Articaine Solution Research Articles

Evaluation of the effectiveness of local anesthetics during septoplasty and tonsillectomy.

Surgical trauma provokes body's stress response with activation of inflammatory, endo-crine, metabolic, and immunological factors, which is believed to be necessary and beneficial response. Aim of the study was to compare the effectiveness of local anesthetics lidocaine and articaine in septoplasty and tonsillectomy in terms of assessing the severity of stress reactions. Patients and Methods: 125 patients with nasal septum deviation (NSD) and chronic tonsillitis (CT) were observed. Patients with NSD were divided into 2 groups: 1A – 32 patients treated by 2% lidocaine local infiltration analgesia (LIA); 1B – 30 patients treated by 2% articaine LIA. Corresponding groups of patients with CT were 2A (32 patients) and 2B (31 patients). For all patients, heart rate variability (HRV), high, low and very low frequency components were measured. Results: Estimation of group variances of HRV showed there were some disadaptation in groups 1B and 2A. High dispersion of SDANN, SDNN index and rMSSD in 1B group, SDANN values in 2A group indicate the sympathetic/parasympathetic imbalance. High frequency component were augmented in 2B group which pointed out prevailing parasympathetic tone but its high dispersion was indicative of disadaptation as well. Conclusion: Thus, with the local infiltration application of an articaine solution during septoplasty, the autonomic nervous system dystonia is observed in the early postoperative period. When anesthesia with lidocaine solution during tonsillectomy, there is also a breakdown of adaptive responses against the background of surgical stress. Based on the above data, of the presented local anesthetics, lidocaine is more effective in septoplasty, and articaine in tonsillectomy.

Anesthetic efficacy of buffered 4% articaine for mandibular first molar infiltration: a crossover clinical trial.

The limited studies on the effect of buffering on the clinical efficacy of articaine have reported controversial results. The purpose of this study was to clinically compare the pain of injection, anesthetic success, onset, and duration of pulpal anesthesia of buffered 4% articaine with epinephrine 1:100000 versus a non-buffered 4% articaine with epinephrine 1:100000 formulation for buccal infiltration of the mandibular first molar. Sixty-three volunteers were enrolled in the study. All volunteers received two injections consisting of a single mandibular first molar buccal infiltration with 1.8 ml of 4% articaine with epinephrine 1:100000 and 1.8 ml of 4% articaine with epinephrine 1:100000 buffered with 8.4% sodium bicarbonate. The infiltrations were applied in two separate appointments spaced at least one week apart. After injection of the anesthetic solution at the examined site, the first molar was pulp-tested every 2 min for the next 60 min. Successful pulpal anesthesia was recorded in 69.8% of cases using non-buffered articaine solution and 76.2% of cases using buffered articaine solution, with no significant difference between the formulations (P = 0.219). The mean time of anesthesia onset for the volunteers with successful anesthetic outcome in both formulations (n = 43) was 6.6 ± 1.6 min for the non-buffered articaine solution and 4.5 ± 1.6 min for the buffered solution, which differed significantly (P = 0.001). In the same volunteers, the mean duration of pulpal anesthesia was 28.4 ± 7.1 min for non-buffered articaine solution and 30.2 ± 8.5 min for buffered articaine solution, with no significant difference between the formulations (P = 0.231). Considering the pain of injection, regardless of the anesthetic success, the mean values of VAS were 11.3 ± 8.2 mm for the non-buffered articaine solution and 7.8 ±6.5 mm for the buffered articaine solution, which differed significantly (P = 0.001 < 0.05). According to the present study, 4% articaine with epinephrine can benefit from buffering and provide better anesthetic behavior, with improved onset and less pain during injection.

