Lingual Infiltration Research Articles

Mylohyoid Nerve Injection for Unsuccessful Anesthesia of Posterior Teeth with Successful Inferior Alveolar Nerve Block.

Background and objective: variations in mylohyoid could lead to failure of an inferior alveolar nerve blockade. This study aimed to evaluate the impact of mylohyoid nerve variation on the persistence of pain following a successful inferior alveolar nerve block. Method: This clinical study was performed at the oral and maxillofacial department/college of Dentistry, Hawler Medical University. All patients with pain following a successful inferior alveolar nerve block were enrolled in this study. An additional submucosal injection (infiltration technique) as few drops in the lingual mucosa of the offending tooth is given by the same surgeon Results: A total of fifty patients were enrolled in this study,30 males and 20 females. age range was (16-56). Among the total only 20 patients (60%females,40% males) experienced pain on the lingual side during the attempt of dental extraction. Following lingual infiltration, all the cases were treated successfully in a pain free environment. Descriptive statistics was used to analyze the data. Conclusion: Lingual submucosal injection of 1/3 of 1.8 ml of local anesthesia might be an effective way to block all possible nerve variation on the lingual side. Keywords: Inferior alveolar nerve block (IANB), mylohyoid nerve variation, lingual mucosal infiltration, pain.

Articaine Infiltrations of the Mandibular Lateral Incisor—Is It Volume or Location of the Infiltrations That Affect Success? A Prospective, Randomized Crossover Study

IntroductionA combination labial infiltration (1.8 mL) plus lingual infiltration (1.8 mL) of 4% articaine with 1:100,000 epinephrine in the mandibular lateral incisor was found superior to a labial infiltration of 1.8 mL of the same solution. However, it is not known whether the volume or the location had the greatest effect. Therefore, the purpose of this prospective, randomized crossover study was to determine the anesthetic efficacy of a labial infiltration of a 3.6 mL volume of 4% articaine with 1:100,000 epinephrine compared with labial infiltration (1.8 mL) plus lingual infiltration (1.8 mL) of 4% articaine with 1:100,000 epinephrine in the mandibular lateral incisor. MethodsOne hundred subjects randomly received 2 sets of injections, using 4% articaine with 1:100,000 epinephrine, consisting of labial and lingual infiltrations of 1.8 mL (3.6 mL total) and 2 labial infiltrations of 1.8 mL (3.6 mL total) of the mandibular lateral incisor in 2 separate appointments. Electric pulp testing was used to determine anesthetic success (highest 80/80 reading). The data were analyzed statistically. ResultsThe labial and lingual combination exhibited a significantly higher anesthetic success rate (97%) when compared with the 2 labial infiltrations (74%) and had significantly higher 80/80s readings from 1 minute to 58 minutes. ConclusionsWithin the limitations of this clinical study, a combination labial plus lingual infiltration using a 3.6-mL volume of 4% articaine with 1:100,000 epinephrine significantly increased pulpal anesthetic success for the mandibular lateral incisor when compared with a labial infiltration using a 3.6-mL volume of articaine. Therefore, location of the infiltrations was more important than volume.

La suplementación lingual opcional después de la anestesia por infiltración bucal con articaína para la extracción de molares inferiores: un estudio clínico comparativo

Purpose: To investigate the anesthetic effectiveness of buccal infiltration (BI) versus buccal plus lingual infiltration (BI+LI) of 4% articaine for intra-alveolar extraction of erupted mandibular molar teeth Material and Methods: Eighty patients were included in this prospective clinical study. They were randomly divided into 1 of 2 equal groups: the 1st group received BI of 4% articaine 1.8 ml and LI of 0.5 ml, while the 2nd group received 4% articaine 1.8 ml BI plus 0.5 ml LI of normal saline. Another 1.8 ml articaine BI was given if initial anesthesia was inadequate. Outcome variables included pain, which was rated by patients at 3 intervals using visual analogue scale, and lingual anesthesia and patients' satisfaction which were measured using 5-score verbal rating scale. Data analyses used were descriptive statistics, t test, χ2 test, and Pearson's correlation coefficient. P-value value less than 0.05 was considered significant Results: There were 46 females and 34 males and the mean age was 35.3 years. All outcome variables were comparable between the two study groups (p˃0.05). Anesthesia was successful in 78% and 88% of cases in the (BI) and (BI+LI) groups respectively with no significant difference (p=0.2392). The mean articaine volume used was 2.5 ml and 2.87 ml respectively without significant difference (p=0.090). Conclusion: The anesthetic efficacy of (BI) alone and (BI+LI) of 4% articaine was comparable. When given in an adequate dose, articaine (BI) alone could be justified as an anesthetic option for the intra-alveolar extraction of mandibular molar teeth.

Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual infiltration using articaine in mandibular molars with irreversible pulpitis: a preliminary prospective randomized single-blind clinical trial.

This study was designed as a prospective randomized single-blind clinical trial to compare the anesthetic efficacy of inferior alveolar nerve block (IANB), IANB plus buccal infiltration, and IANB plus lingual infiltration of 4% articaine with 1:100,000 epinephrine in mandibular molars with irreversible pulpitis. Sixty healthy volunteers who had a first or second mandibular molar diagnosed with irreversible pulpitis participated in the present study. This study was composed of three arms for the first molar and three arms for the second molar. Subjects in test arm A received two IANB injections (3.6 mL). Subjects in test arm B received 1.8 mL IANB injection plus 1.8 mL buccal infiltration. Subjects in test arm C received 1.8 mL IANB injection plus 1.8 mL lingual infiltration. Articaine (4%) with 1:100,000 epinephrine was used for all injections. The subject's pain during access preparation and pulp extirpation was recorded on the Heft-Parker visual analog scale. Success was defined as "none" or "mild" pain during treatment. Kruskal-Wallis test was used to compare pain categories in three groups of interventions for each mandibular molar. IANB with a supplemented buccal infiltration provided more success than IANB alone or IANB plus lingual infiltration, in first molars (P = .019). There were no significant differences between the three injection techniques in second molars (P = .795). Adding a supplemental buccal infiltration to a standard IANB was more successful in providing pain-free treatment for patients experiencing irreversible pulpitis in mandibular first molars.

Anesthetic efficacy of Articaine 4% during extraction of the first and second lower molar by using inferior alveolar nerve block and buccal infiltration techniques

Purpose: The study was designed to evaluate the anesthetic efficacy of 4% articaine with 1:100000 adrenaline in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth. Materials and Methods: This crossovee clinical trial included 40 patients needing extraction of mandibular molar in both side. Patients received infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration in one side and standard IANB in other side with 4% articaine with 1:100000 adrenaline. For assessment of depth of anesthesia obtained by the two anaesthetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale. Results: forty patients received infiltration anesthesia in one side and IANB in the other side. The success rate of pain-free extraction after buccal infiltration was 72.5%, whereas by using IANB with the same anesthetic it was 82.5%. No statistical differences were detected in the success rates between the two anesthetic techniques (P = 0.65). Conclusions: Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.

Local anaesthesia for surgical extraction of mandibular third molars: a systematic review and network meta-analysis.

Pain management for the extraction of the mandibular third molar is a challenge as compelling evidence in comparative anaesthetics is currently lacking. 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. 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). 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. 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.

Efficacy of Infiltration Anaesthesia of 4% Articaine HCl (buccal) Versus 2% Lignocaine HCl (buccolingual) in Extraction of Mandibular Premolars: A Single Centred, Randomised, Crossover Group Study.

The purpose of the study was to evaluate and compare the efficacy of buccal and lingual infiltration (B/L I) of 2% lignocaine HCl and buccal infiltration (BI) of 4% articaine for orthodontic extraction of mandibular premolars. One hundred and four patients (age group 14-26years) were selected with the indication of bilateral mandibular first or second premolar extraction for orthodontic treatment. Patients were randomly distributed in 2 groups. Group A received B/L I with lignocaine and Group B for BI with articaine in two different appointments in 2-week interval. The pain scores for each patient were evaluated during extraction using the visual analogue scale (VAS) and verbal pain scale (VPS). Statistical analysis was performed by descriptive and inferential statistics using Chi-square test. The agreement between VAS and VPS was obtained by applying intra-class correlation coefficient. No pain was experienced during extraction in 77% (VAS) and 79% (VPS) patients infiltrated in group A and 84% (VAS) and 90% (VPS) patients of group B with articaine. The difference between the groups was statistically significant. A strong positive correlation was found between VAS and VPS scores in the both groups. Buccal infiltration with articaine proved to be an effective alternative to buccal and lingual infiltration with lignocaine in the extraction of mandibular premolars.

