Cambios Hemodinámicos Asociados a Exodoncias de Terceros Molares Inferiores con el Uso de Articaína 4 % y/o Lidocaína 2 %: Una revisión sistemática / Hemodynamic Changes Associated with Lower Third Molar Extractions with the Use of Articaine 4 % and/or Lidocaine 2 %: A systematic Review

La exodoncia de los terceros molares inferiores es uno de los procedimientos clínicos más comunes en el cual el control del dolor mediante el bloqueo anestésico del nervio alveolar inferior, bucal y lingual resulta ser fundament al y la manera más común de hacerlo es mediante la infiltración de soluciones de anestesia local. Entre ellos la lidocaína y articaína son algunos de los más comunes y pueden estar asociado a vasoconstrictores como la epinefrina que puede provocar aumento de la presión arterial y frecuencia cardíaca razón por la cual se hace necesario la monitorización de cambios hemodinámicos durante la cirugía. Describir los cambios hemodinámicos asociados al uso de lidocaína al 2 % y/ o articaína al 4 % en la presión sistólica y diastólica, frecuencia cardiaca y saturación parcial de oxígeno en relación a distintos tiempos operatorios. Se realizó una revisión sistemática en las bases de datos de PubMed, SCOPUS, Web of Science y Sciencedirect. Se analizaron 7 ensayos clínicos controlados en los que utilizaron articaína al 4 % y/o lidocaína al 2 % con epinefrina al 1:100,000 y/o 1:200,000 en volúmenes de 1,8 a 5,4 mL, en los cuales evaluaron la presión sistólica y diastólica, frecuencia cardiaca y saturación parcial de oxígeno en distintos tiempos de la cirugía. Si bien hubo cambios en PAS, PAD, FC y SPO2, todas se mantuvieron dentro de rangos normales bajo el uso de articaína al 4 % y lidocaína al 2 % con epinefrina 1:100,000 y/o 1:200,000 a volúmenes de 1,8 a 5,4mL medidas a distintos tiempos operatorios.

The extraction of lower third molars is one of the most common clinical procedures in which pain control through anesthetic blockade of the lower alveolar, buccal and lingual nerves turns out to be essential and the most common way to do it is through the infiltration of solutions of local anesthesia. Among them, lidocaine and articaine are some of the most common and may be associated with vasoconstrictors such as epinephrine, which can cause an increase in blood pressure and heart rate, which is why it is necessary to monitor hemodynamic changes during surgery. To describe the hemodynamic changes associated with the use of 2 % lidocaine and/or 4 % articaine in systolic and diastolic pressure, heart rate and partial oxygen saturation in relation to different operative times. A systematic review was carried out in the PubMed, SCOPUS, Web of Science and Sciencedirect databases. Seven controlled clinical trials were analyzed in which 4 % articaine and/or 2 % lidocaine were used with epinephrine at 1:100,000 and/or 1:200,000 in volumes of 1,8 to 5,4 mL, in which systolic pressure was evaluated. and diastolic, heart rate and partial oxygen saturation at different times of surgery. Although there were changes in SBP, DBP, HR and SPO2, all remained within normal ranges under the use of 4 % articaine and 2 % lidocaine with epinephrine 1:100,000 and/or 1:200,000 at volumes of 1,8 to 5 .4mL measured at different operative times.

COMPARISON BETWEEN SINGLE BUCCAL INFILTRATION VERSUS CONVENTIONAL BUCCAL AND PALATAL INFILTRATION FOR REMOVAL OF MAXILLARY MOLAR TEETH.

Background: Although less painful injection techniques have been developed, most individuals still find palatal injection to be unpleasant. Aims: The purpose of this study was to evaluate the efficacy of single buccal infiltration versus conventional buccal and palatal infiltration for the removal of maxillary molar teeth. Fifty patie Materials and Methods: nts participated in a prospective randomized, split-mouth study, Group 1: 4% Articaine HCL infiltration – Only buccal, Group 2: 2% Lignocaine HCL – Buccal and palatal infiltration. Checking VAS score and Facial pain scale during Infiltration and during extraction. Factor analysis was used to determine the significance of the difference in mean scores between the two groups using both the independent sample t-test. Even though the Results: difference was not statistically significant (P > 0.05), patients in the articaine group reported much less discomfort during having their vital maxillary molars extracted compared to the lignocaine group. As was previously m Conclusion: entioned, it is feasible to avoid the palatal injection while removing molars from the maxilla. Specifically, the extraction of the upper molars, and buccal infiltration with articaine is a viable alternative to the use of traditional local anaesthetic.

Comparative evaluation of anesthetic efficacy of 4% articaine infiltration versus 2% lignocaine inferior alveolar nerve block for extraction of primary mandibular molars A prospective, split-mouth, randomized controlled trial

Context: Control of pain during dental treatment is an essential aspect of pediatric dentistry. Aims: This study was conducted to evaluate and compare the anesthetic efficacy of 4% articaine buccal infiltration with 2% lignocaine inferior alveolar nerve block (IANB) for primary mandibular molar extractions. Settings and Design: The study was a prospective, split-mouth, randomized controlled trial. Methods: Bilateral symmetrical carious primary mandibular molar (n = 92) extractions in 46 healthy children aged 5–10 years were included in this randomized controlled trial. Extraction was performed on one side using 4% of articaine buccal infiltration and on the contralateral side using 2% lignocaine IANB in two subsequent appointments. Pain and behavior were assessed at baseline, during injection and extraction using Wong–Baker Faces Pain Rating Scale, Modified Behavior Pain Scale (MBPS), and Frankl Behavior Rating Scale. Statistical Analysis Used: Values thus obtained were statistically analyzed by one-way analysis of variance test and compared using independent samples test. Results: According to MBPS, the mean value of pain experienced in the form of cry during injection was reported to be more for 2% lignocaine IANB (1.76) as compared to 4% articaine buccal infiltration (1.30), which was statistically significant (P = 0.024). Comparison of behavior depicted showed no statistically significant difference between the groups. Conclusion: Buccal infiltration with 4% articaine can be utilized as an effective alternative to 2% lignocaine IANB for primary mandibular molar extractions.