The study and analysis of the prognosis criteria for a safe local anesthesia in patients with arterial hypertension

Relevance. To develop the algorithm for a safe and effective local anesthesia in dental outpatients with arterial hypertension.Materials and methods. The study was conducted in the laboratory of functional and clinical studies of Moscow State University of Medicine and Dentistry. Electric pulp testing (µA) was performed and pulp microcirculation (PU) was assessed in the intact teeth of patients with hypertension before and 5, 10, 15, 30 and 60 minutes after the administration of local anesthesia. We used 4% articaine solutions without a vasoconstrictor and with its minimal concentration 1:200 000 and 1:400 000, and 3% mepivacaine solution. The safety of the administered local anesthetic was assessed by the continuous hemodynamic monitoring.Results. 4% articaine solution without epinephrine had a shallow anesthetic effect in the maxilla and anterior mandible. 1:400 000 and 1:200 000 vasoconstrictor concentrations in 4% articaine solution increase the depth and duration of the anesthesia from 20 to 30 minutes respectively. Changes in the pulp sensibility but not in blood microcirculation were demonstrated by the functional parameters of the intact dental pulp in patients with hypertension after the administration of 3% mepivacaine solution at the mandibular foramen. The continuous hemodynamic monitoring data showed no changes in arterial blood pressure, heart rate, oxygen saturation on administration of either of the studied local anesthetic solutions or techniques.Conclusion. The analysis of the prognosis criteria for a safe local anesthesia allowed us to ground the choice of anesthetic in dental outpatients with arterial hypertension.

Modified PDL anesthetic injection technique in the pediatric dental practice

Relevance. Effective pain relief is required for high-quality outpatient dental treatment in children. Infiltration and PDL local anesthetic injection techniques are easier and safer for young patients. Purpose – to determine the effectiveness and safety of the modified PDL anesthetic injection technique in the pediatric dental practice. Materials and methods. The study involved 100 children aged 4 to 7 years, in need of caries and pulpitis treatment in the primary dentition. 4% articaine solutions with 1: 200000 and 1: 400000 epinephrine were administered as a local anesthetic. The effectiveness of the treatment was determined by the visual analogue scale.Results. The study determined the high effectiveness and safety of the modified technique of PDL anesthetic injection of 4% articaine solution with epinephrine ratio 1:200 000 and 1:400 000 for the treatment of caries and pulpitis in 100 children aged 4-7 years.Conclusions. The conducted studies have demonstrated the high ffectiveness and safety of the modified PDL anesthetic injection technique of a 4% solution of articaine with epinephrine both at a concentration of 1:200 000 and 1:400 000.

Comparative analysis of 2% and 4% articaine solution efficacy and safety for the local anesthesia

To determine the functional diagnostics criteria for predicting the effectiveness of using 2% and 4% solutions articaine without vasoconstrictor and with epinephrine content of 1:200.000. The study involved 357 patients (193 women and 164 men) aged 20 to 35 years. with the presence of intact single-rooted and multi-rooted teeth without periodontal pathology without pronounced general somatic pathology, and with a low level of situational anxiety according to the Spielberger-Khanin scale. All the patients received injection anesthesia by the infiltration method of 2% and 4% articaine solution without vasoconstrictor or with epinephrine concentration of 1:200.000. The effectiveness of local anesthesia was assessed by recording functional parameters (electrosensitivity threshold test and hemomicrocirculation) of the pulp of intact single-root and multi-root teeth before anesthesia, 5, 10, 15, 30, and 60 minutes after local anesthesia. The safety of the anesthesia was determined by continuous monitoring of the patient's hemodynamic parameters: blood pressure, heart rate, blood oxygen saturation before anesthesia and within 60 minutes after. Articaine solution 2% with epinephrine concentration of 1:200.000 used for infiltration or modified periodontal anesthesia resulted in pulp electrosensitivity threshold growth by 95.93% and 93.58%, respectively. There were no statistically significant differences in hemodynamic values between both study groups. Analysis of the data obtained showed the effectiveness and safe anesthesia with drugs based on 2% articaine with an epinephrine concentration of 1:200.000.

