Maxillary Infiltration Research Articles

Effect of the inferior alveolar nerve block injection versus maxillary infiltration with two local anesthetic agents on cardiovascular parameters: A randomized comparative double-blind clinical trial

Abstract This study aimed to assess the effect of inferior alveolar nerve (IAN) block of the mandible and infiltration anesthesia of the maxilla using lidocaine plus epinephrine or prilocaine with felypressin anesthetic agents on systolic and diastolic blood pressures, heart rate (HR) and peripheral oxygen saturation rate of patients. This randomized double-blind clinical trial evaluated 112 patients in four groups (n=28) based on the jaw (maxilla or mandible) and type of anesthetic agent (lidocaine with epinephrine or prilocaine with felypressin). Groups 1 and 2 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, with 2% lidocaine plus 1:80.000 epinephrine. Groups 3 and 4 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, using prilocaine with felypressin. Systolic and diastolic blood pressures and HR were measured by an automatic upper arm blood pressure monitor and the percentage of peripheral oxygen saturation rate was measured by a finger pulse oximeter 10 minutes before the injection, immediately after injection, 10 minutes after injection and 20 minutes after injection. The mean diastolic blood pressure showed a greater reduction following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p<0.001). The mean HR showed a significantly greater increase following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p<0.001). The effect of type of anesthetic agent on diastolic blood pressure depended on the type of injection (p=0.033). Administration of 2% lidocaine with 1:80.000 epinephrine, in comparison to prilocaine with felypressin, can cause changes in cardiovascular parameters such as heart rate and diastolic blood pressure in patients undergoing restoration of a maxillary or mandibular molar tooth. Type of injection has no significant effect on cardiovascular parameters.

Local Anesthetic Efficacy in Marijuana Users and Nonusers: A Pilot Study.

Despite the common clinical impression that patients with a history of drug use are challenging to anesthetize with local anesthesia, literature on this clinical phenomenon is sparse. The objective of this pilot study was to assess if differences in local anesthetic efficacy for dental treatment exist between marijuana users and nonusers. Subjects were healthy adult males and females who qualified as either chronic marijuana users or nonusers. All subjects had an asymptomatic, vital maxillary lateral incisor that responded to an electric pulp test (EPT). A standard maxillary infiltration injection technique was employed using 1.7 mL 2% lidocaine with 1:100,000 epinephrine over the test tooth, and the tooth was tested with an EPT at 3-minute intervals. A total of 88% of nonusers (15/17) and 61% of users (11/18) were successfully anesthetized, defined as anesthesia onset within 10 minutes and lasting at least 15 minutes. The difference in the proportion of anesthetized subjects was not statistically significant (P = .073). For subjects with successful anesthesia, there was no significant difference between nonusers and users in the onset or duration of anesthesia. No significant differences in local anesthetic efficacy with respect to local anesthetic success, onset, or duration of action were found between chronic marijuana users and nonusers. However, larger studies are likely needed to provide more definitive evidence.

Comparison of Maxillary Lateral Incisor Infiltration Pain Using the Dentapen and a Traditional Syringe: A Prospective Randomized Study

IntroductionThe anterior maxillary infiltration is one of the more painful dental injections. The Dentapen is an electronic syringe that uses computer-controlled delivery technology to administer dental local anesthesia at a slow controlled rate. The purpose of this prospective, randomized, single-blind study was to evaluate solution deposition pain of a maxillary lateral incisor infiltration using the Dentapen with the slow flow rate (1.8 mL/162 sec) and ramp-up setting compared with a traditional syringe infiltration at a flow rate of 1.8 mL/60 sec. MethodsOne hundred thirty adults were administered a maxillary lateral incisor infiltration with the Dentapen and a traditional syringe at 2 separate appointments in a single-blind manner. The infiltrations of 2% lidocaine with 1:100,000 epinephrine were given at a rate of 1.8 mL/162 sec with the ramp-up feature for the Dentapen and 1.8 mL/60 sec for the traditional infiltration. The pain of solution deposition was recorded on a visual analogue scale. At the conclusion of the study, subjects selected their preferred injection technique. The data were analyzed statistically using paired t tests, a mixed-effect model, and odds ratio. ResultsThe pain of solution deposition was significantly less for the Dentapen injection than the traditional injection (P < .001). With the Dentapen device, 16% experienced moderate pain, and for the traditional syringe, 39% experienced moderate pain. Overall, 75% of subjects preferred the Dentapen injection over the traditional injection. ConclusionsThe Dentapen, using the slow flow rate and ramp-up mode, significantly reduced the pain of solution deposition for maxillary lateral incisor infiltrations.

