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de Souza Santos S, Bonatto MS, Mendes PGJ, Martins AVB, Pereira DA, de Oliveira GJPL. Efficacy of analgesia promoted by lidocaine and articaine in third molar extraction surgery. A split-mouth, randomized, controlled trial. Oral Maxillofac Surg 2024; 28:919-924. [PMID: 38355872 DOI: 10.1007/s10006-024-01223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE The aim of this study was to compare the analgesic efficacy of 4% articaine associated with epinephrine (1:100,000), and 2% lidocaine associated with epinephrine (1:100,000) in third molar extraction surgery. METHODS Sixty patients who underwent surgeries to extract upper and lower third molars were included in this split-mouth, double-blind, randomized, controlled trial. The groups in this study were divided according to the anesthetic solution used to provide local anesthesia during extraction of upper and lower third molars: (1) 4% articaine associated with epinephrine (1:100,000); (2) 2% lidocaine associated with epinephrine (1:100,000). The time to the beginning and end of the sensation of analgesia, pain sensation according to the VAS scale, and number of anesthetic tubes necessary for supplementation were analyzed. RESULTS It was found that the onset time for analgesia was shorter on the side anesthetized with articaine compared to the side anesthetized with lidocaine (122.1 ± 52.90 s vs. 144.5 ± 68.85 s) (p < 0.05). In addition, the number of tubes used for anesthetic supplementation was also reduced on the articaine side compared to the lidocaine side (0.26 ± 0.48 vs. 0.50 ± 0.75) (p < 0.05). There were no differences between the anesthetic solutions in the other evaluated parameters. CONCLUSION It can be concluded that the use of 4% articaine associated with epinephrine (1:100,000) reduced the time of onset of analgesia and the necessity for anesthetic supplementation in third molar extraction surgeries compared to the use of 2% lidocaine associated with epinephrine (1:100,000).
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Affiliation(s)
- Samara de Souza Santos
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Mariana Silva Bonatto
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Pedro Gomes Junqueira Mendes
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Ana Vitória Borges Martins
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
| | - Davisson Alves Pereira
- Universidade Federal de Uberlândia - UFU, School of Dentistry, Department of Periodontology, Pará, Av., 1760-1844 - Umuarama, Uberlândia, MG, 38405-320, Brazil
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ANALYSIS OF LOCAL CLINICAL FACTORS THAT AFFECT THE EFFECTIVENESS OF MANDIBULAR ANESTHESIA. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-1-79-16-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gago-García A, Barrilero-Martin C, Alobera-Gracia MÁ, Del Canto-Pingarrón M, Seco-Calvo J. Efficacy of phentolamine mesylate in reducing the duration of various local anesthetics. J Dent Anesth Pain Med 2021; 21:49-59. [PMID: 33585684 PMCID: PMC7871185 DOI: 10.17245/jdapm.2021.21.1.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/30/2020] [Accepted: 01/03/2021] [Indexed: 11/15/2022] Open
Abstract
Background To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]).
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Affiliation(s)
| | | | | | | | - Jesús Seco-Calvo
- Institute of Biomedicine (IBIOMED), University of León, León, Spain; Visiting Researcher of University of the Basque Country (UPV/EHU), Leoia, Spain
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Figueiredo R, Sofos S, Soriano-Pons E, Camps-Font O, Sanmarti-García G, Gay-Escoda C, Valmaseda-Castellón E. Is it possible to extract lower third molars with infiltration anaesthesia techniques using articaine? A double-blind randomized clinical trial. Acta Odontol Scand 2021; 79:1-8. [PMID: 32401086 DOI: 10.1080/00016357.2020.1760348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of inferior alveolar nerve blocks (IANB) with additional buccal infiltration (standard technique) and of buccal and lingual anaesthetic infiltration (experimental technique) for lower third molar (L3M) extractions. STUDY DESIGN A randomised, double-blind clinical trial involving 129 L3M extractions was conducted. In the IANB group, an IANB was performed using the conventional approach, followed by a buccal injection in the extraction area. In the infiltration group (INF), an infiltration was performed in the buccal and lingual areas of the lower second molar. A 4% articaine solution was employed in all cases. The main outcome variable was anaesthetic efficacy. Other variables like intraoperative and postoperative pain, onset time and adverse events were also recorded. Descriptive and bivariate analyses of the data were made. RESULTS 120 patients were randomised. The IANB group showed significantly higher anaesthetic efficacy than the INF group (64.4 vs. 45.8%) (odds ratio = 0.47; 95% confidence interval = 0.22-0.97; p = 0.042). No complications were observed. CONCLUSIONS IANB with additional buccal infiltration is more suitable than the experimental technique for achieving adequate analgesia in L3M extractions. Moreover, the standard method is safe and provides a shorter onset time and lower initial postoperative pain levels.
