RESUMEN
Purpose: To investigate the anesthetic effectiveness of buccal infiltration (BI) versus buccal plus lingual infiltration (BI+LI) of 4% articaine for intra-alveolar extraction of erupted mandibular molar teeth. Material and Methods: Eighty patients were included in this prospective clinical study. They were randomly divided into 1 of 2 equal groups: the 1st group received BI of 4% articaine 1.8 ml and LI of 0.5 ml, while the 2nd group received 4% articaine 1.8 ml BI plus 0.5 ml LI of normal saline. Another 1.8 ml articaine BI was given if initial anesthesia was inadequate. Outcome variables included pain, which was rated by patients at 3 intervals using visual analogue scale, and lingual anesthesia and patients' satisfaction which were measured using 5-score verbal rating scale. Data analyses used were descriptive statistics, t test, χ2 test, and Pearson's correlation coefficient. P-value value less than 0.05 was considered significant. Results: There were 46 females and 34 males and the mean age was 35.3 years. All outcome variables were comparable between the two study groups (pË0.05). Anesthesia was successful in 78% and 88% of cases in the (BI) and (BI+LI) groups respectively with no significant difference (p=0.2392). The mean articaine volume used was 2.5 ml and 2.87 ml respectively without significant difference (p=0.090). Conclusion: The anesthetic efficacy of (BI) alone and (BI+LI) of 4% articaine was comparable. When given in an adequate dose, articaine (BI) alone could be justified as an anesthetic option for the intra-alveolar extraction of mandibular molar teeth.
Objetivo: Investigar la efectividad anestésica de la infiltración bucal (BI) versus la infiltración bucal más lingual (BI+LI) de articaína al 4% para la extracción intraalveolar de molares mandibulares erupcionados. Material y Métodos: Ochenta pacientes fueron incluidos en este estudio clínico prospectivo. Se dividieron aleatoriamente en 1 de 2 grupos iguales: el primer grupo recibió BI de articaína al 4% 1,8 ml y LI de 0,5 ml, mientras que el segundo grupo recibió articaína al 4% 1,8 ml BI más 0,5 ml LI de solución salina normal. Se administró otro BI de articaína de 1,8 ml si la anestesia inicial era inadecuada. Las variables de resultado incluyeron el dolor, que los pacientes calificaron en 3 intervalos mediante una escala analógica visual, y la anestesia lingual y la satisfacción de los pacientes, que se midieron mediante una escala de calificación verbal de 5 puntos. Los análisis de datos utilizados fueron estadística descriptiva, prueba t, prueba χ2 y coeficiente de correlación de Pearson. Se consideró significativo el valor del valor de pinferior a 0,05. Resultados: Hubo 46 mujeres y 34 hombres y la edad media fue de 35,3 años. Todas las variables de resultado fueron comparables entre los dos grupos de estudio (p=0,05). La anestesia fue exitosa en el 78% y 88% de los casos en los grupos (BI) y (BI+LI) respectivamente sin diferencia significativa (p=0,2392). El volumen medio de articaína utilizado fue de 2,5 ml y 2,87 ml respectivamente sin diferencia significativa (p=0,090). Conclusión: La eficacia anestésica de (BI) solo y (BI+LI) de articaína al 4% fue comparable. Cuando se administra en una dosis adecuada, la articaína (BI) sola podría estar justificada para la extracción intraalveolar de molares mandibulares.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Extracción Dental , Carticaína/administración & dosificación , Anestesia Dental , Dimensión del Dolor , Irak/epidemiología , Anestesia LocalRESUMEN