Comparison of anaesthetic efficacy of 4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for pulpotomy in mandibular primary second molars

Background: Pain control and proper anesthesia during pulp therapy is one of the most important aspects of behavior management in pediatric dentistry. Aims: This study compared the success rate of inferior alveolar nerve block (IANB) using 2% lidocaine and infiltration using 4% articaine for pulpotomy of mandibular primary second molars. Settings and Design: The present clinical trial was conducted on 40 children aged 5–8 referred to the Department of Pediatric Dentistry, Guilan University of Medical Sciences, who needed pulpotomy treatment in both mandibular second molars. The patients were randomly divided into two groups (A and B). Subjects and Methods: At the first session, Group A received articaine infiltration and Group B experienced IANB using lidocaine. At the next visit, this trend was reversed. Pain intensity was measured upon the initiation of the pulp exposure using a facial image scale (FIS) and the patients' behavior during pulpotomy was measured using sound eye motor (SEM). Statistical Analysis Used: Wilcoxon signed-rank test was used for the analysis of data. A significant level of differences was taken as P ? 0.05. Results: According to FIS, the pain upon the initiation of the pulp exposure was significantly lower in the lidocaine group (P = 0.028). Patients' behavior was also significantly better in the lidocaine group according to SEM (P = 0.028). Conclusions: IANB using lidocaine has higher anesthetic efficacy in the pulp therapy of the mandibular primary second molars compared to articaine infiltration.

Anestesia complementaria durante bloqueos fallidos del nervio alveolar inferior en casos de pulpitis irreversible / Complementary anesthesia during failed blocks of inferior alveolar nerve in cases of irre- versible pulpitis

Los investigadores realizaron un estudio con enfoque mixto, de tipo no experimental descriptivo; cuya población estuvo constituida por la totalidad de historias clínicas de pacientes que asistieron a la Clínica de Atención Odontológica de la Universidad Regional Autónoma de los Andes, durante la campaña de atención gratuita ejecutada en el periodo abril-agosto 2019, de los que se seleccionaron 30 historias clínicas mediante un muestreo no probabilístico en base a criterios. La misma tuvo el objetivo de caracterizar el uso anestésico de las infiltraciones vestibulares e intraligamentarias utilizando articaína al 4% con epinefrina 1: 100 000, en molares y premolares inferiores diagnosticados con PI, después de un bloqueo fallido del nervio alveolar inferior en el contexto investigado. Sin un margen estadísticamente no significativo, en el caso de las mujeres, la inyección intraligamentaria mostró mejores resultados por (p= 0,109). La inyección intraligamentaria resultó más efectiva en los premolares (p=0,847). La inyección intraligamentaria obtuvo un 86,7% de éxito anestésico, mientras la infiltración vestibular lo fue en un 80% con respecto a la totalidad de la muestra donde se aplicaron (p=0,624).

The researchers carried out a study with a mixed approach, of a descriptive non-experimental type. The population was made up of all the medical records of patients who were attended at the Dental Care Clinic of the Autonomous Regional University of the Andes, during the free care campaign carried out in the period April-August 2019. 30 medical records were selected through non-probability sampling based on criteria. The objective of this study was to characterize the anesthetic use of vestibular and intraligamentary infiltrations using 4% articaine with epinephri- ne 1: 100,000, in lower molars and premolars diagnosed with IP after a failed block of inferior alveolar nerve in the investigated context. There was no a statistically insignificant margin, in the case of women, the intraligamentary injection showed better results by (p = 0.109). The intraligamentary injection was more effective in the premolars (p = 0.847). Intra-league injec- tion obtained 86.7% anesthetic success, while vestibular infiltration was 80% with respect to the entire sample where they were applied (p = 0.624).

Pain perception and efficacy of local analgesia using 2% lignocaine, buffered lignocaine, and 4% articaine in pediatric dental procedures

BACKGROUND: The purpose of this study was to compare the pain perception and anesthetic efficacy of 2% lignocaine with 1:200,000 epinephrine, buffered lignocaine, and 4% articaine with 1:200,000 epinephrine for the inferior alveolar nerve block. METHODS: This was a double-blind crossover study involving 48 children aged 5–10 years, who received three inferior alveolar nerve block injections in three appointments scheduled one week apart from the next. Pain on injection was assessed using the Wong-Baker Faces pain scale and the sound eye motor scale (SEM). Efficacy of anesthesia was assessed by subjective (tingling or numbness of the lip, tongue, and corner of mouth) and objective signs (pain on probing). RESULTS: Pain perception on injection assessed with Wong-Baker scale was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between buffered lignocaine and articaine (P = 0.041). The onset of anesthesia was lowest for buffered lignocaine, with a statistically significant difference between buffered lignocaine and lignocaine (P < 0.001). Moreover, the efficacy of local analgesia assessed using objective signs was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between lignocaine and articaine. CONCLUSION: Buffered lignocaine was the least painful and the most efficacious anesthetic agent during the inferior alveolar nerve block injection in 5–10-year-old patients.

