Hyaluronidase following buccal infiltrations of articaine with epinephrine for anesthesia of mandibular first molars: A split-mouth, double-blind, placebo-controlled randomized clinical trial.

Background: Adjunctive hyaluronidase has been widely used for ophthalmic anesthesia; however, in Dentistry, very few studies are available so far. Thus, the present study aimed to evaluate anesthetic outcomes of adjunctive hyaluronidase administration following buccal infiltration of articaine with epinephrine for anesthesia of mandibular first molars. Material and Methods: Twenty-eight patients received a buccal supraperiosteal infiltration of 4% articaine with 1:100,000 epinephrine for anesthesia of the mandibular first molars, in a split-mouth approach. Afterward, randomly and using the same technique, they received either 1.0 mL of hyaluronidase (150 UTR/mL) or a placebo solution. Considering patients' pain perceptions provoked by electric and mechanical stimulations, as well as using a pain scale, success rate, action onset time, duration of both pulpal and soft tissue anesthesia, and pain immediately after both punctures and on the 2nd day were assessed. Results: The pulpal anesthetic success rate was 85.7% for hyaluronidase and placebo groups. Soft tissue anesthesia showed a shorter action onset time and a longer duration when hyaluronidase was used; however, there was no difference between the groups regarding action onset time and duration of pulpal anesthesia. Pain at the puncture sites did not differ between the groups, regardless of the time point evaluated. Conclusions: Adjunctive hyaluronidase following buccal infiltration of articaine with epinephrine for mandibular first molars seems not to provide any advantage in anesthetic outcomes in which the nerve fibers are intraosseous (i.e., pulpal anesthesia). On the other hand, soft tissue anesthesia may be improved substantially by using this pharmacological strategy. Key words:Hyaluronidase, local anesthesia, dentistry.

Autologous platelet concentrates in extraction sockets for the prevention of osteoradionecrosis: a systematic review of controlled clinical trials.

This systematic review aimed to assess whether the use of autologous platelet concentrates immediately after tooth extraction would prevent ORN in patients treated with radiotherapy (RT) for head and neck cancer (HNC). MEDLINE, Embase, Ovid, Scopus, Web of Science, CENTRAL Cochrane, and OpenGrey databases were searched (up to, and including, June 2021) by two independent reviewers to identify studies, followed by further manual search. As inclusion and exclusion criteria for the studies, only controlled clinical trials (randomized or not) were considered. The risk of bias of each included study was assessed using the Cochrane Risk of Bias Tool. Of the 129 potentially eligible studies, only 2 were included, both randomized controlled clinical trials; however, one used platelet-rich plasma and another leukocyte- and platelet-rich fibrin. Overall, both autologous platelet concentrates had no effect on the outcome assessed. The use of autologous platelet concentrates seems not to be beneficial for ORN prevention following tooth extractions in HNC patients treated with RT; however, according to the available evidence, a reliable statement cannot be made.

Articaína com hialuronidase em infiltração bucal em primeiro molar inferior / Articaine and hyaluronidase in buccal infiltration on inferior first molar

O índice de sucesso em anestesia infiltrativa em molar inferior é muito baixo, o que justifica a técnica de bloqueio do nervo alveolar inferior mesmo essa sendo mais dolorida. Recentes estudos demonstraram que a anestesia infiltrativa com articaína apresentou maior índice de sucesso do que com a lidocaína, porém, ainda não foi possível evitar falha anestésica. Para aumentar o índice de sucesso dessa técnica vislumbra-se a utilização da enzima hialuronidase como fator de difusão do anestésico local e aumentar a eficácia clínica. O estudo avaliou se a hialuronidase à 150 UTR injetada imediatamente após a articaína infiltrativa em primeiro molar inferior seria capaz de prolongar a duração da anestesia local (AL) na polpa e na gengiva, reduzir a latência de ação, aumentar o seu índice de sucesso anestésico e se o uso da H aumenta a dor do local. Participaram 28 pacientes ASA I e II que apresentavam necessidade de restauração em 2 primeiros molares inferiores. Estes foram alocados em 2 grupos: (1º) 28 pacientes receberam anestesia com articaína 4% associada à epinefrina em seguida era injetada H 150 UTR/ml. (2º) Idêntico ao primeiro grupo, porém utilizando placebo (solvente da hialuronidase) de forma duplo-cego e boca dividida. A latência e a duração na polpa foram avaliadas com estímulo elétrico na face vestibular do primeiro molar inferior, a cada 2 e 10 min, respectivamente. Para gengiva vestibular, utilizou-se estímulo mecânico (picada). Para análise do índice de dor utilizou-se escala numérica de dor (1 a 5) em 3 tempos analisados. A presença da hialuronidase não melhorou o índice de sucesso, não diminuiu o tempo de latência gengival, não aumentou a duração de ação pulpar nem a gengival e não aumentou os níveis de dor, mas houve diminuição da latência gengival do grupo H 150 se comparado a todos os demais. Nas condições experimentais, esta concentração de H não melhora a eficácia clínica.

The success rate in infiltrative anesthesia in lower molar is very low, which explains the technique of inferior alveolar nerve block even this is more painful. Recent studies have shown that infiltrative anesthesia with articaine had a higher success rate than with lidocaine, however, has not been possible to avoid failure of anesthesia. To increase the success rate of this technique envisages the use of the enzyme hyaluronidase as a factor of local anesthetic spread and increase clinical efficacy. The study evaluated whether the 150 TRU/ml to hyaluronidase injected immediately after articaine infiltration in the first molar would be able to prolong the duration of local anesthesia (LA) in the pulp and gums and reduce latency of action, increase your success rate of anesthetic and the use of H increases the pain site. Participated in 28 ASA I and II patients who had need of restoration in two mandibular first molars. These were divided into 2 groups: (1) 28 patients received anesthesia with 4% articaine associated with epinephrine was then injected H 150 TRU/ml. (2) Same as the first group, but using placebo (hyaluronidase solvent) in a double-blind, split-mouth. The latency and duration of the pulp electrical stimulation were evaluated on the buccal of the mandibular first molar, every 2 and 10 min, respectively. For vestibular gingiva, we used mechanical stimulation (pinprick). To analyze the level of pain was used numeric pain scale (1-5) at 3 times analyzed. The presence of hyaluronidase didnt improve the success rate was not reduced latency time gum didnt increase the duration of action or the pulp and gum didnt increase levels of pain, but there was reduced latency gum group compared to H 150 all others. Under the experimental conditions, this concentration of H not improved clinical efficacy.