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Loayza SAL, Barbin T, Santos VABD, Groppo FC, Amorim KDS, Paiva DFF, Figueroba SR. Buffered 2% articaine in buccal infiltration of mandibular molars: a randomized triple-blind clinical trial. Braz Oral Res 2023; 37:e132. [PMID: 38126475 DOI: 10.1590/1807-3107bor-2023.vol37.0132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023] Open
Abstract
This crossover study aimed to compare the anesthetic effects of buffered 2% articaine with 1:200,000 epinephrine with that of non-buffered 4% articaine with 1:200,000 epinephrine. Forty-seven volunteers were administered two doses of anesthesia in the buccal region of the second mandibular molars in two sessions using 1.8 mL of different local anesthetic solutions. The onset time and duration of pulp anesthesia, soft tissue pressure pain threshold, and the score of pain on puncture and burning during injection were evaluated. The operator, volunteers, and statistician were blinded. There were no significant differences in the parameters: onset of soft tissue anesthesia (p = 0.80), duration of soft tissue anesthesia (p = 0.10), onset of pulpal anesthesia in the second (p = 0.28) and first molars (p = 0.45), duration of pulp anesthesia of the second (p = 0.60) and first molars (p = 0.30), pain during puncture (p = 0.82) and injection (p = 0.80). No significant adverse events were observed. Buffered 2% articaine with 1:200,000 epinephrine did not differ from non-buffered 4% articaine with 1:200,000 epinephrine considering anesthetic success, safety, onset, duration of anesthesia, and pain on injection.
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Affiliation(s)
- Sandro Alexander Lévano Loayza
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School , Department of Biosciences , Piracicaba , SP , Brazil
| | - Thomas Barbin
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School , Department of Biosciences , Piracicaba , SP , Brazil
| | | | - Francisco Carlos Groppo
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School , Department of Biosciences , Piracicaba , SP , Brazil
| | - Klinger de Souza Amorim
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School , Department of Biosciences , Piracicaba , SP , Brazil
| | - Daniel Felipe Fernandes Paiva
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School , Department of Biosciences , Piracicaba , SP , Brazil
| | - Sidney Raimundo Figueroba
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School , Department of Biosciences , Piracicaba , SP , Brazil
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Alrashdi M, Alhunti A, Almansour A. Efficacy and safety of articaine in 3-year-old children for dental procedures: a protocol for a clinical randomised control trial in Saudi Arabia. BMJ Open 2023; 13:e077751. [PMID: 37865418 PMCID: PMC10603511 DOI: 10.1136/bmjopen-2023-077751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023] Open
Abstract
INTRODUCTION Despite the wide use of articaine in paediatric dentistry owing to its proven effectiveness and safety, articaine application in children <4 years remains controversial due to a lack of data on the use of articaine in very young children. This trial aims to examine the efficacy and safety of 4% articaine compared with 2% mepivacaine in children 3-4 years old requiring dental extractions. We aim to assess local anaesthetic efficacy and safety through a local anaesthetic infiltration technique for primary teeth requiring dental extraction in children 3 years old. METHODS AND ANALYSIS This prospective, double-blind, randomised clinical trial with two parallel arms aims to evaluate the safety and efficacy of 4% articaine compared with 2% mepivacaine in 3-year-old children. The trial's outcomes will be assessed by measuring the pain experienced during injection and treatment, evaluating the child's behaviour during the procedure, and monitoring postoperative pain and complications. A total of 200 children will be included in the study, with 100 children in each arm. ETHICS AND DISSEMINATION The Institutional Review Board (IRB) approved the study protocol and informed consent documents before initiation of the study. The IRB approval was granted by the Qassim Health Cluster under protocol number 607/43/7809. This study was also approved by the Saudi Food and Drug Authority. The study report will be disseminated through scientific forums, including peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER Saudi Clinical Trial Registry (22071802) and ClinicalTrials.gov Registry (NCT05839548).
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Affiliation(s)
- Murad Alrashdi
- Department of Orthodontic and Paediatric Dentistry, Qassim University, Buraydah 52571, Saudi Arabia
| | - Atyaf Alhunti
- Department of Orthodontic and Paediatric Dentistry, Qassim University, Buraydah 52571, Saudi Arabia
| | - Asya Almansour
- Pediatric Dentistry Department, Regional Dental Center in Qassim, Burayadh, Saudi Arabia
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Lyadova MV, Tuchik ES. [Prevention of adverse events following the use of local anesthetics in traumatology and orthopedics]. Khirurgiia (Mosk) 2022:75-79. [PMID: 35477204 DOI: 10.17116/hirurgi202204175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article analyzes the frequency of development of adverse toxic reactions when using local anesthetics in the practice of an orthopedic traumatologist; based on the conclusions of commission forensic medical examinations conducted in the framework of criminal proceedings on the death of patients, the features of the onset of LAST syndrome are studied, which significantly increases the medical risk for the patient and the legal risk for the doctor. An analytical study of scientific publications on the possibilities of using the local anesthetic Articaine-Binergia 20 mg/ml in the daily work of both polyclinic and inpatient doctors to ensure the safety of medical activities was conducted.
