ABSTRACT
OBJECTIVE: To investigate the effectiveness of a single labial infiltration of 4% articaine versus 2% lidocaine for the extraction of mandibular anterior teeth without an additional lingual injection. PATIENTS AND METHODS: A prospective, randomized-controlled, split-mouth clinical study was implemented. Healthy adult patients seeking bilateral extraction of mandibular anterior teeth were included in this study. Teeth extractions were randomly assigned to two equal groups, where one mandibular anterior tooth was extracted using a solitary labial infiltration of either 4% articaine (the study group) or 2% lidocaine (the control group). After 14 days, the other mandibular anterior tooth was extracted using the other local anesthetic agent. The selection of the anesthetic agent injected in the first session was done in a randomized fashion. After 5 min of local anesthetic injection, the tooth was extracted, and each patient was asked to record the intensity of the extraction pain using the Visual Analogue Scale (VAS). RESULTS: Thirty-one patients were included in the study. The efficacy of a single labial injection for mandibular anterior teeth extraction was established by the fact that none of the patients in the study or control group required re-administration of local anesthesia. The mean VAS for pain control during tooth extraction was 1.16 ± 0.93 for the articaine group and 1.71 ± 0.90 for the lidocaine group. The pain score showed a statistically significant decrease in the articaine group compared to that in the lidocaine group (P = 0.017). CONCLUSION: Although the anesthetic effects of only buccal infiltration of 4% articaine and 2% lidocaine for extraction of mandibular anterior teeth were comparable, the use of 4% articaine would have more effective and predictable outcomes. CLINICALTRIALS: ORG: (ID: NCT05223075) 3/2/2022.
Subject(s)
Anesthesia, Local , Carticaine , Adult , Humans , Lidocaine/therapeutic use , Anesthetics, Local/therapeutic use , Prospective Studies , Mouth , PainABSTRACT
PURPOSE: Palatal local anesthetic injection is a painful procedure. Previous studies have reported successful extraction of maxillary teeth using only buccal infiltration of 4% articaine without palatal anesthesia. The aim of the present study was to determine levels of 4% articaine solution in palatal bone and mucosal tissues after buccal injection and compare those levels with 2% lidocaine solution in New Zealand white rabbits. MATERIALS AND METHODS: Eight rabbits received 2 different injections of 0.6 mL of 4% articaine with 1:100,000 epinephrine and 0.6 mL of 2% lidocaine with 1:100,000 epinephrine buccal to the right and left maxillary first molar, respectively, in a split-mouth study design using quantitative syringes. All injections were administered using the buccal infiltration technique without any palatal injection. Ten minutes later, palatal bone and mucosa specimens were collected for analysis. Levels of the 2 local anesthetic agents were measured in palatal tissues using high-performance liquid chromatography (HPLC). RESULTS: HPLC analysis showed markedly higher 4% articaine solution values (0.319 ± 0.037) in palatal mucosal tissues compared with palatal mucosal concentrations of 2% lidocaine solution (0.0839 ± 0.017). In palatal bone, the mean concentration of 2% lidocaine solution was markedly lower than the mean concentration of 4% articaine solution (0.085 ± 0.012 vs 0.155 ± 0.012, respectively). There was no relevant difference between levels of 2% lidocaine in the palatal bone and mucosal tissues. However, the mean concentration of 4% articaine in the palatal mucosa was markedly higher than its concentration in palatal bone. CONCLUSIONS: The buccal vestibule-palatal diffusion of 4% articaine solution with 1:100,000 epinephrine is greater than 2% lidocaine solution with 1:100,000 epinephrine in a rabbit model.