Maxillary Infiltration Anesthesia Research Articles

IDF21-0660 Efficacy and safety of intraoral maxillary infiltration anesthesia in patients with diabetes mellitus type 2

Background: Results of experimental studies show that local anesthetics (LA), even in clinically applicable concentrations, cause more pronounced damage to the peripheral nerves in the presence of DM, with clinically observable changes in parameters of regional anesthesia. Attempts that are made to to minimize risk for LA – induced aggravation of preexisting neuropathy include reduction of the concentration and maximal dose of LA, as well as avoidance of epinephrine as a vasoconstrictor. Intraoral local anesthesia is considered to be more safe in comparison with local anesthesia in general surgery, considering the amount and concentration of LA and vasoconstrictors used.

Efficacy of external cold and a vibrating device in reducing pain and anxiety during local anaesthesia.

Background and Aim:To evaluate and compare the efficacy of external cold and a vibrating device in reducing the pain and anxiety amidst children receiving maxillary infiltration anaesthesia over conventional methods.Method:A sum of thirty subjects aged between 5 and 10 years who had undergone dental procedures requiring maxillary infiltration were enrolled in the current split-mouth randomised control study. The control intervention constitutes infiltration of 1.8 mL of 2% lignocaine in addition to 1:100,000 adrenaline (Lox, Neon Laboratories Mumbai, India) whereas, the experimental group used external cold and a vibrating device (Buzzy®, MMJ Labs, Atlanta, GA, USA) in annexation to the control protocol. Simultaneous to LA administration, pulse rate was employed as an objective measure and the subjective measure was recorded using RMS Pictorial Scale (RMS-PS) for the child’s discomfort. To document the child’s pain as anticipated by the dentist the revised face, limbs, arms, cry and consolability (FLACC-R) scale was employed.Result:Lower pain sensation and anxiety was recorded in the experimental group using Buzzy when compared to control.Conclusion:External cold in adjacent with vibrations might be efficient in lowering pain as well as anxiety in children experiencing infiltration dental anaesthesia though further research work is requisite with a larger sample size.

Effect of Premedication with Ibuprofen, Paracetamol and Diclofenac Sodium on the Outcome of Maxillary Infiltration Anaesthesia in Patients with Irreversible Pulpitis- A Double-blind Randomised Controlled Trial

Introduction: The most important aspect of endodontic treatment is pain control. The quest for newer ways of pain control is always a topic of interest among the researchers. Though local anaesthesia proved to be the effective method of pain control, there are many instances of failure to achieve successful anaesthesia even with proper technique of administration in cases of irreversible pulpitis. Aim: To determine the effect of Preoperative Oral Administration of Paracetamol (PARA), Ibuprofen (IBUP) or Diclofenac Sodium (DS) on the success of maxillary infiltration anaesthesia in patients with irreversible pulpitis in a double-blinded randomised controlled trial. Materials and Methods: One hundred and twenty patients having irreversible pulpitis of a maxillary first molar were selected for this prospective, randomised, double-blind, placebo-controlled study. Patients indicated their pain scores on a Heft Parker visual analog scale, after which they were randomly divided into four groups (n=30). The subjects received identical capsules containing either 500 mg PARA, 400 mg IBUP, 50 mg DS or 400 mg lactose powder (placebo, PLAC), 1 hour before administration of maxillary infiltration anaesthesia with 2% lidocaine containing 1:80,000 epinephrine. Access cavities were then prepared and anaesthesia was defined as successful if pain is absent or patient has mild pain during access preparation and pulp extirpation. The data was analysed using two-way ANOVA and Tukey’s multiple post-hoc tests. p-value at <0.05 to be considered significant. Results: The success rates in descending order were 65% (IBUP), 60.83% (DS), 58.33% (PARA), and 20% (PLAC). A significant (p-value 0.0001) difference was found between the drug groups and the PLAC group. Conclusion: Preoperative administration of PARA (500 mg), IBUP (400 mg), and DS (50 mg) significantly improved the efficiency of maxillary infiltration anaesthesia in patients with irreversible pulpitis.