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Affiliation(s)
- M V Lyadova
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E S Tuchik
- Pirogov Russian National Research Medical University, Moscow, Russia.,Russian Center of Forensic Medical Examination, Moscow, Russia
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Arboleda-Toro D, Toro L, Osorio-Osorno YA, Castrillon-Pino L, Florez-Zapata NMV. Comparing Articaine brands: A randomized non-inferiority controlled trial. Heliyon 2021; 7:e07252. [PMID: 34195402 PMCID: PMC8233148 DOI: 10.1016/j.heliyon.2021.e07252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/05/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction The substitution of reference drugs for similar, new or existing drugs in the market is a dilemma present in daily dental procedures. In order to decide whether or not to adopt a new drug in relation to the reference, a clinical trial can provide the necessary evidence. Methods A total of 179 healthy volunteers (18-25 years) requiring extraction of mandibular third molars completed the study. Subjects were randomized into 4 groups: right, left, Arteek-SP and Septanest. Allocations consisted of 4% Articaine hydrochloride with 1:10000 epinephrine. The primary aim of this randomized controlled trial was to determine whether the test drug Arteek-SP was noninferior by a margin of 10% in the proportion of patients with total absence of pain, compared to the reference drug Septanest in the extraction of mandibular third molars using inferior alveolar nerve blocks. Secondary outcomes included, hemodynamic parameters, volume (mL), pain scores assessed during one visit and reported postoperative discomfort assessed during 8 days. Noninferiority was declared if total absence of pain for both groups was equal to 0.9, with a significance level of 5% (P < 0.05) and power at 90% (β = 0.1) at 95% confidence level. Results Arteek-SP was applied during the first surgery to 90 volunteers (50.28%) and Septanest was applied to 89 subjects (49.72%). Less than 10% difference was identified, in the proportion of patients with total absence of tooth pain P < 0.05 and in the gum P < 0.1, at 95% CI, when Arteek-SP was applied first in comparison with Septanest, establishing noninferiority. Conclusion The clinical performance of the test drug Arteek-SP is noninferior to the reference drug Septanest. They can be considered interchangeable in terms of cost or convenience. Registration ClinicalTrials.org, number NCT4166890.
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Affiliation(s)
- D Arboleda-Toro
- Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
| | - L Toro
- Universidad EIA, Envigado, Colombia.,Cancer Research Institute, Biomedical Research Center of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - Y A Osorio-Osorno
- Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
| | - L Castrillon-Pino
- Facultad de Odontología, Universidad de Antioquia, Medellín, Colombia
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5
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Inferior alveolar nerve block: is articaine better than lidocaine? Br Dent J 2021; 230:579-582. [PMID: 33990740 DOI: 10.1038/s41415-021-2941-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/01/2020] [Indexed: 11/08/2022]
Abstract
This opinion article seeks to analyse current literature surrounding the question: is articaine better than lidocaine for inferior alveolar nerve blocks? It does so with regards to efficacy and risk of paraesthesia associated with administration.
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Halling F, Neff A, Ziebart T. Local Anesthetic Usage Among Dentists: German and International Data. Anesth Prog 2021; 68:19-25. [PMID: 33827123 DOI: 10.2344/anpr-67-03-12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 06/12/2020] [Indexed: 11/11/2022] Open
Abstract
The aim of this study was to analyze the use of dental local anesthetics in Germany compared with international data. The type and distribution of dental local anesthetics and added vasoconstrictors based on a representative sample of German dentists itemized over a period of 7 years (2011 to 2017) were evaluated and statistically analyzed. The results were compared with international dental local anesthetic consumption data published since 2005. With a consistent market share of nearly 98%, articaine was the first-line local dental anesthetic agent in Germany. During the investigation period, German dental local anesthetics with epinephrine 1:200,000 had ∼50% market shares, whereas formulations with epinephrine 1:100,000 had 40% to 45% market shares. Articaine, with market shares between 38% and 81%, was also the preferred anesthetic agent in various other countries, with the notable exceptions of the United Kingdom and the United States, where lidocaine was the preferred local anesthetic agent. Epinephrine was the preferred vasoconstrictor internationally, similar to Germany. The larger market share of higher concentrated epinephrine 1:100,000 was remarkable, considering the increasing number of medically compromised patients. Increased consideration for using agents with reduced dosages of epinephrine (1:200,000) is generally recommended.