Comparative effectiveness of periodontal methods of anesthesia in the treatment of dental caries

The analysis of the criteria for predicting the effectiveness and safety of the use of periodontal anesthesia methods in the treatment of dental caries was carried out. The study involved 78 patients: 41 women and 37 men aged from 25 to 56 years without severe somatic pathology, who needed treatment for dental caries. Intraligamental and modified periodontal anesthesia using a 4% articaine solution with different concentrations of vasoconstrictor were used as methods of anesthesia. The «method of the local injection anesthesia of the tooth pulp evaluating» was used during the modified periodontal and intraligmental anesthesia which determines the criteria for predicting the effectiveness and safety of the planned anesthesia and which is based on determining the functional parameters of the tooth pulp such as electrical excitability and microcirculation. The obtained results demonstrated the high efficiency and safety of the modified periodontal anesthesia with 4% articaine with epinephrine 1:200 000, which is easier to use and does not require specialized equipment. Modified periodontal anesthesia is safe and effective for the treatment of dental caries.

Buffered 2% articaine versus non-buffered 4% articaine in maxillary infiltration: randomized clinical trial.

This randomized, triple-blind, crossover clinical trial aimed to evaluate the efficacy, onset, length of pulp and soft tissue anesthesia, and pain during injection of 2% buffered articaine and 4% non-buffered articaine solutions. Each volunteer received two maxillary supraperiosteal anesthesia infiltrations in canine area. The infiltrations were performed at two different sessions using a different local anesthetic solution for each session, and the anesthetic injection speed was always 1 mL/min. The assessment of the onset and length of pulpal and soft tissue anesthesia was performed with the pulp electrical test "pulp tester" and the esthesiometer kit, respectively. Volunteers marked pain during injection on a visual analog scale (VAS). The anesthetics solutions pH was evaluated through the pH meter equipment. There was no difference between the two anesthetic solutions (onset of soft tissue anesthesia, p = 0.5386; length of soft tissue anesthesia, p = 0.718; onset of pulpal anesthesia, p = 0.747; length of pulpal anesthesia, p = 0.375), except for pain during the injection which was lower when buffered 2% articaine was used (p = 0.001) and the pH. The pH analysis revealed that the solutions differed from one another (p < 0.01). The 2% buffered articaine solution provided the same anesthetic properties then 4% unbuffered articaine with a great reduction in pain during injection. The possibility of use 2% buffered articaine solution instead of 4% articaine maintaining the same anesthetic properties with a great reduction in pain during injection and half of the anesthetic salt concentration.

Is it possible to extract lower third molars with infiltration anaesthesia techniques using articaine? A double-blind randomized clinical trial

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.

THE BASIS OF CARRYING OUT OF SAFE LOCAL ANESTHETIC IN OUTPATIENT DENTAL PRACTICE

On the basis of clinical and functional studies, a protocol for conducting safe local anesthesia in outpatient dental practice has been developed. The essence of the protocol is anesthesia with the treatment and removal of teeth in the upper jaw and lower jaw in the frontal section using a 4% articaine solution with a vasoconstrictor of 1: 200,000 under the infiltration method of anesthesia with an efficiency of 97.3 ± 1.3%, duration 29.2 ± 2.48 minutes and an MPA of 96.3 ± 1.23% and an injection rate of 1 ml / min; in anesthesia of the molars in the lower jaw using the conductive method at the mandibular orifice with the obligatory aspiration test with 4% articaine with epinephrine 1: 200000 with an efficiency up to 92.54% ± 1.3 and a duration of 35.2 ± 2.43 minutes with a speed drug administration - 1 ml / min. Improving the effectiveness of anesthesia to 95.54 ± 0.3% is achieved by the periodontal method of introducing a 4% solution of articaine with a vasoconstrictor of 1: 200,000.

Does articaine, rather than lidocaine, increase the risk of nerve damage when administered for inferior alveolar nerve blocks in patients undergoing local anaesthesia for dental treatment? A mini systematic review of the literature.

