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。     

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.     

阿替卡因麻醉下拔除上颌恒磨牙不施行腭侧注射麻醉的可行性

目的探讨拔除上颌恒磨牙时单用阿替卡因进行颊侧注射不施行腭侧注射的可行性。方法选择2007年5-7月在四川省人民医院口腔科就诊的104例需拔除上颌恒磨牙的患者为研究对象，38例患者为双侧上颌均有恒磨牙需要拔除，选择其中一侧作为试验牙，另一侧作为对照牙；两侧磨牙分2次拔除，间隔时间为7 d。66例患者为单侧上颌恒磨牙拔除，将需拔除牙作为试验牙，以前的拔牙经历作为对照。试验组由颊侧前庭沟注射点注入1.7 mL盐酸阿替卡因，对照组除颊侧注射外，在腭侧同时注射2%盐酸利多卡因0.25 mL。麻醉5 min后拔除患牙。由患者填写视觉模拟量表，对疼痛打分。结果试验组上颌恒磨牙麻醉成功率为96.2%，对照组上颌恒磨牙麻醉成功率为97.1%，二者之间的差异无统计学意义（P>0.05）。结论在上颌恒磨牙的拔除中，阿替卡因颊侧注射麻醉后能达到较好的麻醉效果，可以不进行腭侧麻醉。     

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。     

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.     

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.     

Lack of differential effect by Ultracaine (articaine) and Citanest (prilocaine) in infiltration anaesthesia

It has been claimed that anaesthesia of mandibular pulpal and lingual soft tissue, as well as maxillary palatal soft tissue, results following buccal infiltration of the local anaesthetic Ultracaine (articaine HC1). However, this has never been scientifically proven and the aim of this investigation was to test these claims by comparing articaine to a standard anaesthetic, Citanest (prilocaine HC1). In order to study this, a double blind, randomized trial was conducted in healthy adult volunteers. In these subjects, the ability to induce maxillary and mandibular anaesthesia following buccal infiltration with articaine (as compared to prilocaine given contralaterally), was determined by measuring sensation to electrical stimulation at the tooth, buccal and lingual soft tissue at each of the four non-carious, non-restored, second molars. Results showed that there were no statistically significant differences between articaine and prilocaine in their ability to induce anaesthesia for any tissue at any of the six sites (p greater than 0.05) as determined by chi-square analysis. Analysis of effect on sensation for 25 minutes post-administration also failed to demonstrate a difference between the two drugs. Therefore, these data are not consistent with superior anaesthesia efficacy by articaine at any site, including the mandibular pulpal, lingual or maxillary palatal tissues, in the second molars studied.     

A blinded randomized controlled trial comparing lignocaine and placebo administration to the palate for removal of maxillary third molars

Routine use of a palatal injection for the removal of maxillary third molars has never been validated. The purpose of this blinded, randomized, controlled trial was to assess the requirement of a separate palatal injection for the extraction of maxillary third molars. Fifty-one patients requiring the removal of bilateral maxillary third molars were enrolled. Each patient acting as their own control received buccal infiltrations of lignocaine bilaterally, then 0.2 mL of lignocaine without vasoconstrictor was administered to one side of the palate and the same amount of normal saline administered to the other side. Sides were randomized as to the active ingredient and both the patient and operator were blinded. All extractions were performed by a single operator using a consistent technique and no additional sedative or anaesthetic agents were utilized. Data relating to the pain of the extractions and of the palatal injection were obtained on a Visual Analogue Scale (VAS). Verbal Response Scale (VRS) data were obtained additionally for a subset of 21 patients. Statistical analysis confirmed clinical equivalence between saline and lignocaine to the palate (95% CI -1.7 to 6.2mm, equivalence range -6.75 to 6.75 mm). No patients requested additional lignocaine to the palate in order to ensure comfortable extraction. This study provides evidence that the poorly tolerated palatal injection of local anaesthetic for the removal of maxillary third molars may not be required.     

Efficacy of buccal infiltration anaesthesia with articaine for extraction of mandibular molars: a clinical trial

It is hard to provide adequate anaesthesia by infiltration of lidocaine into the mandible because of the thick buccal cortex. An inferior alveolar nerve block is often used but has a high failure rate, which has led research workers to look for an anaesthetic agent that will anaesthetise the lower teeth by buccal infiltration alone. We have assessed the efficacy of buccal infiltration anaesthesia with articaine by designing a double-blind controlled clinical trial in 133 patients who required extraction of mandibular molars. They were randomly divided into two groups and given infiltration anaesthesia with either 4% articaine or 2% lidocaine by a single injection deep into the mucobuccal fold at the site of the tooth. After five minutes the mesial, distal, buccal, and lingual sides of the tooth were probed. Pain at this time or later during dissection of soft tissue by periosteal elevator was considered as failure, and an inferior alveolar nerve block was given. The amount of pain, and the number of patients who developed pain, were significantly greater in the group given 2% lidocaine (p < 0.001). The two groups did not differ significantly in age or sex. Articaine is more successful in providing adequate depth of anaesthesia, but its efficacy was not sufficient to replace an inferior alveolar nerve block for extraction of mandibular molars (Registration code: IRCT2016062627111N2).     