Effect of premedication with aceclofenac and ibuprofen on the success rate of two different local anesthetic agents in irreversible pulpitis cases of maxillary posterior teeth (a prospective randomized double-blind clinical trial)

A double blind, randomized controlled clinical trial was done to investigate the effect of analgesics aceclofenac and ibuprofen in reducing pre-operative pain following local anesthesia with lidocaine and articaine. One hundred and twenty patients with irreversible pulpitis of the maxillary premolars and first molar region were randomly divided into 2 groups with group 1, 2% lidocaine with 1:200000 epinephrine and group 2, 4% articaine with 1:100000 epinephrine. The two groups were again subdivided into 3 subgroups in which patients were given identical capsules containing ibuprofen 600 mg, aceclofenac 100 mg, placebo (vitamin tablets), half an hour before the administration of buccal infiltration anesthesia. Patients indicated their pain scores on a Heft Parker Visual analog scale (VAS). Infiltration anaesthesia was given under sterile condition.1 min after the injection, electric Imrana Tasneem, B.R. Bharat, Murari Uday Kumar, Srirekha A. Effect of premedication with aceclofenac and ibuprofen on the success rate of two different local anesthetic agents in irreversible pulpitis cases of maxillary posterior teeth (a prospective randomized double-blind clinical trial). IAIM, 2019; 6(5): 40-45. Page 41 pulp test and cold test were done and testing was repeated after every 2 minutes for a total of 10 minutes. Premedication with ibuprofen (600 mg) and aceclofenac (100 mg) resulted in statistically significant increase in onset of action for both the anesthetic agents. There was no significant difference in the time of onset of anesthesia between the two local anesthetic solution (chi-square test/ One way ANOVA).

Efficacy of 2% lidocaine and 4% articaine in mandibular molars with different pulp diagnoses in the mandibular technique / Eficacia de la lidocaína al 2% y la articaína al 4% en molares mandibulares con diferentes diagnósticos pulpares en la técnica mandibular

ABSTRACT. Introduction: the inferior alveolar dental nerve block is the method most commonly used by endodontists to achieve local anesthesia during treatments. This study compared the efficacy of two anesthetic solutions: 2% lidocaine with 1:80,000 epinephrine and 4% articaine with 1:100,000 epinephrine in patients with different pulp diagnoses requiring endodontic treatment. Method: an interventional, randomized clinical trial. The sample included 36 patients who were treated at the postgraduate endodontics service at the Universidad de Cartagena in the year 2016. Descriptive statistics and the X 2 test were used for data analysis, using a limit of 0.05. Results: articaine showed a greater anesthetic effect in vestibular mucosa (88.9%) and tip of tongue (55.6%), compared with lidocaine. The rates of anesthetic success in the lidocaine and articaine groups were 5.6% and 22.2% respectively, but this difference was not statistically significant (p = 0.633). In teeth with normal pulp, the efficacy was 27.3%, and this value considerably decreased in teeth with asymptomatic and symptomatic irreversible pulpitis, with percentages of 5.8% and 12.5% respectively, although this difference was not statistically significant (p = 0.276). Conclusions: no statistically significant differences were found in the anesthetic efficacy of 2% lidocaine and 4% articaine in lower molars with vital pulp. However, articaine showed a better anesthetic success rate. No statistically significant differences were found when comparing the anesthetic efficacy in molars with normal pulp and molars with inflamed pulp-although the percentage of success in normal pulp was greater than in teeth with irreversible pulpitis.

RESUMEN Introducción: el bloqueo del nervio dentario inferior es el método más usado por los endodoncistas para obtener anestesia local en sus tratamientos. En este trabajo se comparó la eficacia de dos soluciones anestésicas: lidocaína al 2% con epinefrina 1:80.000 y articaína al 4% con epinefrina 1:100.000, en pacientes con diferentes diagnósticos pulpares que requirieron tratamiento de endodoncia. Método: estudio de intervención tipo ensayo clínico aleatorizado. La muestra estuvo conformada por 36 pacientes que asistieron al servicio del posgrado de endodoncia de la Universidad de Cartagena en el año 2016. Para el análisis de la información se utilizaron pruebas de estadística descriptiva y el test Chi2. Se asumió un límite de decisión de 0,05. Resultados: la articaína mostró mayor efecto anestésico en mucosa vestibular (88,9%) y punta de lengua (55,6%), en comparación con la lidocaína. Las tasas de éxito anestésico en los grupos de lidocaína y articaína fueron 5,6% y 22,2%, respectivamente, y la diferencia no fue estadísticamente significativa (p = 0,633). En dientes con pulpa normal, la eficacia fue de 27,3% y esta disminuyó considerablemente en dientes con pulpitis irreversible tanto asintomática como sintomática, con porcentajes de 5,8% y 12,5% respectivamente, aunque esta diferencia no fue estadísticamente significativa (p = 0,276). Conclusiones: no se encontraron diferencias estadísticamente significativas en la eficacia anestésica entre la lidocaína al 2% y la articaína al 4% en molares inferiores con pulpa vital. Sin embargo, la articaína demostró tener una mejor tasa de éxito anestésico. No se encontraron diferencias estadísticamente significativas al comparar la eficacia anestésica en molares con pulpa normal y molares con pulpa inflamada (aunque el porcentaje de éxito en pulpa normal fue mayor que en dientes con pulpitis irreversible).

