The effectiveness of articaine in mandibular facial infiltrations

Combined block anesthesia of inferior alveolar nerve, lingual nerve and buccal nerve guided by 3D printed indicator: a randomized controlled trial

AIM

To compare the anesthetic effects of combined block anesthesia of inferior alveolar nerve, lingual nerve and buccal nerve guided by 3D printed indicator (IGT) with Halstead Technique (HT) in the extraction of mandibular third molars.

MATERIALS AND METHODS

A total of 210 patients with impacted mandibular third molars who were admitted to the outpatient department of oral and maxillofacial surgery of Zhongshan People's Hospital from 2022.10 to 2023.3 were randomly divided into IGT group and HT group, with 105 patients in each group. The onset time, anesthesia effect, and incidence of complications were compared between the two groups of patients.

RESULT

There was no statistical difference between the IGT group and the HT group in terms of anesthesia success rate (P = 0.180), anesthesia onset time (P = 0.213), and anesthesia effect (P = 0.933). In terms of anesthesia safety the incidence of anesthesia risk factors in the IGT group was 1.9%, and the incidence of anesthesia risk factors in the HT group was 8.6%. There was a statistically significant difference (P = 0.030) between the two groups.

CONCLUSION

The Combined block anesthesia of inferior alveolar nerve, lingual nerve and buccal nerve guided by 3D printed indicator can obtain good anesthetic effect in the extraction of mandibular third molars. Compared with the Halstead Technique, it is safer.

TRIAL REGISTRATION (RETROSPECTIVELY REGISTERED)

The trail was registered at the Chinese Clinical Trial Registry (ChiCTR2400087941,07/08/2024).

CLINICAL RELEVANCE

Impacted mandibular third molar is a common clinical disease. When extracting the mandibular third molar, it is usually necessary to perform inferior alveolar nerve block. However, the current mainstream inferior alveolar nerve block has certain limitations. This study aims to introduce a method of inferior alveolar nerve block guided by a 3D printed indicator and compare it with traditional anesthesia technique, providing a new approach for dentists in this field.

Articaine buccal infiltration for mandibular first molars with symptomatic irreversible pulpitis: is it as effective as inferior alveolar nerve block with lidocaine? a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to compare the anesthetic efficacy of 4% articaine buccal infiltration (BI) with 2% lidocaine inferior alveolar nerve block (IANB) for mandibular first molars with symptomatic irreversible pulpitis.

METHODS

Randomized clinical trials (RCTs) comparing the anesthetic efficiency of one cartridge of 4% articaine BI (as the primary injection) with one cartridge of 2% lidocaine IANB in permanent first mandibular molars with symptomatic irreversible pulpitis were searched in five databases. The risk of bias (RoB) was evaluated using the RoB2 (Cochrane Risk of Bias Tool). A fixed-effects meta-analysis was performed using STATA software. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

RESULTS

Out of 780 records, five RCTs were included. The meta-analysis revealed no significant difference in the success rates of articaine BI and lidocaine IANB [Risk ratio (RR) = 1.06, 95% confidence interval (CI) = (0.93, 1.20), I2 = 24.51%)]. The certainty of the evidence was graded as "moderate".

CONCLUSIONS

The moderate certainty of evidence suggests that the anesthetic efficacy of 4% articaine BI is comparable to 2% lidocaine IANB for mandibular first molars with symptomatic irreversible pulpitis. However, more clinical trials are needed.

CLINICAL RELEVANCE

BI with 4% articaine for mandibular first molars with symptomatic irreversible pulpitis can be an alternative for clinicians compared with 2% lidocaine IANB.

Revolutionising Third Molar Surgery: Unveiling the Superiority of Articaine and Lignocaine in Nerve Block Techniques. A Ground-breaking Triple-Blind, Randomised Clinical Trial

Aim

The present study compared the efficacy of inferior alveolar nerve block (IANB) and local infiltration with 4% articaine combined with IANB using 2% lignocaine in mandibular third molar surgery.

Materials and Methods

This in-vivo study analysed 90 patients undergoing third molar surgery, divided into three groups. The appropriate groups received 4% articaine hydrochloride with 1:100,000 epinephrine and 2% lignocaine hydrochloride with 1:100,000 epinephrine. Various parameters, including anaesthesia duration, onset, surgery duration, postoperative analgesia duration, and intra-operative pain, were assessed using the Heft-Parker VAS. The collected data was evaluated for statistical analysis.

Results

In this study, articaine demonstrated a shorter onset of action and longer analgesia duration when compared to lidocaine. Articaine infiltration provided an average analgesia duration of 32.37 + 8.9 min during surgery, surpassing articaine IANB and lignocaine IANB. Although the duration of anaesthesia and postoperative anaesthesia showed no significant differences, articaine infiltration had a slightly longer duration of action. Intra-operative pain assessment revealed that 50% of individuals in the articaine IANB group reported no pain.

Conclusion

Articaine infiltrations are highly effective for anaesthesia in mandibular third molar extraction, surpassing other local anaesthetics. It is a superior alternative to regional nerve blocks in minor oral surgeries.

The effect of ibuprofen sustained release oral premedication on intraoperative and postoperative pain: A randomised clinical trial

The aim of this study was to assess the effect of ibuprofen sustained release (SR) oral premedication on the efficacy of buccal infiltration (BI) with intraoperative and postoperative pain after single-visit root canal treatment. Sixty patients diagnosed with symptomatic irreversible pulpitis and apical periodontitis in mandibular molar were divided into two groups. Group SR received ibuprofen SR 800 mg and group PL received placebo capsule 1 h before 3.6 mL articaine BI injection. Pain was recorded using a modified visual analogue scale and postoperatively at intervals 6, 24 and 48 h. Group SR showed a significantly higher anaesthetic success rate (73.3%) compared to group PL (46.7%) (p < 0.05). Intraoperative and postoperative pain was significantly higher in group PL compared to group SR (p < 0.05). Premedication of ibuprofen SR improved the efficacy of primary BI in mandibular molars with symptomatic irreversible pulpitis and decreased postoperative pain at 6 and 48 h.