To determine whether the permeation capacity and analgesic efficacy of articaine (ATC) could be increased and cytotoxicity decreased by encapsulation in poly(É-caprolactone) nanocapsules (ATCnano), aiming at local or topical anesthesia in dentistry. Cellular viability was evaluated (using the MTT test and fluorescence microscopy) after 1 h and 24 h exposure of HaCaT cells to ATC, ATCnano, ATC with epinephrine (ATCepi), and ATC in nanocapsules with epinephrine (ATCnanoepi). The profiles of permeation of 2% ATC and 2% ATCnano across swine esophageal epithelium were determined using Franz-type vertical diffusion cells. Analgesic efficacy was evaluated with a von Frey anesthesiometer in a postoperative pain model in rats, comparing the 2% ATC, 2% ATCnano, 2% ATCepi, and 2% ATCnanoepi formulations to 4% ATCepi (a commercially available formulation). We show that use of the nanocapsules decreased the toxicity of articaine (P<0.0001) and increased its flux (P = 0.0007). The 2% ATCepi and 4% ATCepi formulations provided higher analgesia success and duration (P<0.05), compared to 2% ATC, 2% ATCnano, and 2% ATCnanoepi. Articaine-loaded poly(É-caprolactone) nanocapsules constitute a promising formulation for intraoral topical anesthesia (prior to local anesthetic injection), although it is not effective when injected in inflamed tissues for pain control, such as irreversible pulpitis.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Carticaína/administración & dosificación , Nanocápsulas/administración & dosificación , Animales , Línea Celular , Supervivencia Celular/efectos de los fármacos , Humanos , Queratinocitos/efectos de los fármacos , Ratas , Ratas WistarRESUMEN
OBJECTIVE: The aim of this randomized clinical trial was to compare the success rate of three different anesthetic techniques in mandibular molars with symptomatic irreversible pulpitis. MATERIALS AND METHODS: Ninety patients with symptomatic irreversible pulpitis in mandibular molars randomly received three anesthetic techniques. Group I: an inferior alveolar nerve block (IANB) of 2% lidocaine. Group II: IANB and buccal infiltration (BI) of 4% articaine. Group III: IANB + BI and intraseptal injection of articaine in each mesial and distal papilla. The pain (Heft-Parker visual analog scale (VAS)) and electric pulp tester (EPT) scores were recorded prior to (VAS1, EPT1) and after the injection and during access preparation (VAS2, EPT2). The success of anesthesia was defined as the ability to access the tooth with no or mild pain (VAS ≤ 54). RESULTS: The mean value for VAS2 was significantly less and the mean value for EPT2 was significantly more in groups II and III compared with group I. The success rates for groups I, II, and III were 30.33%, 66.66%, and 80.00% respectively. Also, differences of EPT2, VAS2, and success rates were statistically significant between groups II and III. CONCLUSION: Administration of articaine as a supplemental intraseptal and BI following IANB can be considered a more successful anesthetic technique in mandibular molars with symptomatic irreversible pulpitis compared with the conventional IANB and supplemental BI. CLINICAL RELEVANCE: The addition of an articaine intraseptal injection to IANB+BI technique may result in a significantly higher success rate of pulpal anesthesia in mandibular molars with symptomatic irreversible pulpitis.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Bloqueo Nervioso , Pulpitis/cirugía , Adulto , Anestésicos Locales , Carticaína/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Lidocaína/administración & dosificación , Masculino , Nervio Mandibular , Diente Molar , Dimensión del Dolor , Adulto JovenRESUMEN
Dental anesthesia is one of the most frequently performed medical procedures. Although the frequency of ocular complications is extremely low, these reactions can be highly alarming and may bring up medicolegal issues when they do occur. Dentists and oral surgeons should be well-informed of these adverse reactions and should be aware that both ophthalmologists and emergency physicians might be required to care for these patients.