This mini systematic review seeks to analyse the available literature and determine if a 4% articaine solution poses a greater risk of inferior alveolar and/or lingual nerve damage compared to that of 2% lidocaine, when administered for an inferior alveolar nerve block. After a mini systematic review of the published literature, seven suitable studies were identified: one double-blind random controlled trial (DBRCT) and six retrospective cohort studies. The DBRCT and two of the cohort studies concluded that 4% articaine poses no greater risk of nerve damage. The remaining four cohort studies suggested that caution should be exhibited when using a 4% local anaesthetic solution rather than a 2% solution. However, these studies also concluded that no evidence exists to explain the reasons for their results. The included articles present no conclusive evidence to suggest that 4% articaine causes more nerve damage than 2% lidocaine, although some authors advise caution when using this agent. All studies conclude that further quality research is required, and it is therefore suggested that dental practitioners exhibit caution when choosing to use 4% articaine in an inferior alveolar nerve block until further scientific research has been performed.

The efficacy of therapeutic nerve blocks in patients with cervicogenic headache

To compare the efficacy of 2% articaine solution and 2% lidocaine solution used to perform therapeutic nerve blocks of the large occipital nerve in patients with cervicogenic headache. A randomized prospective comparative clinical study was conducted in two groups treated with articaine (n=22) or lidocaine (n=21). The therapeutic great occipital nerve blocks were performed on the 1st, 3d and 5th days of treatment. The efficacy of treatment was assessed by the pain intensity measured with the Visual Analogue scale (VAS) and the duration of individual pain paroxysms on the 5th and 10th days. The baseline VAS pain intensity was 6.3±1.2 and 5.9±2.0 centimeters, whereas the duration of individual pain paroxysms was 7.8±2.3 and 9.1±2.8 hours in the articaine group and the lidocaine group, respectively. By the 5th day, there was a more dramatically decrease in VAS pain intensity and duration in the articaine group (up to 3.0±0.8 and 4.3±1.2 centimeters VAS (p<0.05)) compared to the lidocaine group (up to 1.9±0.6 to 4.8±1.3 hours (p<0.05)). By the 10th day, the pain intensity did not differ between groups (1.2±0.5 and 1.7±0.7 centimeters (p>0.05)). The duration of pain episodes was still lower in the articaine group (0.5±0.08 hours) compared to the lidocaine group (2.4±0.8 hours) (p<0.05). Therapeutic large occipital nerve blocks with 2% solution of articaine show the significant decrease in pain intensity and duration of pain paroxysms in a short period of time for patients with cervicogenic headache.

Efficacy of epinephrine-free articaine compared to articaine with epinephrine (1:100000) for maxillary infiltration, a randomised clinical trial.

The selection of local anaesthetic in dental practice is essential to the patient's comfort and the success of the treatment. Many patients prefer anaesthesia even for short treatments. Articaine is a local anaesthetic commonly used for dental practice. The duration of the effect of articaine on the nerve fibres is not yet precisely reported. This study was aimed to evaluate the clinical efficacy of 4% articaine with and without epinephrine in treatment of occlusal caries. Thirty healthy patients were included in this randomised double-blind study. Each subject received 4% articaine with and without epinephrine (1:100000). Maxillary infiltration was used for occlusal caries of the maxillary premolars on right and left sides. Quantitative sensory testing (QST) was performed in the innervation area of the infraorbital nerve, and pulp vitality test was performed on restoration-free canines. Duration of anaesthesia was longer when articaine with epinephrine was used. Articaine without epinephrine showed faster recovery of sensory blockade compared to articaine with epinephrine. The epinephrine-containing agent, when compared to the plain articaine solution, showed significantly stronger and longer anaesthetic efficacy on the soft tissue by all parameters of QST. Articaine with epinephrine caused a more reliable pulpal analgesia. A pain-free treatment of the soft tissue up to 15minutes can be performed under the vasoconstrictor-free anaesthetic without causing long-lasting numbness. Epinephrine-containing articaine delivers a longer, more effective anaesthesia and is preferable for caries treatments and longer invasive treatments of the soft tissue.