Hemodynamic Behavior in Third Molar Surgeries Using Lidocaine or Articaine / Comportamiento Hemodinámico en Cirugías de los Terceros Molares Utilizando Lidocaína vs Articaina

SUMMARY: The aim of this research was to assess the hemodynamic variations during the extraction of impacted lower third molars using lidocaine 2 % or articaine 4 %, as local anesthetics. Fourteen patients with a mean age of 22.4 (SD=3.25), were submitted to the bilateral extraction of lower third molars, with an interval of three to four weeks between the two extractions. Systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate and oxygen saturation in the blood were assessed at seven specific time points: baseline; anesthetic puncture; two minutes after anesthesia; osteotomy; suture and five minutes after the procedure had been completed. The statistical analysis involved descriptive analysis, the Shapiro-Wilk test, the Mann-Whitney test, the t-test and the repeated measurements test. No significant differences were found for any of the hemodynamic behavior variables when comparing lidocaine 2 % and articaine 4 %. Significant differences were found between the time points assessed within each group, particularly in relation to the variable heart rate. In the articaine group, systolic blood pressure exhibited a significant decrease five minutes after the procedure. There were no significant variations in hemodynamic behavior between the two different anesthetic groups (articaine 4 % and lidocaine 2 %).

RESUMEN: El objetivo de esta investigación fue evaluar las variaciones hemodinámicas durante la extracción de terceros molares inferiores impactados utilizando lidocaína al 2 % o articaína al 4 %, como anestésicos locales. Catorce pacientes con una edad promedio de 22,4 (SD = 3,25), fueron sometidos a la extracción bilateral de terceros molares inferiores, con un intervalo de tres a cuatro semanas entre las dos extracciones. Se evaluaron la presión arterial sistólica, la presión arterial diastólica, la presión arterial media, la frecuencia cardíaca y la saturación de oxígeno en la sangre, en siete momentos específicos: línea base; punción anestésica; dos minutos después de la anestesia; osteotomía; sutura y cinco minutos después de que el procedimiento fue completado. El análisis estadístico involucró el análisis descriptivo, la prueba de Shapiro-Wilk, la prueba de Mann-Whitney, la prueba t y la prueba de mediciones repetidas. No se encontraron diferencias significativas para ninguna de las variables de comportamiento hemodinámico al comparar lidocaína 2 % y articaína 4 %. Se encontraron diferencias significativas entre los puntos de tiempo evaluados dentro de cada grupo, particularmente en relación con la frecuencia cardíaca variable. En el grupo de articaína, la presión arterial sistólica exhibió una disminución significativa cinco minutos después del procedimiento. No se observaron variaciones significativas en el comportamiento hemodinámico entre los dos grupos anestésicos diferentes (articaína 4 % y lidocaína 2 %).

Inferior alveolar nerve block by intraosseous injection with Quicksleeper® at the retromolar area in mandibular third molar surgery

BACKGROUND: There are many techniques of inferior alveolar nerve block injection (IANBI); one among them is the computer-assisted intraosseous injection (CAIOI). Here we aim to evaluate the effectiveness of CAIOI with Quicksleeper® in mandibular third molar surgery. METHODS: This study is a clinical, single-blind, randomized, split-mouth, controlled trial including 25 patients (10 males and 15 females, mean age 21 years). The patients underwent surgical removal of bilateral mandibular third molars with two different IANBI techniques. One side was injected using Quicksleeper®, and the other side was injected using a conventional IANBI. Both techniques used one cartridge (1.7 ml) of 1:100,000 epinephrine 4% articaine. A supplementary injection was used if necessary. All volumes of anesthetic agent used were recorded. Statistical analysis was performed using paired t-test and Wilcoxon test. RESULTS: This research showed that CAIOI has faster onset and shorter duration of action than IANBI (P < 0.05). The pain was similar in both techniques. In the CAIOI group, one-third of the cases could be completed without additional anesthesia. The remaining two-thirds required minimal supplementary volume of anesthesia. The success rates were 68% for CAIOI and 72% for IANBI, respectively. CONCLUSION: CAIOI is an advantageous anesthetic technique. It can be used as an alternative to conventional IANBI for mandibular third molar surgery.

Analysis of adverse reaction induced by articaine hydrochloride and epinephrine tartrate injection in 75 cases / 中华口腔医学杂志

Objective@#To investigate the causes and clinical manifestation of adverse reaction of articaine hydrochloride and epinephrine tartrate injection.@*Methods@#A retrospective analysis was conducted on the adverse drug reactions (ADR) of local anesthetic articaine hydrochloride and epinephrine tartrate injection.@*Results@#In 75 cases of adverse reactions, there were 40 cases of female and 35 cases of male. Adverse reactions occured more frequently at the age of 3-10 [33% (25/75)] and 1-10 min and one day after injection, respectively accounting for 20% (15/75), and two days, accounting for 15% (15/75), 10-21 days accounting for 8% (6/75). The main manifestations were injection site ulcers, followed by skin reactions such as pain, swelling, necrosis and pruritus at the injection site.@*Conclusions@#The main adverse reactions of articaine hydrochloride and epinephrine tartrate injection are the injection site ulceration, followed by injection site pain, rash, pruritus and drowsiness, nausea and dizziness, palpitations, sweat and hypotension. Doctors should ask the medical history in detail and pay close attention to the patient's medication safety.