Asunto(s)
Anestesia Dental/efectos adversos , Anestesia Local/efectos adversos , Anestésicos Locales/efectos adversos , Carticaína/efectos adversos , Diplopía/etiología , Epinefrina/efectos adversos , Oftalmoplejía/etiología , Extracción Dental , Adulto , Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Epinefrina/administración & dosificación , HumanosRESUMEN
Buccal and palatal injections are required for administration of anesthetic agents before maxillary tooth extractions, but palatal injections are painful for patients. Studies suggest that the palatal injection can be eliminated when articaine is delivered as a local anesthetic agent via buccal injection, but the anatomical mechanism for this effectiveness remains unclear. The objective of this study was to explore the potential mechanism by which buccal infiltration results in palatal anesthesia. The study approach included examining cadaveric specimens and investigating the pharmacologic properties of articaine. Twenty-eight formalin-fixed cadaveric hemimaxillae were dissected and sectioned into anterior, premolar, and molar regions. The maxillary sections were measured in 3 planes: inferior, middle, and superior. Buccal cortical plate (BCP), palatal cortical plate (PCP), and total buccopalatal (TBP) thickness were independently evaluated by 2 measurers using standard digital calipers. Statistical analysis of regional maxillary thickness measurements was achieved via 2-way analysis of variance. Measurements of BCP and PCP thickness revealed no statistically significant differences along the maxillae (P > 0.05). Both the BCP and PCP mean values were significantly less than the TBP measurement (P < 0.0001). In all 3 regions, the mean TBP thickness in the superior plane was significantly greater than that of the inferior plane (P < 0.05). The mean TBP thickness was significantly greater in the molar and premolar regions than in the anterior region (P < 0.05). The mean BCP measurements were significantly lesser in the maxillary premolar and molar regions than in the corresponding mandibular regions (P < 0.0001). The pharmacologic properties of articaine, which is capable of diffusing greater distances than other local anesthetics, coupled with the uniformly thin, cancellous maxillary bone, provide a plausible explanation for the success of palatal anesthesia achieved through buccal infiltration of articaine, obviating the need for a palatal injection.
Asunto(s)
Anestesia Dental , Anestesia Local , Anestésicos Locales/administración & dosificación , Carticaína , Paladar Duro , Administración Bucal , Anestesia Dental/métodos , Anestesia Local/métodos , Carticaína/administración & dosificación , Humanos , Membrana Mucosa , Paladar Duro/metabolismoRESUMEN
PURPOSE: To evaluate the anesthetic adequacy of buccal versus buccal plus lingual infiltration of 4% articaine 1.8 mL for mandibular premolar teeth extraction. PATIENTS AND METHODS: A randomized, double-blinded, placebo-controlled clinical trial was conducted in which patients presented with a mandibular premolar for extraction under local anesthesia. The sample population was randomly divided into 2 equal groups: the first group received infiltration of 4% articaine 1.8 mL buccally and 0.4 mL lingually and the second group received infiltration of 4% articaine 1.8 mL buccally plus lingual injection of normal saline 0.4 mL. Pain was measured during anesthetic injection, 8 minutes after injection, and during extraction using a visual analog scale. Initial lingual anesthesia and patients' satisfaction were measured using a 5-score verbal rating scale. Statistical analyses included descriptive statistics, t test, and Pearson χ2 test. Significance was set at a P value less than.05. RESULTS: Seventy-two patients were included in this study (37 men and 35 women; average age, 49.8 yr). Mean pain scores during injection and extraction and satisfaction scores were comparable between study groups (P = .432, .240, and .478, respectively). Success rates were 100 and 89% in groups A and B, respectively, with no significant difference (P = .1145). CONCLUSIONS: The anesthetic parameters of 1 buccal infiltration of 4% articaine 1.8 mL with and without lingual supplementation were comparable. This result could justify the use of buccal articaine infiltration as an effective alternative to the standard inferior alveolar nerve block technique for extraction of lower premolar teeth.