Assessment of anesthetic efficacy of 4%articaine and 2%Lidocaine during implant pilot hole preparation in the mandibular posterior region infiltration

Aim.The aim of this study was to evaluate and compare the anesthetic efficacy of 4%articaine and 2% lidocaine (both with 1:100,000 epinepherine) for buccal andlingual infiltration in patients need implant placement.Materials and methods.Forty patients have edentulus regions posterier to mentalforamen were divided into 4 study groups and received buccal and lingualinfiltration of either 4% articaine or 2% lidocaine. Surgical procedure was begun5 minutes after solution deposition. Success was defined as no or milddiscomfort (VAS recordings) during during pilot hole drill.Results.The success rate for mandibular infiltration to produce anesthesia usingarticaine was 100% in premolar and molar area for the articaine solution andsuccess rate was 80% in preamolar and 30% in molar area. There was highsignificant difference between the articaine and lidocaine solutions (ANOVA P&lt; 0.001).Conclusion. The efficacy of 4% articaine was superior to 2% lidocaine formandibular posterior regoin.

Articaine Versus Lidocaine Concentration in the Palatal Tissues After Supraperiosteal Buccal Infiltration Anesthesia

Palatal local anesthetic injection is a painful procedure. Previous studies have reported successful extraction of maxillary teeth using only buccal infiltration of 4% articaine without palatal anesthesia. The aim of the present study was to determine levels of 4% articaine solution in palatal bone and mucosal tissues after buccal injection and compare those levels with 2% lidocaine solution in New Zealand white rabbits. Eight rabbits received 2 different injections of 0.6mL of 4% articaine with 1:100,000 epinephrine and 0.6mL of 2% lidocaine with 1:100,000 epinephrine buccal to the right and left maxillary first molar, respectively, in a split-mouth study design using quantitative syringes. All injections were administered using the buccal infiltration technique without any palatal injection. Ten minutes later, palatal bone and mucosa specimens were collected for analysis. Levels of the 2 local anesthetic agents were measured in palatal tissues using high-performance liquid chromatography (HPLC). HPLC analysis showed markedly higher 4% articaine solution values (0.319±0.037) in palatal mucosal tissues compared with palatal mucosal concentrations of 2% lidocaine solution (0.0839±0.017). In palatal bone, the mean concentration of 2% lidocaine solution was markedly lower than the mean concentration of 4% articaine solution (0.085±0.012 vs 0.155±0.012, respectively). There was no relevant difference between levels of 2% lidocaine in the palatal bone and mucosal tissues. However, the mean concentration of 4% articaine in the palatal mucosa was markedly higher than its concentration in palatal bone. The buccal vestibule-palatal diffusion of 4% articaine solution with 1:100,000 epinephrine is greater than 2% lidocaine solution with 1:100,000 epinephrine in a rabbit model.

Evaluation of the Anaesthetic Efficacy of 4% Articaine with 1:200000 Epinephrine Versus 2% Lignocaine with 1:200000 Epinephrine in Simple Extractions of Mandibular Posterior Teeth

Background: The aim of the study was to evaluate the anaesthetic efficacy of 4% articaine hydrochloride with epinephrine/adrenaline 1:200000 versus 2% lignocaine hydrochloride with epinephrine/adrenaline 1:200000 in extractions of permanent mandibular posterior teeth. Materials and methods: One hundred (100) patients were selected for the study in the Department of Oral and Maxillofacial Surgery and Implantology. Patients were equally but randomly divided into two different groups: i) Group 1-4% articaine solution; ii) Group 2-2% lignocaine solution, both with equal concentration of epinephrine (1:200000). Standardized clinical parameters included the Visual Analogue Scale (VAS) score for each, Pain on injection, Intraoperative Pain, Onset of anaesthesia, Duration of anaesthesia, Need of reanaesthesia. Results: On statistical evaluation of the values obtained for each patient, it was observed that Group I (4% articaine with 1:200000 epinephrine) demonstrated low pain on injection, early onset of anaesthesia (shorter latency), low intraoperative pain and reasonable duration of soft tissue anaesthesia compared to Group II (2% lignocaine with 1:200000 epinephrine) that demonstrated slow onset, more intraoperative pain and minimally longer duration of soft tissue anaesthesia. Conclusion: it can be stated that Septanest (4% articaine hydrochloride with 1:2000000 epinephrine) may be preferred to Xylocaine (2% lignocaine hydrochloride with 1:2000000 epinephrine) in simple minor oral surgical procedures.