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Affiliation(s)
- Rui Figueiredo
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- IDIBELL institute, Catalonia, Spain
| | - Stavros Sofos
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Eduardo Soriano-Pons
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Octavi Camps-Font
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- IDIBELL institute, Catalonia, Spain
| | - Gemma Sanmarti-García
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- IDIBELL institute, Catalonia, Spain
| | - Cosme Gay-Escoda
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- IDIBELL institute, Catalonia, Spain
- Department of Oral Surgery and Implantology, EHFRE International University, Belize, Spain
- Oral Surgery, Implantology and Maxillofacial Surgery Department, Teknon Medical Center, Barcelona, Spain
| | - Eduard Valmaseda-Castellón
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- IDIBELL institute, Catalonia, Spain
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Gazal G. Does articaine, rather than prilocaine, increase the success rate of anaesthesia for extraction of maxillary teeth. Saudi J Anaesth 2020; 14:297-301. [PMID: 32934619 PMCID: PMC7458028 DOI: 10.4103/sja.sja_94_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/03/2020] [Accepted: 03/17/2020] [Indexed: 12/04/2022] Open
Abstract
Objective: To compare the anesthetic performances of 3% prilocaine and 4% articaine when used for the extraction of the maxillary teeth. Materials and Methods: Ninety-five patients, aged between 16 and 70 years, were included in this study. Patients were divided into two groups. Group one received articaine 4% with 1:00.000 adrenaline. Group two received prilocaine with 3% felypressin (0.03 I.U. per ml). Onset time of anesthesia was objectively evaluated by using electronic pulp testing. Results: Eighty-five patients in this study had a successful local anesthetic followed by extraction within the study duration time (10 minutes). However, there were six patients with failure anesthesia (5 in prilocaine group and 1 in articaine group). By applying Person's Chi-square test (x2), there were no significant differences in the number of episodes of the anesthetic success between articaine and prilocaine groups at time intervals (P = 0.5). T-test showed that there have been no important variations within the mean onset time of anesthesia for articaine and prilocaine buccal infiltrations (P = 0.1). Conclusions: 3% Prilocaine with felypressin is as effective as 4% articaine with adrenaline when used for the extraction of maxillary teeth. Recommendations would be given to the dental practitioners to use prilocaine more frequently than articaine because of its low toxicity. Trial registration number: NCT04236115.
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial Surgery, Taibah University, College of Dentistry, Madinah Al- Munawwarah, Saudi Arabia
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Cavallini CN, Toledano-Serrabona J, Gay-Escoda C. Evaluation of different mandibular blocks for the removal of lower third molars: a meta-analysis of randomised clinical trials. Clin Oral Investig 2020; 25:2129-2139. [PMID: 32839834 DOI: 10.1007/s00784-020-03525-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe the efficacy and number of side effects for the Gow-Gates mandibular block (GGMB) and Vazirani-Akinosi mandibular block (VAMB) compared to inferior alveolar nerve block (IANB) in patients requiring lower third molar (L3M) extraction. MATERIALS AND METHODS A systematic search was performed in three electronic databases and complemented with a manual search. The inclusion criteria were randomised clinical trials in healthy patients who underwent at least one L3M extraction. Screening and article selection were carried out by two independent reviewers. After data extraction, a meta-analysis was performed for the success rate, number of positive aspirations, and onset time outcomes. RESULTS Six randomised clinical trials were included out of the 367 potentially eligible papers. No significant differences were found in terms of success rate using GGMB (risk ratio [RR] 1.04; 95% confidence interval [CI] 0.92 to 1.18; P = 0.48) nor VAMB (RR 0.96; 95% CI 0.86 to 1.06; P = 0.41). The VAMB group exhibited a lower number of positive aspirations than the IANB group (RR 0.08; 95% CI 0.01 to 0.55; P = 0.01), but there was no statistically significant difference between the GGMB and IANB groups (RR 1.06; 95% CI 0.13 to 8.78; P = 0.96). The delayed onset was even longer in GGMB (mean difference [MD] 3.32 min; 95% CI 1.98 to 4.66; P < 0.001) and VAMB (MD 0.90 min; 95% CI 0.37 to 1.43; P = 0.0001) than IANB. CONCLUSIONS GGMB and VAMB seem to be effective and safe anaesthetic techniques for the removal of L3M, but these blocks exhibited a more delayed onset time than IANB. CLINICAL RELEVANCE GGMB and VAMB are safe and effective anaesthetic techniques for the removal of L3M. However, IANB can still be considered the first option since GGMB and VAMB exhibited more delayed onset times and variable buccal nerve anaesthesia.