Effectiveness of Articaine Buccal Infiltration Anesthesia for Mandibular Premolar Extraction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

To evaluate the anesthetic adequacy of buccal versus buccal plus lingual infiltration of 4% articaine 1.8mL for mandibular premolar teeth extraction. A randomized, double-blinded, placebo-controlled clinical trial was conducted in which patients presented with a mandibular premolar for extraction under local anesthesia. The sample population was randomly divided into 2 equal groups: the first group received infiltration of 4% articaine 1.8mL buccally and 0.4mL lingually and the second group received infiltration of 4% articaine 1.8mL buccally plus lingual injection of normal saline 0.4mL. Pain was measured during anesthetic injection, 8minutes after injection, and during extraction using a visual analog scale. Initial lingual anesthesia and patients' satisfaction were measured using a 5-score verbal rating scale. Statistical analyses included descriptive statistics, t test, and Pearson χ2 test. Significance was set at a P value less than.05. Seventy-two patients were included in this study (37 men and 35 women; average age, 49.8yr). Mean pain scores during injection and extraction and satisfaction scores were comparable between study groups (P=.432, .240, and .478, respectively). Success rates were 100 and 89% in groups A and B, respectively, with no significant difference (P=.1145). The anesthetic parameters of 1 buccal infiltration of 4% articaine 1.8mL with and without lingual supplementation were comparable. This result could justify the use of buccal articaine infiltration as an effective alternative to the standard inferior alveolar nerve block technique for extraction of lower premolar teeth.

Efficacy of IANB and Gow-Gates Techniques in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective Randomized Double Blind Clinical Study.

Introduction:The aim of the present study was to compare the efficacy of the inferior alveolar nerve block (IANB) and Gow-Gates techniques in mandibular molars with symptomatic irreversible pulpitis. Methods and Materials :In this randomised, double-blind clinical trial, 80 patients referred to Mashhad Dental School, were randomly divided into two groups: IANB and Gow-Gates anaesthetic techniques using 2% lidocaine with 1:100000 epinephrine. After injection, if pain during caries/dentin removal and access cavity preparation was reported in each group, the patients once again were randomly allocated to receive buccal or lingual supplementary infiltration. Pain severity was evaluated using a visual analogue scale. The rates of positive aspiration and changes in heart rate were compared between the IANB and Gow-Gates. Paired and individual t-tests and the Mann-Whitney U-test were used to compare the reduction in pain severity. The level of significance was set at 0.05. Results:The success rates of anaesthesia in the Gow-Gates and IANB techniques were 50% and 42.5%, respectively with no significant difference (P=0.562). Supplementary infiltrations significantly reduced pain severity in all subgroups (P<0.05). Lingual infiltration resulted in a significantly greater reduction in pain severity in the IANB group than in the Gow-Gates group (P<0.05). No significant difference in heart rate or positive aspiration results was observed between groups (P>0.05). Conclusions:In the present study, the efficacy of the IANB and Gow-Gates techniques was comparable in mandibular molars with symptomatic irreversible pulpitis. Supplementary buccal and lingual infiltration significantly reduced pain severity.

Anesthetic Efficacy of 4% Articaine During Extraction of the Mandibular Posterior Teeth by Using Inferior Alveolar Nerve Block and Buccal Infiltration Techniques.

The study was designed to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine (A100) in infiltration and inferior alveolar nerve block (IANB) anesthetic techniques for the pain control during extraction of the mandibular posterior teeth. This prospective randomized single-blind clinical trial included 100 patients needing extraction of at least two mandibular molars. Patients received either infiltration in the buccal vestibule opposite to the first molar supplemented with lingual infiltration or standard IANB with A100. For assessment of depth of anesthesia obtained by the two anaethetic techniques, presence or absence of pain during the extraction were rated using the visual analog scale. Fifty patients received infiltration anesthesia and fifty patients were anesthetized by IANB. The success rate of pain-free extraction after buccal infiltration was 94%, whereas by using IANB with the same anesthetic it was 92%. No statistical differences were detected in the success rates between the two anesthetic techniques (P=0.15). Buccal Infiltration can be considered a good option during extraction of the mandibular molar and premolar teeth of course, with supplemental lingual anesthesia.