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Affiliation(s)
- Frank Halling
- Assistant Professor, Private Practice, Gesundheitszentrum Fulda, Fulda, Germany, and Department of Maxillofacial Surgery, University Hospital, Marburg, Germany
| | - Andreas Neff
- Professor, Department of Maxillofacial Surgery, University Hospital, Marburg, Germany
| | - Thomas Ziebart
- Assistant Professor, Department of Maxillofacial Surgery, University Hospital, Marburg, Germany
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Batista da Silva C, Volpato MC, Muniz BV, dos Santos CP, Serpe L, Ferreira LEN, de Melo NFS, Fraceto LF, Groppo FC, Franz-Montan M. Promising potential of articaine-loaded poly(epsilon-caprolactone) nanocapules for intraoral topical anesthesia. PLoS One 2021; 16:e0246760. [PMID: 33571275 PMCID: PMC7877576 DOI: 10.1371/journal.pone.0246760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/25/2021] [Indexed: 01/12/2023] Open
Abstract
To determine whether the permeation capacity and analgesic efficacy of articaine (ATC) could be increased and cytotoxicity decreased by encapsulation in poly(ɛ-caprolactone) nanocapsules (ATCnano), aiming at local or topical anesthesia in dentistry. Cellular viability was evaluated (using the MTT test and fluorescence microscopy) after 1 h and 24 h exposure of HaCaT cells to ATC, ATCnano, ATC with epinephrine (ATCepi), and ATC in nanocapsules with epinephrine (ATCnanoepi). The profiles of permeation of 2% ATC and 2% ATCnano across swine esophageal epithelium were determined using Franz-type vertical diffusion cells. Analgesic efficacy was evaluated with a von Frey anesthesiometer in a postoperative pain model in rats, comparing the 2% ATC, 2% ATCnano, 2% ATCepi, and 2% ATCnanoepi formulations to 4% ATCepi (a commercially available formulation). We show that use of the nanocapsules decreased the toxicity of articaine (P<0.0001) and increased its flux (P = 0.0007). The 2% ATCepi and 4% ATCepi formulations provided higher analgesia success and duration (P<0.05), compared to 2% ATC, 2% ATCnano, and 2% ATCnanoepi. Articaine-loaded poly(ɛ-caprolactone) nanocapsules constitute a promising formulation for intraoral topical anesthesia (prior to local anesthetic injection), although it is not effective when injected in inflamed tissues for pain control, such as irreversible pulpitis.
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Affiliation(s)
- Camila Batista da Silva
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- Health Sciences, University of Mogi das Cruzes–UMC, Mogi das Cruzes, São Paulo, Brazil
| | - Maria Cristina Volpato
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
| | - Bruno Vilela Muniz
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- Itapeva Faculty of Social and Agrarian Sciences—FAIT, Itapeva, São Paulo, Brazil
| | - Cleiton Pita dos Santos
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
| | - Luciano Serpe
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- Department of Dentistry, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil
| | - Luiz Eduardo Nunes Ferreira
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- Laboratory of Inflammation and Immunology, Guarulhos University–UNG, Guarulhos, São Paulo, Brazil
| | - Nathalie Ferreira Silva de Melo
- Department of Environmental Engineering, São Paulo State University, Sorocaba, SP, Brazil
- Department of Immunology and Molecular Biology, São Leopoldo Mandic Research Institute, Campinas, SP, Brazil
| | | | - Francisco Carlos Groppo
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
| | - Michelle Franz-Montan
- Department of Biosciences, Piracicaba Dental School, University of Campinas—UNICAMP, Piracicaba, São Paulo, Brazil
- * E-mail:
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8
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Amorim KS, Fontes VTS, Gercina AC, Groppo FC, Souza LMA. Buffered 2% articaine versus non-buffered 4% articaine in maxillary infiltration: randomized clinical trial. Clin Oral Investig 2020; 25:3527-3533. [PMID: 33151422 DOI: 10.1007/s00784-020-03674-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This randomized, triple-blind, crossover clinical trial aimed to evaluate the efficacy, onset, length of pulp and soft tissue anesthesia, and pain during injection of 2% buffered articaine and 4% non-buffered articaine solutions. METHODS Each volunteer received two maxillary supraperiosteal anesthesia infiltrations in canine area. The infiltrations were performed at two different sessions using a different local anesthetic solution for each session, and the anesthetic injection speed was always 1 mL/min. The assessment of the onset and length of pulpal and soft tissue anesthesia was performed with the pulp electrical test "pulp tester" and the esthesiometer kit, respectively. Volunteers marked pain during injection on a visual analog scale (VAS). The anesthetics solutions pH was evaluated through the pH meter equipment. RESULTS There was no difference between the two anesthetic solutions (onset of soft tissue anesthesia, p = 0.5386; length of soft tissue anesthesia, p = 0.718; onset of pulpal anesthesia, p = 0.747; length of pulpal anesthesia, p = 0.375), except for pain during the injection which was lower when buffered 2% articaine was used (p = 0.001) and the pH. The pH analysis revealed that the solutions differed from one another (p < 0.01). CONCLUSION The 2% buffered articaine solution provided the same anesthetic properties then 4% unbuffered articaine with a great reduction in pain during injection. CLINICAL RELEVANCE The possibility of use 2% buffered articaine solution instead of 4% articaine maintaining the same anesthetic properties with a great reduction in pain during injection and half of the anesthetic salt concentration.
