosseous injection increased success to 80%. A second intraosseous injection further increased success to 98%. These differences were significant (p < 0.05). Eight percent () of the initial intraosseous injections resulted in solution being expressed into the oral cavity; these were considered technique failures.Conclusions. For mandibular posterior teeth with irreversible pulpitis, a supplemental intraosseous injection of 3% mepivacaine increased anesthetic success. A second intraosseous injection, when necessary, further improved success.     

计算机控制下局部麻醉注射系统在儿童的应用

目的 比较计算机控制下局部麻醉注射系统(CCLADS)与手推式注射器局部麻醉中的儿童行为特征及对2种注射器的自评估情况.方法 选择4～9岁需局部麻醉且同颌相应磨牙所需治疗方式相同的患儿30例,随机分为2组,第1组先应用CCLADS进行麻醉,其中上颌采用颊侧骨膜上浸润麻醉,下颌采用牙周膜(PDL)麻醉;第2组先应用手推式...     

Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis

The purpose of this study was to determine the anesthetic efficacy and heart rate effect of 4% articaine with 1:100,000 epinephrine for supplemental intraosseous injection in mandibular posterior teeth diagnosed with irreversible pulpitis. Thirty-seven emergency patients, diagnosed with irreversible pulpitis of a mandibular posterior tooth, received an inferior alveolar nerve block and had moderate-to-severe pain upon endodontic access. The Stabident system was used to administer 1.8 ml of 4% articaine with 1:100,000 epinephrine. Success of the intraosseous injection was defined as none or mild pain upon endodontic access or initial instrumentation. The results demonstrated that anesthetic success was obtained in 86% (32 of 37) of the patients. Maximum mean heart rate was increased 32 beats/minute during the intraosseous injection. We can conclude that when the inferior alveolar nerve block fails to provide profound pulpal anesthesia, the intraosseous injection of 4% articaine with 1:100,000 epinephrine would be successful 86% of the time in achieving pulpal anesthesia in mandibular posterior teeth of patients presenting with irreversible pulpitis.     

Measurement of mechanical allodynia and local anesthetic efficacy in patients with irreversible pulpitis and acute periradicular periodontitis

An essential feature of symptomatic periradicular inflammation is mechanical allodynia, defined as reduced mechanical pain thresholds. A previous study evaluating a new digital force transducer showed that it reliably measures mechanical pain thresholds of teeth with normal periradicular tissues. In this study, we tested the hypothesis that the force transducer quantitatively measures mechanical allodynia in teeth with acute periradicular periodontitis (APP) and detects the effects of local anesthetic injection. Mechanical pain thresholds were measured in patients (n = 30) with irreversible pulpitis (IP) and APP and compared with their contralateral teeth. The results show that the mechanical pain thresholds of teeth with IP and APP were reduced by 77% compared with contralateral control teeth. The administration of local anesthesia reversed the mechanical allodynia by 62%, and significant sex-specific effects were observed. In addition, the normal teeth contralateral to the symptomatic teeth had lower mechanical thresholds than those observed in healthy volunteers, suggesting that central sensitization occurs during this type of odontalgia. Thus, we show that the mechanical pain thresholds are significantly reduced in teeth with IP and APP and that the force transducer has potential application as a diagnostic aid in measuring mechanical allodynia and as an outcome measure in endodontic clinical trials such as pharmacologic studies and mechanistic research.     

Anaesthetic efficacy of intraligamentary injection techniques on mandibular molars diagnosed with asymptomatic irreversible pulpitis: A retrospective study

The objective of this study was to evaluate the success rate of intraligamentary injections (ILI) using a two‐ or four‐site injection technique. One hundred and fifty‐one mandibular molars diagnosed with asymptomatic irreversible pulpitis received ILI at the mesiobuccal and distobuccal aspects of the roots. Patients who experienced pain when the access cavity was performed received additional supplemental ILI in the mesiolingual and distolingual aspects. Pulpal anaesthesia was considered successful when complete analgesia was achieved. The data were analysed by means of the Fisher's exact and Pearson's chi‐square tests. IL anaesthesia was successful for 92.1% of the teeth. Forty‐eight teeth (31.8%) were sufficiently anaesthetised using the two‐site ILI and 91 teeth (60.3%) following supplemental IL anaesthesia in two more sites. The results of this study indicate that the use of four‐site IL injections as a primary anaesthetic technique may be considered a favourable alternative to the common IANB.     

Anesthetic efficacy of the Gow-Gates injection and maxillary infiltration with articaine and lidocaine for irreversible pulpitis

The aim of this randomized, double-blinded study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine (AE) with 2% lidocaine with 1:100,000 epinephrine (LE) for Gow-Gates blocks and maxillary infiltrations in patients experiencing irreversible pulpitis in mandibular and maxillary posterior teeth. Forty patients diagnosed with irreversible pulpitis of a posterior tooth randomly received either AE or LE by using a Gow-Gates injection or maxillary infiltration. Endodontic access was initiated after no response to Endo-ice 15 minutes after solution deposition. Success was defined as none to mild pain on a visual analogue scale after access. Chi-square and analysis of variance statistical tests were used to analyze the data. Successful endodontic treatment substantially reduced the assessment of pulpitis pain by patients (analysis of variance, P < .0001). Overall anesthetic success in both dental arches was 87.5%. Anesthetic success was not influenced by tooth arch (chi(2), P > .7515) or gender (chi(2), P > .1115). AE proved to be as effective but not superior to LE (P > .6002). These results demonstrated the similar anesthetic effectiveness of AE and LE when used during the endodontic treatment of teeth diagnosed with irreversible pulpitis.     

Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.     

Prophylactic intraligamentary injection of piroxicam (feldene) for the management of post‐endodontic pain in molar teeth with irreversible pulpitis

The purpose of this prospective research was to evaluate the post‐endodontic pain‐reducing effect of piroxicam (feldene), a non‐selective non‐steroidal anti‐inflammatory drug. Pain following endodontic treatment is often linked to the inflammatory process as well as additional central mechanisms. The effects of intraligamentary injection of piroxicam have not previously been studied. Sixty‐five patients with irreversible pulpitis were randomly divided into two groups. The active group received intraligamentary injections totalling 0.4 mL of piroxicam, while the placebo group received the same amount of lidocaine. One‐appointment endodontic therapy was performed by a single endodontist. Visual Analogue Scale was used to record pain before treatment and 4, 8, 12, 24 and 48 h postoperatively. The decrease in the intensity of post‐treatment pain between the two groups was very significant. Intraligamentary injection of piroxicam can be considered an effective method for reducing post‐endodontic pain.     

局麻注射仪用斯康杜尼在恒磨牙牙髓治疗中的应用

目的观察无痛局部麻醉仪注射Scandonest在恒磨牙牙髓治疗中的麻醉效果。方法484例522颗需要牙髓治疗的患牙随机分为2组,分别采用无痛局麻仪注射Scandonest和注射器推注利多卡因后进行开髓,拔髓及根管预备,比较两者在注射时及牙髓治疗中的疼痛程度。结果实验组在注射时及治疗过程中无痛率及有效率皆优于对照组(P<0.01)。结论无痛局麻仪注射Scandonest在恒磨牙牙髓治疗中麻醉效能高,是简单,安全,快速,长效的控制疼痛的方法。     

Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis

The purpose of this prospective, randomized, single-blind study was to compare the anesthetic efficacy of lidocaine with epinephrine to lidocaine plus meperidine with epinephrine for inferior alveolar nerve blocks (IAN) in patients with mandibular posterior teeth experiencing irreversible pulpitis. Forty-eight emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a single-blind manner, 36 mg of lidocaine with 18 mug epinephrine or 36 mg of lidocaine with 18 mug of epinephrine plus 36 mg meperidine with 18 mug epinephrine, using a conventional inferior alveolar nerve block. Endodontic access was begun 15 minutes after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recordings) upon endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using the lidocaine solution was 26%, and for the lidocaine/meperidine solution, the success rate was 12%. There was no significant difference (p = 0.28) between the two solutions. In conclusion, for mandibular posterior teeth with irreversible pulpitis, the addition of 36 mg of meperidine to a lidocaine solution administered in a conventional IAN block did not improve the success rate over a standard lidocaine solution.     

A computer-controlled anesthetic delivery system in a periodontal practice: patient satisfaction and acceptance

Background : Many dental patients are fearful about receiving intraoral injections of local anesthetic. In fact, many patients cite injections as their primary reason for avoiding dental treatment. In late 1997, however, a computerized local anesthetic delivery system was introduced to address the problems of pain and anxiety associated with these injections. The author initiated a yearlong assessment study in which patients evaluated and rated injections administered with the computerized device as compared with previously administered standard injections.
Methods : One hundred and fifty randomly selected patients received local anesthesia delivered via the computer-controlled anesthetic delivery system. All patients had at some time received standard injections during treatment at the practice. Different types of injections were administered to all quadrants, enabling the researcher to qualify results according to injection type and location. Patient responses were recorded and evaluated to assess the levels of anxiety and pain associated with the computer-driven system.
Results : Overall, 71.4% of patients reported the experience to be superlative, positive, or somewhat positive. Results indicated that the system was highly preferred to traditional injection techniques, regardless of the arch and quadrant receiving the injection. Several factors may have contributed to this preference, including increased patient comfort, the nonthreatening appearance of the instrument, and the lack of residual facial numbness commonly associated with oral anesthetic injections.     

Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with symptomatic versus asymptomatic irreversible pulpitis

This study sought to determine the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine in patients with symptomatic and asymptomatic irreversible pulpitis in mandibular posterior teeth and if individual patient factors, pulpal disease characteristics, and previous medication are correlated to local anesthetic success. A second objective was to determine the specificity and sensibility of a cold test for prediction of anesthetic success prior to endodontic treatment. Seventy patients diagnosed with irreversible pulpitis in mandibular posterior teeth received 1.6 mL of 4% articaine with 1:100,000 epinephrine for an inferior alveolar nerve block (IANB) using a metal guide. The anesthetic solution was injected with a computer-preprogrammed delivery system for local anesthesia. Endodontic access was begun 15 minutes after solution deposition; later, patients rated their discomfort using the visual analog scale (VAS). The success rate for the IA NB using articaine was 64.2% in patients with symptomatic irreversible pulpitis and 86.9% in patients with asymptomatic irreversible pulpitis. Cold test prior to root canal treatment had a specificity and sensibility of 12.5% and 87.1%, respectively. The anesthetic efficacy of articaine in irreversible pulpitis is moderately acceptable, and anesthetic success increases when the patient has been premedicated with NSAIDs. The cold test appears to be a favorable indicator for predicting anesthetic success.     

The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible pulpitis

The aim of this randomized clinical trial was to compare the success rate of three different anesthetic techniques in mandibular molars with symptomatic ir