Comparison of Local Anesthetic Efficiency of Tramadol Hydrochloride and Lidocaine Hydrochloride

This study investigated the local anesthetic efficiency of tramadol versus lidocaine hydrochloride in maxillary infiltration anesthesia. This study was a randomized double-blinded study involving 50 healthy volunteers. In the experimental part of this study, each volunteer received a buccal 0.5-mL injection of tramadol hydrochloride 25mg on one side and a buccal 0.5-mL injection of vasoconstrictor-free lidocaine hydrochloride 20mg on the other side. No other treatment was performed. After the injections, total duration of anesthesia, start and finish times of anesthesia, soft tissue (sensory) innervation, depth of anesthetic, possible side effects, and satisfaction levels were recorded from all volunteers. There was no relevant difference between solutions for total anesthesia duration and peak values. However, statistically, the effect of lidocaine started and ended early. The efficacy of tramadol was markedly more effective in the gingiva and skin, especially at 15 and 20minutes, compared with lidocaine. Both anesthetic agents were well tolerated by the volunteers. Tramadol hydrochloride can be a good alternative to local anesthetic agents and beneficial to support anesthesia during long operations.

A Clinical Study on the Effect of Injection Sites on Efficacy of Anesthesia and Pulpal Blood Flow in Carious Teeth.

This randomized clinical trial evaluated the efficiency of maxillary infiltration anesthesia in carious teeth at two different injection sites and their impact on the laser Doppler recordings of pulpal blood flow (PBF) during a caries excavation procedure. The null hypothesis tested was that there are no differences in the efficiency of anesthesia and PBF reduction between maxillary infiltrations at the two injection sites. One hundred twenty patients were divided into three groups according to the degree of carious lesion of their maxillary left central incisors (moderate caries, deep caries, or no caries). Forty patients in each group randomly received infiltrations over the root apex of maxillary left central incisors (site X) or over the midpoint of the line connecting the root apexes of both maxillary left central and lateral incisors (site Y) using 0.9 mL 2% lidocaine with 1:100,000 adrenaline. Teeth were pulp tested at five-minute intervals after injection except for the period of cavity cutting, which was done 12 minutes after injection. The PBF changes after injection were monitored by laser Doppler flowmetry. The observation period in this study was 60 minutes. Success of anesthesia was defined as no or mild pain on cavity cutting by visual analog scale recordings. Deep caries group showed significantly higher baseline PBF ( p<0.05). All groups showed 100% success of anesthesia and similar duration time ( p>0.05). Subgroups that had the injection at site Y showed significantly less reduction of PBF ( p<0.05). Cavity-cutting procedures increased the amplitude of the PBF around the lowest value after injection. Independent of the cavity depth, carious anterior teeth anesthetized by infiltration further from the apex had significantly less reduction on the pulpal blood flow compared with teeth anesthetized by infiltration at the apex.

Epinephrine Affects Pharmacokinetics of Ropivacaine Infiltrated Into Palate.

Pulpal anesthesia success rates for ropivacaine following maxillary infiltration anesthesia seem to be low. We investigated the hypothesis that the addition of epinephrine would affect the pharmacokinetics of ropivacaine by retaining ropivacaine in the mucosa of the injected area through the time-dependent distribution of ropivacaine in the rat maxilla and serum following maxillary infiltration anesthesia using (3)H-labeled ropivacaine. We then examined the vasoactivity of ropivacaine with or without epinephrine on local peripheral blood flow. The addition of epinephrine to ropivacaine increased ropivacaine concentrations in the palatal mucosa and adjacent maxilla by more than 3 times that of plain ropivacaine at 20 minutes. By observing the autoradiogram of (3)H-ropivacaine, plain ropivacaine in the maxilla was remarkably reduced 20 minutes after injection. However, it was definitely retained in the palatal mucosa, hard palate, adjacent maxilla, and maxillary nerve after the administration with epinephrine. Ropivacaine with epinephrine significantly decreased labial blood flow. This study suggests that 10 μg/mL epinephrine added to 0.5% ropivacaine could improve anesthetic efficacy and duration for maxillary infiltration anesthesia over plain ropivacaine.