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Affiliation(s)
- Klinger Souza Amorim
- Pharmacology, Anesthesiology and Therapeutics Department, Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracicaba, São Paulo, 13414-903, Brazil
| | - Vanessa Tavares Silva Fontes
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil.
| | - Anne Caroline Gercina
- Pharmacology, Anesthesiology and Therapeutics Department, Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracicaba, São Paulo, 13414-903, Brazil
| | - Francisco Carlos Groppo
- Pharmacology, Anesthesiology and Therapeutics Department, Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracicaba, São Paulo, 13414-903, Brazil
| | - Liane Maciel Almeida Souza
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil
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Is nasopalatine nerve block still mandated for the extraction of maxillary anterior teeth? Br Dent J 2020; 228:865-868. [DOI: 10.1038/s41415-020-1632-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sandilya V, Andrade NN, Mathai PC, Aggarwal N, Sahu V, Nerurkar S. A Randomized Control Trial Comparing Buccal Infiltration of 4% Articaine with Buccal and Palatal Infiltration of 2% Lignocaine for the Extraction of Maxillary Premolar Teeth. Contemp Clin Dent 2020; 10:284-288. [PMID: 32308291 PMCID: PMC7145254 DOI: 10.4103/ccd.ccd_529_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction The use of articaine has been claimed to obviate the need for routine palatal local anesthetic injections on account of its better diffusion through soft and hard tissues as compared to other local anesthetic agents. Objective The objective of the study is to evaluate the efficacy of 4% articaine (with 1:100,000 adrenaline) infiltrated only buccally in the extraction of maxillary premolars for orthodontic reasons. Materials and Methods A double-blind randomized clinical trial with a split-mouth design, where each patient (n = 100) was part of two groups, was conducted. Experimental Group 1: single buccal infiltration of 4% articaine with 1:100,000 adrenaline (Septanest™ with adrenaline 1:100,000 by Septodont). Control Group 2: routine buccal and palatal infiltrations of 2% lignocaine with 1:200,000 adrenaline (Lox™ 2% with adrenaline 1:200,000 by Neon). The parameters studied were time to onset of anesthesia, pain during the extraction procedure (not during the injecting of the local anesthetic), and frequency of extra amount of local anesthetic injected. Results The difference was not statistically significant (P > 0.05) between the two groups with respect to all three parameters. This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases. Conclusion This proves that a single buccal infiltration of articaine can be used as an alternative to lignocaine for the extraction of the maxillary premolar teeth in most of the cases.
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Affiliation(s)
- Vikas Sandilya
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Neelam Noel Andrade
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Paul C Mathai
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Neha Aggarwal
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Vyankatesh Sahu
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
| | - Shibani Nerurkar
- Department of Oral and Maxillofacial Surgery, Nair Hospital Dental College, Mumbai, Maharashtra, India
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Venkatachalam D, Chambers JP, Kongara K, Singh P. Analgesic efficacy of articaine hydrochloride for velvet antler removal in red deer ( Cervus elaphus) and analysis of drug residues in the harvested velvet antlers. N Z Vet J 2019; 67:228-233. [PMID: 31034783 DOI: 10.1080/00480169.2019.1611503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS To investigate the analgesic efficacy of articaine hydrochloride for antler removal in red deer (Cervus elaphus) following S/C administration as a ring block, and to quantify the residue concentrations of articaine compared to lignocaine in the harvested antlers. METHODS Articaine hydrochloride (40 mg/mL) was administered to 10 male red deer as a ring block around the base of each antler at 1 mL/cm of pedicle circumference. Analgesia was evaluated by determining the response to a saw cut test every 1-minute, until no response was observed. Behaviour during and following removal of antlers was also recorded. Twenty commercially harvested velvet antlers were also collected following S/C administration of 2% lignocaine hydrochloride. A liquid chromatography-mass spectrometry (LC-MS) method for quantification of residues of articaine and lignocaine in velvet antlers was developed and validated. RESULTS In red deer administered 4% articaine hydrochloride as a ring block, the median interval to analgesia was 4 (min 3, max 5) minutes and no deer showed withdrawal responses during antler removal. There were no signs of toxicity or adverse effects up to 2 hours after administration. The sample preparation method developed for the LC-MS was simple and had acceptable extraction recoveries of articaine and lignocaine from the velvet antlers. The lower limits of quantification of lignocaine and articaine were 5 and 50 ng/g, respectively. Mean concentrations of articaine in antlers following ring block with 4% articaine hydrochloride were 1.50 (SD 1.09) mg/kg, and of lignocaine following ring block with 2% lignocaine hydrochloride were 0.66 (SD 0.71) mg/kg. CONCLUSIONS AND CLINICAL RELEVANCE A ring block with 4% articaine hydrochloride at a dose of 1 mL/cm of pedicle circumference provided effective analgesia for velvet antler removal in red deer. The LC-MS method developed and validated to quantify articaine and lignocaine was simple and sensitive. Based on these results, articaine hydrochloride appears to be an effective alternative to lignocaine hydrochloride for velvet antler removal. However, further studies to evaluate the safety and residue concentrations of articaine and articainic acid are required before it can be recommended for use in deer.Abbreviations: DMA: 2,6-dimethylaniline; LC-MS: Liquid chromatography-mass spectrometry; MEGX: Monoethylglycinexylidide; MRL: Maximum residue level.
