Mandibular Infiltration Research Articles

Articaine and lignocaine

Cochrane Central, Medline, Embase, and ProQuest Health and Medical Complete, the metaRegister of the controlled trials database and a leading manufacturer. Randomised controlled trials in patients requiring non-complex routine dental treatments comparing 4% articaine (1:100,000 epinephrine) with 2% lignocaine (1:100,000 epinephrine) for maxillary and mandibular infiltrations and block anaesthesia were included. The principal outcome measures were anaesthetic success, onset of action, post-injection adverse events or post-injection pain. Following data abstraction a meta-analysis was performed using random-effects model. Eight studies were included in a meta-analysis. Articaine is more likely than lignocaine to achieve an anaesthetic success in the posterior first molar area, with a relative risk for success of 1.31 (95% CI 1.12-1.54, P=0.0009). There is no difference in post-injection adverse events between articaine and lignocaine with a relative risk of 1.05 (95% CI 0.66-1.65, P=0.85). However, articaine injection results in a higher pain score as measured by Visual Analogue Scale than lignocaine at the injection site, after anaesthetic reversal, with a weighted mean difference of 6.49 (95% CI 0.02-12.96, P=0.05) decreasing to 1.10 (95% CI 0.18-2.02, P=0.02) on the third day after injection. The results of this systematic review provide support for the argument that articaine is more effective than lignocaine in providing anaesthetic success in the first molar region for routine dental procedures. In addition, both drugs appear to have similar adverse effect profiles. The clinical impact of articaine's higher post-injection pain scores than lignocaine is negligible. Hence, articaine is a superior anaesthetic to lignocaine for use in routine dental procedures. Use in children under 4 years of age is not recommended, since no data exist to support such usage.

The efficacy and safety of articaine versus lignocaine in dental treatments: A meta-analysis

Objectives Although articaine has been recommended for providing an improved local anaesthetic effect in patients presenting for dental treatments, a relevant meta-analysis has been lacking. Despite articaine's popularity, there is contradictory evidence to support the claims. The aim of this systematic review was to compare the efficacy and safety of articaine with lignocaine in maxillary and mandibular infiltrations and block anaesthesia in patients presenting for routine dental treatments. Data sources The following databases were searched: Cochrane Central, Medline, Embase, and ProQuest Health and Medical Complete. In addition, the metaRegister of the controlled trials database was searched to identify dissertations and ongoing or unpublished trials, and the Australian division of Septodont (the manufacturer of articaine and lignocaine) was contacted. The bibliographies of identified articles were also searched. Study selection Inclusion was limited to: (1) randomized controlled trials in patients requiring non-complex routine dental treatments; (2) interventions comparing 4% articaine (1:100,000 epinephrine) with 2% lignocaine (1:100,000 epinephrine) for maxillary and mandibular infiltrations and block anaesthesia; and (3) with principal outcome measures of anaesthetic success, post-injection adverse events or post-injection pain. Trial quality was evaluated by assessing randomization, allocation concealment, blinding, intention to treat analyses and how losses to follow up were addressed. Treatment effects were combined by meta-analysis using the random effects method. Results Articaine is more likely than lignocaine to achieve an anaesthetic success in the posterior first molar area with a relative risk for success at 1.31 (95% CI 1.12–1.54, P = 0.0009). There is no difference in post-injection adverse events between articaine and lignocaine with a relative risk of 1.05 (95% CI 0.66–1.65, P = 0.85). However, articaine injection results in a higher pain score as measured by Visual Analogue Scale, than lignocaine at the injection site after anaesthetic reversal with a weighted mean difference of 6.49 (95% CI 0.02–12.96, P = 0.05) decreasing to 1.10 (95% CI 0.18–2.02, P = 0.02) on the third day after injection. Conclusion The results of this systematic review provide support for the argument that articaine is more effective than lignocaine in providing anaesthetic success in the first molar region for routine dental procedures. In addition, both drugs appear to have similar adverse effect profiles. The clinical impact of articaine's higher post-injection pain scores than lignocaine is negligible. Hence, articaine is a superior anaesthetic to lignocaine for use in routine dental procedures. Use in children under 4 years of age is not recommended, since no data exists to support such usage.