Comparative Effects of Clonidine and Adrenaline with Lignocaine during Maxillary Infiltration Anaesthesia for Dental Extraction.

Lignocaine is a commonly used local anaesthetic in dental practice. Many practitioners use adrenaline (epinephrine) as additive with lignocaine, and some have used clonidine, instead of adrenaline. Both having benefits and limitations. Hence a study was undertaken in our department to evaluate the advantages and disadvantages of using (plain lidocaine local anaesthetic) versus (lidocaine with adrenaline as additive) versus (lidocaine with clonidine as additive). Randomised, prospective, double blind study. Seventy five patients requiring extraction of maxillary molar teeth who fall under ASA I category were included and randomly divided into group - I (n=25) (Lignocaine), group - II (n=25) (Lignocaine ± Adrenaline) and group - III (n=25) (Lignocaine ± Clonidine). The observations recorded were, time of onset of anaesthesia, hemodynamic parameters, blood loss during procedure and duration of post operative analgesia. The statistical analysis was carried out using SPSS 16 software. A statistically significant difference was seen in blood loss, being higher in group I and duration of anaesthesia, being shortest in group I. There was no statistical difference between the three groups amongst other parameters. Adrenaline at 10 μg/ml and clonidine at 15 μg/ml can be safely used as additives with lignocaine, in maxillary infiltration anaesthesia for dental extraction; with addition of either of these two drugs, having an equal advantage over use of plain lignocaine; in terms of lower blood loss and longer duration of anaesthesia; but, with no difference in the onset of anaesthesia and with no significant hemodynamic changes.

Effects of Epinephrine on Lidocaine Pharmacokinetics and Blood Volume in the Dental Pulp

IntroductionEpinephrine potentiates and prolongs the efficacy of local anesthetics by reducing blood flow. We investigated the effect of epinephrine on the pharmacokinetics of lidocaine and the pulpal blood volume after maxillary infiltration anesthesia in rats. MethodsWe measured the 14C-radioactivity and 14C-distribution in the maxilla and the dental pulp after the injection of 2% 14C-lidocaine with or without 10 μg/mL epinephrine (n = 7) into the palatine mucosa proximal to the first molar. The blood volume in the pulp was measured using 99mTc-pertechnetate (n = 5). ResultsWhen lidocaine was injected together with epinephrine, the lidocaine became widely distributed throughout the maxilla and was observed mainly in the first molar pulp. The lidocaine amount in the dental pulp at 10–60 minutes was more than 2 times higher than that after the injection of lidocaine alone. The relative pulpal blood volume after 20 minutes decreased to 63.1% of the value after the injection of lidocaine alone. ConclusionsWe found that lidocaine had infiltrated into the molar pulp after infiltration anesthesia. Furthermore, our results suggested that epinephrine augmented the retention of lidocaine in the pulp.

The Local Pharmacokinetics of 3H-Ropivacaine and 14C-Lidocaine After Maxillary Infiltration Anesthesia in Rats

The effects of infiltration anesthesia with ropivacaine on the dental pulp are considered to be weak. This may be partly associated with its permeation into the oral tissue. With the objective of investigating the local pharmacokinetics of ropivacaine and lidocaine following infiltration anesthesia, we injected (3)H-ropivacaine or (14)C-lidocaine to the palatal mucosa in rats, measured distributions of radioactivity in the maxilla, and compared the local pharmacokinetics of these agents. The animals were sacrificed at various times and the maxillas were removed. The palatal mucosa and maxillary nerve were resected, and the bone was divided into 6 portions. We measured radioactivity in each tissue and calculated the level of each local anesthetic (n = 8). Lidocaine diffused to the surrounding tissue immediately after the injection, whereas ropivacaine tended to remain in the palatal mucosa for a longer period. Lidocaine showed a higher affinity for the maxillary bone than ropivacaine. There was a correlation between the distribution level of local anesthetics in the maxillary bone and that in the maxillary nerve. The lower-level effects of infiltration anesthesia with ropivacaine on the dental pulp may be because ropivacaine has a high affinity for soft tissue, and its transfer to bone is slight.

