1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| | | |
Collapse
|
3
|
Weckwerth GM, Dionísio TJ, Costa YM, Zupelari-Gonçalves P, Oliveira GM, Torres EA, Bonjardim LR, Faria FAC, Calvo AM, Moore T, Absher DM, Santos CF. Multifocal Analysis of Acute Pain After Third Molar Removal. Front Pharmacol 2021; 12:643874. [PMID: 33935738 PMCID: PMC8082138 DOI: 10.3389/fphar.2021.643874] [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: 12/19/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To analyze the pain modulation capacity profile in a Brazilian population, the relationship between opioid receptor (OPRM1) and Catechol-O-methyltransferase (COMT) 1polymorphisms and pain modulation capacity was determined through preoperative pain modulation tests and acute postoperative pain control evaluation, swelling, and trismus in 200 volunteers undergoing lower third molar removal. Methods: Psychologic and clinical parameters were measured. Patient DNA was sequenced for single nucleotide polymorphisms in OPRM1 and COMT, and the salivary concentration of interleukin (IL)-2 (IL)-6, interferon (IFN)-γ and tumor necrosis factor (TNF)-α was evaluated. Primary outcomes were the influence of all predictors on the fluctuation of pain intensity using a visual analogue scale (VAS), and swelling and trismus on the 2nd and 7th postoperative days. Preoperative pain modulation capacity (CPM), pain catastrophizing scale (PCS), body mass index (BMI), and surgery duration and difficulty were evaluated. Results: Salivary concentration of IFN-γ and IL-2 as well as the duration of surgery influenced the fluctuation of postoperative pain in the VAS, and in the sum of the differences in pain intensity test at 8, 48, and 96 h. BMI influenced swelling, while both BMI and COMT haplotype influenced trismus on the 2nd postoperative day. Conclusion: Polymorphisms in COMT, salivary concentrations of IL-2 and IFN-γ, BMI, and duration of surgery were predictors for pain fluctuation, swelling, and trismus on the 2nd day after lower third molar extraction. This therapy was effective in controlling inflammatory symptomatology after lower third molar extraction and ibuprofen was well tolerated by patients. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT03169127.
Collapse
Affiliation(s)
- Giovana Maria Weckwerth
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Thiago José Dionísio
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Yuri Martins Costa
- Department of Biosciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Paulo Zupelari-Gonçalves
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Gabriela Moraes Oliveira
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Elza Araújo Torres
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | | | | | - Adriana Maria Calvo
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Troy Moore
- Kailos Genetics Inc., HudsonAlpha Institute for Biotechnology, Huntsville, AL, United States
| | | | - Carlos Ferreira Santos
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| |
Collapse
|
4
|
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.
Collapse
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:
| |
Collapse
|
5
|
Santos-Sanz L, Toledano-Serrabona J, Gay-Escoda C. Safety and efficacy of 4% articaine in mandibular third-molar extraction: A systematic review and meta-analysis of randomized clinical trials. J Am Dent Assoc 2021; 151:912-923.e10. [PMID: 33228884 DOI: 10.1016/j.adaj.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The authors aimed to assess whether 4% articaine is a safe and effective local anesthetic (LA) for mandibular third-molar extractions. TYPES OF STUDIES REVIEWED The authors searched MEDLINE (PubMed), Cochrane Library, Scopus, and Web of Science databases to identify randomized clinical trials that fulfilled the eligibility criteria. Risk of bias was evaluated using the Cochrane risk-of-bias assessment tool. The authors performed a meta-analysis of safety and efficacy variables comparing 4% articaine with different LAs. RESULTS The authors assessed 482 articles but only 14 randomized clinical trials met the inclusion criteria for review. No statistically significant differences were found among the selected LAs regarding safety. Four percent articaine required fewer reinjections than 2% lidocaine and had a shorter onset time than 2% lidocaine, 0.5% bupivacaine, and 4% lidocaine. Four percent articaine had a longer anesthesia effect than 2% lidocaine and 2% mepivacaine, but a shorter anesthesia effect than 0.5% bupivacaine. PRACTICAL IMPLICATIONS Use of 4% articaine for mandibular third-molar extraction is a safe choice that requires fewer reinjections and has a shorter onset time than other aminoamide-type LAs.
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Torrecillas-Martínez L, Catena A, O'Valle F, Solano-Galvis C, Padial-Molina M, Galindo-Moreno P. On the Relationship Between White Matter Structure and Subjective Pain. Lessons From an Acute Surgical Pain Model. Front Hum Neurosci 2020; 14:558703. [PMID: 33328926 PMCID: PMC7732636 DOI: 10.3389/fnhum.2020.558703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Pain has been associated with structural changes of the brain. However, evidence regarding white matter changes in response to acute pain protocols is still scarce. In the present study, we assess the existence of differences in brain white matter related to pain intensity reported by patients undergoing surgical removal of a mandibular impacted third molar using diffusion tensor imaging (DTI) analysis. Methods: 30 participants reported their subjective pain using a visual analog scale at three postsurgical stages: under anesthesia, in pain, and after the administration of an analgesic. The diffusion data were acquired prior to surgery. Results: DTI analysis yielded significant positive associations of fractional anisotropy in white matter areas related to pain processing (corticospinal tract, corona radiata, corpus callosum) with the differences in pain between the three postsurgery stages. Extent and location of these associations depended on the magnitude of the subjective pain differences. Tractography analysis indicated that some pain–tract associations are significant only when pain stage is involved in the contrast (posterior corona radiata), while others (middle cerebellar peduncle, pontine crossing) are only when anesthesia is involved in the contrast. Conclusions: The association of white matter fractional anisotropy and connectivity, measured before the pain stages, with subjective pain depends on the magnitude of the differences in pain scores.
