Analgesic efficiency of dexketoprofen trometamol in third molar surgery: a systematic review and meta-analysis.

This study aims to compare the analgesic efficacy of dexketoprofen trometamol (DT) with other analgesic drugs for pain relief after third molar surgery. The PubMed, Scopus, and Web of Science databases were searched to identify randomized controlled trials comparing DT with other analgesics for third molar surgery. The outcome measures were the sum of pain intensity differences (SPID), total pain relief (TOTPAR) at the 6th and 8th postoperative hours, time to rescue medication, and tolerability. In total, four studies met our inclusion criteria. A total of 660 third molar surgeries were performed: 365 in the DT group and 295 in the active control group. Compared to other analgesics, DT produced significantly better pain relief at the 6th postoperative hour: SPID (MD, 0.33; P = 0.01) and TOTPAR (MD, 0.41; P = 0.02). However, there were no statistically significant differences in the efficiency of pain relief at the 8th postoperative hour, time to rescue medication, or tolerability. Overall, a 25 mg dose produced the best results for pain relief. In conclusion, DT (25 mg) is a viable alternative to contemporary analgesics for pain relief after third molar surgery, particularly during the early postoperative period.

Expression of CLLD7 and CHC1L Proteins in Oral Epithelial Dysplasia in a Group of Thai Patients.

OBJECTIVES: Previous study showed aberrant CLLD7 and CHC1L protein expression in oral squamous cell carcinoma (OSCC) compared to normal oral mucosa (NOM). This study aimed to evaluate the expression of these proteins in oral epithelial dysplasia (OED). MATERIALS AND METHODS: Forty specimens of OED and 11 NOM were used. The expression of CLLD7 and CHC1L was determined by immunohistochemistry. In each case, at least 1000 cells were counted. Presence of nuclear, cytoplasmic, and/or membrane staining of CLLD7 and CHC1L were considered positive. Percentages of total positive cells and positive cells at different locations were recorded. SPSS version 18 was used to compare variation between groups with statistical significance at p<0.05. RESULTS: No significant differences in the percentages of total positive cells of CLLD7 and CHC1L were found between NOM and all grades of OED. Nevertheless, there were significant differences in subcellular staining of these two proteins. In CLLD7, the nuclear staining of the moderate and the severe OED groups was significantly lower than that of the NOM group (p<0.05). The percentages of membrane staining of CHC1L in moderate and severe OED were significantly higher than that of NOM (p<0.001). In addition, the nuclear staining of CHC1L in each grade of OED was significantly lower than that of NOM (p<0.05). CONCLUSION: The subcellular mislocalization of CLLD7 and CHC1L in OED suggests that the expression of these potential tumor suppressor proteins might be dysregulated during the dysplastic process. The distinct membrane staining of CHC1L observed in OED but not in NOM is a useful characteristic that can be used to separate OED from NOM. Thus, CHC1L may be a good marker to assist in the diagnosis of OED.

Preliminary Study on the Expression of CLLD7 and CHC1L Proteins in Oral Squamous Cell Carcinoma.

OBJECTIVE: This study aimed to preliminarily evaluate the expression of two putative tumor suppressor proteins, including chronic lymphocytic leukemia deletion gene 7 (CLLD7) and chromosome condensation 1-like (CHC1L) proteins in oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Expression of CLLD7 and CHC1L proteins was analyzed in 19 OSCC and 12 normal oral mucosa (NOM) using immunohistochemistry. The percentage of positive cells and intensity of staining were semiquantitatively assessed and expressed with an immunoreactive score. The number of positive cells at various subcellular localizations was evaluated and presented in percentages. The immunoreactivity scores and percentages of positive cells at various localizations were compared between the normal and OSCC groups with statistical significance at p-value less than 0.05. RESULTS: According to immunohistochemical analysis, the immunoreactivity scores for both CLLD7 and CHC1L were higher in NOM than those of OSCC. Analysis of CLLD7 localization revealed predominant nuclear staining at basal and parabasal areas in NOM, whereas more cytoplasmic staining was observed in OSCC. For CHC1L, nuclear staining was prominent in NOM. In contrast, significantly increased plasma membrane staining was detected in OSCC. CONCLUSION: The expression of CLLD7 and CHC1L proteins was reduced in OSCC. Alterations in the subcellular localization of these two proteins in OSCC were also demonstrated. These preliminary results suggest that CLLD7 and CHC1L are aberrantly expressed in OSCC. The precise mechanisms of these putative tumor suppressor proteins in OSCC require future studies.