Evaluation of mandibular infiltration versus mandibular block anaesthesia in treating primary canines in children

The objectives of this study were to determine the effectiveness of mandibular infiltration compared with mandibular block in treating primary canines in children and to relate the effectiveness to the type of treatment performed. A total of 89 children, 6-9 years old, requiring identical treatment on contralateral mandibular canines were selected. The split mouth study design was used. The anaesthetic used in both techniques was 2% lidocaine solution with 1 : 80,000 epinephrine. Dental procedures included class III, IV, and V restorations, formocresol pulpotomies, and extractions. Child's pain reaction and behaviour for each anaesthesia technique and the type of treatment were rated at certain intervals of treatment using sounds, motor, and ocular changes indicating pain and the Frankl Behaviour Rating Scale. Evaluations were made upon injection, probing, rubber dam placement, and during tooth preparation and extraction. No statistically significant difference was found between the two anaesthetic techniques for either pain or behaviour at all evaluation intervals (P > 0.05), during the performance of restorations, pulpotomies, or during extractions. Mandibular infiltration anaesthesia is as effective as mandibular block for restoration, pulpotomy, and extraction in primary canines. The mandibular infiltration anaesthesia was not significantly less painful than the mandibular block.

The Efficacy of Six Local Anesthetic Formulations Used for Posterior Mandibular Buccal Infiltration Anesthesia

The authors conducted a randomized, double-blind clinical trial to evaluate pulpal anesthesia achieved after mandibular infiltration of five commonly marketed dental local anesthetic formulations as compared with a control formulation of lidocaine with epinephrine. The authors evaluated 2 percent lidocaine with 1:100,000 epinephrine (L100) against 4 percent articaine with 1:100,000 epinephrine (A100), 4 percent articaine with 1:200,000 epinephrine (A200), 4 percent prilocaine with 1:200,000 epinephrine (P200), 3 percent mepivacaine without vasoconstrictor (Mw/o) and 0.5 percent bupivacaine with 1:200,000 epinephrine (B200). This repeated-treatment trial involved 18 healthy participants. The investigators administered mandibular infiltration injections (six sessions per participant) of 0.9 milliliters of anesthetic into the buccal fold adjacent to the distal root of the mandibular first molar. The authors determined anesthetic efficacy across a 20-minute period by measuring changes in sensory threshold to electrical pulp test (EPT) stimulation. Twelve female and six male participants (mean age, 24.9 years; range, 18-53 years) completed the study. The maximum mean increase from baseline of EPT measurements for the six formulations were 43.5 percent for L100, 44.8 percent for B200, 51.2 percent for P200, 66.9 percent for A200, 68.3 percent for Mw/o and 77.3 percent for A100 (A100 versus L100, P = .029). Adverse reactions were minor and not formulation dependent. The authors found that mandibular infiltration with 0.9 mL of the tested dental anesthetics could induce only partial pulpal anesthesia, a level likely to be inadequate for most dental procedures. When compared with L100, only the A100 induced statistically greater pulpal anesthesia after mandibular buccal infiltration.

Evaluation of Mandibular Infiltration Compared to Mandibular Block Anesthesia in Pediatric Dentistry

Aims: The aim of this study is to determine the effectiveness of mandibular infiltration compared with the mandibular block in treating mandibular primary molars in children and to relate it to the type of treatment performed. Materials and Methods: The study design was case control study. The study sample consisted of 98 cooperative children of age 3-9 years old. Forty eight children were the study group (infiltration group). Equal number of children to the study group matched for age and gender were chosen (block group), they had the same criteria of the study group and required the same type of treatment. Dental procedure included amalgam restorations, foromcresol pulpotomies, and extractions. Evaluations of pain for each anesthesia technique and type of treatment were conducted using sounds; motor and ocular changes indicating pain. Evaluations were made upon probing, during tooth preparation, coronal pulp removal and extraction. Results: No statistically significant difference was found between the two anesthetic techniques of pain, when performing amalgam restorations (p>0.05). Mandibular infiltration was significantly less effective than mandibular block for pulpotomy and extraction (p<0.05). Conclusions: In this study, the mandibular infiltration was found to be a reliable local anesthetic technique in amalgam restoration. For pulpotomy and extraction, mandibular infiltration was not as effective as mandibular block. It is recommended to avoid the mandibular infiltration anesthesia, whenever possible for pulpotomy or extraction procedure in primary molars.

Site-specificity of pain sensitivity to intraoral anesthetic injections in children

A total of 455 children (242 males and 213 females) aged 5-6 years were investigated for their pain reactions to maxillary and mandibular infiltration anesthesia, middle superior alveolar nerve block, posterior superior alveolar nerve block, greater palatine nerve block, nasopalatine nerve block, and inferior alveolar nerve block, and the responses were quantified using the sound, eye and motor (SEM) scale. Administration of nasopalatine nerve block produced maximum pain (median SEM score: 10) while that of posterior superior alveolar nerve block and inferior alveolar nerve block was accompanied by minimum pain (3 and 4, respectively). There was no significant gender-specific difference in pain reactions (P = 0.39). Administration of local anesthesia in the maxilla was more painful than injections into the mandible (7 versus 5, P < 0.05). Furthermore, infiltration into the anterior and posterior segments of the maxilla produced maximum and minimum pain reactions, respectively (8 versus 3, P < 0.001). It seems that the anatomical location of an injection is one of the most important determinants of pediatric pain reaction, and that mandibular injections are generally less painful. Prioritization of treatment by consideration of site-dependent variability in pain sensitivity may help to achieve optimal behavioral control during dental treatment in young children.