Emerging Anesthetic Nanomedicines: Current State and Challenges

Anesthetics, which include both local and general varieties, are a unique class of drugs widely utilized in clinical surgery to alleviate pain and promote relaxation in patients. Although numerous anesthetics and their traditional formulations are available in the market, only a select few exhibit excellent anesthetic properties that meet clinical requirements. The main challenges are the potential toxic and adverse effects of anesthetics, as well as the presence of the blood-brain barrier (BBB), which makes it difficult for most general anesthetics to effectively penetrate to the brain. Loading anesthetics onto nanocarriers as anesthetic nanomedicines might address these challenges and improve anesthesia effectiveness, reduce toxic and adverse effects, while significantly enhance the efficiency of general anesthetics passing through the BBB. Consequently, anesthetic nanomedicines play a crucial role in the field of anesthesia. Despite their significance, research on anesthetic nanomedicines is still in its infancy, especially when compared to other types of nanomedicines in terms of depth and breadth. Although local anesthetic nanomedicines have received considerable attention and essentially meet clinical needs, there are few reported instances of nanomedicines for general anesthetics. Given the extensive usage of anesthetics and the many of them need for improved performance, emerging anesthetic nanomedicines face both unparalleled opportunities and considerable challenges in terms of theory and technology. Thus, a comprehensive summary with systematic analyses of anesthetic nanomedicines is urgently required. This review provides a comprehensive summary of the classification, properties, and research status of anesthetic nanomedicines, along with an exploration of their opportunities and challenges. In addition, future research directions and development prospects are discussed. It is hoped that researchers from diverse disciplines will collaborate to study anesthetic nanomedicines and develop them as a valuable anesthetic dosage form for clinical surgery.

Comparative study of the anaesthetic efficacy of 4% articaine versus 2% mepivacaine in mandibular third molar germectomy using different anaesthetic techniques: a split-mouth clinical trial

BACKGROUND

Currently, one of the most discouraging aspects for many patients undergoing dental procedures is the administration of local anaesthesia. Therefore, there is a constant search for new techniques to avoid the invasive and painful nature of the injection. This study aimed to compare the clinical efficacy of local anaesthetics with articaine 4% or mepivacaine 2% (both with epinephrine 1:100.000), using different anaesthetic techniques to perform germectomy of lower third molars and to assess patients' feelings and pain during surgery.

METHODS

Totally 50 patients (ranged 11-16 years) who required germectomy of mandibular third molars were recruited. Each patient received local anaesthesia on one side with articaine inoculated with plexus technique while on the other side with mepivacaine using inferior alveolar nerve block technique. The patients' evaluation was performed on pre and intraoperative tactile-pressure feelings and intraoperative pain with four levels on the Visual Analogue Scale (VAS).

RESULTS

Surgical operations lasted less with more efficient analgesia when articaine was used. The additional intraosseous injection was required mainly in the mepivacaine group intraoperatively. A few patients had tactile-pressure feelings while intraoperative pain sensation was absent in 90% of cases with articaine. Significant differences were found in the cases who reported "absent" and "moderate" VAS values, favoring the use of articaine.

CONCLUSIONS

Articaine injected with a plexus anaesthetic technique seems to be more clinically manageable than mepivacaine for the mandibular third molar germectomy. The discomfort of tactile-pressure feelings and pain experienced was lower using articaine anaesthetic technique used.

Impact of maxillary teeth morphology on the failure rate of local anesthesia

Objective:

To investigate the effect of maxillary single and multiple rooted teeth on the success rate of buccal infiltration anesthesia.

Subjects and Methods:

This clinical study was performed by dividing the participants into three groups. Group one included 30 patients with upper anterior teeth, group two 23 patients with upper premolars teeth and group three 39 patients with upper molars for extraction. Onset time of anesthtic action was evaluted by using electronic pulp tester. Pulp testing assessments were carried out immediately before the injection and at the intervals of 2 mins following the injection until the anesthetic success obtains.

Results:

Seventy-nine patients in this study secured anesthetic success within study duration time (10 min). However, there were 13 patients with dental anesthesia failures (3 patients with single rooted teeth and 10 patients with multiple rooted teeth). There were no significant differences in the mean onset time of pulpal anesthesia between the anterior, middle and posterior teeth (P value = 0.449). Clinically, patients with single rooted teeth reported faster dental anesthesia and earlier teeth extraction than patients with multiple rooted teeth.

Conclusion:

This study showed that the single rooted teeth have faster pulpal anesthesia and early extraction than teeth with multiple roots but not statistically significant. Administration of extra local anesthetic cartridge or using intraseptal injection technique can be a solution to overcome the failure of anesthesia in the maxillary posterior teeth.

Local anesthesia for mandibular third molar extraction

Mandibular third molar extraction is commonly performed in dental clinics. However, the optimal method of anesthesia has not been established for this procedure. The conventional inferior alveolar nerve block is the most widely used method. However, its success rate is not high and it may lead to complications, such as aspiration and nerve injury. Therefore, various anesthesia methods are being investigated. Articaine has been proven to be efficacious in a number of studies and is being used with increasing frequency in clinical practice. In this review article, we will briefly review various local anesthesia techniques, anesthetics, and a computer-controlled local anesthetic delivery (CCLAD) system, which reduces pain by controlling the speed of drug injection, for mandibular third molar extraction.

Comparison of onset anesthesia time and injection discomfort of 4% articaine and 2% mepivacaine during teeth extractions

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.