Comparison of Preoperative Oral Ketorolac on Anesthetic Efficacy of Inferior Alveolar Nerve Block and Buccal and Lingual Infiltration with Articaine and Lidocaine in Patients with Irreversible Pulpitis: A Prospective, Randomized, Controlled, Double-blind Study

IntroductionIrreversible pulpitis (IP) commonly results in decreased anesthetic efficacy of the inferior alveolar nerve block (IANB) for mandibular molar. It has been shown that supplementary buccal and/or lingual infiltration as well as premedication with ketorolac result in improved efficacy of the IANB. MethodsOne hundred fifty emergency patients who had their lower first or/and second molar diagnosed with IP participated in the study. All patients were randomly divided into 2 major IANB groups: 1 group received 4% articaine with 1:100,000 epinephrine, and the other group received 2% lidocaine with 1:80,000 epinephrine. Each group was further divided into 3 subgroups of 25 each: (1) buccal and lingual infiltration with articaine and lidocaine, respectively; (2) preoperative oral medication of ketorolac; and (3) preoperative oral medication of ketorolac followed by buccal and lingual infiltration with articaine and lidocaine, respectively. Endodontic access was initiated 15 minutes after solution deposition, and all patients were required to have profound lip numbness. Success of the anesthetic was defined as none or mild pain on endodontic access and initial instrumentation. ResultsStatistical analysis was performed using multiple-comparison analysis of variance (Kruskal-Wallis) and t tests. Articaine IANB with infiltrations plus oral ketorolac premedication significantly increased the success rate to 76%. The success rate after the administration of an articaine IANB with infiltration injections was 64%, whereas with lidocaine it was 32% (P < .05). ConclusionsPremedication with ketorolac significantly increases the anesthetic efficacy of articaine IANB plus infiltration in mandibular molars with IP.

Fixed Partial Denture Treatment With Mini Dental Implants

Fixed Partial Denture Treatment With Mini Dental Implants

Articaine (4%) Buccal Infiltration versus Lidocaine (2%) Inferior Alveolar Nerve Block for Mandibular Teeth Extraction in Patients on Warfarin Treatment

Background: Although lidocaine inferior alveolar nerve block is a common dental injection in case of managing mandibular teeth, it may not be the first choice in specific situations. Patients on warfarin therapy are at high risk of bleeding during dental procedures. In this study we aimed to investigate and compare the efficacy of articaine buccal infiltration in mandibular teeth extraction with lidocaine inferior alveolar nerve block for extraction of mandibular teeth in patients on warfarin treatment. Methods: Patients included in the present study were on warfarin treatment and referred for simple dental extraction. Patients were divided randomly in two groups, one group received standard inferior alveolar nerve block (1.8 ml of 2% lidocaine with 1:80,000 adrenaline) and the second group received buccal infiltration supported with lingual infiltration using 4% articaine and 1:100,000 adrenaline. Data was analyzed by descriptive analysis using SPSS program V.17. A Mann-Whitney U test to compare the results and p value of less than 0.05 was considered significant. Results: A total of 23 adult patients (10 women and 13 men) aged 40 to 57 years (mean=48.9) were recruited into the study with 6 excluded as they needed a second local anesthetic cartridge to obtain profound anesthesia. The success rate of inferior alveolar nerve block using lidocaine was 81.8% while the success rate for articaine buccal infiltration in obtaining good profound pulpal anesthesia was 66.6%. Both surgeons and patients were satisfied with anesthesia using both drugs. Conclusion: Buccal infiltration of 4% Articaine for mandibular teeth can have a high success rate using one local anesthetic cartridge, and is considered a good alternative option for nerve block in patients on warfarin treatment to avoid complication related to the nerve block.

The effectiveness of an additional lingual infiltration in the pulpal anesthesia of mandibular teeth: a systematic review.

