Abstract
Objectives: To compare the possible benefits of the combination of dexamethasone–bupivacaine with articaine–epinephrine as an anaesthetic block after third molar surgery. Materials and Methods: Triple-blind, randomized, controlled, parallel, phase 3 clinical trial. Two groups: experimental (93 patients) with standard anaesthetic block: 40/0.005 mg/mL articaine–epinephrine and submucosal reinforcement with 0.8 mg dexamethasone–5% bupivacaine; and control group (91 patients) with standard block: 40/0.005 mg/mL articaine–epinephrine. The surgery consisted of the extraction of the impacted mandibular third molar by performing a procedure following the same repeatable scheme. The visual analogue scale (VAS) was used to analyse postoperative pain. Results: Groups were homogeneous, without significant differences related to epidemiological variables. Postoperative pain among the first, second, and seventh postoperative days was statistically significantly lower in the experimental group compared to the control group (p < 0.001). Drug consumption was lower in the experimental group throughout the study period (p < 0.04). Conclusion: Bupivacaine is an alternative to articaine in oral surgery, being more effective in reducing postoperative pain by reducing patients’ scores on the VAS as well as their consumption of analgesic drugs after surgery.
Highlights
Impacted teeth are very prevalent, with a high incidence of complications: inflammation, infections, cysts, tumours, and so forth
The experimental group received the study mixture of 0.8 mg dexamethasone diluted in 1.62 mL bupivacaine at 0.5%, while the control group had the same procedure but received 40/0.005 mg/mL articaine with epinephrine
Group A, the experimental group (n = 93), received the studied anaesthetic combination, 0.8 mg dexamethasone diluted in 1.62 mL bupivacaine at 0.5%, while Group B, the control group (n = 91), received the standard anaesthetic of 40/0.005 mg/mL articaine with epinephrine
Summary
Impacted teeth are very prevalent, with a high incidence of complications: inflammation, infections, cysts, tumours, and so forth. These require specialized treatment, with surgical extraction generally indicated in most cases [1]. Of the dental impactions that are symptomatic or have a pathology in Caucasians, the most common by far affect the lower wisdom teeth, representing nearly 60–70% of the surgical dental extractions and dentoalveolar surgeries performed [1]. The aetiology of abnormalities in tooth development is related to the coexistence of inherent genetic components and specific environmental conditions under which odontogenesis occurs. The latest studies published by Trybek et al showed the indisputable molecular basis of dental defects, which, complex and polygenic, seems to have a direct relationship with protein products related to genes including MSX1 [2]
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