Efficacy of epinephrine‐free articaine compared to articaine with epinephrine (1:100 000) for maxillary infiltration,a randomised clinical trial

The selection of local anaesthetic in dental practice is essential to the patient′s comfort and the success of the treatment. Many patients prefer anaesthesia even for short treatments. Articaine is a local anaesthetic commonly used for dental practice. The duration of the effect of articaine on the nerve fibres is not yet precisely reported. This study was aimed to evaluate the clinical efficacy of 4% articaine with and without epinephrine in treatment of occlusal caries. Thirty healthy patients were included in this randomised double‐blind study. Each subject received 4% articaine with and without epinephrine (1:100 000). Maxillary infiltration was used for occlusal caries of the maxillary premolars on right and left sides. Quantitative sensory testing (QST) was performed in the innervation area of the infraorbital nerve, and pulp vitality test was performed on restoration‐free canines. Duration of anaesthesia was longer when articaine with epinephrine was used. Articaine without epinephrine showed faster recovery of sensory blockade compared to articaine with epinephrine. The epinephrine‐containing agent, when compared to the plain articaine solution, showed significantly stronger and longer anaesthetic efficacy on the soft tissue by all parameters of QST. Articaine with epinephrine caused a more reliable pulpal analgesia. A pain‐free treatment of the soft tissue up to 15 minutes can be performed under the vasoconstrictor‐free anaesthetic without causing long‐lasting numbness. Epinephrine‐containing articaine delivers a longer, more effective anaesthesia and is preferable for caries treatments and longer invasive treatments of the soft tissue.     

Severe Mitral Regurgitation Caused by Perivalvular Abnormal Communication of the Mitral Valve Due to Blunt Chest Trauma

Perivalvular leaks are usually caused by suture interruption in prosthetic valves or infective endocarditis. Traumatic mitral annular dehiscence is a very uncommon event. We present a rare case of severe mitral regurgitation secondary to perivalvular abnormal communication in a 35‐year‐old man with a history of blunt chest trauma. He presented with symptoms of cough and chest tightness for 3 months. Preoperative two‐dimensional and real time three‐dimensional transesophageal echocardiography clearly showed the position and size of the perivalvular abnormal communication and the incident damage of the left ventricular wall. The patient finally underwent successful surgical repair.