Buccal Injection of 2% Lidocaine With Epinephrine for the Removal of Maxillary Third Molars

The aim of the study was to demonstrate if 2% lidocaine hydrochloride with 1 : 200,000 epinephrine could provide palatal anesthesia in maxillary tooth removal with a single buccal injection. The subjects included in the clinical study were those requiring extraction of the maxillary third molar of either side. For the purpose of comparison, the sample was randomly divided into 2 main groups: group 1 (study group) included 100 subjects who were to receive a single injection before extraction, and group 2 (control group) included 100 subjects who were to receive a single buccal injection and a single palatal injection before extraction. After 5 minutes the extraction was performed. All patients were observed for Faces Pain Scale during extraction and asked for the same on a 100-mm visual analog scale after extraction. According to visual analog scale and Faces Pain Scale scores, when maxillary third molar removal without palatal injection (study group) and with palatal injection (control group) were compared the difference was not statistically significant (P > .05). Removal of maxillary third molars without palatal injection is possible by depositing 2 mL of 2% lidocaine hydrochloride with 1 : 200,000 epinephrine to the buccal vestibule of the tooth.Key Words: Maxillary third molar, Lidocaine hydrochloride with 1 : 200,000 epinephrine single buccal injection, Local anesthesiaAchieving excellent local anesthesia is the key to many dental treatments. Pain-free operating is an added benefit to the patient but also helps the operator to treat the patient in a calm, unhurried fashion.¹ The removal of maxillary third molars is one of the most frequently performed procedures by dental surgeons. Indications for removal include common pathological conditions such as caries, buccal eruption with food impaction or cheek biting, and recurrent pericoronitis.²According to the literature, for the removal of maxillary third molars, anesthetic solution should be administered as either a greater palatine nerve block or local palatal infiltration plus either a posterior alveolar nerve block or a buccal infiltration.³ Palatal injections are frequently associated with some level of discomfort due to strong attachment of palatal mucosa to the bone and dense innervation of the palatal mucosa. Many studies reported that palatal injections are poorly tolerated by the majority of patients.^3–5Initially there was inadequate evidence in the literature to support maxillary third molar removal with only buccal infiltration of local anesthesia,⁶ but now more studies have evaluated the bucco-palatal diffusion of local anesthesia in extractions with only buccal vestibular anesthesia, without palatal complementation.^7,8Many techniques have been tried to reduce the discomfort of intraoral injections, including transcutaneous electronic nerve stimulation, topical anesthetic application, topical cooling of the palate, computerized injection systems, pressure administration, and eutectic mixture of local anesthetics. Some claim that articaine has a higher potential of diffusibility through soft and hard tissues, precluding palatal injection when maxillary third molars are extracted.^7,9 In a comparative study between articaine and lidocaine, both solutions presented similar behavior and properties.¹⁰The aim of our study was to find out if lidocaine hydrochloride with epinephrine could provide palatal anesthesia in maxillary third molar removal without the need for a palatal injection.