Collapse
Affiliation(s)
- Laura Torrecillas-Martínez
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Andrés Catena
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Francisco O'Valle
- Department of Pathology, School of Medicine and Instituto de Biopatología y Medicina Reparativa, University of Granada, Granada, Spain
| | - César Solano-Galvis
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| |
Collapse
|
8
|
Weckwerth GM, Dionísio TJ, Costa YM, Colombini-Ishiquiriama BL, Oliveira GM, Torres EA, Bonjardim LR, Calvo AM, Moore T, Absher DM, Santos CF. CYP450 polymorphisms and clinical pharmacogenetics of ibuprofen after lower third molar extraction. Eur J Clin Pharmacol 2020; 77:697-707. [PMID: 33205280 DOI: 10.1007/s00228-020-03046-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE This study hypothesized that drugs accumulate in the bloodstream of poor-metabolizing patients and may have more adverse effects and different pain perceptions and aimed to investigate the influence of CYP450 polymorphisms on acute postoperative pain, swelling, and trismus controlled by ibuprofen (600 mg) in 200 volunteers after dental extraction. In addition, surgical outcomes can determine pain, edema, and trismus and indicate inflammatory reactions after oral surgeries. METHODS Genetic sequencing was performed to identify CYP450 polymorphisms and the surgical parameters evaluated: pre and postoperative swelling, trismus, and temperature; self-reported postoperative pain with visual analog scale (VAS); rescue medication consumed; and severity of adverse reactions. RESULTS A multiple linear regression model with independent variables [single nucleotide polymorphisms (SNPs), BMI (body mass index), duration, and difficulty of surgery] and dependent variables [postoperative pain by sum of pain intensity difference (SPID), trismus, and swelling] was used for analysis. The duration of surgery was a predictor for pain at 8 h and 96 h after surgery, and BMI was a predictor for both swelling and trismus on the 2nd postoperative day. When evaluating CYP2C8 and C9 genotyped SNPs, it was observed that normal metabolizers showed higher pain levels than the intermediate/poor metabolizers on the postoperative periods as compared with time 0 h. In another analysis, the poor metabolizers for CYP2C8 and C9 presented lower levels of postoperative pain after 8 h and used rescue medication earlier than normal metabolizers. CONCLUSION Ibuprofen 600 mg was very effective in controlling inflammatory pain after lower third molar surgeries, without relevant adverse reactions; although in a very subtle way, patients with poor metabolism had higher levels of pain in the first hours, and no longer after 8 h, and used pain relief medication earlier. TRIAL REGISTRATION The study was registered with ClinicalTrials.gov ID (NCT03169127), on March 16th, 2017.
Collapse
Affiliation(s)
- Giovana M Weckwerth
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Thiago J Dionísio
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Yuri M Costa
- Piracicaba Dental School, Department of Physiological Sciences, University of Campinas, Piracicaba, SP, Brazil
| | - Bella L Colombini-Ishiquiriama
- Bauru School of Dentistry, Department of Pediatric Dentistry, Orthodontics and Community Health, University of São Paulo, Bauru, SP, Brazil
| | - Gabriela M Oliveira
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Elza A Torres
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Leonardo R Bonjardim
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Adriana M Calvo
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil
| | - Troy Moore
- Kailos Genetics Inc., Huntsville, AL, USA
| | - Devin M Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, USA
| | - Carlos F Santos
- Discipline of Pharmacology, Bauru School of Dentistry, Department of Biological Sciences, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, SP, 17012-901, Brazil.