The efficacy of pre-operative oral medication of paracetamol, ibuprofen, and aceclofenac on the success of maxillary infiltration anesthesia in patients with irreversible pulpitis: A double-blind, randomized controlled clinical trial

Aim:To determine the effect of preoperative administration of paracetamol (PARA), ibuprofen (IBUP), or aceclofenac (ACEC) on the success of maxillary infiltration anesthesia in patients with irreversible pulpitis in a double-blinded randomized controlled trial.Materials and Methods:One hundred and twenty patients with irreversible pulpitis of a maxillary first molar participated. Patients indicated their pain scores on a Heft Parker visual analog scale, after which they were randomly divided into four groups (n = 30). The subjects received identical capsules containing 1000 mg PARA, 800 mg IBUP, 100 mg ACEC or cellulose powder (placebo, PLAC), 1 h before administration of maxillary infiltration anesthesia with 2% lidocaine containing 1:200,000 epinephrine. Access cavities were then prepared and success of anesthesia was defined as the absence of pain during access preparation and root canal instrumentation. The data were analyzed using chi-squared tests.Results:The success rates in descending order were 93.3% (IBUP), 90% (ACEC), 73.3% (PARA), and 26.5 % (PLAC). A significant (P < 0.001) difference was found between the drug groups and the PLAC group.Conclusions:Pre-operative administration of PARA, IBUP, and ACEC significantly improved the efficacy of maxillary infiltration anesthesia in patients with irreversible pulpitis.

Comparison of onset and duration of action of soft tissue and pulpal anesthesia with three volumes of 4% articaine with 1:100,000 epinephrine in maxillary infiltration anesthesia

This randomized double-blind investigation was conducted to compare the onset and duration of action of soft tissue and pulpal anesthesia with three volumes of 4% articaine with 1:100,000 epinephrine in maxillary infiltration anesthesia. The injection discomfort associated with three volumes of infiltration anesthesia was also assessed. A total of 10 subjects received 0.6mL (group 1), 0.9mL (group 2), and 1.2mL (group 3) of the anesthetic buccal to the upper canine. Test teeth were assessed with electrical stimulation to determine onset and duration of pulpal anesthesia. Soft tissue anesthesia was assessed by pin-prick test, and injection discomfort was assessed using a visual analogue scale. The statistical analysis of the data recorded was carried out with one-way ANOVA and post-hoc tests. The 1.2-mL dose induced faster onset of pulpal anesthesia, a higher success rate, and a longer duration of soft tissue/pulpal anesthesia than was achieved with 0.6mL (P < 0.005). No differences in injection discomfort were observed between treatment groups. Group 3 where 1.2mL of local anesthetic was injected showed faster onset and longer duration of action of articaine. Group 3 also had longer soft tissue anesthesia as compared to groups 1 and 2. Maxillary infiltration anesthesia with articaine and epinephrine has a faster onset, a greater success rate, and a longer duration when a volume of 1.2mL is used than when volumes less than 1.0mL are used. Palatal tissues were anesthetized with the highest concentration (1.2mL) in our study (30% of cases).

Comparison of ropivacaine and articaine with epinephrine for infiltration anaesthesia in dentistry - a randomized study

To compare the efficacy, onset time and duration of maxillary infiltration anaesthesia with 0.5% plain ropivacaine or 4% articaine with epinephrine 1 : 100 000 and to determine their possible influence on cardiovascular parameters. Sixty volunteers received 1.8 mL of the anaesthetic for buccal infiltration anaesthesia of maxillary central and lateral incisors and canine teeth without caries, restorations or signs of pulpitis. The efficacy, onset time and duration of pulp anaesthesia were assessed with an electric pulp tester. The duration of numbness of the upper lip was also monitored. Blood pressure and heart rate were measured before and after administration of the solutions. The efficacy of anaesthesia of lateral and central incisors was 100% for both anaesthetics. There were insignificant differences in effectiveness of canine pulp anaesthesia. The mean onset time was significantly (P < 0.05) shorter for ropivacaine (2.22 min) when compared with articaine (4.08 min). The duration of action and soft tissue anaesthesia were also significantly (P < 0.05) longer for ropivacaine (79.2 and 264 min) when compared with articaine (63.7 and 195.2 min, respectively). Ropivacaine caused significant (P < 0.05) increases in blood pressure and heart rate. Ropivacaine (0.5%) achieved effective and long duration of uninflamed pulp and soft tissue anaesthesia. Ropivacaine could be useful for long-lasting operative procedures without the need for a vasoconstrictor.