Injection pain of prilocaine plain, mepivacaine plain, articaine with epinephrine, and lidocaine with epinephrine

In a double-blind study design, 1,391 consecutive patients in a general dental practice received one of four different local anesthetics (articaine with epinephrine, lidocaine with epinephrine, mepivacaine plain, or prilocaine plain) via a maxillary buccal infiltration, palatal infiltration, or inferior alveolar block injection. The anesthetics were administered under clinical conditions by one of two dentists. Immediately after receiving the injection, patients rated the pain from each injection on a ten-point scale. The pain response was analyzed according to the dentist administering the injection, the location of injection, the patient's gender, and the type of anesthetic administered. Injection of prilocaine plain produced significantly lower pain scores than lidocaine with epinephrine, mepivacaine plain, or articaine with epinephrine.     

Size doesn't matter: needle gauge and injection pain

Many dentists prefer using smaller gauge (27- or 30-gauge) needles for anesthesia injection, believing that needles with a smaller diameter result in less injection pain than wider diameter needles. For this study, three dentists in a general practice administered 930 injections to 810 adult patients using 25- and 27-gauge needles for mandibular inferior alveolar block injections and 25-, 27-, and 30-gauge needles for maxillary buccal infiltration or palatal injections. Patients, who were blinded as to the needle gauge, were asked afterward to rate the injection pain on an 11-point scale (0-10). There was no statistically significant difference in perceived injection pain based on needle gauge when analyzed for injection location (mandibular, maxillary posterior, maxillary anterior, and palatal), injection side, patient gender, treating dentist, or overall. These results indicate that when it comes to injection pain and needle gauge, size does not matter.     

Clinical efficacy of lidocaine,mepivacaine, and articaine for local infiltration

Aim: To assess and compare the efficacy of single buccal and palatal infiltration of lidocaine, mepivacaine, or articaine with 1:100 000 epinephrine by maxillary anesthetic injection. Methods: A double‐blinded, randomized, clinical trial was conducted with 33 patients undergoing upper premolar extraction. The patients were randomly allocated into one of three groups, according to the local anesthetic agent used: 2% lidocaine, 2% mepivacaine, or 4% articaine, all with 1:100 000 epinephrine, and were blinded to the anesthetic used. The extent of anesthetization, pulpal anesthetization in adjacent teeth, pain on injection, and adverse effects of the anesthetic agents were assessed. Results: The extent of anesthetization produced by 4% articaine (42 mm) was statistically more significant (P ≤ 0.05) than 2% lidocaine (33 mm) and 2% mepivacaine (32.5 mm). The successful anesthetization of adjacent teeth occurred more often in the articaine group than in the lidocaine and mepivacine groups, although not to a statistically‐significant extent. The pain scores for the injections were comparable between the three groups. Conclusions: Local anesthetization using 4% articaine with 1:100 000 epinephrine covers a wider area of soft tissue and adjacent teeth than 2% lidocaine or 2% mepivacaine with 1:100 000 epinephrine, which is sufficient for the extraction of one or two teeth.     

Comparative study of articaine and lidocaine without palatal injection for maxillary teeth extraction

Clinical Oral Investigations - There is significant evidence that articaine and lidocaine buccal injections alone are sufficient for painless extraction of maxillary teeth. The aim of this study...     

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.     

Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block

Aim  To compare mandibular tooth pulpal anaesthesia and reported discomfort following lidocaine inferior alveolar nerve block (IANB) with and without supplementary articaine buccal infiltration.
Methodology  In this prospective randomized double-blind cross-over study, thirty-six healthy adult volunteers received two IANB injections of 2 mL lidocaine 2% with epinephrine 1 : 80 000 over two visits. At one visit, an infiltration of 2 mL of articaine 4% with epinephrine 1 : 100 000 was administered in the mucobuccal fold opposite a mandibular first molar. At the other visit, a dummy injection was performed. Injection discomfort was recorded on 100 mm visual analogue scales. Pulpal anaesthesia of first molar, premolar, and lateral incisor teeth was assessed with an electronic pulp tester until 45 min post-injection. A successful outcome was recorded in the absence of sensation on two or more consecutive maximal pulp tester stimulations. Data were analysed using McNemar and Student's t -tests.
Results  The IANB with supplementary articaine infiltration produced more success than IANB alone in first molars (33 volunteers vs. 20 volunteers respectively, P  < 0.001), premolars (32 volunteers vs. 24 volunteers respectively, P  = 0.021) and lateral incisors (28 volunteers vs. 7 volunteers respectively, P  < 0.001). Buccal infiltration with articaine or dummy injection produced less discomfort than IANB injection ( t  = 4.1, P  < 0.001; t  = 3.0, P  = 0.005 respectively).
Conclusions  The IANB injection supplemented with articaine buccal infiltration was more successful than IANB alone for pulpal anaesthesia in mandibular teeth. Articaine buccal infiltration or dummy buccal infiltration was more comfortable than IANB.     

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.     