| |
Collapse
|
9
|
Rossi MT, de Oliveira MN, Vidigal MTC, de Andrade Vieira W, Figueiredo CE, Blumenberg C, de Almeida VL, Paranhos LR, Oliveira LB, Siqueira WL, de Brito Júnior RB. Effectiveness of anesthetic solutions for pain control in lower third molar extraction surgeries: a systematic review of randomized clinical trials with network meta-analysis. Clin Oral Investig 2020; 25:1-22. [PMID: 33161499 DOI: 10.1007/s00784-020-03675-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/29/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the effectiveness of different anesthetic solutions for pain control immediately after the extraction of lower third molars. METHODS Nine databases were used to identify randomized clinical trials, without restriction of language or year of publication. The "JBI Critical Appraisal Tools for Systematic Reviews" was used to assess the risk of bias in the studies. The network meta-analysis was performed to compare the effectiveness of different anesthetics to control the pain immediately after the surgery of lower third molars, using the standardized mean difference (SMD) as the effect estimate. The GRADE approach was used to assess the certainty of evidence. RESULTS The search presented 13,739 initial results, from which 45 met the eligibility criteria and presented low to moderate risk of bias. Thirteen studies were included in the meta-analysis. The 2% lidocaine + clonidine presented the lowest pain scores (SMD = - 1.44; - 2.72 to - 0.16) compared to 4% articaine + adrenaline, followed by 0.5% bupivacaine + adrenaline (SMD = - 1.36; - 2.13 to - 0.59). The certainty of evidence varied between very low to moderate. CONCLUSION 2% lidocaine + clonidine and 0.5% bupivacaine + adrenaline were the anesthetics with the highest probability for pain control immediately after the surgical procedure of removing impacted lower third molars. CLINICAL SIGNIFICANCE The use of an adequate anesthetic with effective pain control can contribute to a more comfortable postoperative period.
Collapse
Affiliation(s)
- Marco Tulio Rossi
- Postgraduate Program in Dentistry, Faculdade São Leopoldo Mandic, Campinas, Brazil
| | - Murilo Navarro de Oliveira
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Walbert de Andrade Vieira
- Department of Restorative Dentistry, Endodontics Division, School of Dentistry of Piracicaba, State University of Campinas, UNICAMP, Piracicaba, Brazil
| | - Cristiano Elias Figueiredo
- Postgraduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Cauane Blumenberg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Vinicius Lima de Almeida
- Residency Training in Oral and Maxillofacial Surgery, School of Medicine, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Luiz Renato Paranhos
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Campus Umuarama, Av. Pará, 1720, Bloco 2G, sala 1, Uberlândia, Minas Gerais, 38405-320, Brazil.
| | | | - Walter Luiz Siqueira
- College of Dentistry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | |
Collapse
|
10
|
Almeida PC, Raldi FV, Sato FR, Nascimento RD, Moraes MB. Volume and effectiveness assessment of articain 4% versus mepivacaine 2% used in third molar surgery: randomized, double-blind, split-mouth controlled clinical trial. Med Oral Patol Oral Cir Bucal 2020; 25:e762-e768. [PMID: 32701928 PMCID: PMC7648918 DOI: 10.4317/medoral.23780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/04/2020] [Indexed: 12/31/2022] Open
Abstract
Background The different indications for extraction of the lower third molars, require resources to manage pain and discomfort, such as, for example, adequate anesthetic techniques, and the type of anesthetic used can influence the management of pain in tooth extractions. Few studies in the literature compare the anesthetics 4% articaine hydrochloride and 2% mepivacaine hydrochloride showing evidence that both allow for successful pain management. This study sought to compare the volume, efficacy and safety of these two anesthetic drugs, both associated with epinephrine at a ratio of 1:100,000, used in the extraction of lower third molars.
Material and Methods A controlled, clinical, split-mouth compared these both local anesthetics in a sample of 20 patients requiring bilateral extraction of teeth. Pain was the main parameter to be assessed by means of the visual analogue scale (VAS) applied during and immediately after the surgery. Hemodynamic parameters, adverse events, presence of paresthesia and satisfaction of patients and surgeon were also analysed.
Results Pain management was more effective with mepivacaine up to two hours after surgery (p=0.014), whereas the surgeon was more satisfied with the use of articaine during divulsion and suture (p<0.05). However no statistically significant differences were found between both anesthetics regarding pain perception.
Conclusions It was observed that both anesthetics are efficient and safe in the management of pain for extraction of third molars, in which less amount of mepivacaine is needed. The satisfaction of patients and surgeon was the same for both anesthetics, with articaine being highlighted during divulsion and suture. Key words:Pain, third molar, local anaesthesia, paresthesia.