Healing Abutment Distortion in Implant Prostheses: An In Vitro Study.

Little has been studied regarding the repeated usage of healing abutments and their effects on the distortion of dental implant-healing abutment hex surfaces. Additionally, implant manufacturers do not provide specific guidelines on how many times a healing abutment can be used before discarding. Therefore, we evaluated the effect of repeated screwing-unscrewing of implant-healing abutment on the healing abutment hex surface and screw head. A total of 12 Biomate implants with 4 mm diameter and 13 mm length were inserted into a synthetic bone block. The standard healing abutments of 3 mm diameter and 4 mm length were screwed onto each implant using a torque ratchet at a final torque of 30 Ncm. Immediately, the abutments were unscrewed at 30 Ncm. Then, screwing-unscrewing was repeated for 4, 8, 16, 24, 32, 40, 80, 160, 320, and 400 times and the healing abutments were scanned under the scanning electron microscope for any distortion. Distortion was graded as 0, 1, 2, and 3. Data were analyzed using SPSS 24.0. Descriptive statistics were calculated. One-way ANOVA with post hoc using Tukey's HSD test was performed to analyze the difference in distortion at different screwing-unscrewing times. A significant level was selected at p-value = 0.05. It was found that distortion healing abutments screws were seen after 32 times screwing and unscrewing. There was a significant difference in the distortion (p-value < 0.05) after 24 times of repeated usage of healing abutment and at 160, 320, and 400 times. No surface distortions were observed at the healing abutment screw head at 4, 8, 16, 24, 32, 40, 80, 160, 320, and 400 cycles of screwing-unscrewing. It can be concluded that repeated screwing and unscrewing of the implant-healing abutments causes damage to the healing abutment hex surface. The distortion of healing abutments screws was seen after 32 times screwing and unscrewing. No surface distortions were observed on the healing abutment screw head until 400 times of screwing and unscrewing. Hence, the clinician should be cautious while using the healing abutments repeatedly.

Contemporary Concepts in Osseointegration of Dental Implants: A Review.

In a society highly conscious of esthetics, prosthetic rehabilitation of lost teeth with tissue-integrated implants has gained wide acceptance and demand by patients and clinicians. The backbone of these tissue-integrated implants is the biotechnical process of osseointegration. Although the concept has been introduced and discussed for ages, the deepening knowledge about its cellular and molecular mechanisms has led the researchers to borrow further into the factors influencing the process of osseointegration. This has aided in the hastening and improving the process of osseointegration by exploiting several, even the minutest, details and events taking place in this natural process. Recently, due to the high esthetic expectations of the patients, the implants are being loaded immediately, which demands a high degree of implant stability. Implant stability, especially secondary stability, largely depends on bone formation and integration of implants to the osseous tissues. Various factors that influence the rate and success of osseointegration can either be categorized as those related to implant characteristics like the physical and chemical macro- and microdesign of implants or the bone characteristics like the amount and quality of bone and the local and systemic host conditions, or the time or protocol followed for the functional loading of the dental implant. To address the shortcomings in osseointegration due to any of the factors, it is mandatory that continuous and reliable monitoring of the status of osseointegration is done. This review attempts to encompass the mechanisms, factors affecting, and methods to assess osseointegration, followed by a discussion on the recent advances and future perspectives in dental implantology to enhance the process of osseointegration. The review was aimed at igniting the inquisitive minds to usher further the development of technology that enhances osseointegration.

Penetration and Tensile Strength of Various Impression Materials of Vinylsiloxanether, Polyether, and Polyvinylsiloxane Impression Materials.