Asunto(s)
Anestesia Dental , Anestesia Local , Anestésicos Locales , Carticaína , Extracción Dental , Anestésicos Locales/administración & dosificación , Diente Premolar , Carticaína/administración & dosificación , Método Doble Ciego , Femenino , Humanos , Masculino , Nervio Mandibular , Persona de Mediana Edad , Diente MolarRESUMEN
OBJECTIVES: The aim of this study was to determine the effect of intraosseous (IO) anesthesia with 4% articaine and 1:100,000 epinephrine on pulpal blood flow (PBF) and pulpal anesthesia of mandibular first molars and canines in human subjects. MATERIALS AND METHODS: Ten healthy volunteers with intact mandibular first molar and canine were given an osteocentral technique of IO injection using the Quick Sleeper 5 system and 4% articaine with 1:100,000 epinephrine at distal site of mandibular first molar. The PBF was monitored by a laser Doppler flowmeter (LDF). Pulpal anesthesia was assessed with an electric pulp tester (EPT). RESULTS: IO injection caused a decrease in PBF in molars from 6.31 ± 3.85 perfusion units (P.U.) before injection to 2.51 ± 2.53 P.U. 1 min after injection (P < 0.001). The percentage reduction in PBF was 60% after 1 min and PBF returned back to the baseline after 45 min. No significant reduction in PBF was observed in the canines (P = 0.212). For pulpal anesthesia in the molars, the mean onset was 2.40 ± 0.84 min and the mean duration was 38 ± 16.19 min. In the canines, there was a decrease in the sensitivity to EPT but complete pulpal anesthesia was not achieved. CONCLUSIONS: IO injection distal to mandibular first molar caused a decrease in PBF and successful pulpal anesthesia in first molar, but not in canine. Both PBF and EPT readings returned to normal, suggesting that pulpal ischemia may not occur. CLINICAL RELEVANCE: IO anesthesia is safe to use as a primary technique in teeth with normal pulp.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Pulpa Dental/irrigación sanguínea , Pulpa Dental/efectos de los fármacos , Epinefrina/administración & dosificación , Bloqueo Nervioso/métodos , Vasoconstrictores/administración & dosificación , Adolescente , Adulto , Diente Canino , Femenino , Voluntarios Sanos , Humanos , Inyecciones/métodos , Flujometría por Láser-Doppler , Masculino , Mandíbula , Diente MolarAsunto(s)
Anestesia Local , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Láseres de Gas/uso terapéutico , Lidocaína/administración & dosificación , Tetracaína/administración & dosificación , Administración Tópica , Adulto , Humanos , Absorción Cutánea/efectos de la radiación , Crema para la Piel , Soluciones , Factores de TiempoRESUMEN
Data sourcesCochrane CENTRAL Register of Controlled Trials, Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, SCIEXPANDED (ISI Web of Knowledge).Study selectionTwo reviewers selected randomised clinical trials (RCTs) that compared the efficacy of articaine and lidocaine in pain rating during dental treatment in child patients.Data extraction and synthesisTwo authors extracted data using a standardised form, and risk of bias was assessed based on Cochranes Risk of bias tool for RCTs. Meta-analysis was performed on all included studies (n=6) where self-reported pain during and after dental procedure was recorded, and which compared articaine local anaesthesia (LA) to lidocaine LA in children. Then a sensitive analysis was performed excluding the studies with high overall risk of bias (n=3).ResultsSix studies were included, one had 'low', two had 'moderate/uncertain' and three had 'high' risk of bias. To evaluate the impact of these studies with 'high' overall risk of bias, a sensitivity analysis was performed and even when excluding these studies, children who had articaine reported significantly less pain after procedure. However, during the procedure no difference was found between self-reported pain when articaine infiltration and lidocaine inferior dental nerve block were compared.ConclusionsLow quality evidence suggests no difference in efficacy between lidocaine Inferior alveolar dental nerve blocks and articaine infiltration when used for routine dental treatment in children. Also, no difference was found in self-reported pain between lidocaine and articaine during treatment procedures, but apparently articaine leads to less pain reporting after the procedure. The body of the evidence is quite low due to the substantial heterogeneity in the reported outcomes and the overall high risk of bias of the included studies.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Lidocaína/administración & dosificación , Dolor Asociado a Procedimientos Médicos/prevención & control , Niño , Odontología Basada en la Evidencia , HumanosRESUMEN
It is hard to provide adequate anaesthesia by infiltration of lidocaine into the mandible because of the thick buccal cortex. An inferior alveolar nerve block is often used but has a high failure rate, which has led research workers to look for an anaesthetic agent that will anaesthetise the lower teeth by buccal infiltration alone. We have assessed the efficacy of buccal infiltration anaesthesia with articaine by designing a double-blind controlled clinical trial in 133 patients who required extraction of mandibular molars. They were randomly divided into two groups and given infiltration anaesthesia with either 4% articaine or 2% lidocaine by a single injection deep into the mucobuccal fold at the site of the tooth. After five minutes the mesial, distal, buccal, and lingual sides of the tooth were probed. Pain at this time or later during dissection of soft tissue by periosteal elevator was considered as failure, and an inferior alveolar nerve block was given. The amount of pain, and the number of patients who developed pain, were significantly greater in the group given 2% lidocaine (p<0.001). The two groups did not differ significantly in age or sex. Articaine is more successful in providing adequate depth of anaesthesia, but its efficacy was not sufficient to replace an inferior alveolar nerve block for extraction of mandibular molars (Registration code: IRCT2016062627111N2).