Collapse
Affiliation(s)
- P-C Almeida
- Cale Francisco José Longo Avenue, 777 Jardim São Dimas, São José dos Campos SP, Brazil, 12245 -000
| | | | | | | | | |
Collapse
|
11
|
Local anaesthesia for surgical extraction of mandibular third molars: a systematic review and network meta-analysis. Clin Oral Investig 2020; 24:3781-3800. [PMID: 32833132 DOI: 10.1007/s00784-020-03490-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/31/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Pain management for the extraction of the mandibular third molar is a challenge as compelling evidence in comparative anaesthetics is currently lacking. MATERIALS AND METHODS Thorough literature searches took place in PubMed, ScienceDirect, CENTRAL, Embase, Web of Science, CBM, and CNKI. Thirty-three trials were meta-analysed using a Bayesian statistical approach within the random-effects model. Grading of Recommendations Assessment, Development, and Evaluation was performed to determine the overall quality of evidence across all comparisons. RESULTS In terms of success rate, an inferior alveolar nerve block (IANB) injection of 2% lidocaine with epinephrine was less effective than a combined injection of buccal infiltration (BI) and lingual infiltration (LI) with a 4% articaine (RR = 0.85 [0.75, 0.96], P = 0.611). According to visual analogue scale (VAS), 2% lidocaine-IANB with epinephrine caused higher VAS scores than 4% articaine-IANB with epinephrine (MD = 0.84 [0.28, 1.40], P = 0.057), whereas 0.5% levobupivacaine-IANB showed lower scores than 2% lidocaine-IANB (MD = - 1.62 [- 2.97, - 0.28], P = 0.045). Also, 2% lidocaine-IANB with epinephrine presented longer latency than both 4% articaine-IANB with epinephrine (MD = 39.44 [16.97, 61.90], P < 0.001) and 4% articaine-BI + LI with epinephrine (MD = 164.41 [16.23, 312.58], P < 0.001); 4% articaine-IANB with epinephrine produced shorter latency than 0.5% bupivacaine-IANB with epinephrine (MD = - 42.92 [- 70.28, - 15.56], P = 0.106); 0.75% ropivacaine-IANB caused shorter onset of action compared with 2% lidocaine-IANB (MD = - 40.88 [- 65.50, - 16.26], P < 0.001). In addition, 2% lidocaine-IANB with epinephrine produced significantly shorter duration than both 4% articaine-IANB with epinephrine (MD = - 47.33 [- 57.88, - 36.77], P = 0.265) and 2% mepivacaine-IANB with epinephrine (MD = - 10.01 [- 19.59, - 0.44], P = 0.769). The duration of action triggered by 4% articaine-IANB with epinephrine was shorter compared with 0.5% bupivacaine-IANB with epinephrine (MD = - 64.17 [- 74.65, - 53.69], P = 0.926). Both 0.5% levobupivacaine-IANB and 0.75% ropivacaine-IANB produced longer duration of action than 2% lidocaine-IANB (MD = 333.70 [267.33, 400.07], P < 0.001) and (MD = 288.01 [287.67, 288.34], P = 0.634, respectively). CONCLUSIONS The network meta-analysis demonstrated that the intraosseous injection of 4% articaine with epinephrine had the most noteworthy success rate. However, the combination of BI and LI of 4% articaine with epinephrine, and IANB of 0.5% bupivacaine were, according to a VAS, the most effective. It should be noted that a rapid onset of action was produced by BI combined with LI of 4% articaine with epinephrine and IANB of 2% mepivacaine with epinephrine, while the most prolonged duration of action was generated by IANB of 0.5% levobupivacaine or 0.5% bupivacaine. CLINICAL RELEVANCE For a better understanding of local anaesthesia for the extraction of the third molar, our study was aimed to provide evidence to guide better dental practices in pain management for clinicians.
Collapse
|
12
|
Camps-Font O, Figueiredo R, Sánchez-Torres A, Clé-Ovejero A, Coulthard P, Gay-Escoda C, Valmaseda-Castellón E. Which is the most suitable local anaesthetic when inferior nerve blocks are used for impacted mandibular third molar extraction? A network meta-analysis. Int J Oral Maxillofac Surg 2020; 49:1497-1507. [PMID: 32473767 DOI: 10.1016/j.ijom.2020.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/11/2020] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
The aim of this study was to compare the efficacy and safety of the different local anaesthetic agents for the extraction of impacted lower third molars. A network meta-analysis was performed of all published reports of randomized controlled clinical trials assessing efficacy (anaesthetic success and absence of need for supplementary anaesthesia during the surgical procedure) and/or safety (number of adverse events) of anaesthetic agents. Three electronic databases were searched, from their earliest records up to April 2019. Additionally, the grey literature was searched to identify further potential candidates for inclusion. Anaesthesia had to be delivered by an inferior alveolar nerve block, complemented with infiltration anaesthesia of the buccal nerve. The quality of the studies was assessed using the Cochrane Collaboration tool. This study included a total of 21 trials (2021 molars) assessing the efficacy and 19 trials (1977 molars) assessing the safety of 11 anaesthetic solutions. Seven of the studies included were considered to have a high risk of bias. The most effective local anaesthetic for the extraction of impacted mandibular third molars appeared to be 4% articaine, with significant differences when compared with 2% lidocaine, 0.5% bupivacaine, and 1% ropivacaine. Lidocaine is the safest local anaesthetic, although all investigated solutions can be used safely.
