Maxillary Infiltration Research Articles

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.

Pharmacokinetic profile of liposome-encapsulated ropivacaine after maxillary infiltration anaesthesia

The aim of this study was to determine the pharmacokinetic parameters of liposomal ropivacaine after dental anesthesia in 14 healthy volunteers. In this randomized, double-blind and crossover study, the volunteers received maxillary infiltration of liposome-encapsulated 0.5% ropivacaine and, 0.5% ropivacaine with 1:200,000 epinephrine in two different sessions. Blood samples were collected before and after (from 15 to 1440 min) the administration of either ropivacaine formulation. HPLC with UV detection was used to quantify plasma ropivacaine concentrations. The pharmacokinetic parameters AUC0-24 (area under the plasma concentration × time curve from baseline to 24 h), AUC0-∞ (area under the plasma concentration-time curve from baseline to infinity), Cmax (maximum drug concentration), CL (renal clearance), Tmax (maximum drug concentration time), t1/2 (elimination half-life) and Vd (volume of distribution) were analyzed using the Wilcoxon signed-rank test. No differences (p > 0.05) were observed between both formulations for any of the pharmacokinetic parameters evaluated and plasma ropivacaine concentrations, considering each period of time. Both formulations showed similar pharmacokinetic profiles, indicating that the liposomal formulation could be a safer option for use of this local anesthetic, due to the absence of a vasoconstrictor.

A Prospective, Randomized, Double-Blind Comparison of 2% Lidocaine With 1 : 100,000 Epinephrine, 4% Prilocaine With 1 : 200,000 Epinephrine, and 4% Prilocaine for Maxillary Infiltrations

The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1:100,000 epinephrine, 4% prilocaine with 1:200,000 epinephrine, and 4% prilocaine in maxillary lateral incisors and first molars. Sixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine, 1.8 mL of 4% prilocaine with 1:200,000 epinephrine, and 1.8 mL of 4% prilocaine, at 3 separate appointments spaced at least 1 week apart. The teeth were pulp-tested in 3-minute cycles for a total of 60 minutes. Anesthetic success (ie, obtaining 2 consecutive 80 readings with the electric pulp tester) and onset of pulpal anesthesia were not significantly different between 2% lidocaine with 1:100,000 epinephrine, 4% prilocaine with 1:200,000 epinephrine, and 4% prilocaine for the lateral incisor and first molar. For both lateral incisor and first molar, 4% prilocaine with 1:200,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine were equivalent for incidence of pulpal anesthesia. However, neither anesthetic agent provided an hour of pulpal anesthesia. For both lateral incisor and first molar, 4% prilocaine provided a significantly shorter duration of pulpal anesthesia compared with 2% lidocaine with 1:100,000 epinephrine and 4% prilocaine with 1:200,000 epinephrine.

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.

A Prospective, Randomized, Double-blind Comparison of 2% Lidocaine With 1:100,000 and 1:50,000 Epinephrine and 3% Mepivacaine for Maxillary Infiltrations

Introduction The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1:100,000 and 1:50,000 epinephrine and 3% mepivacaine in maxillary lateral incisors and first molars. Methods Sixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine, 2% lidocaine with 1:50,000 epinephrine, and 3% mepivacaine at three separate appointments spaced at least 1 week apart. The teeth were pulp tested in 3-minute cycles for a total of 60 minutes. Results and Conclusions Anesthetic success and the onset of pulpal anesthesia were not significantly different between 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine and 3% mepivacaine for the lateral incisor and first molar. Increasing the epinephrine concentration from 1:100,000 to 1:50,000 in a 2% lidocaine formulation significantly decreased pulpal anesthesia of short duration for the lateral incisor but not the first molar. For both the lateral incisor and first molar, 3% mepivacaine significantly increased pulpal anesthesia of short duration compared with 2% lidocaine with either 1:100,000 or 1:50,000 epinephrine.

A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations

A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations

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.