Eficacia de lidocaína 2 % y articaína 4 % al usar la técnica infraorbitaria modificada para incisivos y premolares maxilares / Efficacy of 2 % lidocaine and 4 % articaine with the modified infraorbital nerve block to anesthetize maxillary incisors and premolars

Se realizó un ensayo clínico, aleatorizado, en el cual se determinó la eficacia de la técnica infraorbitaria modificada al usar de Lidocaína 2 % y Articaína 4 %, para lograr anestesia pulpar exitosa en incisivos y premolares maxilares. Se realizó un estudio experimental, controlado doble ciego. 20 sujetos voluntarios recibieron 1,8 ml de Lidocaína 2 % y Articaína 4 % con epinefrina, en la técnica infraorbitaria modificada. Se utilizó un vitálometro para medir la anestesia pulpar exitosa en incisivos y premolares maxilares. El grado de anestesia pulpar fue considerada cuando el vitálometro alcanzó dos lecturas consecutivas a 80. Los participantes informaron además sobre anestesia de tejidos blandos y percepción de comodidad de dicha anestesia. Los datos se analizaron usando la prueba de Shapiro Wilk, Mann-Whitney y McNemar. Resultados: Se observó que en el 100 y 95 % de los incisivos centrales, no hubo anestesia pulpar exitosa para el grupo de Articaína y Lidocaína respectivamente (p=0,50). En el incisivo lateral, el 85 % y 90 % de los dientes presentaron igual comportamiento (p=0,698). El canino presentó anestesia pulpar exitosa en el 70 % de los casos para el grupo de Articaína y en el 40 % para Lidocaína, datos estadísticamente significativos (p=0,027). La anestesia de tejidos blandos fue del 100 % y el 60 % de los pacientes del grupo de articaína la refirieron como incomoda. Conclusiones. La técnica infraorbitaria modificada usando Articaína 4 % o Lidocaína al 2 % no es eficaz para lograr la anestesia pulpar en los incisivos centrales y laterales, demostrando tener una mejor tasa de éxito en caninos cuando se utiliza articaína. Los autores recomiendan anestesiar las ramas alveolares antero y medias superiores para lograr anestesia pulpar profunda en incisivos y premolares.

The aim of this study was to compare de degree of successful pulpal anesthesia in maxillary incisors and premolars applying the modified infraorbital anesthetic technique using 2 % lidocaine and 4 % articaine with epinephrine. An experimental study, controlled, double-blind was conducted. 20 volunteer subjects received 1.8 ml of 2 % lidocaine and 4 % articaine with epinephrine, in the modified infraorbital technique. An electric pulpal tester was used to measure the pulpal anesthesia in maxillary incisors and premolars. The participants informed the degree of pulpal anesthesia, soft tissue anesthesia and comfort. The data was analyzed using the Shapiro Wilk, Mann-Whitney and McNemar tests. The 100-85 % of non-anesthetized cases was observed in the central incisors (p=0.500) and 95 -90 % in the lateral incisors (p=0.500) for articaine and lidocaine respectively. At a level of canines the degree of successful pulpal anesthesia for the 4 % articaine group was 70 % and for 2 % lidocaine was 40 % (p=0.027), differences were statistically significant. At a level of first and second premolars, the degree of successful pulpal anesthesia for the 4 % articaine group was 85 % and for 2 % lidocaine was 75 %(p=0.347) The subjective incidence of the soft tissue anesthesia was 100 % and 60 % of the patients of the articaine group referred to it as uncomfortable. The modified infraorbital technique using 2 % lidocaine or 4% articaine is not effective to achieve pulpal anesthesia in central and lateral incisors, showing a better success rate in canines when using 4 % articaine. The authors recommend anesthetizing the anterior and middle superior alveolar branches to achieve successful anesthesia in incisors and premolars procedures.

Comparison of the infiltration anesthesia effect of compound articaine and lidocaine in anterior teeth / 中国基层医药

Objective To compare the the infiltration anesthesia effect of compound articaine and lidocaine in anterior teeth anesthesia.Methods 100 patients with irreversible pulpitis of anterior teeth(137 teeth)were selected.According to the different anesthesia drugs,the patients were divided into two groups.The observation group was given compound articaine anesthesia,and the control group was given lidocaine infiltration anesthesia.The clinical anesthetic effect of the two groups was evaluated.Results The total effective rate of infiltration anesthesia in the observation group was 100.00%,which was significantly higher than 95.38% in the control group(x2=3.654,P0.05).Conclusion The effect of ropivacaine for a compound infiltration effect than lidocaine on anterior teeth infiltration,pain reaction is small,and has higher security.