The aim of this systematic review is to investigate the effect of an additional lingual infiltration on the pulpal anesthesia of mandibular teeth. Prospective clinical trials were searched from Medline, EMBASE, Cochrane Library, Pubmed, SCI, and the China National Knowledge Infrastructure. Papers that met the inclusion criteria were accepted. Data was extracted by two investigators using a designed extraction form. The anesthetic efficacy of an additional lingual infiltration on the pulpal anesthesia of mandibular teeth was analyzed. Seven prospective randomized controlled trials were included. All subjects of these studies were volunteers with healthy pulps, without patients with pulpitis. Compared to buccal infiltration alone, an additional lingual infiltration following buccal infiltration is more likely to achieve a successful pulpal anesthesia in the mandibular incisor area, with a relative risk for success of 2.00 [1.08, 3.72] for 2% lidocaine and 1.32 [1.15, 1.51] for 4% articaine. For mandibular canines and premolars, the additional lingual infiltration following inferior alveolar nerve block did not enhance the anesthetic efficacy. In the mandibular molar area, no significant difference was found after an additional lingual infiltration with either 2% lidocaine or 4% articaine. An additional lingual infiltration following buccal infiltration can enhance the anesthetic efficacy compared with buccal infiltration alone in the mandibular incisor area. For mandibular canines, premolars, and molars, an additional lingual infiltration is not recommended, since no data exist to support such usage. Lingual infiltration of articaine in the mandibular teeth with pulpitis should be studied further.

Anaesthetic efficacy of supplemental lingual infiltration of mandibular molars after inferior alveolar nerve block plus buccal infiltration in patients with irreversible pulpitis

To investigate the effect of supplemental lingual infiltration (LI) of mandibular molars following an inferior alveolar nerve block (IANB) plus buccal infiltration (BI) in patients with irreversible pulpitis. Eighty adult patients diagnosed with irreversible pulpitis participated in this prospective study. All patients received standard IANB via injection of 4 mL of 2% lidocaine with 1 : 100,000 epinephrine. Ten minutes after the IANB, patients with numbness of the lower lip were randomly divided into two groups. In the BI group, 40 patients received supplemental BI of 0.9 mL of 4% articaine with 1 : 100,000 epinephrine. In the buccal plus lingual infiltration (BLI) group, 40 patients received supplemental BI of 0.9 mL of 4% articaine with 1 : 100,000 epinephrine and, subsequently, LIs with the same anaesthetic solution and dose. Endodontic access cavity preparation began 15 min after the IANB. Pain during treatment was recorded using a Heft-Parker visual analogue scale. Success was defined when pain was 'none' or 'mild' on endodontic access and initial instrumentation. The pain was estimated and statistically analysed by the chi-squared test (α = 0.05). The success rates for the BI and BLI groups were 70% and 62.5%, respectively. No statistical difference was found between the two groups (P = 0.478). Supplemental LIs are not recommended for administration in mandibular molars with irreversible pulpitis, because they do not improve the anaesthetic success after IANB plus BI.

Bulbar muscle weakness and fatty lingual infiltration in glycogen storage disorder type IIIa

Glycogen storage disorder type III (GSD III) is a rare autosomal recessive disorder resulting from a deficiency of glycogen debranching enzyme, critical in cytosolic glycogen degradation. GSD IIIa, the most common form of GSD III, primarily affects the liver, cardiac muscle, and skeletal muscle. Although skeletal muscle weakness occurs commonly in GSD IIIa, bulbar muscle involvement has not been previously reported. Here we present three GSD IIIa patients with clinical evidence of bulbar weakness based on instrumental assessment of lingual strength. Dysarthria and/or dysphagia, generally mild in severity, were evident in all three individuals. One patient also underwent correlative magnetic resonance imaging (MRI) which was remarkable for fatty infiltration at the base of the intrinsic tongue musculature, as well as abnormal expansion of the fibro-fatty lingual septum. Additionally, we provide supportive evidence of diffuse glycogen infiltration of the tongue at necropsy in a naturally occurring canine model of GSD IIIa. While further investigation in a larger group of patients with GSD III is needed to determine the incidence of bulbar muscle involvement in this condition and whether it occurs in GSD IIIb, clinical surveillance of lingual strength is recommended.

The use of the mandibular infiltration anesthetic technique in adults

The author describes the use of the infiltration anesthetic technique to anesthetize mandibular teeth in adults and explores its mechanism of action. The author reviewed articles describing randomized controlled trials of the mandibular infiltration anesthetic technique in healthy participants. The author found that using the mandibular infiltration anesthetic technique can produce anesthesia in adult mandibular teeth. The success was dose dependent and the choice of anesthetic solution was significant; 4 percent articaine with 1:100,000 epinephrine was more effective than 2 percent lidocaine with 1:100,000 epinephrine. Combining buccal and lingual infiltrations increased success in the mandibular incisor region. The success of the mechanism of infiltration of anesthetic at the mandibular first molar appeared to depend on the mental foramen. The mandibular infiltration anesthetic technique is an effective method of anesthetizing mandibular incisors. Four percent articaine with epinephrine appears to be the preferred solution. The choice of anesthetic solution is important when using the infiltration anesthetic technique in the adult mandible.