Anesthetic Efficacy of the Gow-Gates Injection and Maxillary Infiltration with Articaine and Lidocaine for Irreversible Pulpitis

The aim of this randomized, double-blinded study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine (AE) with 2% lidocaine with 1:100,000 epinephrine (LE) for Gow-Gates blocks and maxillary infiltrations in patients experiencing irreversible pulpitis in mandibular and maxillary posterior teeth. Forty patients diagnosed with irreversible pulpitis of a posterior tooth randomly received either AE or LE by using a Gow-Gates injection or maxillary infiltration. Endodontic access was initiated after no response to Endo-ice 15 minutes after solution deposition. Success was defined as none to mild pain on a visual analogue scale after access. Chi-square and analysis of variance statistical tests were used to analyze the data. Successful endodontic treatment substantially reduced the assessment of pulpitis pain by patients (analysis of variance, P < .0001). Overall anesthetic success in both dental arches was 87.5%. Anesthetic success was not influenced by tooth arch (χ 2, P > .7515) or gender (χ 2, P > .1115). AE proved to be as effective but not superior to LE ( P > .6002). These results demonstrated the similar anesthetic effectiveness of AE and LE when used during the endodontic treatment of teeth diagnosed with irreversible pulpitis.

A Prospective, Randomized, Double-blind Comparison of Articaine and Lidocaine for Maxillary Infiltrations

The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in maxillary lateral incisors and first molars. Eighty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of one cartridge of 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine at two separate appointments spaced at least 1 week apart. In maxillary lateral incisors, articaine exhibited a significantly higher anesthetic success rate of 88% when compared with a 62% success rate with lidocaine. In maxillary first molars, articaine had a similar success rate to lidocaine (78% vs 73%), and there was no significant difference between the two solutions. In conclusion, a maxillary infiltration of 4% articaine with 1:100,000 epinephrine statistically improved anesthetic success when compared with 2% lidocaine with 1:100,000 epinephrine in the lateral incisor but not in the first molar.

Anesthetic Efficacy of 1.8 mL and 3.6 mL of 2% Lidocaine with 1:100,000 Epinephrine for Maxillary Infiltrations

The purpose of this prospective, randomized, single-blinded study was to measure the degree of anesthesia obtained with 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine in maxillary infiltrations. Ninety-six adult subjects randomly received infiltrations of 1.8 mL and 3.6 mL of the lidocaine solution at two separate appointments, in a crossover design. Thirty-two lateral incisors, 32 first premolars and 32 first molars were studied in this investigation. Anesthetic success (obtaining two consecutive 80 readings with the electric pulp tester) for the two volumes ranged from 97% to 100%. The onset of pulpal anesthesia was not statistically different between the two volumes. For both volumes, the lateral incisors had a higher percentage of anesthesia of short duration than the first premolar and first molar. The 3.6 mL volume provided a statistically longer duration of pulpal anesthesia for the lateral incisor, first premolar, and first molar.

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.

A Prospective, Randomized, Double-blind Comparison of Bupivacaine and Lidocaine for Maxillary Infiltrations

The purpose of this prospective, randomized, double-blind study was to evaluate the anesthetic efficacy of 1.8 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1.8 mL of 2% lidocaine with 1:100,000 epinephrine in maxillary lateral incisors and first molars. Sixty-five subjects randomly received, in a double-blind manner, two infiltrations at two separate appointments, in a crossover design. The injections consisted of maxillary lateral incisor and first molar infiltrations of 1.8 mL 0.5% bupivacaine with 1:200,000 epinephrine and 1.8 mL 2% lidocaine with 1:100,000 epinephrine. In maxillary lateral incisors, bupivacaine exhibited a significantly lower anesthetic success rate (obtaining two consecutive 80 readings with the pulp tester within 10 minutes) of 78% when compared with a 97% success rate with lidocaine. In maxillary first molars, bupivacaine's onset of pulpal anesthesia (7.7 minutes) was significantly slower than lidocaine (4.3 minutes). Bupivacaine had a lower success rate than lidocaine (64% versus 82%) but there was no significant difference between the two solutions. Neither solution provided pulpal anesthesia for 1 hour.

Reaction of children to dental injection with 27‐ or 30‐gauge needles

The purpose of this study was to assess children's reaction while receiving dental local anaesthesia with a 27- and a 30-gauge needle and to record their sensation. Ninety-five children (43 boys and 52 girls) participated in this study. A random crossover design was used so that each child served as his or her own control, receiving each treatment on the opposite sides of the same arch (right vs. left). Each patient received an injection either with a 27- or 30-gauge needle during the first visit and during the second visit with the other needle. Objective and subjective evaluation were performed. Children's reactions to maxillary buccal infiltration either with a 27- or 30-gauge needle were similar. Significantly more children cried while receiving mandibular block injection with a 27-gauge needle than they did when receiving the injection with a 30-gauge needle (P = 0.002). According to subjective evaluation, most children rated both injections as a positive, non-painful experience. Mandibular block is less unpleasant, and children cry less when administered with a 30-gauge needle than they do when it is delivered with a 27-gauge needle. No difference in crying during injection is observed when maxillary infiltration is provided with 27- or 30-gauge needles.