OBJECTIVES: The aim of this study was to evaluate and compare penetration ability and tensile strength among vinylsiloxanether (VSE), polyether (PE), and polyvinylsiloxane (PVS) elastomeric dental impression materials. MATERIALS AND METHODS: The models were constructed for penetration ability test by simulated gingival sulcus width and moist environment. The 0.05, 0.1, and 0.2 mm of simulated gingival sulcus widths were used. Each simulated gingival sulcus width was impressed 10 repeats per one elastomeric impression material. All extension of elastomeric dental impression materials was scaled by Measuring Microscope (MM-11; Nikon, Tokyo, Japan). On the issue of the tensile strength study, the models were constructed following type 1 of the ISO 37:2017 specifications and/or type C of ASTM.D412 specifications. The two-way analysis of variance (ANOVA) and Tukey's honest significant difference test were performed in the penetration ability test. The one-way ANOVA and Dunnett's T3 test were performed in the tensile strength test. The significance level was set at 0.05. RESULTS: PE showed the best extension into all widths of simulated sulcus followed by VSE and PVS, respectively. PVS was significantly higher in tensile strength than VSE and PE, while VSE was significantly higher than PE. CONCLUSION: Penetration ability of elastomeric dental impression materials was depended on gingival sulcus width. The wider the sulcular width, the better the penetration ability of elastomeric dental impression materials. PE presented the best penetration ability, while the novel PVS showed highest tensile strength.

Rare Report Case of Oral Verruca Vulgaris on Torus Palatinus.

Verruca vulgaris, also known as common warts, is most often seen on the skin of hands and feet. Human papilloma virus (HPV) plays an aetiological role in the development of this lesion. Oral verruca vulgaris (OVV) may occur on the palate, buccal mucosa, and tongue. Although asymptomatic and benign, HPV has been linked to squamous cell carcinoma in the oral cavity and oropharyngeal areas. Therefore, prompt surgical removal of OVV is warranted. We report a case of a OVV in a 48-year-old male patient on palate. The lesion was a white nonscrapable lesion in the middle of a torus palatinus. Excisional biopsy was done together with surgical removal of torus palatinus. Histopathological analysis confirmed the diagnosis of OVV.

Comparison of anesthetic efficacy of intraosseous injection with conventional inferior alveolar nerve block in mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: This review focused on comparing the anesthetic efficacy of intraosseous injection and conventional inferior alveolar nerve block in mandibular third molar surgery. STUDY DESIGN: Three electronic databases (PubMed, Scopus, and Web of Science) were accessed to identify randomized controlled trials comparing intraosseous injection with conventional inferior alveolar nerve block in mandibular third molar surgery. The outcome measures included onset of anesthesia, success of anesthetic technique, pain during injection of anesthesia, pain during surgery, and duration of anesthesia. RESULTS: Four studies met the inclusion criteria and consisted of 242 mandibular third molar surgeries. No significant differences were found between the anesthetic techniques in terms of onset of anesthesia, success of anesthetic technique, pain during injection of anesthesia, and pain during surgery. However, the intraosseous technique revealed a significantly shorter duration of anesthesia than the inferior alveolar nerve block (mean difference, -56.34 minutes; 95% confidence interval, -70.72 to -41.97; P < .001). CONCLUSIONS: Despite having anesthetic efficacy similar to that of the conventional inferior alveolar nerve block, intraosseous injection has an added benefit of early recovery of sensation owing to its shorter duration of anesthesia.

Review of dexamethasone administration for management of complications in postoperative third molar surgery.

Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.