Collapse
Affiliation(s)
- O Camps-Font
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - R Figueiredo
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - A Sánchez-Torres
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - A Clé-Ovejero
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - P Coulthard
- Oral and Maxillofacial Surgery, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - C Gay-Escoda
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - E Valmaseda-Castellón
- Oral Surgery and Implantology, Faculty of Medicine and Health Sciences, University of Barcelona, L'Hospitalet de Llobregat, Spain
| |
Collapse
|
13
|
Torrecillas-Martínez L, Catena A, O'Valle F, Padial-Molina M, Galindo-Moreno P. Does experienced pain affects local brain volumes? Insights from a clinical acute pain model. Int J Clin Health Psychol 2019; 19:115-123. [PMID: 31193130 PMCID: PMC6517646 DOI: 10.1016/j.ijchp.2019.01.001] [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] [Received: 09/24/2018] [Accepted: 01/23/2019] [Indexed: 12/04/2022] Open
Abstract
Background/Objective:To study pain-brain morphometry associations as a function of post-surgery stages (anesthesia, pain and analgesia) in an acute pain model. Method:Impacted mandible third molar were extracted. Before surgery, an anatomical T1 scan was obtained. Regional brain volumen and subcortical nuclei shapes were obtained. Statistical analyses were done using multiple regression, being pain scores the predictors and voxel volumes, subcortical nuclei volumes and subcortical nuclei shapes, the outcomes. Results:Pain was significantly larger at pain than at anesthesia and analgesia stages, and was higher during anesthesia than during analgesia. Pain intensity was related to grey matter in several cortical (Insula, Mid Frontal and Temporal Gyruses, Precuneus, Anterior Cingulate), and subcortical nuclei (Hippocampus, Thalamus, Putamen, Amygdala), depending of the post-surgical stage. A larger number of brain areas showed significance at pain that at anesthesia and analgesia stages. Conclusions:The relationships of regional brain volumes and subcortical nuclei shapes with pain scores seemed to be unsteady, as they changed with the patient's actual pain stage.
Collapse
Affiliation(s)
| | - Andrés Catena
- Mind, Brain and Behavior Research Center, University of Granada, Spain
| | - Francisco O'Valle
- Department of Pathology, School of Medicine & IBIMER, University of Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Spain
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Spain
| |
Collapse
|
14
|
Simoneti LF, Weckwerth GM, Dionísio TJ, Torres EA, Zupelari-Gonçalves P, Calvo AM, Lauris JR, Faria FC, Santos CF. Efficacy of Ketoprofen With or Without Omeprazole for Pain And Inflammation Control After Third Molar Removal. Braz Dent J 2018; 29:140-149. [PMID: 29898059 DOI: 10.1590/0103-6440201802254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/18/2018] [Indexed: 12/15/2022] Open
Abstract
In view of the gastrointestinal problems generated by the ketoprofen use, the ketoprofen association with omeprazole is available on the market. However, this association efficacy in acute pain control has not been established. Bilateral extraction of lower third molars in similar positions is currently the most used model for the evaluation and investigation of the efficacy and pharmacological effects of new compounds for the treatment of acute postoperative pain. The randomized and crossover study consisted in evaluating the clinical efficacy of therapy performed by ketoprofen 100 mg (twice daily-b.i.d.) versus ketoprofen 200 mg + omeprazole 20 mg (once daily-q.d.) to pain, swelling and trismus control in the bilateral extraction model of lower third molars in similar positions in two different appointments, in 50 volunteers. Volunteers reported significantly less postoperative pain at various post-operative periods and consumed less rescue analgesic medication (acetaminophen 750 mg) throughout the study when they took the combination of ketoprofen 200 mg + omeprazole 20 mg (q.d.). Following administration of both study drugs, no gastrointestinal adverse reactions were reported by volunteers. Furthermore, the evaluations of the drugs in pain control by the volunteers were significantly favorable to ketoprofen 200 mg + omeprazole 20 mg (q.d.). For swelling and trismus control, the treatments presented similar results. In conclusion, when volunteers took ketoprofen 200 mg + omeprazole 20 mg (q.d.), they reported significantly less postoperative pain at various post-surgical periods and consumed less rescue analgesic medication throughout the study compared with ketoprofen 100 mg (b.i.d).
Collapse
Affiliation(s)
- Luis Fernando Simoneti
- Department of Biological Sciences, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| | - Giovana Maria Weckwerth
- Department of Biological Sciences, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| | - Thiago José Dionísio
- Department of Biological Sciences, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| | - Elza Araujo Torres
- Department of Biological Sciences, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| | - Paulo Zupelari-Gonçalves
- Department of Biological Sciences, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| | - Adriana Maria Calvo
- Department of Biological Sciences, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| | - José Roberto Lauris
- Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| | - Flávio Cardoso Faria
- Department of Biological Sciences, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| | - Carlos Ferreira Santos
- Department of Biological Sciences, Bauru School of Dentistry, USP - Universidade de São Paulo, Bauru, SP, Brazil
| |
Collapse
|
15
|
Gazal G. Is Articaine More Potent than Mepivacaine for Use in Oral Surgery? J Oral Maxillofac Res 2018; 9:e5. [PMID: 30429965 PMCID: PMC6225598 DOI: 10.5037/jomr.2018.9305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/28/2018] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To investigate the potency and speed of action of 4% articaine and 2% mepivacaine for maxillary teeth extractions. MATERIAL AND METHODS Ninety-four patients, aged between 16 to 70 years old, were recruited in this study. Two regimens were randomly administered over one visit. Patients of treatment group 1 received mepivacaine 2% with 1:100,000 adrenaline, whereas treatment group 2 - articaine 4% with 1:100,000 adrenaline. The onset time of pulp anaesthesia for maxillary teeth indicated for extraction was determined by electronic pulp testing. At any point of trial (10 minutes), the anesthetized tooth becomes unresponsive for maximal pulp stimulation (64 reading), the extraction was carried out. RESULTS In this study, 85 patients had successful local anaesthetic followed by extraction within the study duration time (10 min). However, 5 patients had failed dental extraction (4 in mepivacaine group and 1 in articaine group). Patients in the articaine buccal infiltration group recorded faster onset time of action regarding anaesthesia and teeth extraction than patients in mepivacaine buccal infiltration group (P = 0.03). CONCLUSIONS Articaine is an effective anaesthetic with a rapid onset, comparable to mepivacaine in infiltrative techniques used for maxillary teeth extraction. However, articaine has clinically achieved faster dental anaesthesia and earlier teeth extraction than mepivacaine. So, articaine can be the local anaesthetic of first choice in oral surgery.