Anesthetic effect of compound articaine on children's dental pulp without pain / 中国生化药物杂志

Objective To analyze the anesthetic effect of Compound Articaine on Children's dental pulp without pain, and provide reference for clinical treatment.Methods124 patients with children with dental pulp disease in hospital from February 2015 to May 2016 were selected, patients were randomly divided into observation group and control group, every group with 62 cases.Control group patients were given Lidocaine anesthesia, observation group patients were taken trentment of compound articaine anesthesia, anesthetic effect of patients were compared.Changes in heart rate, blood pressure, adverse effects, and patient pain were recorded before and after anesthesia.ResultsThe total effective rate (96.8%) in the observation group was significantly higher than that in the control group (80.9%) (P<0.05).Observation group (79%) was significantly higher than the control group (1.6%,P<0.05), the observation group of severe pain rate (58.1%) was significantly lower than the control group (11.3%) (P<0.05),The heart rate and blood pressure in the observation group were no significant change, In the control group, the diastolic blood pressure (71.7±10.8) mmHg was significantly lower in the observation group (74.5±12.8) mmHg and the heart rate (80.2±8.8)/min was significantly higher than that in the observation group (76.2±8.3).Two groups of patients in the treatment of adverse reactions, including tachycardia, dizziness, headache, observation group of adverse reaction rate and the control group was not significantly different.ConclusionCompound articaine anesthesia was the implementation of children's dental painless treatment, can reduce the pain of patients, maintain the blood pressure and heart rate stable, has the use value.

4% lidocaine versus 4% articaine for inferior alveolar nerve block in impacted lower third molar surgery

BACKGROUND: No study has compared lidocaine with articaine, each at a concentration of 4% and combined with epinephrine. The purpose of this study was to compare the effectiveness of 4% lidocaine with that of 4% articaine, with a concentration of 1:100,000 epinephrine added to each, in an inferior alveolar nerve block for surgery on impacted lower third molars. METHOD: This study was conducted at the Faculty of Dentistry, Mahidol University in Bangkok, Thailand. The randomized, single-blind, comparative split-mouth study was carried out in patients with symmetrically impacted lower third molars, as identified on panoramic radiographs. Each patient underwent surgery for the removal of the lower third molars by the same surgeon under local anesthesia at two separate visits, 3 weeks apart. The onset and duration of local anesthesia, intra-operative pain, surgical duration, and number of additional anesthetics administered were recorded. RESULTS: The subjective and objective onset of action for the local anesthetics showed statistically significant differences (P < 0.05). However, the intra-operative pain, surgical duration, duration of local anesthesia, and number of additional anesthetics administered did not show statistically significant differences. CONCLUSION: The use of 4% articaine for the inferior alveolar nerve block was clinically more effective in the onset of subjective and objective anesthesia as compared with the use of 4% lidocaine. Based on the pain scores from the visual analogue scale, 4% lidocaine provided more analgesia during the procedure, and patients noted less intra-operative pain than with 4% articaine; however, the difference was not clinically significant.

Perception of discomfort during injection and the need for supplemental anesthesia in the intraosseous technique using 4 per cent articaine / Percepción de incomodidad durante la inyección y necesidad de anestesia suplementaria en anestesia intraósea usando articaína al 4

The authors conducted an experimental study to determine patient perception of discomfort during injection and the need for supplemental anesthesia using the intraosseous technique with 4% articaine with 1:100,000 epinephrine in patients with symptomatic pulpitis in mandibular molars. At different clinical sessions, researchers used 4% articaine with 1:100,000 epinephrine to apply intraosseous injection (Group 1) or inferior alveolar nerve block (Group 2). Each technique was applied in 35 patients. In each group, the need for additional anesthesia was determined and patient discomfort during injection was assessed with a Visual Analogue Scale (VAS) test. In the intraosseous group, no supplemental technique was needed in 22 patients (62.85 %), and results were similar for the inferior alveolar technique (n: 23 65.71%). The intraosseous technique proved to be more comfortable than the mandibular technique (18 patients - 25.7%). This study found that the use of intraosseous technique with 4% articaine shows promising results regarding patient comfort and reducing the need for additional anesthesia.

Los autores condujeron un estudio experimental para deter minar la eficacia de la técnica anestésica intraósea usando articaína al 4% con epinefrina 1:100.000, en pacientes con pulpitis aguda en molares mandibulares. En diferentes sesiones clínicas, los miembros del equipo de investigadores usaron articaína al 4% con epinefrina 1:100.000 para inducir anestesia mandibular con la técnica intraósea (Grupo 1) o con el bloqueo del nervio alveolar inferior (Grupo 2), se aplicó cada técnica en 35 pacientes con diagnóstico de pulpitis aguda en molares inferiores. En cada grupo, se determinó la necesidad de hacer anestesia complementaria y la comodidad del paciente con un test Escala Visual Analoga. Un total de 70 pacientes fueron enrolados en este estudio (35 sujetos por grupo). En el grupo de intraósea no fue necesaria la aplicación de técnicas complementarias en 22 pacientes (31.4%), resultados similares en la técnica alveolar inferior (n: 23 32.8%). La técnica intraósea demostró ser más cómoda al compararla con técnica mandibular (18 pacientes 25.7%). Este estudio demostró que el uso de la técnica intraósea conarticaína al 4%, arrojó resultados prometedores en lo que a comodidad y reducción en la anestesia complementaria hace referencia.