EFFECT OF LOCALLY DELIVERED BISPHOSPHONATES ON ALVEOLAR BONE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

OBJECTIVE: To assess the effect of locally applied bisphosphonate drugs on alveolar bone defects caused by periodontitis and marginal bone level after placement of dental implants. MATERIALS AND METHODS: Three electronic databases (PubMed/MEDLINE, Web of Science, and Scopus) were searched from January 2010 until May 2020 for randomized controlled clinical trials reporting the effect of locally delivered bisphosphonates on alveolar bone. The risk of bias was assessed and quantitative synthesis was conducted with both fixed and random-effects meta-analyses by using RevMan version 5.3. Subgroup and sensitivity analyses were performed whenever required. RESULTS: Among the included studies, the effect of locally delivered bisphosphonates on alveolar bone regeneration in periodontitis was measured by 15 studies and on marginal bone level after installation of dental implants by three studies. Bisphosphonates showed significantly higher intrabony defect depth reduction than placebo/control in vertical bone defects treated with non-surgical approach (MD = 1.69mm; 95% CI, 1.32-2.05; P < 0.00001; I²=93%) or surgical approach (MD = 0.70mm; 95% CI, 0.23-1.16; P = 0.003; I²â€¯= 78%) and in class II furcation defects treated with non-surgical approach (MD = 1.61mm; 95% CI, 1.15-2.07; P < 0.00001; I²â€¯= 99%) or surgical approach (MD = 0.24mm; 95% CI, 0.05-0.42; P = 0.01; I²â€¯= 62%). Clinical attachment loss increased by 1.39mm (95% CI, 0.92-1.85; P < 0.01; I²=93%) and 1mm (95% CI, 0.75-1.26; P < 0.001; I²â€¯= 0%) in vertical bone defects after non-surgical and surgical treatments, respectively, and by 1.95mm (95% CI, 1.37-2.53; P < 0.00001; I²â€¯= 96%) and 0.84mm (95% CI, 0.58-1.10; P < 0.01, I²â€¯= 47%) after non-surgical and surgical treatment in class II furcation defects, respectively. Lesser marginal bone loss during pre-loading (MD = -0.18 mm; 95% CI, -0.24- -0.12; P<0.00001; I²=0%) and 1-year post-loading (MD = -0.33 mm; 95% CI, -0.59-0.07; P = 0.01; I²â€¯= 0%) periods was observed when bisphosphonate coated dental implants were used. CONCLUSION: Locally delivered bisphosphonates induce bone regeneration in periodontal defects and decrease the rate of marginal bone loss after dental implant therapy.

A Review on the Application of Silver Nanoparticles in Oral and Maxillofacial Surgery.

Silver nanoparticles (AgNPs) have been taken advantage of in dentistry because of their good antibacterial resistance and self-sustaining potential. However, in oral and maxillofacial surgery and implantology, there is a lesser amount of evidence. The few pieces of evidence need to be accentuated for possible amplification of its use in the dental setting. AgNPs in oral and maxillofacial surgery can be used in wound healing, bone healing, extractions, guided tissue regeneration, apical surgeries, oral cancer, and dental implants. This review aims to feature the utilization and application of AgNPs in oral and maxillofacial surgery and implant dentistry, emphasizing its need for potential future development in clinical settings.

Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management.

Over the years, the pain has been defined numerous times in several ways. In oral and maxillofacial surgery, the occurrence of pain, especially postoperatively, is anticipated. Pain arises as a combination of various processes after tissue damage. Distinct pain experiences in oral surgery were depicted in several previous studies, adding knowledge to the field. The management of these encounters has been suggested over time, improving treatment approaches in the clinical setting. This review aims to understand the pain and its types and intervention in the field of oral and maxillofacial surgery.

Comparative efficiency of the preoperative pterygomandibular space injection of two doses of dexamethasone in mandibular third molar surgery.

BACKGROUND: Impacted mandibular third molar removal is one of the most commonly performed oral surgical procedures. This procedure can lead to several postoperative complications, such as trismus, facial swelling, and pain, which occur as a result of the inflammatory responses to surgery. This study compared the efficiency of preoperative injections of 4 mg versus 8 mg dexamethasone into the pterygomandibular space to reduce postoperative sequelae. METHODS: This was a randomized, prospective, split-mouth, controlled study, including 52 mandibular third molar surgeries in 26 patients. Each patient was randomized to either the 4 mg or 8 mg dexamethasone injection group. Dexamethasone was injected into the pterygomandibular space after numbness from local anesthesia. Data were collected for trismus, facial swelling, visual analog scale (VAS) pain score, and the number of analgesics taken during the evaluation period. The level of significance was set at P < 0.05. RESULTS: Statistically significant differences in postoperative facial swelling (P = 0.031, diff = 1.4 mm) and pain (P = 0.012, diff = 0.020) were found between the 8 mg and 4 mg dexamethasone groups. However, there were no significant differences between the groups for trismus and the total number of analgesics consumed (P > 0.05). CONCLUSION: Compared to the 4 mg preoperative dexamethasone injection, the 8 mg preoperative dexamethasone injection into the pterygomandibular space was more effective in reducing postoperative swelling and pain following the surgical removal of the impacted mandibular third molar. However, the difference in trismus could not be evaluated clinically. Therefore, the recommendation of administering the 4 mg dexamethasone preoperative injection is optimal in the third molar surgical procedure.

Single buccal infiltration of high concentration lignocaine versus articaine in maxillary third molar surgery.