Collapse
Affiliation(s)
- Giath Gazal
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Taibah University, Madinah Al-MunawwarahSaudi Arabia.
| |
Collapse
|
16
|
da Silva-Junior GP, de Almeida Souza LM, Groppo FC. Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery. Anesth Prog 2018; 64:80-84. [PMID: 28604089 DOI: 10.2344/anpr-64-02-06] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
In order to compare the efficacy of lidocaine and articaine for pain control during third molar surgery, 160 patients presenting bilateral asymptomatic impacted mandibular third molars were selected. They received 1.8 mL of 2% lidocaine with epinephrine 1:100,000 during inferior alveolar nerve block. In group 1 (n = 80), an infiltrative injection of 0.9 mL of 2% lidocaine with epinephrine 1:100,000 was performed in buccal-distal mucosa of the third molar. Group 2 (n = 80) received 0.9 mL of 4% articaine with epinephrine 1:100,000 in the contralateral side. All procedures were performed at the same visit, by a single operator, in a double-blind and parallel design. The duration of each surgery and the moment when the patient expressed pain were noted. Data were analyzed by nonpaired t test and chi-square test (alpha = 5%). Duration of surgery did not differ (p = .83) between Groups 1 (19.8 ± 2.3 minutes) and 2 (19.7 ± 3.0 minutes). Pain was expressed more in group 1 (26.3%) than in group 2 (10%) (odds ratio = 3.2, p = .0138). In both groups, tooth sectioning was the most painful event (p < .0001). No influence of gender (p = .85) or age (p = .96) was observed in pain response. Buccal infiltration of 4% articaine with epinephrine 1:100,000 showed more efficacy than 2% lidocaine with epinephrine 1:100,000 when used in combination with inferior alveolar nerve block in controlling intraoperative pain related to impacted mandibular third molar surgery.
Collapse
|
17
|
Cazaubon Y, Mauprivez C, Feliu C, Binet L, Oget O, Gozalo C, Djerada Z. Population pharmacokinetics of articaine with 1:200,000 epinephrine during third molar surgery and simulation of high-dose regimens. Eur J Pharm Sci 2018; 114:38-45. [PMID: 29197630 DOI: 10.1016/j.ejps.2017.11.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Articaine is more and more used in third molar surgery under local anesthesia (LA). The objectives of this analysis were to characterize the pharmacokinetics of articaine for this type of surgery and to simulate dosing regimens. METHODS Non-linear mixed-effects modeling conducted in Monolix 4.4.0 was used to describe articaine plasma concentration-time data from 20 patients. Monte Carlo simulations were then performed to evaluate the probability of cardiotoxic target attainment (PCTA) of various dosage regimens. RESULTS Articaine concentration data were best described by a linear one-compartment model, with an additional depot compartment for submucosal route with a zero-order transfer to central compartment. Age and gender were found to influence duration transfer (Tk0) and elimination rate constant (Ke), respectively. Simulated maximum recommended dose regimen (7mg/kg) had a PCTA of 0%. Simulated higher doses of 10mg/kg and 15mg/kg had a PCTA of 0% and about 1-4%, respectively. CONCLUSIONS The model adequately described the articaine pharmacokinetics. This is the first PK model qualified for articaine administered by submucosal route. The simulations suggest that maximum recommended dose regimen is safe concerning the cardiotoxicity in healthy patients.
Collapse
Affiliation(s)
- Yoann Cazaubon
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France; Department of Pharmacology, EA3801, SFR CAP-santé, URCA Reims University, Reims 51100, France
| | - Cédric Mauprivez
- Department of Odontology, Reims University Hospitals, 45 rue Cognacq Jay, Reims 51092, France; EA4691, Biomatériaux et Inflammation en Site Osseux, URCA Reims University, 51 rue Cognacq Jay, Reims 51092, France
| | - Catherine Feliu
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France; Department of Pharmacology, EA3801, SFR CAP-santé, URCA Reims University, Reims 51100, France
| | - Laurent Binet
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France
| | - Olivier Oget
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France
| | - Claire Gozalo
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France
| | - Zoubir Djerada
- Department of Pharmacology and Toxicology, Pharmacology and Toxicology Laboratory, Reims University Hospital, 45 rue Cognacq Jay, Reims 51092, France; Department of Pharmacology, EA3801, SFR CAP-santé, URCA Reims University, Reims 51100, France.