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Affiliation(s)
- D Venkatachalam
- a School of Veterinary Science , Massey University , Palmerston North , New Zealand
| | - J P Chambers
- a School of Veterinary Science , Massey University , Palmerston North , New Zealand
| | - K Kongara
- a School of Veterinary Science , Massey University , Palmerston North , New Zealand
| | - P Singh
- a School of Veterinary Science , Massey University , Palmerston North , New Zealand
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12
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Stirrup P, Crean S. Does articaine, rather than lidocaine, increase the risk of nerve damage when administered for inferior alveolar nerve blocks in patients undergoing local anaesthesia for dental treatment? A mini systematic review of the literature. Br Dent J 2019; 226:213-223. [DOI: 10.1038/sj.bdj.2019.98] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2018] [Indexed: 11/09/2022]
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13
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Kumar DP, Sharma M, Patil V, Subedar RS, Lakshmi GV, Manjunath NV. Anesthetic Efficacy of Single Buccal Infiltration of 4% Articaine and 2% Lignocaine in Extraction of Maxillary 1 st Molar. Ann Maxillofac Surg 2019; 9:239-246. [PMID: 31909001 PMCID: PMC6933991 DOI: 10.4103/ams.ams_201_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The extraction of tooth being the most common procedure in oral surgery should be pain free with limited dosage and limited needlepricks. Articaine being unique among amide local anesthetics contains a thiophene group, which increases its liposolubility, and an ester group which helps biotransformation in plasma. Because of the high diffusion properties, it can be used as a single buccal infiltration to extract a maxillary tooth. Aim and Objective: Objective of the study was to compare the efficacy of single buccal infiltration of 4% articaine with that of 2% lignocaine for maxillary first molar extraction. Methodology: A triple blind randomized controlled study was carried on 100 patients of age group 18-60 years who required maxillary first molar extraction, visiting the Department of Oral and Maxillofacial surgery. They were included in the study after obtaining informed consent. Buccal infiltration of 1.8 ml of anesthetic solution was given randomly to 100 patients with appropriate blinding of the cartridges. Objective signs were checked. If any additional injection was given, it was noted as type and number of rescue injection given. Postoperatively VAS score and surgeon's quality of anesthesia was noted. Duration of anesthesia was measured every 5 minutes for 50 minutes from infiltration. Results: Out of 50 patients in group A (Articaine), in 44 patients extraction was done without the need of additional injection whereas in group B(Lignocaine), 29 patients require additional infiltration on the palatal side. The VAS score values for group A were also significantly less in comparison with group B. The mean duration of anesthesia for Group A being (71.70 ± 17.82 min) in 44 patients who only received buccal infiltration. Interpretation and Conclusion: The efficacy of single buccal injection of articaine is comparable to buccal and palatal injection of lignocaine.