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Diente Molar/cirugía , Extracción Dental , Adulto , Método Doble Ciego , Femenino , Humanos , Lidocaína/administración & dosificación , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: The purpose of this study is to compare the success rates of inferior alveolar nerve block (IANB) and buccal infiltration anesthesia of mandibular second premolar with irreversible pulpitis and to evaluate the level of patient discomfort with these methods. MATHERIALS AND METHODS: Forty patients, who had irreversible pulpitis in the mandibular 2nd premolar teeth, were included in the study. Patients were randomly distributed in two groups. In one group IANB, in the other group buccal infiltration anesthesia were performed. The efficacy of these two different anesthesia techniques on the related teeth was investigated with the Heft-Parker visual analog scale. In addition, with a pulse oximetry device, the changes in the patients' heart rates were compared between the groups. The obtained data were evaluated statistically. RESULTS: Both anesthesia techniques reduced the pain significantly in patients before the administration (P < 0.05), but there was no significant difference among the groups regarding the pain control and success rates of anesthesia (P > 0.05). Both of the anesthesia techniques increased the heart rate (P < 0.05). The increase in the heart rate of the patients was significantly higher in the buccal infiltration anesthesia group than the other anesthesia group (P < 0.05). CONCLUSION: Within the limitation of this in vivo study, there was no difference between the efficacies of the buccal infiltration anesthesia and IANB anesthesia in the mandibular 2nd premolar teeth with irreversible pulpitis. Buccal infiltration anesthesia caused more discomfort in the patients compared with the IANB during the administration.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Nervio Mandibular/efectos de los fármacos , Diente Molar/inervación , Bloqueo Nervioso/métodos , Pulpitis/tratamiento farmacológico , Adulto , Diente Premolar , Método Doble Ciego , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Dimensión del Dolor/efectos de los fármacos , Estudios Prospectivos , Pulpitis/fisiopatologíaRESUMEN
AIM: To compare the anaesthetic efficacy for pain and behaviour during treatment with mandibular infiltration using 4% articaine (BI) with inferior dental nerve clock (IDNB) using 2% lidocaine for extraction or pulp therapy in mandibular primary molars. DESIGN: This was equivalence parallel prospective RCT. A total of 98 children aged 5-9 years old were randomly assigned into two groups: BI supplemented by buccal intrapapillary infiltration with 4% articaine; IDNB with 2% lidocaine supplemented with long buccal infiltration. Behaviour during the injection and treatment procedures was assessed using Wong-Baker Facial Rating Scale (W-BFRS), Visual Analogue Scale (VAS), and Frankl Behaviour Rating Scale (FBRS). RESULTS: During the injection phase, the absolute differences in success rates between the two techniques were 0.06 (95% CI: -0.11 to 0.23) for VAS and -0.08 (95% CI: -0.19 to 0.03) for the behaviour of the child (FBRS). FBRS results showed the equivalence of the two, whereas the VAS results showed nonequivalence with the 95% confidence intervals slightly exceeding the equivalence margin (±0.20). W-BFRS success rates were 63.3% for both. During the treatment, VAS results showed similar success rates, demonstrating equivalence between the two as did the results for FBRS. CONCLUSION: The results suggested equivalence in success rates for both anaesthetic techniques during treatment.