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Affiliation(s)
| | - Jorge Toledano-Serrabona
- EFHRE International University/FUCSO, Belize City, Belize. .,School of Medicine and Health Sciences, Campus de Bellvitge, University of Barcelona, C/Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain. .,IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain. .,Oral and Maxillofacial Surgery Department, University of Barcelona, Barcelona, Spain.
| | - Cosme Gay-Escoda
- EFHRE International University/FUCSO, Belize City, Belize.,School of Medicine and Health Sciences, Campus de Bellvitge, University of Barcelona, C/Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.,IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain.,Oral and Maxillofacial Surgery Department, University of Barcelona, Barcelona, Spain.,Oral Surgery, Implantology and Maxillofacial Surgery Department, Teknon Medical Centre, Barcelona, Spain
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Effectiveness of Articaine Buccal Infiltration Anesthesia for Mandibular Premolar Extraction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Oral Maxillofac Surg 2019; 77:1784-1789. [DOI: 10.1016/j.joms.2019.03.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/19/2019] [Accepted: 03/23/2019] [Indexed: 11/17/2022]
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Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial, Taibah University, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia. E-mail.
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Knipfer C, Rohde M, Oetter N, Muench T, Kesting MR, Stelzle F. Local anaesthesia training for undergraduate students - how big is the step from model to man? BMC MEDICAL EDUCATION 2018; 18:308. [PMID: 30547783 PMCID: PMC6295027 DOI: 10.1186/s12909-018-1389-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Local anesthesia is an important skill and a prerequisite for most dental treatments. However, the step from theory to application on the patient is huge for the novice. Hence, a mannequin training model course was developed and implemented into the existing local anesthesia curriculum in undergraduate dental students. It was the aim of this study to evaluate the relation between training-model and real-life anesthesia performance and to measure whether a gain in skill on the model translates to the actual patient situation. METHODS Thirty-six third-year students (14 males, 22 females, age 24 years±2.98) attended the four-day course comprising each 4 h of lectures and practical training. The student cohort gave subjective ratings about the didactical components of the course after attendance by using the TRIL questionnaire (TRIL-mod; University of Trier). At the end of the course the performance of each student in administering an inferior alveolar nerve (IAN) block on the training model as well as on a fellow dental student was investigated using a standardized checklist. To evaluate the successful performance, the in vivo IAN-block was assessed using subjective patient-feeling, the sharp-blunt test and an objective pain- and thermal sensitivity tester (PATH). RESULTS The course was rated with an average score of 5.25 ± 0.44 (range 1-6; 6 = best). On the training model, 69.4% of the students successfully performed an IAN-block. The in vivo assessment, objectified by the PATH test, showed a successful anesthesia in 36.9% of the cases. The assessment of local anesthesia by using the sharp blunt test and the subjective patient feeling significantly correlated with these findings (k = 0.453-0.751, p < 0.05). The model performance did not correlate with the performance on the patient (k = 0.137, p = 0.198). CONCLUSIONS Although subjective ratings of the course were high, the anesthesia success rate on mannequin models did not imply an equal performance on the in vivo setting. As local anesthesia training models are a valuable didactic complement, the focus of the training should be on to the actual real life situation. Chair side feedback should be offered to the students using one of the presented evaluation methods.
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Affiliation(s)
- Christian Knipfer
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg Eppendorf, University of Hamburg, Martinistraße 52, 20246 Hamburg, Germany
| | - Maximilian Rohde
- Department of Oral and Maxillofacial Surgery, University Medical Center Munich, Ludwig-Maximilian University Munich, Lindwurmstraße 2a, 80337 Munich, Germany
| | - Nicolai Oetter
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Glückstrasse 11, 91054 Erlangen, Germany
| | - Tim Muench
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Glückstrasse 11, 91054 Erlangen, Germany
| | - Marco Rainer Kesting
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Glückstrasse 11, 91054 Erlangen, Germany
| | - Florian Stelzle
- Department of Oral and Maxillofacial Surgery, Erlangen University Hospital, Friedrich-Alexander University Erlangen-Nuremberg, Glückstrasse 11, 91054 Erlangen, Germany
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