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Affiliation(s)
| | - Mandeep Sharma
- Private Consultant, Oral and Maxillofacial Surgeon, Practicing in Jammu, Jammu and Kashmir, India
| | - Vinay Patil
- Department of Oral and Maxillofacial Surgery, Nanded Rural Dental College and Research Center, Nanded, Maharashtra, India
| | - Rohit Singh Subedar
- Fellow in Traumatology in Hitkarini Dental College and Hospital, Jabalpur, Madhya Pradesh, India
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Ramadurai N, Gurunathan D, Samuel AV, Subramanian E, Rodrigues SJL. Effectiveness of 2% Articaine as an anesthetic agent in children: randomized controlled trial. Clin Oral Investig 2018; 23:3543-3550. [DOI: 10.1007/s00784-018-2775-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 12/05/2018] [Indexed: 11/25/2022]
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Kämmerer PW, Schneider D, Palarie V, Schiegnitz E, Daubländer M. Comparison of anesthetic efficacy of 2 and 4 % articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial. Clin Oral Investig 2016; 21:397-403. [PMID: 27020911 DOI: 10.1007/s00784-016-1804-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this clinical prospective, randomized, double-blind trial was to compare the anesthetic efficacy of 2 % articaine and 4 % articaine in inferior alveolar nerve block anesthesia for extraction of mandibular teeth. MATERIALS AND METHODS In 95 patients, 105 lower molar and premolar teeth were extracted after intraoral inferior alveolar nerve block. In 53 cases, 2 % articaine (group I) and, in 52 cases, 4 % articaine (group II) was administered. The primary objective was to analyze the differences of anesthetic effects between the two groups (complete/sufficient vs. insufficient/none). Furthermore, differences in pulpal anesthesia (onset and depth, examined with pulp vitality tester (min)), as well as in length of soft tissue anesthesia (min), were evaluated. Additionally, the need of a second injection, pain while injecting (numeric rating scale (NRS)), pain during treatment (NRS), pain after treatment (NRS), and other possible complications (excessive pain, bleeding events, prolonged deafness) were analyzed. RESULTS Anesthesia was sufficient for dental extractions in both groups without significant differences (p = 0.201). The onset of anesthesia did not differ significantly (p = 0.297). A significantly shorter duration of soft tissue anesthesia was seen in group I (2.9 vs. 4 h; p < 0.001). There was no significant difference in the need for a second injection (p = 0.359), in injection pain (p = 0.386), as well as in pain during (p = 0.287) or after treatment (p = 0.121). In both groups, no complications were seen. CONCLUSIONS The local anesthetic effect of the 4 % articaine solution is not significantly better when compared to 2 % articaine. CLINICAL RELEVANCE For mandibular tooth extraction, articaine 2 % may be used as alternative as well.
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Affiliation(s)
- P W Kämmerer
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center Rostock, Schillingallee 35, 18057, Rostock, Germany.
| | | | - V Palarie
- Laboratory of Tissue Engineering, State University of Medicine and Pharmacy "N. Testemitanu", Chisinau, Moldova
| | - E Schiegnitz
- Department of Oral, Maxillofacial and Plastic Surgery, University Medical Center Mainz, Mainz, Germany
| | - M Daubländer
- Department of Oral Surgery, University Medical Centre Mainz, Mainz, Germany
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Gazal G, Alharbi AM, Al-Samadani KH, Kanaa MD. Articaine and mepivacaine buccal infiltration in securing mandibular first molar pulp anesthesia following mepivacaine inferior alveolar nerve block: A randomized, double-blind crossover study. Saudi J Anaesth 2015; 9:397-403. [PMID: 26543456 PMCID: PMC4610083 DOI: 10.4103/1658-354x.159463] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aims: A crossover double-blind, randomized study was designed to explore the efficacy of 2% mepivacaine with 1:100,000 adrenaline buccal infiltration and 4% articaine with 1:100,000 adrenaline buccal infiltration following 2% mepivacaine with 1:100,000 adrenaline inferior alveolar nerve block (IANB) for testing pulp anesthesia of mandibular first molar teeth in adult volunteers. Materials and Methods: A total of 23 healthy adult volunteers received two regimens with at least 1-week apart; one with 4% articaine buccal infiltration and 2% mepivacaine IANB (articaine regimen) and another with 2% mepivacaine buccal infiltration supplemented to 2% mepivacaine IANB (mepivacaine regimen). Pulp testing of first molar tooth was electronically measured twice at baseline, then at intervals of 2 min for the first 10 min, then every 5 min until 45 min postinjection. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation were obtained within 10 min and continuously sustained for 45 min postinjection. Results: In total, the number of no sensations to maximum pulp testing for first molar teeth were significantly higher after articaine regimen than mepivacaine during 45 min postinjection (267 vs. 250 episodes, respectively, P < 0.001), however, both articaine and mepivacaine buccal infiltrations are equally effective in securing anesthetic success for first molar pulp anesthesia when supplemented to mepivacaine IANB injections (P > 0.05). Interestingly, volunteers in the articaine regimen provided faster onset and longer duration (means 2.78 min, 42.22 min, respectively) than mepivacaine regimen (means 4.26 min, 40.74 min, respectively) for first molar pulp anesthesia (P < 0.001). Conclusions: Supplementary mepivacaine and articaine buccal infiltrations produced similar successful first molar pulp anesthesia following mepivacaine IANB injections in volunteers. Articaine buccal infiltration produced faster onset and longer duration than mepivacaine buccal infiltration following mepivacaine IANB injections.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Saudi Arabia