Asunto(s)
Anestesia Dental , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Lidocaína/administración & dosificación , Dolor/prevención & control , Pulpotomía , Extracción Dental , Anestesia Local , Niño , Preescolar , Femenino , Humanos , Inyecciones , Masculino , Bloqueo Nervioso , Dimensión del Dolor , Estudios Prospectivos , Diente PrimarioRESUMEN
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.
Asunto(s)
Anestesia Local/métodos , Anestésicos Locales/farmacocinética , Carticaína/farmacocinética , Lidocaína/farmacocinética , Paladar Duro/metabolismo , Administración Bucal , Anestésicos Locales/administración & dosificación , Animales , Carticaína/administración & dosificación , Cromatografía Líquida de Alta Presión , Lidocaína/administración & dosificación , Masculino , ConejosRESUMEN
OBJECTIVES: The purpose of this study was to evaluate the anesthetic efficiency of local infiltration anesthesia administered with a pressure syringe (P-INF) via a special technique versus direct block anesthesia of the inferior alveolar nerve (IANB) for tooth extraction in the posterior mandible. MATERIALS AND METHODS: In a prospective randomized study, 101 teeth in 101 patients were extracted in the posterior mandible under local anesthesia whereby two different administration techniques were used (P-INF n = 48; IANB n = 53). Primary objectives were comparisons of anesthetic success rate (yes/no) and efficacy (full/sufficient vs. insufficient). Secondary objectives were patients' pain perception during treatment, pain of injection (numerical rating scale), need for second injections (always IANB), time until onset of anesthetic action (min), and duration of local numbness (min). RESULTS: IANB was successful in all cases, whereas initial P-INF achieved 35% of success only. Furthermore, IANB reached significant higher values of anesthetic efficacy compared to P-INF (P < 0.001). Concerning pain of injection, patients rated IANB to be more painful (P = 0.039). Second injections were significantly more often necessary for P-INF (P = 0.006) whereas duration until onset of action as well as the duration of local numbness were found to be equal. CONCLUSIONS: For anesthetic efficacy as well as anesthetic success, block anesthesia of the inferior alveolar nerve (IANB) turned out to be more proficient to local infiltration via special delivering system with a special technique. CLINICAL RELEVANCE: Infiltration, even when performed with 4% articaine and a pressure syringe system, is not a suitable method of anesthesia in the posterior mandible.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Diente Premolar/cirugía , Carticaína/administración & dosificación , Diente Molar/cirugía , Bloqueo Nervioso/métodos , Extracción Dental , Adolescente , Adulto , Diseño de Equipo , Femenino , Humanos , Inyecciones , Masculino , Mandíbula/cirugía , Nervio Mandibular , Dimensión del Dolor , Estudios Prospectivos , Jeringas , Resultado del TratamientoRESUMEN
In patients undergoing endoscopic transsphenoidal hypophysectomy, the nasal mucosa is often infiltrated with local anesthetic solutions that contain epinephrine to aid hemostasis. This may, however, result in hemodynamic changes, especially hypotension. We characterized the cardiovascular changes using a LiDCOrapid monitor in 13 patients after the infiltration of 4% articaine containing 1:200,000 epinephrine. Nine (69%) had a >20% decrease in mean arterial pressure at a median time of 116 seconds after the infiltration of articaine with epinephrine. Analysis of the cardiac output data revealed that this was caused by a sustained reduction in systemic vascular resistance. The arterial blood pressure normalized over a period of 60 to 90 seconds secondary to increases in stroke volume and heart rate producing an elevation in cardiac output. Transient hypotension following the infiltration of epinephrine-containing local anesthetics may be caused by epinephrine stimulation of ß2-adrenoceptors producing vasodilation.