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.

Onset and duration periods of articaine and lidocaine on maxillary infiltration

Objectives The aim of this study was to compare the onset and duration of pulpal anesthesia by maxillary infiltration using 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. Method and Materials Twenty healthy patients randomly received 1.8 mL of one of the three local anesthetics during operative dentistry procedures of low complexity on three maxillary posterior teeth. Onset and duration were determined using an electric pulp tester. Results The mean values for pulpal onset were 2.8, 1.6, and 1.4 minutes and for pulpal duration were 39.2, 56.7, and 66.3 minutes, respectively, for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. Statistical analysis by the Kruskal-Wallis nonparametric test showed significant differences with better results (shorter onset and longer duration periods) for both articaine solutions compared with the lidocaine solution. Although 4% articaine with 1:100,000 epinephrine clinically presented the shortest onset and the longest duration periods, there was no statistically significant difference between the articaine solutions. Conclusion Both articaine solutions produced shorter onset and longer duration of pulpal anesthesia by maxillary infiltration than the lidocaine solution did. Statistical analysis did not confirm better clinical results of 4% articaine with 1:100,000 epinephrine than with 4% articaine with 1:200,000 epinephrine.— Reprinted with permission of Quintessence Publishing .

Efficacy of lidocaine with clonidine in maxillary infiltration anaesthesia

Efficacy of lidocaine with clonidine in maxillary infiltration anaesthesia

Effectiveness of pH adjusted lidocaine versus commercial lidocaine for maxillary infiltration anesthesia

In this study, alkalinizetion of com-mercial local anesthetic solution was attempted in order to determine its effect on onset and pain experienced during injection as well as its effect on depth of anesthesia achieved for maxillary tooth extraction. Total 200 patients participated and randomly distributed into two groups, 100 patients for each. The first group received maxillary infiltration anesthesia for extraction of maxillary tooth with commercial local anesthetic solution at pH 3.5, and the second group received the same injection with alkalinized solution to pH 7.2 using sodium bicarbonate 8.4%. The result of this study showed a significant rapid onset in pH adjusted group comparing to control group. Signifi-cant difference noticed between both gr-oups regarding pain noticed during injec-tion with less pain experienced in study group. No significant difference in the depth of anesthesia achieved. When data assessed for patients with periapical lesion only, a significant difference noticed bet-ween pH adjusted group comparing to control group and less pain recorded during extraction with enhanced depth of anesthesia achieved in study group. In conclusion, pH adjusted anesthesia, although not recommended routinely, co-uld be used to reduce injection pain when severe pain on injection expected. Also, it could be used for patient with periapical lesion to enhance depth of anesthesia.

Injection pain of bupivacaine with epinephrine vs. prilocaine plain

Prilocaine plain has been described in the literature as causing less pain on injection than bupivacaine with epinephrine, possibly because of the higher pH of the prilocaine anesthetic solution. In a double-blind study design, 681 consecutive patients in a general dental practice received maxillary buccal infiltration, posterior palatal infiltration or inferior alveolar block injections, administered under clinical conditions by one of two dentists. Immediately after injection, patients rated the pain from each injection on a six-point scale. The pain response was analyzed according to treating dentist, location of injection, patient's sex and anesthetic administered. The reported pain on injection of bupivacaine with epinephrine was significantly greater than that of prilocaine plain. Patients reported no significant difference in pain at different injection locations, except that palatal injections caused significantly more reported pain than did anterior maxillary infiltration, posterior maxillary infiltration or inferior alveolar block injections. Under clinical conditions, the injection of bupivacaine with epinephrine causes significantly more perceived pain than does the injection of prilocaine plain. Clinical Implications. Bupivacaine with epinephrine and prilocaine plain have certain advantages and disadvantages that should be considered before choosing an anesthetic for a dental procedure. A disadvantage of bupivacaine with epinephrine is that it produces more perceived pain than does prilocaine plain.