Eficácia da articaína, da bupivacaína e da lidocaína associadas à epinefrina em pacientes com pulpite irreversível em molares inferiores / Effectiveness of articaine, bupivacaine and lidocaine with epinephrine in patients with irreversible pulpitis in molars

O objetivo deste estudo foi comparar a eficácia anestésica da articaína 4%, da lidocaína 2%, ambas associadas à epinefrina 1:100.000, e da bupivacaína 0.5%, associada à epinefrina 1:200.000, durante pulpectomia em pacientes com pulpite irreversível em molares inferiores. Cento e cinco voluntários do Setor de Urgência da Faculdade de Odontologia da Universidade de São Paulo receberam, aleatoriamente, 3,6mL de um dos anestésicos locais para o convencional bloqueio do nervo alveolar inferior (BNAI). No caso de falha do BNAI, foram administrados 3,6mL da mesma solução como injeção complementar no ligamento periodontal. O sinal subjetivo de anestesia do lábio, a presença de anestesia pulpar e ausência de dor durante a pulpectomia foram avaliados, respectivamente, por indagação ao paciente, por meio do aparelho estimulador pulpar elétrico (pulp tester) e por uma escala analógica verbal. A análise estatística foi realizada por meio dos testes Qui-quadrado, Kruskal Wallis e Razão de Verossimilhanças. Foi adotado nível de significância de 0,05 (P <= 0,05). Todos os pacientes reportaram anestesia no lábio após o BNAI. A lidocaína apresentou valores superiores (42,9%) para a anestesia pulpar após o BNAI e após a injeção no ligamento periodontal (61,5%). A bupivacaína apresentou valores superiores para a analgesia (80%) após o BNAI e a lidocaína (92,3%) após a injeção no ligamento periodontal. Após a falha do BNAI, a dor na câmara pulpar foi a mais frequente para articaína e lidocaína e na dentina para a bupivacaína e após a falha da injeção no ligamento periodontal, a dor foi similar para articaína nas diferentes regiões; câmara, canal e dentina; para a bupivacaína foi mais frequente na dentina e para a lidocaína no canal. No entanto, essas diferenças não foram estatisticamente significantes. Portanto as três soluções anestésicas locais se comportam de forma semelhante e não apresentam efetivo controle da dor no tratamento da pulpite irreversível em molares inferiores.

The aim of this study was to compare the anesthetic efficacy of 4% articaine and 2% lidocaine both associated with 1:100,000 epinephrine and 0.5% bupivacaine associated with 1:200,000 epinephrine in patients with irreversible pulpitis of the mandibular molars during a pulpectomy procedure. One hundred and five volunteers from the Emergency Center of the School of Dentistry at University of São Paulo randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and the absence of pain during the pulpectomy procedure were, respectively, evaluated by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. Statistical analysis was performed using the chi-square test, Kruskal Wallis and likelihood rations. The level for significance of differences was P <= .05. All patients reported the subjective signal of lip numbness after the application of either IANB. Lidocaine showed higher values for pulpal anesthesia after the IANB (42.9%) and after injection in the periodontal ligament (61.5%). Bupivacaine presented higher values for analgesia after the IANB (80,0%) and lidocaine after injection in the periodontal ligament (92,3%). After the failure of the IANB, the pain in the pulp chamber was the most frequent to articaine and lidocaine and bupivacaine for dentin and after the failure of the periodontal ligament injection, the pain was equal to articaine in different regions, chamber, canal and dentin; for bupivacaine was greater in dentin and lidocaine was higher in the channel. However, these differences were not statistically significant. So the three local anesthetic solutions behave similarly and not present any effective pain control in the treatment of irreversible pulpitis in mandibular molars.

Articaine (4%) with epinephrine (1:100,000 or 1:200,000) in inferior alveolar nerve block: Effects on the vital signs and onset, and duration of anesthesia

BACKGROUND: This prospective, randomized, double-blind, clinical study was conducted to compare the effects of 4% articaine with 1:100,000 epinephrine (A100) and 4% articaine with 1:200,000 epinephrine (A200) on the vital signs and onset and duration of anesthesia in an inferior alveolar nerve block (IANB). METHODS: In the first appointment, an IANB was performed by injecting A100 or A200 in 1 side of the mouth (right or left) randomly in patients referred for extraction of both their first mandibular molars. In the second appointment, the protocol was repeated and the other anesthetic solution was injected in the side that had not received the block in the previous session. Systolic and diastolic blood pressures (SBP and DBP) and pulse rate were measured during and 5 min after the injection. The onset and duration of anesthesia were also evaluated. Data were analyzed using t-test and Mann-Whitney U-test, and p-value was set at 0.05. RESULTS: SBP and pulse rate changes were slightly more with A100; however, DBP changes were more with A200, although the differences were not significant (P > 0.05). There were no statistically significant differences in the parameters evaluated in this study. The onset and duration of anesthesia, and the changes in SBP, DBP, and pulse rate during and 5 min after the injection were the same in both the groups. CONCLUSIONS: For an IANB, A200 and A100 were equally efficient and successful in producing the block. Epinephrine concentration did not influence the effects of 4% articaine.

Onset and Duration Period of Pulpal Anesthesia of Articaine and Lidocaine in Inferior Alveolar Nerve Block

The purpose of this prospective, randomized, double blind study was to compare the onset and duration periods of pulpal anesthesia using 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:100,000 epinephrine and 4% articaine with 1:200,000 epinephrine in inferior alveolar nerve block (IANB). Thirty subjects received 1.8 mL of each of the three local anesthetic solutions in IANB. Onset and duration periods of pulpal anesthesia were determined using electric pulp stimulation. The mean time of onset of pulpal anesthesia was 8.7, 7.4 and 7.7 min and the mean duration of pulpal anesthesia was 61.8, 106.6 and 88.0 min for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:100,000 epinephrine and 4% articaine with 1:200,000 epinephrine, respectively. For onset, there was only a significant difference between 2% lidocaine with 1:100,000 epinephrine and 4% articaine with 1:100,000 epinephrine (p=0.037). For duration, there was significant difference for all the local anesthetic solutions (p≤0.05). In conclusion, 4% articaine with 1:100,000 epinephrine exhibited faster onset and also had longest duration of pulpal anesthesia in IANB.