| | - Abdullah Muteb Alharbi
- Department of Oral and Maxillofacial, College of Dentistry, Taibah University, Medina, Saudi Arabia
| | | | - Mohammad Dib Kanaa
- Department of Oral and Maxillofacial Surgery, Kettering General Hospital, Kettering, NN16 8UZ, United Kingdom
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Senes AM, Calvo AM, Colombini-Ishikiriama BL, Gonçalves PZ, Dionísio TJ, Sant'ana E, Brozoski DT, Lauris JRP, Faria FAC, Santos CF. Efficacy and Safety of 2% and 4% Articaine for Lower Third Molar Surgery. J Dent Res 2015. [PMID: 26202994 DOI: 10.1177/0022034515596313] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This double-blind crossover randomized clinical trial compared the efficacy of 2 concentrations of articaine, 2% (A2) and 4% (A4), with 1:200,000 epinephrine, for lower third molar removal. During 2 separate appointments with either A2 or A4, both similarly positioned lower third molars in 46 volunteers were extracted. The following were evaluated: onset and duration of anesthetic action on soft tissues, intraoperative bleeding, hemodynamic parameters, postoperative analgesia, and mouth opening and wound healing during the 7th postoperative day, along with the incidence, type, and severity of adverse reactions. Nearly identical volumes of both anesthetic solutions were used for each appointment: 3.4 ± 0.9 mL ≈ 68 mg of articaine (A2) and 3.3 ± 0.8 mL ≈ 132 mg of articaine (A4). Statistical analysis indicated no differences in onset or duration of anesthetic action on soft tissues or duration of postoperative analgesia evoked by A2 and A4 anesthetic solutions (P > 0.05). The surgeon's rating of intraoperative bleeding was considered minimal throughout all surgery with both anesthetic solutions. While transient changes in blood pressure, heart rate, and oxygen saturation were observed, these factors were clinically insignificant and were uninfluenced by articaine concentration (P > 0.05). No systemic or local adverse reactions were observed in the preoperative and postoperative periods due to A2 or A4, but 1 case of bilateral paresthesia was observed. There were no significant differences between preoperative and postoperative (7th day) values of mouth opening and wound healing whether volunteers received A2 or A4 (P > 0.05). In conclusion, both A2 and A4, administered in equal volumes, were effective and safe during lower third molar surgery, and no significant differences were found between their efficacy and safety (ClinicalTrials.gov NCT02457325).
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Affiliation(s)
- A M Senes
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - A M Calvo
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | | | - P Z Gonçalves
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - T J Dionísio
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - E Sant'ana
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - D T Brozoski
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - J R P Lauris
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - F A C Faria
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - C F Santos
- Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
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Abstract
Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations.
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Affiliation(s)
- Marc Snoeck
- Department of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
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Efficacy of 4 % Articaine and 2 % Lidocaine: A clinical study. J Maxillofac Oral Surg 2012; 12:3-10. [PMID: 24431806 DOI: 10.1007/s12663-012-0368-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/05/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES This study was undertaken to compare the anesthetic properties of 4 % Articaine hydrochloride and 2 % Lidocaine both with 1:100,000 epinephrine for mandibular inferior alveolar nerve anesthesia. MATERIALS AND METHODS Thirty healthy patients were included in this randomized double-blind clinical cross over study. Each subject received each test solution at different times. Inferior alveolar nerve block anesthesia was used for extraction of bilateral impacted mandibular third molar on different occassions. The time of onset of action, duration of anesthesia, efficacy of anesthesia, hemodynamic parameters and oxygen saturation were monitored during the procedure. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions. RESULTS No statistically significant differences were seen in the onset and duration of anesthesia between the Articaine and Lidocaine solutions. CONCLUSIONS 4 % Articaine offers better clinical performance than 2 % Lidocaine, particularly in terms of latency and duration of the anesthetic effect. However, no statistically significant differences in anesthetic efficacy were recorded between the two solutions.