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.

Effect of Warming Anesthetic Solution on Pain Perception During Maxillary Infiltration: A Split Mouth Randomized Control Trial

Objective: To evaluate the effectiveness of using anesthesia at 42°C (107.6°F) for the insight of pain as dental sedative in contrast to its administration at room temperature 21°C throughout the procedure of maxillary infiltration.&#x0D; Study Design: Double-blind, Split-Mouth randomized clinical trial (Clinical trial number: ISRCTN79560957)&#x0D; Place and Duration of Study: Department of Armed Forces Institute of Dentistry, Rawalpindi, from Jan to Jun 2021.&#x0D; Methodology: A total of 38 patients were examined, undergoing maxillary premolar extractions for orthodontic purposes. Group- A received local anesthesia injection with the anesthesia warmed to 42°C (107.6°F) and group- B patients receiving local anesthesia injection with anesthesia at room temperature. The injection point was placed in the mucobuccal fold apically in the middle of maxillary premolars using a 27G short needle and injecting 0.9 mL of the anesthetics at the speed of 0.15 mL/second. Patients were instructed to grade intensity of pain on Visual analogue scale.&#x0D; Results: According to the Visual analogue scale score, the level of pain perceived with the anesthesia at 42°C (107.6°F) in group-1 was 3.81 ± 1.48 and the level of pain perceived with the anesthesia at temperature 21°C in group-2 was 5.57 ± 1.50 with statistically significant result (p=0.001).&#x0D; Conclusion: The use of anesthesia at 42°C (107.6°F) significantly reduced the pain during the injection of anesthesia compared to its use at room temperature during maxillary injections.

Effect of Transcodent painless needles on injection pain in maxillary anterior infiltration: a split-mouth controlled randomized clinical trial.

ObjectivesThe present study aimed to determine the pain perceived during supraperiosteal (infiltration) injection in anterior maxillary region by Transcodent painless needle tips in comparison to the regular needle tips.Material and methodsIn this split‐mouth controlled randomised clinical trial, 30 patients were selected as candidates for cosmetic treatment who needed infiltration injections on both sides of canine area. They were each administered 0.9 mL of Lidocaine HCl 2% with epinephrine 1:100,000 in the buccal vestibules using two types of needle tips, Transcodent painless needle tip or regular needle tip. Immediately after the injection, the pain was measured using a 100 mm visual analog scale. The level of pain was statistically analyzed in the two groups using the parametric paired t‐test. A 5% significance level was considered for statically significant difference between two means.ResultsIn accordance with the results, the patients' level of pain were estimated as 18.3 ± 10.7 mm with Transcodent painless needle tips and 43.1 ± 13.1 mm in regular needle tip (p < 0.05).ConclusionThe Transcodent painless needle showed considerable reduction of pain in the anterior maxillary infiltration when compared to the regular needle tips.

Comparison of the Effects of Articaine and Lidocaine Anesthetics on Blood Pressure after Maxillary Infiltration Technique: A Triple-Blind Randomized Clinical Trial.

Background Many dental procedures begin with local anesthesia. Subsequent increase in blood pressure in healthy individuals commonly occurs and may be affected by several factors such as mental and physical stress, painful stimuli, and action of catecholamines present in local anesthetic solutions. The aim of the present study is to compare the effects of 4% articaine with 1 : 100000 epinephrine and 2% lidocaine with 1 : 80000 epinephrine on blood pressure after maxillary infiltration technique. Materials and Methods In this randomized clinical trial, 102 patients were randomly assigned into two groups. One group received 4% articaine with 1 : 100000 epinephrine and the other group received 2% lidocaine with 1 : 80000 epinephrine for local maxillary infiltration. Systolic and diastolic blood pressure of both groups was determined twice: once before anesthetic injection and once 10 minutes after injection. The data were statistically analyzed using descriptive statistics, Shapiro–Wilks test, Levene test, chi-square test, independent t-test, and paired t-test. Results The mean systolic blood pressure after anesthetic injection in the articaine and lidocaine groups was 125.00 ± 5.67 and 123.16 ± 6.417 mmHg, respectively, showing no statistically significant difference (p=0.127). The mean diastolic blood pressure after injection was 85.02 ± 7.331 in the articaine group and 81.35 ± 12.815 mmHg in the lidocaine group. These values show no statistically significant difference (p=0.080). In both groups, the mean systolic and diastolic blood pressures have increased significantly (p < 0.001). Conclusion Articaine can be regarded as a suitable alternative for lidocaine for maxillary local infiltration, as no significant difference was observed between the effects of the two anesthetic solutions on blood pressure.