| |
Collapse
|
18
|
Calvo AM, Zupelari-Gonçalves P, Dionísio TJ, Brozoski DT, Faria FA, Santos CF. Efficacy of piroxicam for postoperative pain after lower third molar surgery associated with CYP2C8*3 and CYP2C9. J Pain Res 2017; 10:1581-1589. [PMID: 28740425 PMCID: PMC5505550 DOI: 10.2147/jpr.s138147] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Nonsteroidal anti-inflammatory drugs (NSAIDs) are metabolized by the cytochrome P450 enzymes (CYPs), predominantly CYP2C8 and CYP2C9. The aim of this study was to evaluate the possible association of polymorphisms in the CYP2C8*3 and CYP2C9 genes with the clinical efficacy of oral piroxicam (20 mg daily for 4 days) after lower third molar surgeries with regard to postoperative pain, swelling, trismus, adverse reactions, need for rescue medication and the volunteer’s overall satisfaction. Materials and methods For this purpose, 102 volunteers were genotyped for CYP2C8*3 and CYP2C9 polymorphisms. Briefly, genomic DNA was isolated from saliva collected from volunteers subjected to invasive lower third molar surgeries, and the preoperative, intraoperative and postoperative parameters were collected and analyzed. Results An equal amount of piroxicam sufficiently managed postoperative pain and inflammatory symptoms, with visual analog pain scores typically <40 mm for all genotypes investigated. Furthermore, only two out of 102 volunteers heterozygous for CYP2C8*3 and CYP2C9*3 reported adverse side effects. Conclusion In general, slow metabolizers of piroxicam, who were volunteers with mutant alleles, were indifferent from normal metabolizers with the wild-type alleles and therefore did not require specialized piroxicam doses to manage postoperative pain and inflammation.
Collapse
Affiliation(s)
- Adriana Maria Calvo
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Paulo Zupelari-Gonçalves
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Thiago José Dionísio
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Daniel Thomas Brozoski
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Flávio Augusto Faria
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Carlos Ferreira Santos
- Department of Biological Sciences, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
19
|
Sawang K, Chaiyasamut T, Kiattavornchareon S, Pairuchvej V, Bhattarai BP, Wongsirichat N. Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery. J Dent Anesth Pain Med 2017; 17:121-127. [PMID: 28879339 PMCID: PMC5564145 DOI: 10.17245/jdapm.2017.17.2.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/11/2017] [Accepted: 05/23/2017] [Indexed: 11/15/2022] Open
Abstract
Background There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. Method This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. Results The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P < 0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. Conclusion We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery.
Collapse
Affiliation(s)
- Kamonpun Sawang
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Teeranut Chaiyasamut
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Verasak Pairuchvej
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Bishwa Prakash Bhattarai
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral & Maxillofacial Surgery, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| |
Collapse
|
20
|
Zupelari-Goncalves P, Weckwerth G, Calvo A, Simoneti L, Dionisio T, Brozoski D, Torres E, Lauris J, Faria F, Santos C. Efficacy of oral diclofenac with or without codeine for pain control after invasive bilateral third molar extractions. Int J Oral Maxillofac Surg 2017; 46:621-627. [DOI: 10.1016/j.ijom.2017.01.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 12/12/2016] [Accepted: 01/09/2017] [Indexed: 02/02/2023]
|
21
|
Gazal G, Alharbi R, Fareed WM, Omar E, Alolayan AB, Al-Zoubi H, Alnazzawi AA. Comparison of onset anesthesia time and injection discomfort of 4% articaine and 2% mepivacaine during teeth extractions. Saudi J Anaesth 2017; 11:152-157. [PMID: 28442952 PMCID: PMC5389232 DOI: 10.4103/1658-354x.203017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective: To investigate the speed of action and injection discomfort of 4% articaine and 2% mepivacaine for upper teeth extractions. Materials and Methods: Forty-five patients were included in the articaine 4% group, and 45 in the mepivacaine 2% control group. After all injections, soft and hard tissue numbness was objectively gauged by dental probe at intervals of 15 s. Furthermore, the discomfort of the injections were recorded by the patients after each treatment on standard 100 mm visual analog scales, tagged at the endpoints with “no pain” (0 mm) and “unbearable pain” (100 mm). Results: There were significant differences in the meantime of first numbness to associated palatal mucosa and tooth of patients between mepivacaine and articaine buccal infiltration (BI) groups P = 0.01 and 0.01. Patients in the articaine group recorded earlier palatal mucosa and teeth numbness than those in the mepivacaine group. With regards to the discomfort of the needle injections, palatal injection was significantly more painful than BI (t-test: P < 0.001). Articaine buccal injection was significantly more painful than mepivacaine buccal injection (t-test: P <0.001). However, articaine palatal injection was less painful than articaine BI. Clinically, anesthesia onset time was faster in anterior upper teeth than upper middle and posterior teeth. Conclusions: BIs with 4% articaine was faster in achieving palate and teeth anesthesia than 2% mepivacaine for extraction of upper maxillary teeth. Patients in mepivacaine BI and articaine palatal injection groups reported less pain with needle injection. Failure of anesthesia was noticeable with maxillary multiple-rooted teeth.