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Kingon A, Sambrook P, Goss A. Higher concentration local anaesthetics causing prolonged anaesthesia. Do they? A literature review and case reports. Aust Dent J 2011; 56:348-51. [DOI: 10.1111/j.1834-7819.2011.01358.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Enkling N, Heussner S, Nicolay C, Bayer S, Mericske-Stern R, Utz KH. Tactile Sensibility of Single-Tooth Implants and Natural Teeth Under Local Anesthesia of the Natural Antagonistic Teeth. Clin Implant Dent Relat Res 2009; 14:273-80. [DOI: 10.1111/j.1708-8208.2009.00252.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endod J 2009; 42:238-46. [PMID: 19228214 DOI: 10.1111/j.1365-2591.2008.01507.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M D Kanaa
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Gregorio LVL, Giglio FPM, Sakai VT, Modena KCS, Colombini BL, Calvo AM, Sipert CR, Dionísio TJ, Lauris JRP, Faria FAC, Trindade Junior AS, Santos CF. A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal. ACTA ACUST UNITED AC 2008; 106:19-28. [PMID: 18420431 DOI: 10.1016/j.tripleo.2007.11.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Revised: 10/12/2007] [Accepted: 11/21/2007] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study compared the clinical efficacy of 4% articaine (A200) and 0.5% bupivacaine (B200), both with 1:200,000 epinephrine, for lower third molar removal. STUDY DESIGN Fifty patients underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia either with A200 or B200, in a double-blind, randomized, and crossover manner. Time to onset, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated. RESULTS A statistically significant difference between the time to onset of A200 (1.66 +/- 0.13 minutes) and B200 (2.51 +/- 0.21 minutes) was found (P < .05). There was no statistically significant difference in the duration of analgesia, whether the patient was subjected to osteotomy or not, regardless of the local anesthetic used (3 to 4 hours; P > .05). However, when patients received B200 they experienced a statistically significant longer period of anesthesia on the soft tissues as compared with when they had received A200 (around 5 hours and 4 hours, respectively, P < .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal for both anesthetics. In the surgeries with osteotomy, the comparison between A200 and B200 showed statistically significant differences in the diastolic (64 mm Hg and 68 mm Hg, respectively, P = .001) and mean arterial pressure (86 mm Hg and 89 mm Hg, respectively, P = .031) when data from all the surgical phases were pooled. Additionally, the mouth opening at the suture removal was statistically different for A200 and B200 solutions (91.90% +/- 3.00% and 88.57% +/- 2.38% of the preoperative measure, respectively) when surgeries required bone removal (P < .05). CONCLUSIONS In comparison with 0.5% bupivacaine, 4% articaine (both with 1:200,000 epinephrine) provided a shorter time to onset and comparable hemostasis and postoperative pain control with a shorter duration of soft tissue anesthesia in lower third molar removal.
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A Prospective, Randomized, Double-blind Comparison of Articaine and Lidocaine for Maxillary Infiltrations. J Endod 2008; 34:389-93. [DOI: 10.1016/j.joen.2008.01.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 01/06/2008] [Indexed: 11/22/2022]
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Santos CF, Modena KC, Giglio FP, Sakai VT, Calvo AM, Colombini BL, Sipert CR, Dionísio TJ, Faria FA, Trindade AS, Lauris JR. Epinephrine Concentration (1:100,000 or 1:200,000) Does Not Affect the Clinical Efficacy of 4% Articaine for Lower Third Molar Removal: A Double-Blind, Randomized, Crossover Study. J Oral Maxillofac Surg 2007; 65:2445-52. [DOI: 10.1016/j.joms.2007.04.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 11/23/2006] [Accepted: 04/09/2007] [Indexed: 10/22/2022]
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Robertson D, Nusstein J, Reader A, Beck M, McCartney M. The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc 2007; 138:1104-12. [PMID: 17670879 DOI: 10.14219/jada.archive.2007.0324] [Citation(s) in RCA: 124] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors conducted a prospective, randomized, double-blind, crossover study comparing the degree of pulpal anesthesia achieved by means of mandibular first molar buccal infiltrations of two anesthetic solutions: 4 percent articaine with 1:100,000 epinephrine and 2 percent lidocaine with 1:100,000 epinephrine. METHODS Each of 60 blinded adult subjects randomly received two buccal infiltrations at the first molar site: one cartridge of 4 percent articaine with 1:100,000 epinephrine at one appointment and one cartridge of 2 percent lidocaine with 1:100,000 epinephrine at another appointment. The injections were administered during two separate appointments spaced at least one week apart. The authors used an electric pulp tester to assess the first and second molars and the first and second premolars for pulpal anesthesia in three-minute cycles for 60 minutes. They considered anesthesia to be successful when they obtained two consecutive pulp test readings of 80 (meaning the subject evidenced no response at the maximum output on the pulp tester). RESULTS With the lidocaine formulation, successful pulpal anesthesia ranged from 45 to 67 percent. With the articaine formulation, successful pulpal anesthesia ranged from 75 to 92 percent. There was a significant difference (P < .05) in anesthetic success between the lidocaine and articaine formulations for each of the four teeth. Pulpal anesthesia declined slowly over 60 minutes with both formulations. CONCLUSION AND CLINICAL IMPLICATIONS For a mandibular buccal infiltration of the first molar, 4 percent articaine with 1:100,000 epinephrine will result in a higher success rate than will 2 percent lidocaine with 1:100,000 epinephrine, but the duration of pulpal anesthesia will decline over 60 minutes with either formulation.
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