An Unusual Pattern of Self-inflicted Injury after Dental Local Anesthesia: A Report of 2 Cases

The local anesthetics used in dentistry are considered very safe and have a low incidence of adverse reactions associated with their administration. A frequent finding by clinicians engaged in treatment of children is, following a dental appointment requiring local anesthesia to treat dental disease, a child may bite his or her lip out of curiosity associated with the unfamiliar sensation of being numb or inadvertently because no pain is felt. We describe two unusual case reports of postanesthetic self-inflicted injuries in this article. The first being the ulceration due to lip biting and the scratch injury on the chin after inferior alveolar nerve block. The second report presents an unusual scratch injury on the ala of nose following maxillary infiltration anesthesia. The common treatment modalities and the possible methods of prevention are discussed.

Anesthetic efficacy of liposomal prilocaine in maxillary infiltration anesthesia

Animal studies have shown that liposome encapsulation increases prilocaine anesthetic efficacy. This randomized, blind, crossover, three-period study evaluated the anesthetic efficacy of liposome-encapsulated 3% prilocaine, compared to 3% plain prilocaine and 3% prilocaine with 0.03IU/mL felypressin, after a 1.8-mL infiltration in the buccal sulcus of the maxillary right canine, in 32 volunteers. Anesthesia success, onset, and duration of pulpal and gingival anesthesia in the lateral incisor, and canine and first premolar were evaluated. Injection pain was assessed by a visual analog scale (VAS). Results were submitted to Kruskal-Wallis (onset and duration of pulpal anesthesia), Tukey (VAS), Friedman (duration of gingival anesthesia), and log-rank and McNemar tests (anesthesia success) (α = 5%). Liposomal prilocaine did not differ from plain prilocaine (P > 0.05), but presented lower anesthesia success and duration for canine, premolar, and gingival anesthesia (P < 0.05) than prilocaine with felypressin. Liposomal prilocaine did not differ from the other formulations concerning onset and anesthesia success for the lateral incisor (p > 0.05); plain prilocaine presented lower success rates and slower onset of anesthesia for this tooth, in comparison to prilocaine with felypressin (P < 0.05). No differences were observed among the formulations in relation to duration of anesthesia for lateral incisor, VAS scores, and onset of gingival and pulpal anesthesia for the canine and premolar (P > 0.05). In conclusion, liposomal prilocaine presents similar anesthetic efficacy in relation to plain prilocaine and lower efficacy, in comparison to prilocaine with felypressin in maxillary infiltration. Prilocaine does not seem to benefit from liposomal encapsulation.

Maxillary infiltration anesthesia

Maxillary infiltration anesthesia

Maxillary infiltration anaesthesia by ropivacaine for upper third molar surgery

The main purpose of this study was to assess the clinical efficacy and haemodynamic effects of ropivacaine for infiltration anaesthesia in patients undergoing surgical removal of upper third molars. The safety profile of ropivacaine was also studied by investigating the maximal venous plasma concentration of ropivacaine and the reactivity to ropivacaine of isolated human infraorbital arteries. Ropivacaine in concentrations of 0.5, 0.75 and 1% achieved dose-dependent parameters of maxillary infiltration aneasthesia, clinically relevant in concentrations 0.75 and 1%. Postoperative needs for analgesics were observed in 67-100% of patients. Haemodynamic parameters were stable during surgery with significant changes occuring 10 min after surgery. After maxillary infiltration of 2.0 ml 1% ropivacaine, the maximum venous plasma concentration (Cmax) was 82+/-15 microg/l. On isolated human infraorbital artery, ropivacaine (10(-4)M) induced endothelium-independent contraction. This study suggests that 0.75 and 1% ropivacaine offers adequate and safe intraoperative analgesia but not successful postoperative pain control for the surgical removal of upper third molars.

