Bupivacaine 0.5% versus articaine 4% for the removal of lower third molars. A crossover randomized controlled trial.

OBJECTIVE: To compare the anesthetic action of 0.5% bupivacaine in relation to 4% articaine, both with 1:200,000 epinephrine, in the surgical removal of lower third molars. As a secondary objective hemodynamic changes using both anesthetics were analyzed. STUDY DESIGN: Triple-blind crossover randomized clinical trial. Eighteen patients underwent bilateral removal of impacted lower third molars using 0.5% bupivacaine or 4% articaine in two different appointments. Preoperative, intraoperative and postoperative variables were recorded. Differences were assessed with McNemar tests and repeated measures ANOVA tests. RESULTS: Both solutions exhibited similar latency times and intraoperative efficacy. Statistical significant lower pain levels were observed with bupivacaine between the fifth (p=0.011) and the ninth (p=0.007) postoperative hours. Bupivacaine provided significantly longer lasting soft tissue anesthesia (p<0.5). Systolic blood pressure and heart rate values were significantly higher with articaine. CONCLUSIONS: Bupivacaine could be a valid alternative to articaine especially due to its early postoperative pain prevention ability.

Wearability and physiological effects of custom-fitted vs self-adapted mouthguards.

OBJECTIVES: The purpose of this study was to measure the comfort, wearability, physiological effects and its influence on athletes' physical performance, of custom-fitted compared with self-adapted mouthguards (MGs). METHODS: Eleven rugby players were put under specific efforts similar to those of the competition. Each player made three consecutive tests randomly wearing a commercially available 'boil-and-bite' self-adapted mouthguard (MG2), a custom-fitted mouthguard (MG3), and no mouthguard (reference). Forced expiratory air volume at 1 s (FEV(1)), expiratory flow rates peak (PEF), forced vital capacity (FVC), rebound (RB) jump 15 s, and counter-movement jump (CMJ) were measured on each player before and after the training exercise tests. Subjective evaluations by means of a visual analog scale (VAS) questionnaire took place. Comforts, adaptability, stability, tiredness, thirst, oral dryness, nausea, ability to talk, breathe, and drink were evaluated. RESULTS: The wearing of the self-adapted MG showed significant improvement in PEF (P < 0.05). There were no statistically significance differences regarding the others spirometer parameters. In CMJ, there were no differences between both the MGs. On RB power was similar with both MGs and control. However, RB height reduced significantly wearing MGs. MG3 showed superior properties in comfort, adaptability, stability, and ability to talk and to breathe. CONCLUSIONS: MG3 showed the smallest range of changes in players' performance, suggesting improved fit, comfort, and acceptation compared with MG2. Furthermore, its greatest advantage is the individualized design according to the proper anatomy of the oral cavity. Greater efforts must be made to improve the comfort of MGs if their use is to be increased.

Analgesic efficacy of diclofenac sodium versus ibuprofen following surgical extraction of impacted lower third molars.

OBJECTIVE: An evaluation is made of the analgesic efficacy of diclofenac sodium versus ibuprofen after impacted lower third molar surgery. STUDY DESIGN: The patients were randomly assigned to one of two groups (ibuprofen or diclofenac). The difficulty of third molar surgery, performed under local anesthesia, was assessed by the degree of inclusion involved. The recorded study variables were pain intensity and the need for rescue medication during one week. The recordings were made once a day at the same time, using a patient-completed questionnaire. RESULTS: Eighty-one patients were finally included in the study (87.1%). The results were similar in the first 48 postoperative hours in both groups, though on the third day the diclofenac group tended to show higher pain scores--the differences being nonsignificant, however (p<0.05). This tendency was also reflected by an increased need for rescue medication and the consumption of a larger number of tablets in the diclofenac group. CONCLUSIONS: There were no statistically significant differences in analgesic efficacy between diclofenac sodium and ibuprofen, though the former was associated with an increased need for supplementary medication in the first two postoperative days (p<0.05).