Collapse
Affiliation(s)
- Giath Gazal
- Department of Maxillofacial Surgery, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Rashdan Alharbi
- Department of Maxillofacial Surgery, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Wamiq Musheer Fareed
- Department of Maxillofacial Surgery, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Esam Omar
- Department of Maxillofacial Surgery, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Albraa Badr Alolayan
- Department of Maxillofacial Surgery, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Hassan Al-Zoubi
- Department of Orthodontics, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| | - Ahmad A Alnazzawi
- Department of Prosthodontics, College of Dentistry, Taibah University, Al Madinah Al Munawwarah, Saudi Arabia
| |
Collapse
|
22
|
Weckwerth GM, Simoneti LF, Zupelari-Gonçalves P, Calvo AM, Brozoski DT, Dionísio TJ, Torres EA, Lauris JRP, Faria FAC, Santos CF. Efficacy of naproxen with or without esomeprazole for pain and inflammation in patients after bilateral third molar extractions: A double blinded crossover study. Med Oral Patol Oral Cir Bucal 2017; 22:e122-e131. [PMID: 27918744 PMCID: PMC5217490 DOI: 10.4317/medoral.21514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023] Open
Abstract
Background Using a double-blinded randomized crossover design, this study aimed to evaluate acute postoperative pain management, swelling and trismus in 46 volunteers undergoing extractions of the two lower third molars, in similar positions, at two different appointments who consumed a tablet of either NE (naproxen 500 mg + esomepraz ole 20 mg) or only naproxen (500 mg) every 12 hours for 4 days. Material and Methods Parameters were analyzed: self-reported pain intensity using a visual analog scale (VAS) pre- and postoperative mouth opening; incidence, type and severity of adverse reactions; total quantity consumed of rescue medication; and pre- and postoperative swelling. Results Female volunteers reported significantly more postoperative pain at 1, 1.5, 2, 3 and 4hrs after surgery while also taking their first rescue medication at a time significantly earlier when consuming NE when compared to naproxen (3.7hrs and 6.7hrs). Conversely, no differences were found between each drug group in males. Conclusions In conclusion, throughout the entire study, pain was mild after using either drug in both men and women with pain scores on average well below 40mm (VAS), although in women naproxen improved acute postoperative pain management when compared to NE. Key words:Oral surgery, third molar, pain, naproxen, esomeprazole, NSAIDs.
Collapse
Affiliation(s)
- G-M Weckwerth
- Discipline of Pharmacology, Bauru School of Dentistry, University of São Paulo, Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo, Brasil,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Göçmen G, Özkan Y. Comparison of the Efficacy of Local Infiltration and Mandibular Block Anesthesia With Articaine for Harvesting Ramus Grafts. J Oral Maxillofac Surg 2016; 74:2143-2150. [PMID: 27294877 DOI: 10.1016/j.joms.2016.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE We compared the efficacy of local infiltrative anesthesia and regional mandibular block anesthesia using articaine to harvest ramus grafts and the postoperative sequelae. MATERIALS AND METHODS A total of 20 patients with alveolar bone deficiency participated in the present comparative, prospective, randomized study. The first group received regional anesthesia with the mandibular block technique (group A; n = 10), and those in the second group received local infiltration anesthesia (group B; n = 10). Intraoperative pain and bleeding were evaluated as the primary outcome variables. The visual analog scale (VAS) scores were compared at 0.5, 1, 2, and 4 hours postoperatively. The maximal interincisal mouth opening (MIO) (on days 3 and 7) and VAS scores (at 6, 12, 24, and 48 hours and on days 3 and 7) were compared as secondary outcome variables. The correlation between pain (VAS scores) and trismus (MIO) were also compared. RESULTS A painless procedure was performed in both groups. The VAS score, MIO, and intraoperative bleeding were not significantly different between the 2 groups. Paresthesia was not observed in either group postoperatively. No statistically significant correlations were found between the VAS scores and MIO. CONCLUSIONS Local infiltrative anesthesia preserves almost the same depth of anesthesia as mandibular block anesthesia. No differences were found between these techniques in terms of efficacy and postoperative sequelae during and after ramus graft harvest. Thus, using articaine with a local infiltration technique is an alternative to mandibular block anesthesia during ramus graft harvesting and results in a reduced risk of inferior alveolar nerve damage.
Collapse
Affiliation(s)
- Gökhan Göçmen
- Resident, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Istanbul, Turkey.
| | - Yaşar Özkan
- Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Marmara University, Istanbul, Turkey
| |
Collapse
|
24
|
Calvo AM, Santos GM, Dionísio TJ, Marques MP, Brozoski DT, Lanchote VL, Fernandes MHR, Faria FAC, Santos CF. Quantification of piroxicam and 5′-hydroxypiroxicam in human plasma and saliva using liquid chromatography–tandem mass spectrometry following oral administration. J Pharm Biomed Anal 2016; 120:212-20. [DOI: 10.1016/j.jpba.2015.12.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 01/06/2023]
|