Large infiltration of chronic lymphocytic leukemia in the mandibular region

Orofacial complications of leukemia include lymphadenopathy, gingival bleeding, petechiae, ulceration, gingival enlargement and infections. Chronic lymphocytic leukemia (CLL) is the most prevalent type of adult lymphoproliferative disorder, but oral manifestations are uncommon. We describe a rare case of extensive mandibular infiltration in chronic lymphocytic leukemia.

Alternative to the inferior alveolar nerve block anesthesia when placing mandibular dental implants posterior to the mental foramen.

Local anesthesia block of the inferior alveolar nerve is routinely taught throughout dental education. This commonly used technique eliminates all somatosensory perception of the mandible, mandibular teeth, floor of the mouth, ipsilateral tongue, and all but the lateral (buccal) gingivae. Generally, the dentist or surgeon desires these structures to be anesthetized. However, in the placement of mandibular implants, it may be useful for the patient to be able to sense when the inferior alveolar nerve is in danger of being damaged, possibly producing permanent paresthesia. In this article, the technique of mandibular infiltration prior to mandibular implant placement in the mandible is discussed.

The role of computed tomography in the preoperative assessment and follow-up of oromandibular reconstruction with microvascular osteomyocutaneous free flaps.

To investigate the capacity of helical CT in the pre- and post-operative management of oromandibular reconstruction of patients with oropharyngeal carcinoma using microvascular composite free flaps. Thirty-four patients with oropharyngeal cancer were examined by helical CT and nine (six men and three women) submitted to oromandibular reconstruction. The osteomyocutaneous flaps used for reconstruction were taken from the iliac crest in six cases and from the fibula in three cases. All patients were examined by CT 1 - 4 days postoperatively and then at 6 monthly intervals. Double helical scans were performed in all cases, with slices of 2 - 3 mm for primary lesion studies and 5 mm for lymph node staging, pitch >/=1 and RI=1. Multiplanar (MPR) and 3D reconstructions were obtained from pre- and postoperative CT examinations. Preoperative CT showed massive bone infiltration in six of the nine surgical patients and marginal infiltration in three. These findings were confirmed histologically. There were no false negatives. The immediate postoperative examination showed correct flap positioning in eight of nine cases. The flap underwent ischemic necrosis in two cases; CT showed very early signs of bone ischemia in both. CT detected two cases of recurrence after about 1 year. Axial CT permitted adequate assessment of the extent of mandibular infiltration and detected early ischemic complications and distant recurrences. Integration with MPR and 3D reconstructions simplified the choice of flap type and size and enabled the postoperative assessment of correct flap positioning. This helped the surgeon plan subsequent rehabilitation with osseo-integrated implants.

Correlation of imaging and clinical features in the assessment of mandibular invasion of oral carcinomas

The detection in the mandible of early local spreading of adjacent primary malignancies poses a difficult problem. A survey of 60 patients suspected of carcinomatous mandibular infiltration was undertaken, and the most important clinical and imaging data were studied. Tumor localization and bone scintigraphy proved to offer the most important predictive power. A decision tree and a logistic regression model which determines a score function combining these characteristics were designed. This decision tree improves the sensitivity and specificity of the preoperative assessment and provides the surgeon with an algorithm for the accurate estimation of early mandibular invasion.

口腔癌の下顎骨浸潤症例に対する放射線とｂｌｅｏｍｙｃｉｎ併用療法の効果

The effect of concurrent combined treatment with 22.5 Gy of radiation and 110 mg of bleomycin or 55mg of peplomycin on oral carcinoma involving the mandible was examined histologically.In 14 of 18 patients who had mandibles resected after this combined treatment, bone invasion by carcinoma was observed histologically. According to Shimosato's classification of histological effects, 3 belonged to Grade III/IV, 4 to II b, 3 to II a and 4 to I. The formation of new bone that was considered to be reparable was observed in the marked effective patients.In 4 patients the Grade II b, residual surviving cancer cells were observed in the mandible.Accordingly, excision was needed in the area of radiologic features of mandibular infiltration. But it is considered that although the excision scope for the patient who has received the preoperative treatment is the same as that for the patient who has not, it is advantageous for the former patient that a wider safety region is obtained.