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.

Learning local anesthetic techniques in dental college of Purvanchal Region, India: A cross-sectional questionnaire study

Introduction: Dentistry deals with teeth and related oral structures. Most of the procedure require anesthesia to make it painless. Objective: The objective of this study was (1) Recording the most frequently used local anesthetic techniques in our dental colleges and (2) satisfaction rate of dental students toward their curriculum of learning local anesthesia. Finally, we also wanted to formulate a research hypothesis, i.e., will artificial models be able to restitute conventional ways of learning local anesthesia in dental colleges. Materials and Methods: Prevalidated questions from published articles were picked and using Google Forms, an online survey platform was prepared, students who were the part of the study were asked to mark their response. Out of 90 students, 74 replied to the questionnaire. Response rate was 82.22%. This study was conducted between April and June 2019. Results: The survey results show that inferior alveolar nerve block and greater palatine were used very frequently (75.7% and 58.1%), respectively. Whereas, papillary (interdental) injection (PI) rarely (43.2%) or never (24.3%) and mental/incisive nerve block rarely (31.1%) or never (10.8%). Fifty-eight percent reported to learn local anesthesia on patient. Two-third (67.6%) of students was satisfied with their routine way of learning local anesthesia. Conclusion: Our study infers that, inferior alveolar nerve block is very frequently used nerve block. PI is rarely or never used block. Maxillary infiltration is marked as easy technique and can be performed without getting additional training. Two-third of students are satisfied with the present dental curriculum while one third wants a change.

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.

Facial Blanching after Local Anesthesia Injection: Clinico-anatomical Correlation-Review of Literature.

Facial blanching as a complication of local anesthesia is reported in dentistry. Inadvertent arterial penetration and subsequent vasospasm has been accepted as the mechanism of this phenomenon. Most cases occur after inferior alveolar nerve block injection. In this article, five cases are reported after Gow-Gates injection, maxillary nerve block via greater palatine foramen, inferior alveolar nerve block, and maxillary buccal infiltration. It is the largest case series in this topic. Also, clinico-anatomical correlation between facial–mucosal blanching and the site of intra-arterial injection is explained. To the best of our knowledge, partial blanching of the face subsequent to buccal infiltration is reported for the first time in this article. Cutaneous surgeon should be aware of this complication and should not carry out unnecessary treatment.

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 &lt;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.

Comparing the Efficacy of a Compound Topical Anesthetic Versus Benzocaine: A Pilot Study.

To compare the effectiveness of a combination of 10% lidocaine, 10% prilocaine, and 4% tetracaine versus 20% benzocaine for use as a topical anesthetic agent prior to dental injections. A double-blind randomized prospective clinical trial was conducted with 26 participants receiving a topical anesthetic of 20% benzocaine (control) and 26 participants receiving a compound topical anesthetic mixture of 10% lidocaine, 10% prilocaine, and 4% tetracaine (experimental) prior to a maxillary infiltration injection. The procedure was conducted by 1 operator with the Wand® injection system. Pain was assessed directly with visual analog scale (VAS) scores and indirectly by measuring changes in heart rate at 4 different time points. Complications associated with the application of the topical anesthetics were also assessed. The experimental group had a significantly higher mean VAS score of 19.5 ± 19.7 mm versus 14.2 ± 14.6 mm for the control group (p < .001). No significant differences in heart rate at any of the 4 measured time points compared with baseline were noted for either group. The experimental group had a significantly higher incidence of complications, including tissue sloughing, when compared with the control group (p < .001). Participants in the control group reported significantly lower VAS scores than those in the experimental group. Both types of topical anesthetic showed similar impacts on alterations to heart rate. No benefits were seen with the use of 10% lidocaine, 10% prilocaine, and 4% tetracaine as a topical anesthetic prior to a maxillary infiltration of local anesthetic when compared with 20% benzocaine.

Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: A systematic review and meta-analysis.