Asunto(s)
Anestesia Local/efectos adversos , Epinefrina/efectos adversos , Hipofisectomía/métodos , Hipotensión/inducido químicamente , Hipotensión/fisiopatología , Cavidad Nasal/cirugía , Vasoconstrictores/efectos adversos , Adulto , Anciano , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Presión Sanguínea/efectos de los fármacos , Carticaína/administración & dosificación , Carticaína/efectos adversos , Epinefrina/administración & dosificación , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Hipofisectomía/efectos adversos , Masculino , Persona de Mediana Edad , Mucosa Nasal , Estudios Prospectivos , Volumen Sistólico/efectos de los fármacos , Resistencia Vascular/efectos de los fármacos , Vasoconstrictores/administración & dosificaciónRESUMEN
PURPOSE: We compared the efficacy of local infiltrative anesthesia and regional mandibular block anesthesia using articaine to harvest ramus grafts and the postoperative sequelae. MATERIALS AND METHODS: A total of 20 patients with alveolar bone deficiency participated in the present comparative, prospective, randomized study. The first group received regional anesthesia with the mandibular block technique (group A; n = 10), and those in the second group received local infiltration anesthesia (group B; n = 10). Intraoperative pain and bleeding were evaluated as the primary outcome variables. The visual analog scale (VAS) scores were compared at 0.5, 1, 2, and 4 hours postoperatively. The maximal interincisal mouth opening (MIO) (on days 3 and 7) and VAS scores (at 6, 12, 24, and 48 hours and on days 3 and 7) were compared as secondary outcome variables. The correlation between pain (VAS scores) and trismus (MIO) were also compared. RESULTS: A painless procedure was performed in both groups. The VAS score, MIO, and intraoperative bleeding were not significantly different between the 2 groups. Paresthesia was not observed in either group postoperatively. No statistically significant correlations were found between the VAS scores and MIO. CONCLUSIONS: Local infiltrative anesthesia preserves almost the same depth of anesthesia as mandibular block anesthesia. No differences were found between these techniques in terms of efficacy and postoperative sequelae during and after ramus graft harvest. Thus, using articaine with a local infiltration technique is an alternative to mandibular block anesthesia during ramus graft harvesting and results in a reduced risk of inferior alveolar nerve damage.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Mandíbula/trasplante , Bloqueo Nervioso/métodos , Manejo del Dolor/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Estudios Prospectivos , Escala Visual AnalógicaRESUMEN
The aim of the study was to evaluate the algorithm of safe emergency dental care in pregnant patients. Eighty-five pregnant women aged 20-35 were included in the study. The paper presents elaborated state-of-the-art guidelines for emergency dental care in pregnant patients. Articaine 4% with epinephrine 1:200,000 is recommended as a choice agent for local anesthesia in these patients.
Asunto(s)
Atención Odontológica/métodos , Complicaciones del Embarazo/cirugía , Enfermedades Estomatognáticas/cirugía , Adulto , Algoritmos , Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Servicios Médicos de Urgencia , Epinefrina/administración & dosificación , Femenino , Humanos , Embarazo , Vasoconstrictores/administración & dosificación , Adulto JovenRESUMEN
AIM: To review the current teaching of the use and administration of local anaesthesia in United Kingdom dental schools, along with their local guidelines and protocols. METHODS: A qualitative and quantitative questionnaire was sent to sixteen UK dental schools to probe the methods of local anaesthetic teaching within each school. RESULTS: 14 of the 16 schools replied and the responses show a variety of practices being taught in the dental schools. 2% Lidocaine 1:80,000 Adrenaline is the first choice local anaesthetic solution for the majority of clinical situations. CONCLUSION: 2% Lidocaine with 1:80,000 Adrenaline remains the gold standard dental local anaesthetic with teaching about its safety and uses in all but a few situations. Most are taught the use of additional aids such as safety syringes and topical anaesthesia. There is variation with regards to the use of alternative anaesthetic agents.