Comparison of two epinephrine concentrations in an articaine solution for local anesthesia in children.

Painless dental treatment is of major interest in pediatric dentistry. Local anesthesia contains epinephrine, which prolongs soft tissue anesthesia.This, however, is often a source of iscomfort for children and is responsible for certain side effects (e.g., self-inflicted soft tissue lesions). The aim of this study was to investigate whether an epinephrine-reduced articaine solution could reduce the duration of soft tissue anesthesia and thereby reduce the risk of self-inflicted soft tissue lesions, while still providing an adequate anesthesia. In a non-interventional clinical study, routine dental treatment was performed on children and adolescents. An articaine 4% solution with an epinephrine-reduced solution (Ubistesin™ mite, 1:400,000) and a conventional epinephrine solution (Ubistesin™ forte, 1:100,000) were compared in terms of duration of soft tissue anesthesia. One hundred and fifty-eight patients (mite: 75, forte: 83) were treated (80% with infiltration anesthesia). In both groups, the average volume of the injection was comparable (mite: 1.2 ml, forte: 1.1 ml). One patient from each group showed unwanted side effects. In both groups, the local anesthesia was complete or sufficient (96%) to perform the planned treatment. The average treatment time was 24 minutes in the mite group and 28 minutes in the forte group. The difference in mean duration of soft tissue anesthesia was statistically significant (p = 0.001, mite: 2.1 h, forte: 2.8 h). Thanks to its high efficacy, tolerance, and reduced soft tissue anesthesia, the articaine 4% solution with the reduced epinephrine concentration (1:400,000) was considered a safe and suitable drug for routine treatments in pediatric dentistry.

Comparison of two epinephrine concentrations in an articaine solution for local anesthesia in children.

Painless dental treatment is of major interest in pediatric dentistry. Local anesthesia contains epinephrine, which prolongs soft tissue anesthesia.This, however, is often a source of iscomfort for children and is responsible for certain side effects (e.g., self-inflicted soft tissue lesions). The aim of this study was to investigate whether an epinephrine-reduced articaine solution could reduce the duration of soft tissue anesthesia and thereby reduce the risk of self-inflicted soft tissue lesions, while still providing an adequate anesthesia. In a non-interventional clinical study, routine dental treatment was performed on children and adolescents. An articaine 4% solution with an epinephrine-reduced solution (Ubistesin™ mite, 1:400,000) and a conventional epinephrine solution (Ubistesin™ forte, 1:100,000) were compared in terms of duration of soft tissue anesthesia. One hundred and fifty-eight patients (mite: 75, forte: 83) were treated (80% with infiltration anesthesia). In both groups, the average volume of the injection was comparable (mite: 1.2 ml, forte: 1.1 ml). One patient from each group showed unwanted side effects. In both groups, the local anesthesia was complete or sufficient (96%) to perform the planned treatment. The average treatment time was 24 minutes in the mite group and 28 minutes in the forte group. The difference in mean duration of soft tissue anesthesia was statistically significant (p = 0.001, mite: 2.1 h, forte: 2.8 h). Thanks to its high efficacy, tolerance, and reduced soft tissue anesthesia, the articaine 4% solution with the reduced epinephrine concentration (1:400,000) was considered a safe and suitable drug for routine treatments in pediatric dentistry.