BACKGROUND: This research evaluated the numbness produced by lignocaine at an equal or higher concentration than that of 4% articaine through a single point of injection for maxillary third molar surgery. This randomized double-blind study was conducted to compare the anesthetic efficiency of 4% lignocaine with that of 4% articaine in impacted maxillary third molar surgery using a single buccal infiltration alone. METHODS: The study participants were 30 healthy patients requiring the bilateral surgical removal of symmetrically-positioned maxillary third molars. Using a split-mouth design, each patient randomly received buccal infiltration of 1.7 ml of 4% lignocaine and 1.7 ml of 4% articaine during two separate appointments. After 15 minutes of anesthetic injection, surgery was performed by the same surgeon using a consistent technique on both sides. Pinprick test pain scores of the buccal and palatal gingiva of the maxillary third molar after 10 minutes and 15 minutes latencies, pain scores during the surgery, the need for supplemental anesthesia, and patients' satisfaction with anesthetic efficiency were recorded. Surgery performed without supplemental anesthesia was categorized as successful. RESULTS: The success rates of 4% lignocaine and 4% articaine (83.34% vs. 86.67%, P = 1.00) were not significantly different. Only 5 cases (4 cases in the articaine group and 1 case in the lignocaine group) reported mild pain and pressure sensation (NRS ≤ 1) on probing at the palatal side after 15 minutes of latency (P = 0.25). The pain scores of maxillary third molar surgery in the two groups were not significantly different (P > 0.05). Moreover, the statistical analysis confirmed the comparable patient satisfaction of two study groups (P = 0.284). CONCLUSION: This study provides evidence that single buccal infiltrations of 4% lignocaine and 4% articaine have comparable anesthetic efficacy and success rates for impacted maxillary third molar surgery. Both 4% lignocaine and 4% articaine can produce effective palatal anesthesia and pain control using buccal infiltration alone after 15 minutes of latency.

Quackery in Dental Practice in Nepal.

Quackery and fraud in dental practice, seen in many countries, is also rampant in Nepal, and they are unethical practices. There is a growing need for strict enforcement of government policy measures to eliminate quackery and fraudulent dental practice in Nepal. The government should mobilize all dental workforce (dental specialists, dentists, and dental auxiliaries) and aware of their responsibilities and limitations. This article presents a brief review showing some cases of malpractice in dentistry in Nepal.

The anesthetic efficiency of retromolar infiltrations with two local anesthetic solutions of the same concentration in lower third molar surgery.

BACKGROUND: Mandibular third molar removal is the most common surgical procedure encountered in oral and maxillofacial clinics. It also presents the greatest challenges and controversies for surgeons when surgical removal is considered. Furthermore, diverse anesthesia results and success rates are achieved after using the same concentrations of different solutions or the same amounts of local anesthetics. The purpose of this study was to examine the efficiency of using double-cartridge (3.4 ml) 4% lidocaine (high concentration) and 4% articaine with a 1:100000 epinephrine infiltration in the retromolar region for impacted lower third molar surgery. METHODS: This double-blind study included 30 patients with symmetrically impacted lower third molars. The patients were randomly selected to receive 4% articaine on one side and 4% lidocaine on the other, as a local anesthetic for third molar surgery. The onset, duration of soft-tissue numbness, pulpal sensitivity, amount of additional local anesthetic needed, pain score during the surgical procedure, and duration of the operation were recorded. RESULTS: The results of this research indicate that 86.7% of the operations in the 4% articaine group and 83.3% of those in the 4% lidocaine group were successful. Furthermore, the outcomes in both groups were not statistically significant (P > 0.05). Numbness onset occurred faster in the articaine group than it did in the lidocaine group. However, the duration of soft-tissue anesthesia and pain scores recorded immediately postoperatively were similar. CONCLUSION: It is concluded that 4% lidocaine and 4% articaine had a similar infiltration efficacy in the retromolar region and both local anesthetics are adequate for impacted lower third molar surgery. There were no statistically significant differences between the two local anesthetics regarding pain control and the duration of soft-tissue numbness during the procedure.

Anesthetic and analgesic efficacy of bupivacaine in mandibular third molar surgery: a systematic review and meta-analysis.