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

Introduction

The purpose of this study was to evaluate and compare the anesthetic efficacy of posterior superior alveolar (PSA) nerve blocks, buccal infiltrations, and buccal plus palatal infiltrations with 2% lidocaine with 1:200,000 epinephrine in maxillary first molars with irreversible pulpitis.

Methods

Ninety-four adult patients participated in this prospective, randomized, single-blinded study. The patients were divided into 3 treatment groups on a random basis. Twenty-eight patients received a PSA nerve block, 33 patients received buccal infiltrations, and 33 patients received buccal plus palatal infiltrations with 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated 15 minutes after injection. Pain during treatment was recorded using a Heft-Parker visual analog scale. Success was recorded as “none” or “mild” pain.

Results

Statistical analysis using nonparametric chi-square tests revealed that there was no statistical difference between the anesthetic success of PSA nerve blocks (64%), buccal infiltrations (54%), and buccal plus palatal infiltrations (70%).

Conclusions

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

上颌口腔腭侧黏膜疼痛敏感度的初步研究

目的:研究不同部位口腔上颌腭侧黏膜疼痛敏感度,发现相对敏感区域并提出相应对策,以减轻患者注射麻药时的疼痛感及全身并发证的发生。方法:对需拔除的上颌患牙进行局部浸润麻醉,采用碧兰麻及相对应的0.3mm×21mm细针头,注射部位距离腭侧牙龈缘约5mm,后记录注射部位的疼痛程度,所记录的疼痛程度是注射针刺入黏膜时的疼痛。疼痛分级采用国际通用方法,但加以改良,使之更详细。采用χ2检验分析各牙位的中重度和重度疼痛患者构成比。结果:800例患者中,无痛到中度疼痛患者646例,占总数的80.75%;中重度和重度疼痛患者154例,占19.25%。中重度和重度疼痛患者在中切牙组占47%,侧切牙组占39%,尖牙组占27%,第一前磨牙组占12%,第二前磨牙组占9%,第一磨牙和第二磨牙组均占8%,上颌结节区占4%。与前磨牙、磨牙和上颌结节区相比,中切牙、侧切牙和尖牙组的中重度和重度疼痛患者比例明显增加,差异有统计学意义(χ2检验,P<0.01)。结论:中切牙、侧切牙和尖牙腭侧黏膜疼痛敏感度较高,先表面麻醉后再注射麻药,以减少患者的疼痛感,同时减少患者的恐惧感和全身并发症的发生。     

Articaine and lignocaine efficiency in infiltration anaesthesia: a pilot study

AIM: The purpose of this study was to evaluate the onset of action of pulpal and soft tissue anaesthesia, and pain experience after buccal and palatal infiltrative injections with 4% articaine with 1:100,000 adrenaline, and 2% lignocaine with 1:100,000 adrenaline. METHOD: A double blind cross-over study was conducted with 20 healthy adult subjects who, in two appointments at least two weeks apart, randomly received an infiltration anaesthesia with the solutions in the buccal and palatal regions of the upper right canine. The tooth was tested with a pulp tester before (to establish its baseline response), and after the injection, until return to the base threshold level. The pain experience caused by palatal injection was verified by the visual analogue scale (VAS). Data were analysed using Wilcoxons test (alpha = 0.05). RESULTS: There were no significant statistical differences between the solutions with respect to VAS (p = 0.45), onset of action (p = 0.80) and pulpal (p = 0.08) and soft tissue (p = 0.18) anaesthesia duration, although pulpal anaesthesia may have reached statistical significance if a higher number of volunteers had been used. CONCLUSION: Under the conditions of this study it can be concluded that both anaesthetic solutions showed similar pain experience.     

Alternative anesthetic technique for maxillary periodontal surgery

Background: Maxillary periodontal surgery typically requires multiple injections and may inadvertently affect facial structures such as the upper lip, lateral aspect of the nose, and lower eyelid. To minimize these sequelae and reduce the number of total injections, a relatively new injection technique has been proposed for maxillary procedures. The anterior middle superior alveolar (AMSA) injection is reported to effectively anesthetize maxillary teeth and associated gingival tissues extending from the buccal root of the first molar mesially to the central incisor with a single injection while avoiding undesirable side effects. The purpose of this article is to provide background information on the AMSA injection and demonstrate its use in a variety of maxillary periodontal surgeries. Methods: Anesthesia was provided for five separate maxillary periodontal surgeries with unilateral or bilateral AMSA injections. Injections were administered via conventional syringe with a 27-gauge needle. Confirmation of anesthesia was subjectively tested with buccal mucosal sticks and palatal transgingival probing. Results: The AMSA injection provided promising results for a variety of maxillary periodontal surgical procedures. Benefits of the AMSA injection included outstanding palatal hemostatic control, avoidance of undesirable collateral anesthesia, and a reduced number of cumulative injections. Drawbacks of the AMSA injection included occasionally inadequate buccal hemostatic control and short-lived anesthesia of the maxillary central incisors. Conclusion: The AMSA injection is a novel anesthetic technique that may prove useful for certain maxillary periodontal surgeries.