The aim of the present systematic review and meta-analysis was to address the following Population, Intervention, Comparison, and Outcome question: Is the efficacy of articaine better than lignocaine in adults requiring dental treatment? Four percent articaine was compared with 2% lignocaine for maxillary and mandibular infiltrations and block anesthesia, and with the principal outcome measures of anesthetic success. Using RevMan software, the weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared using a random-effects model. For combined studies, articaine was more likely to achieve successful anesthesia than lignocaine (N=18, odds ratio [OR]: 1.92, 95% CI: 1.45-2.56, P<0.00001, I2 =32%). Maxillary and mandibular infiltration studies showed obvious superiority of articaine to lignocaine (N=8, OR: 2.50, 95% CI: 1.51-4.15, P=0.0004, I2 =41%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lignocaine (N=5, OR: 1.69, 95% CI: 0.88-3.23, P=0.11, I2 =19%). For combined mandibular anesthesia studies, articaine was superior to lignocaine (N=14, OR: 1.99, 95% CI: 1.45-2.72, P<0.0001, I2 =32%), with further subgroup analysis showing significant differences in both mandibular block anesthesia (N=11, OR: 1.55, 95% CI: 1.19-2.03, P=0.001), I2 =0%) and mandibular infiltration (N=3, OR: 3.87, 95% CI: 2.62-5.72, P<0.00001, I2 =0%), indicating that articaine is more effective than lignocaine in providing anesthetic success in routine dental procedures.

Anesthetic Efficacy of Intranasal 3% Tetracaine plus 0.05% Oxymetazoline (Kovanaze) in Maxillary Teeth

IntroductionNeedle-free anesthetic delivery is a promising alternative to traditional anesthetic routes of administration. The purpose of this study was to determine the patient preference for and pulpal anesthetic efficacy of a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray in maxillary lateral incisors and first premolars. MethodsFifty adult subjects randomly received a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray and mock infiltration or a mock nasal spray and 2% lidocaine with 1:100,000 epinephrine infiltration at the maxillary lateral incisor or first premolar in 2 appointments spaced at least 1 week apart in a single-blind cross-over design. Pulpal anesthesia was evaluated with an electric pulp tester. Side effects and subject preferences were also recorded. ResultsAnesthetic success was significantly lower for the Kovanaze nasal spray and mock infiltration (22%–37%) than for the mock nasal spray and lidocaine infiltration (89%–91%). Subjects reported more unwanted effects (nasal drainage and congestion, burning, pressure, and sinus congestion) after the Kovanaze nasal spray and mock infiltration than the mock spray and maxillary infiltration. Before participating in the study, more subjects (56%) preferred the nasal spray route versus a standard infiltration (44%). After experiencing both routes of administration, 100% of subjects preferred the standard infiltration. ConclusionsThe 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray provided significantly less successful pulpal anesthesia than the lidocaine infiltration, was less preferable, and caused more unwanted effects.

Efficacy of external cold and a vibrating device in reducing discomfort of dental injections in children: A split mouth randomised crossover study.

To study the discomfort and fear associated with maxillary infiltration injections when using a combination of external cold and a commercially available vibrating device. A total of 60 children aged 7years old participated in this split mouth randomised crossover study. The control intervention comprised of the administration of 1.8ml of 2% lidocaine with 1:100,000 adrenaline using a 24mm 30 gauge needle, while the test intervention used external cold and a commercially available vibrating device in addition to the control protocol. The heart rate of the child at the time of injection was used as an objective measure and the Wong-Baker pain scale was used as a subjective measure of the child's discomfort. The face, limbs, arms, cry and consolability (FLACC) scale was used to record the child's pain as perceived by the dentist. Children reported a significantly lower Wong-Baker score and the operators observed a significantly lower heart rate and FLACC scores in the test visit than the control visit. Combining external cold with vibrating devices might be effective in reducing discomfort and fear in children undergoing infiltration dental analgesia. NCT02675387.

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.

Utility of Vibratory Stimulation for Reducing Intraoral Injection Pain.

Intraoral local anesthesia injection is often perceived as a painful and anxiety-causing dental procedure. Vibration stimulus is one of the nonpharmacologic methods used to reduce unwanted sensations of local anesthesia injection. This clinical study evaluated the effectiveness of a recently introduced vibratory stimulation device in intraoral local anesthesia administration. Thirty-two subjects underwent 2 maxillary local anesthesia injections in 2 different sessions: 1 with conventional techniques and 1 with the aid of a vibratory stimulation device (DentalVibe). The pain levels were evaluated with a visual analog scale and the Wong-Baker FACES Pain Rating Scale. The subjects were asked to choose the preferred method for future injections. The data were evaluated statistically. There were no significant differences between the 2 injection methods with regard to either pain evaluation method. The preference of the subjects regarding future injection technique was evenly distributed between the groups. The vibratory stimulation device used in this study did not provide any reduction in pain level associated with maxillary infiltration local anesthesia administration.

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.