Buccal versus lingual articaine infiltration for mandibular tooth anaesthesia: a randomized controlled trial

To compare the effectiveness of buccal and lingual local anaesthetic injections in the mandibular first molar region in obtaining pulpal anaesthesia in mandibular teeth. Twenty healthy volunteers received 1.8 mL of 4% articaine with 1 : 100,000 epinephrine as a buccal or lingual infiltration in the mandibular first molar region in a randomized double-blind cross-over design. The responses of the first molar, a premolar and the lateral incisor teeth were assessed using an electronic pulp tester over a 47-min period. Successful anaesthesia was defined as no response to maximum stimulus from the pulp tester on two or more consecutive tests. Success between techniques was analysed using the McNemar test and variations between teeth were compared with Chi-square. The number of no responses to maximum stimulation from an electronic pulp tester was significantly greater for all test teeth after the buccal injection compared with the lingual approach (P < 0.001). Successful anaesthesia was more likely following the buccal infiltration compared with the lingual method for molar (65% and 10%, respectively) and premolar (90% and 15%, respectively) teeth. There was no difference in anaesthetic success for the lateral incisor. Buccal infiltration at the first mandibular molar is more effective than lingual infiltration in the same region in obtaining anaesthesia of the mandibular first molar and premolar teeth.

The efficacy of infiltration anaesthesia for adult mandibular incisors: a randomised double-blind cross-over trial comparing articaine and lidocaine buccal and buccal plus lingual infiltrations

To compare the efficacy of 2% lidocaine and 4% articaine both with 1:100,000 adrenaline in anaesthetising the pulps of mandibular incisors. Thirty-one healthy adult volunteers received the following local anaesthetic regimens adjacent to a mandibular central incisor: 1) buccal infiltration of 1.8 mL lidocaine plus dummy lingual injection (LB), 2) buccal plus lingual infiltrations of 0.9 mL lidocaine (LBL), 3) buccal infiltration of 1.8 mL articaine plus dummy lingual injection (AB), 4) buccal plus lingual infiltrations of 0.9 mL articaine (ABL). Pulp sensitivities of the central incisor and contralateral lateral incisor were assessed electronically. Anaesthetic efficacy was determined by two methods: 1) Recording the number of episodes with no responses to maximal electronic pulp tester stimulation during the course of the study period, 2) recording the number of volunteers with no response to maximal pulp tester stimulation within 15 min and maintained for 45 min (defined as sustained anaesthesia). Data were analysed by McNemar, chi-square, Mann-Whitney and paired t-tests. For both test teeth, the number of episodes of no sensation on maximal stimulation was significantly greater after articaine than lidocaine for both techniques. The split buccal plus lingual dose was more effective than the buccal injection alone for both solutions (p <0.001). 4% articaine was more effective than 2% lidocaine when comparing sustained anaesthesia in both teeth for each technique (p <0.001), however, there was no difference in sustained anaesthesia between techniques for either tooth or solution. 4% articaine was more effective than 2% lidocaine (both with 1:100,000 adrenaline) in anaesthetising the pulps of lower incisor teeth after buccal or buccal plus lingual infiltrations.

Anesthetic Efficacy of Articaine for Combination Labial Plus Lingual Infiltrations versus Labial Infiltration in the Mandibular Lateral Incisor

Introduction Previous studies have shown higher success rates when using an articaine formulation versus a lidocaine formulation for buccal mandibular first molar infiltrations. However, there is little information on articaine's effect in mandibular anterior teeth. Methods The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 2 sets of mandibular lateral incisor infiltrations given in 2 separate appointments in 82 adult subjects. One set of infiltrations consisted of an initial labial infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine plus a lingual infiltration of the same anesthetic and dose. The other set of infiltrations consisted of an initial labial infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine plus a mock lingual infiltration. The authors used an electric pulp tester to test the lateral incisor for pulpal anesthesia in 2-minute cycles for 60 minutes after the injections. Results and Conclusions The labial plus lingual infiltration significantly improved the success rate (no response to 2 consecutive 80 readings with the pulp tester) to 98% when compared with a labial infiltration of a cartridge of the same articaine formulation (76% success). The combination labial and lingual infiltrations did not provide pulpal anesthesia for an hour.