Anesthetic Efficacy of 3 Volumes of Lidocaine With Epinephrine in Maxillary Infiltration Anesthesia

The objective of this randomized double-blind investigation was to compare the anesthetic efficacy and injection discomfort of 3 volumes of 2% lidocaine with 1:100,000 epinephrine for maxillary infiltration anesthesia. A total of 25 subjects received 0.6, 0.9, and 1.2 mL of the anesthetic buccal to an upper canine. Test teeth were assessed with electrical stimulation to determine onset and duration of pulpal anesthesia; soft tissue anesthesia and injection discomfort were assessed by pin-prick test and visual analog scale (VAS). Data were analyzed by 2-way analysis of variance (ANOVA), Friedman, and chi-square tests (alpha = 5%). The 1.2 mL dose induced faster onset of pulpal anesthesia, a higher success rate, and a longer duration of soft tissue/pulpal anesthesia than were achieved with the other doses (P < .05). No differences in injection discomfort were observed between treatments. It is concluded that maxillary infiltration anesthesia with lidocaine and epinephrine has a faster onset, a greater success rate, and a longer duration when a volume of 1.2 mL is used than when volumes less than 1.0 mL are used.

Lidocaine + clonidine for maxillary infiltration anaesthesia: parameters of anaesthesia and vascular effects

The local anaesthetic and haemodynamic parameters achieved by lidocaine with clonidine or epinephrine, administered for maxillary infiltration anaesthesia, were studied in 40 patients (American Society of Anesthesiologists, physical status 1) who underwent upper third molar surgery. All patients received 2 ml of 2% lidocaine with clonidine (15 μg/ml; n = 20) or epinephrine (12.5 μg/ml; n = 20) in a randomized, double-blind fashion. Vascular effects were evaluated on the isolated human infraorbital arteries. The parameters of maxillary infiltration anaesthsia produced by a combination of lidocaine + clonidine were similar to those obtained with lidocaine + epinephrine. In both groups, haemodynamic parameters exhibited similar variations, with the exception of a significant reduction in heart rate and systolic blood pressure in the lidocaine + clonidine group and significant increase in heart rate in the lidocaine + epinephrine group, 10 min after surgery. Clonidine (10 −7, 10 −6 and 10 −5 M) produced an endothelium-independent vasocontractile effect on the isolated human infraorbital arteries. The results of this study indicate for the first time in dental anaesthesia that the lidocaine + clonidine combination could be a useful and safe alternative to lidocaine + epinephrine for intraoral infiltration anaesthesia.

The anesthetic efficacy of 4 percent articaine 1:200,000 epinephrine: Two controlled clinical trials

The authors conducted two double-blinded, randomized, multicenter clinical trials to determine the efficacy and clinical anesthetic characteristics of 4 percent articaine hydrochloride (HCl) with 1:200,000 epinephrine (A200) as compared with those of 4 percent articaine HCl with 1:100,000 epinephrine (A100) and 4 percent articaine HCl without epinephrine (Aw/o). During separate testing sessions, members of the authors' research team used three articaine study formulations to induce either inferior alveolar nerve block anesthesia (Trial 1) or maxillary infiltration anesthesia (Trial 2). In each trial, subjects received, in a randomized sequence, each of the three formulations to determine efficacy (success rate) and anesthetic characteristics (onset time and duration). The authors evaluated pulpal anesthesia via subjects' response to electric pulp testing (EPT). A total of 126 subjects were enrolled in the two studies (63 subjects in each trial). In both mandibular and maxillary trials, the success rates for inducing profound anesthesia (EPT score > 80), the mean onset times and the mean durations of anesthesia were similar for both epinephrine-containing formulations (A200 and A100). In subjects who received the formulation containing no epinephrine (Aw/o), the success rate for profound anesthesia was significantly less. These studies demonstrated that the inclusion of epinephrine in 4 percent articaine anesthetic formulations is essential for achieving profound anesthesia. The authors found that the A200 formulation provided a level of pulpal anesthesia comparable with that of the A100 formulation.

Efficacy of lidocaine with clonidine in maxillary infiltration anaesthesia

Efficacy of lidocaine with clonidine in maxillary infiltration anaesthesia