Patient discomfort and intensity of intraseptal anesthesia of computer-controlled articaine/epinephrine delivery for scaling and root planing

OBJECTIVES

The primary aim was to assess the pain during intraseptal anesthesia (ISA) administration, as well as during and after scaling and root planing (SRP). The secondary aims pertained to comparing the pain in different jaw regions and evaluating the factors affecting pain during ISA administration, during and after SRP.

MATERIAL AND METHODS

ISA was obtained with three different doses of 4% articaine with 1:100,000 epinephrine (4%Ar + Ep) in 360 patients. The pain levels were measured using the visual analogue scales (VAS) for pain intensity during ISA administration (VASa), during SRP (VASi), and after SRP (VASp). These findings were then correlated with periodontal parameters. Regression analysis was performed for pain during ISA, during and after SRP.

RESULTS

Anesthesia administration was painful in 80.8% of cases. VASa negatively correlated with pocket depth (PPD). VASi showed no dose-dependency, except in mandibular premolars. VASi negatively correlated with the clinical attachment level (CAL). VASp positively correlated with PPD and CAL. Positive bleeding on probing reduced the chance of pain during ISA administration. Longer anesthesia duration and wider anesthetic field (orally) increased the prospects of painless SRP.

CONCLUSIONS

No dose-dependent differences were found regarding patient discomfort and pain intensity of ISA delivery of 4%Ar + Ep for SRP.

CLINICAL RELEVANCE

The pain during ISA administration was mild and well tolerated regardless of the anesthetic dose. A lower intensity of pain during SRP can be expected in patients with greater CAL. Post-treatment pain can be anticipated after SRP in the regions with greater PPD and CAL.

CLINICAL TRIALS REGISTRATION NUMBER

NCT04392804 (May 9th, 2020).

Efficacy of intraseptal anesthesia obtained by computer-controlled articaine with epinephrine delivery in scaling and root planing

OBJECTIVES

The primary aim of this study was to compare the anesthetic efficacy of the intraseptal anesthesia (ISA) obtained with three doses of 4% articaine with 1:100,000 epinephrine (4%Ar + Ep) for scaling and root planing (SRP), using a computer-controlled local anesthetic delivery system (CCLADS). The secondary aims were to compare the clinical anesthetic parameters in relation to different jaw regions and examine the possible influence of sex and smoking habits on them.

MATERIALS AND METHODS

SRP under ISA obtained with different doses (0.1 ml, 0.2 ml, and 0.3 ml) of 4%Ar + Ep was performed in 360 patients. The success rate, onset, duration of soft tissue anesthesia, and the anesthetic field widths were recorded by pinprick testing.

RESULTS

The anesthesia success was high (90-95%). The onset was immediate. The duration and anesthetic field widths showed a dose-related significance, however, without a consistent sex-related or smoking-related significance. The multiple logistic regression analysis revealed a twofold higher chance of anesthesia success by increasing the dose and increased bleeding on probing-related and female sex-reduced probability of anesthesia success.

CONCLUSIONS

ISA obtained with 0.3 ml of 4%Ar + Ep delivered by a computer-controlled local anesthetic delivery system provided a high anesthetic success and the adequate clinical anesthetic parameters for SRP in all regions of both jaws.

CLINICAL RELEVANCE

ISA obtained with 4%Ar + Ep provides an effective anesthesia for SRP. The anesthetic success rate may be reduced in the presence of gingival inflammation and in females as well. The study was registered in a Clinical Trials database (NCT04392804, registration date May 9, 2020).

Anesthetic Efficacy of Articaine and Lidocaine in a Primary Intraseptal Injection: A Prospective, Randomized Double-Blind Study

Additional studies are needed to evaluate intraseptal anesthesia in the mandibular first molar. The purpose of this study was to compare the anesthetic efficacy of a primary intraseptal injection of articaine and lidocaine, administered with a computer-controlled local anesthetic delivery (CCLAD) system, in asymptomatic mandibular first molars. Using a crossover design, 100 subjects randomly received intraseptal injections of 1.4 mL of 4% articaine and 2% lidocaine, both with 1:100,000 epinephrine, at 2 separate appointments. Injections were given in the interdental papillae, mesial (0.7 mL) and distal (0.7 mL) to the first molar. An electric pulp tester was used to test for pulpal anesthesia. Pain of injection, postoperative pain, and pulse rate were also evaluated. Data were statistically analyzed. Anesthetic success rate for the mandibular first molar was 32% for articaine and 30% for lidocaine, with no statistically significant difference (p = .8689) between the two. No significant differences were found between formulations for pain of injection. The intraseptal injection did not cause a clinically meaningful increase in pulse rate. Postoperative pain decreased each day with no significant differences between formulations. In conclusion, a primary intraseptal injection does not achieve a high success rate of pulpal anesthesia in the mandibular first molar.