OBJECTIVE: This study was conducted to compare the anesthetic and analgesic efficacy of bupivacaine with other local anesthetic agents routinely used for mandibular third molar surgery. METHOD AND MATERIALS: Four electronic databases (PubMed, Scopus, Cochrane, and Web of Science) were explored to isolate randomized controlled trials up to 10 February 2019. The anesthetic and analgesic efficacies were assessed using six evaluation outcomes: onset of anesthesia, success of anesthesia, duration of anesthesia, duration of analgesia, pain score on the fourth postoperative hour, and number of analgesics consumed. Stata software (version 13, StataCorp) was used to analyze the data. RESULTS: Fourteen studies met the specified criteria. The sample consisted of 1,078 mandibular third molar surgeries performed in 858 patients. Bupivacaine, lidocaine/lignocaine, articaine, etidocaine, levobupivacaine, and carbonated bupivacaine were the local anesthetics used. Compared with other anesthetic agents, bupivacaine showed longer duration of anesthesia (weighted mean difference [WMD] 123.431 minutes; 95% confidence interval [CI] 34.01 to 212.851; P = .007), lower pain score at the fourth and eighth postoperative hours (4 hr-WMD 2.757; 95% CI 0.893 to 4.62; P = .004; 8 hr-WMD 1.697; 95% CI 1.178 to 2.216; P < .001), and lower number of analgesics requirement (WMD 0.663; 95% CI 0.258 to 1.067; P = .001). The onset of anesthesia was slower for bupivacaine (WMD 0.865 minutes; 95% CI 0.799 to 0.931; P < .001). However, for success of anesthesia (risk ratio 1.003; 95% CI 0.972 to 1.035; P = .831) and duration of analgesia (WMD 45.285 minutes; 95% CI -48.021 to 138.537; P = .342), the local anesthetic agents showed no significant differences. CONCLUSIONS: Except for the onset of anesthesia, bupivacaine showed better anesthetic and analgesic properties than other local anesthetic agents for mandibular third molar surgery.

An epidemiological study on the prevalence of temporomandibular disorder and associated history and problems in Nepalese subjects.

BACKGROUND: Temporomandibular disorder (TMD) represents a subgroup of painful orofacial disorders involving pain in the temporomandibular joint (TMJ) region, fatigue of the cranio-cervico-facial muscles (especially masticatory muscles), limitation of mandible movement, and the presence of a clicking sound in the TMJ. TMD is associated with multiple factors and systemic diseases. This study aimed to assess the prevalence of TMD in Nepalese subjects for the first time. METHODS: A total of 500 medical and dental students (127 men and 373 women) participated in this study from May 2016 to September 2016. The Fonseca questionnaire was used as a tool to evaluate the prevalence of TMD, and Fonseca's Anamnestic Index (FAI) was used to classify the severity of TMD. RESULTS: The majority of the participants with TMD had a history of head trauma, psychological stress, and dental treatment or dental problems. The prevalence of TMD in Nepalese students was mild to moderate. CONCLUSIONS: The prevalence of TMD in Nepalese subjects was mild to moderate. The majority of the study subjects had eyesight problems, history of head trauma, psychological stress, and drinking alcohol and had received dental treatments.

Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery.

BACKGROUND: There are no studies regarding 4% articaine infiltration injection into the retro-molar area for an impacted lower third molar (LITM) surgery. This study aimed to evaluate the efficacy of infiltration using 1.7 ml (single cartridge: SC) of 4% articaine versus 3.4 ml (double cartridges: DC) of 4% articaine with 1:100,000 epinephrine in LITM surgery. METHOD: This study involved 30 healthy patients with symmetrical LITM. The patients were assigned to receive either a DC or SC of 4% articaine with 1:100,000 epinephrine as a local anesthetic for each operation. Onset, duration, profoundness, need for additional anesthetic administration, total volume of anesthetic used, vitality of the tooth, and pain score during operation were recorded. RESULTS: The DC of 4 % articaine had a significantly higher success rate (83.3%) than did the SC (53.3%; P < 0.05). The duration of soft tissue anesthesia was longer in the DC group. The intra-operative pain was higher in the SC group with a significant (P < 0.05) requirement for a supplementary local anesthetic. CONCLUSION: We concluded that using DC for the infiltration injection had a higher success rate, longer duration of anesthesia, less intra-operative pain, and a lower amount of additional anesthesia than SC in the surgical removal of LITM. We recommend that a DC of 4% articaine and a 1:100,000 epinephrine infiltration in the retro-molar region can be an alternative anesthetic for LITM surgery.