Asunto(s)
Anestesia Dental/métodos , Anestesia Local/métodos , Anestesiología/educación , Educación en Odontología , Facultades de Odontología , Adulto , Anatomía/educación , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Niño , Competencia Clínica , Evaluación Educacional/métodos , Epinefrina/administración & dosificación , Humanos , Lidocaína/administración & dosificación , Mepivacaína/administración & dosificación , Bloqueo Nervioso/métodos , Farmacología/educación , Prilocaína/administración & dosificación , Seguridad , Encuestas y Cuestionarios , Jeringas , Enseñanza/métodos , Libros de Texto como Asunto , Reino Unido , Vasoconstrictores/administración & dosificaciónRESUMEN
INTRODUCTION: The purpose of this prospective, randomized, double-blind, placebo-controlled study was to determine whether ketorolac buccal infiltrations (BIs) helped to improve the success of inferior alveolar nerve blocks (IANBs) in patients with acute irreversible pulpitis (AIP). METHODS: Forty adult volunteers with AIP in a mandibular molar were included in this study. Patients were instructed to evaluate their pain by using a Heft-Parker visual analog scale. They were randomly divided into 2 groups (n = 20). All patients received standard IANB injection and after that a BI of 4% articaine with 1:100,000 epinephrine. After 5 minutes, 20 patients received a BI of 30 mg/mL ketorolac, and the other received a BI of normal saline (control group). Endodontic access cavity preparation (ACP) was initiated 15 minutes after the IANB when the patient reported lip numbness and had 2 electric pulp tests with no responses. The patient's pain during caries and dentin removal, ACP, and canal length measurements (CLM) was recorded by using Heft-Parker visual analog scale. Successful anesthesia was defined as no or mild pain during any of these steps, without the need for additional injection. Data were statistically analyzed by using Mann-Whitney U and χ(2) tests. RESULTS: Successful anesthesia after an IANB plus BI of articaine was obtained in 15% of patients in the control group at the end of CLM. Adding BI of ketorolac significantly increased the success rate to 40% (P < .05). Patient's pain during ACP and CLM was significantly lower in the ketorolac group (P < .05). CONCLUSIONS: Ketorolac BI can increase the success rate of anesthesia after IANB and BI with articaine in patients with AIP.
Asunto(s)
Anestesia Local/métodos , Ketorolaco/administración & dosificación , Nervio Mandibular/efectos de los fármacos , Bloqueo Nervioso/métodos , Cuidados Preoperatorios/métodos , Pulpitis/terapia , Adolescente , Adulto , Anciano , Anestesia Dental/métodos , Carticaína/administración & dosificación , Método Doble Ciego , Epinefrina/administración & dosificación , Femenino , Humanos , Inyecciones/métodos , Irán , Labio/efectos de los fármacos , Masculino , Persona de Mediana Edad , Diente Molar/efectos de los fármacos , Diente Molar/inervación , Dimensión del Dolor , Estudios Prospectivos , Preparación del Conducto Radicular/métodos , Cloruro de Sodio/administración & dosificación , Adulto JovenRESUMEN
INTRODUCTION: The purpose of this retrospective study was to determine the anesthetic success of the inferior alveolar nerve (IAN) block, and supplemental articaine buccal infiltration after a failed IAN block, in first and second molars and premolars in patients presenting with symptomatic irreversible pulpitis. METHODS: As part of 6 studies, 375 emergency patients presenting with symptomatic irreversible pulpitis received 2% lidocaine with 1:100,000 epinephrine via an IAN block. After profound lip numbness, endodontic access and instrumentation were initiated. If the patient felt moderate to severe pain, a supplemental buccal infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine was administered (204 patients), and endodontic treatment continued. Success was defined as the ability to access and instrument the tooth without pain (visual analogue scale rating of 0) or mild pain (visual analogue scale rating less than or equal to 54 mm). RESULTS: IAN block success was 28% for the first molars, 25% for the second molars, and 39% for the premolars. There were no significant differences when comparing molars with premolars. For the supplemental articaine buccal infiltration, success was 42% for the first molars, 48% for the second molars, and 73% for the premolars. There were no significant differences when comparing the molars, but there was a significant difference when comparing the premolars with the molars. CONCLUSIONS: For patients presenting with symptomatic irreversible pulpitis, the success rates for the IAN block and supplemental buccal infiltration of articaine of the molars and premolars would not be high enough to ensure profound pulpal anesthesia.