The Pulpal Anesthetic Efficacy of Articaine Versus Lidocaine in Dentistry : A Meta - Analysis

ABSTRACT Background The authors evaluated published evidence from controlled clinical trials regarding the efficacy of two local anesthetic solutions in providing successful pulpal anesthesia. Methods The authors searched MEDLINE and Embase databases to identify peer-reviewed randomized controlled trials in which researchers directly compared articaine and lidocaine local anesthetic solutions in adult participants. They extracted study characteristics and outcomes data as a basis for meta-analysis. They completed subgroup analyses for both infiltration and mandibular inferior alveolar block anesthetic techniques. Results Articaine solutions had a probability of achieving anesthetic success superior to that of lidocaine, with an odds ratio of 2.44 (95 percent confidence interval [CI], 1.59–3.76; P P P = .009), and no difference when the authors considered only symptomatic teeth. Clinical Implications Research evidence supports using articaine versus lidocaine for achieving pulpal anesthesia when the infiltration mode of administration is used. It is premature to recommend articaine for mandibular block anesthesia in cases involving irreversible pulpitis.

Comparative clinical evaluation of different epinephrine concentrations in 4 % articaine for dental local infiltration anesthesia

The aims of this study were to compare and evaluate the clinical anesthetic efficacy of five 4% articaine solutions with and without epinephrine in pulpal anesthesia after infiltration. In a randomized, double-blinded, crossover study, ten volunteers received local anesthesia infiltration in the maxillary right central incisor with five different solutions (4% articaine + epinephrine 1:100,000, + epinephrine 1:200,000, + epinephrine 1:300,000, + epinephrine 1:400,000, without epinephrine). Electronic pulp tester was used to calculate the onset, utilization time, time to recede, and the surface integral under the time-effect curve. Additionally, cardiovascular parameters and post-experimental soft tissue anesthesia were examined. Onset as well as time to recede was not influenced by the epinephrine concentration. When using the epinephrine-free agent, time to recede was significantly shorter. Upon decreasing epinephrine concentration, duration of pulpal anesthesia and total anesthetic efficacy declined. The shortest time of anesthesia and lowest anesthetic efficacy were seen for the solution without epinephrine. No association was found between the local anesthetic drug and cardiovascular parameters. Soft tissue anesthesia was significantly shorter without epinephrine. This study shows the substantial benefits of vasoconstrictors in dental infiltration anesthesia. These findings were reflected by means of prolonged and deeper therapeutic effect in a dose-dependent manner. Even when utilizing agents with reduced amount of epinephrine, a safe anesthesia is possible. The epinephrine-free solutions resulted in a distinct limitation of utilization time and efficacy.

Epinephrine-reduced articaine solution (1:400,000) in paediatric dentistry: a multicentre non-interventional clinical trial

AimIn paediatric dentistry, epinephrine may contribute to systemic and local side-effects. On the other hand it is necessary to provide good and safe local analgesia. Therefore, an articaine solution with reduced epinephrine concentration was tested in a clinical setting.MethodsIn a non-interventional clinical study, dental treatment was performed in children and adolescents (4–17 years). For local analgesia, articaine 4 % plus epinephrine 1:400,000 was used in the technique chosen by the dentist. Efficacy and tolerance as well as duration of soft tissue analgesia and side-effects were evaluated.Results999 patients (50.5 % male, 49.5 % female) with a mean age of 7.9 (SD 2.34) years were treated. Two hundred seventy six patients (27.6 %) received sedation prior to treatment. The mean treatment time was 15 min (SD 10). In 93.5 % of cases, initial local analgesia was sufficient to perform the planned treatment. In 99 % of cases (n = 989) the planned treatment could be completed. A second injection was necessary in 6.5 % of cases. A mean duration of soft tissue analgesia of 2.19 h (SD 1.01) was seen. Slight side-effects occurred in 3.1 % of subjects.ConclusionsDue to high efficacy, tolerance and safety, the articaine 4 % solution with the reduced epinephrine concentration (1:400,000) was a safe and suitable drug for paediatric routine treatment.