A proposta deste estudo prospectivo, randomizado e duplo cego foi comparar o período de latência e duração da anestesia pulpar utilizando lidocaina 2% com epinefrina 1:100.000, articaina 4% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:200.000 no bloqueio do nervo alveolar inferior (BNAI). Trinta pacientes receberam 1,8 mL de cada uma das soluções anestésicas no BNAI. Os períodos de latência e duração da anestesia pulpar foram determinados usando estimulação pulpar elétrica. O tempo médio da latência da anestesia pulpar foi 8,7, 7,4 e 7,7 min e da duração média da anestesia pulpar foi 61,8, 106,6 e 88,0 min para lidocaina 2% com epinefrina 1:100.000, articaina 4% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:200.000, respectivamente. Para latência houve somente diferença significante entre lidocaina 2% com epinefrina 1:100.000 e articaina 4% com epinefrina 1:100.000 (p=0,037). Para a duração houve diferença significante para todas as soluções anestésicas locais (p≤0,05). Em conclusão, articaina 4% com epinefrina 1:100.000 exibiu mais rápida latência e também obteve mais longa duração da anestesia pulpar no BNAI.

Comparação da latência anestésica da Articaína, Lidocaína e Ropivacaína, avaliadas por meio de "Pulp Tester" / A comparative evaluation of anesthetic latency of Articaine, Lidocaine and Ropivacaine evaluated by a pulp tester

Objetivo: Avaliar a latência anestésica da ropivacaína 7,5 mg/mL, comparada à lidocaína 2%, associada à epinefrina 1:100.000 e à articaína 4% com epinefrina 1:100.000 em anestesia de bloqueio do nervo alveolar superior posterior (BNASP). Método: Realizou-se um estudo duplo cego, cruzado e randomizado, em que foram selecionados 40 pacientes que necessitavam de tratamento odontológico e que se submeteriam a três sessães com bloqueio do nervo alveolar superior posterior. Foram realizados 120 bloqueios anestésicos em sessães distintas com intervalo de uma semana entre as sessães sendo: 40 bloqueios com ropivacaína 7,5 mg/mL, 40 bloqueios com articaína 4% com epinefrina 1:100.000 e 40 bloqueios com lidocaína 2% com epinefrina 1:100.000. A latência anestésica foi medida por meio de ôpulp testerõ em ciclos de 2 min, considerando a insensibilidade pulpar na ausência de resposta após dois testes consecutivos de 80muW. Os testes de Qui-quadrado, Wilcoxon, Friedman e teste t foram utilizados para comparar as latências anestésicas. Resultados: Na comparaçÆo da latência anestésica, que é o tempo entre o final da injeçÆo da soluçÆo anestésica e o bloqueio da conduçÆo nervosa, das três soluçães, verificaram-se diferenças estatisticamente significantes (teste de Friedman, p=0.0033) entre a lidocaína 2% com epinefrina 1:100.000, que apresentou menores (p<0,05) valores, e a ropivacaína 7,5 mg/mL, mas nÆo houve diferenças significantes (p>0,05) entre a articaína 4% com epinefrina 1:100.000 e as outras soluçães.ConclusÆo: A ropivacaína 7,5 mg/mL é uma boa alternativa para a anestesia local nos diversos procedimentos odontológicos. Apesar de apresentar maior tempo de latência em relaçÆo à lidocaína 2% com epinefrina 1:100.000, enquanto que a articaína 4% com epinefrina 1:100.000 apresenta tempo de latência intermediário em relaçÆo às outras duas soluçães anestésicas...

Objective: To evaluate the anesthetic latency of ropivacaine 7.5 mg/mL compared with 2% lidocaine with 1:100,000 epinephrine and 4% articaine with 1:100,000 epinephrine for posterior superior alveolar nerve (PSAN) block. Method: A randomized double-blind and crossover test was undertaken with 40 patients who required dental treatment sessions under PSAN blocks. A total of 120 PSAN blocks were performed in separate sessions with a 1-week interval between the appointments, being 40 with ropivacaine 7.5 mg/mL, 40 with 4% articaine with 1:100,000 epinephrine, and 40 with 2% lidocaine with 1:100,000 epinephrine. The anesthetic latency was measured using a pulp tester in 2-minute cycles. The pulp was considered as non-sensitive when noresponse was obtained after two consecutive 80muW tests. Theanesthetic latencies were compared using chi-square, Wilcoxon, Friedman and Student?s t-tests. Results: Comparisons among the three solutions regarding the anesthetic latency, which is the time between the end of injection and the blocking of nerve conduction, revealed statistically significant differences (Friedman test, p=0.0033). Lidocaine 2% with 1:100,000 epinephrine presented the lowest values (p<0.05) and differed significantly from ropivacaine 7.5 mg/mL. No statistically significant difference was found between 4% articaine with 1:100,000 epinephrine and the other solutions. Conclusion: Ropivacaine 7.5 mg/mL is a good alternative for local anesthesia in the various dental procedures despite its longer anesthetic latency compared with lidocaine 2% with 1:100,000 epinephrine. Articaine 4% with 1:100,000 epinephrine presented an intermediate latency time relative to the other two anesthetic solutions...