Articaine VS Lignocaine in Orthodontic Extraction of Maxillary Premolars - A Randomized, Double-Blinded Study

BACKGROUND Local anaesthetics helps in preventing pain during surgical and dental procedures by blocking the peripheral nerves. The primary objective of this investigation was to compare and evaluate 4 % articaine hydrochloride (with 1 : 100000 adrenaline) and 2 % lignocaine hydrochloride (with 1 : 80000 adrenaline) in terms of pulpal anaesthesia, volume of anaesthetic solution administered, need of re-anaesthesia and difficulty of extraction during orthodontic extraction of maxillary first premolars. METHODS This prospective randomized, double-blinded study was conducted on 43 patients of less than 40 years of age requiring bilateral maxillary first premolar extractions for orthodontic purposes. Each patient was randomly assigned to receive either 2 % lignocaine hydrochloride or 4 % articaine hydrochloride for premolar extraction of one side and other solution was administered for premolar extraction of contralateral side spaced 1 to 3 weeks apart. In each patient, the difference in pulpal anaesthesia, volume of anaesthetic solution administered, need of re-anaesthesia, difficulty of extraction and duration of anaesthesia was assessed on administration of lignocaine hydrochloride and articaine hydrochloride. RESULTS Statistically significant difference in pulpal anaesthesia levels was found when the articaine and lignocaine groups (P > 0.05) were compared, with a higher mean pulpal anaesthesia among the articaine group. There was no difference in volume of anaesthetic solution administered on buccal and palatal side among the articaine and lignocaine groups. Only 2.3 % of patients in both the groups required re-anaesthesia on the buccal side. There was no significant difference in difficulty of extraction in both the groups. The articaine group had a longer mean duration of anaesthesia as compared to the lignocaine group which was highly significant. CONCLUSIONS Articaine may be used to replace lignocaine in orthodontic extraction of maxillary premolars with clinical advantages like higher pulpal anaesthesia and longer duration of anaesthesia. KEY WORDS Local Anaesthetic, Lignocaine Hydrochloride, Articaine Hydrochloride, Orthodontic Extraction, Prospective Study, Double-Blinded Study.

Difficult subarachnoid anaesthesia Prediction and Performance

Spinal anaesthesia (SA) has enjoyed a long history of success, celebrating soon its 125th anniversary. Puncturing the dura mater is considered a simple procedure, followed by a subarachnoid injection of a local anaesthetic (LA) agent into the cerebrospinal fluid (CSF). Even when the technique is performed perfectly, there is no guarantee that the block sits perfectly. Failure is not uncommon and encompasses a range from total absence of any neuraxial blockade, a partial block (insufficient height, quality or duration) or a patchy block. Table 1 lists a large number of potential causative factors that may result in a failed spinal anaesthetic, providing suggestions of solutions. Analysing each distinct phase of the procedure, i.e., spinal puncture, injection of local anaesthetic solution, spread of the local anaesthetic solution through the cerebrospinal fluid, action of the drug on subarachnoid neural tissue and patient management, are the keys to success at each stage. Mechanisms of failure of spinal anaesthesia include insufficient preparation and check of equipment and drugs, suboptimal positioning of the patient, unsuccessful puncture due to inadequate training or experience and inadequate use of needles and local anaesthetic solution.1-5 Besides operator, preparation, technique-dependent and patient-related factors (anatomical variations), there are also organisational factors (lack of block room, lack of adequate monitoring and trained personnel, insufficient time between block and onset of surgery, subsequent management following block). The use of the correct local anaesthetic (dose, volume, concentration) injected at the correct lumbar interspace is of paramount importance to produce an adequate spinal block for the right surgical intervention. Nevertheless, failures may still occur. Therefore, the anaesthetist should always have a contingency plan for a failed spinal block. Indeed, patients expect reliable surgical anaesthesia when undergoing an operation

Local Infiltration Anaesthesia with a Bloodless Operative Field (WALANT). Presentation of the Technique and its Use in Hand Surgery

Local infiltration anaesthesia with a bloodless operation field (WALANT) allows for performing hand surgery without a tourniquet. This effect is obtained through an injection of greater than standard volume of the anaesthetic solution composed of lignocaine and adrenaline. The addition of adrenaline induces spasm of small arteries within the infiltration area, which inhibits bleeding and allows visualization of most of the subtle but important structures in the hand and fingers. This article presents a method of preparation of the anaesthetic solution and the technique of anaesthesia for several common procedures in hand surgery. In 2019, our centre performed 340 operations under WALANT anaesthesia, with no serious complications observed. Data from the literature are presented showing that this technique is attracting increasing popularity worldwide. Our centre was the first in Poland to introduce the WALANT method to hand surgery.

An In-vitro Assessment of Effect of Interaction Between Local Anaesthetic Solution with Sodium Hypochlorite on the Sealing Ability of Root Canal Obturation

Introduction: Endodontic treatment failures are caused by persistent or secondary infection due to inefficient cleaning or re-infection of the obturated root canal system because of coronal or apical leakage. Intrapulpal Injection (IPI) technique is the most commonly employed supplemental anaesthetic procedure and NaOCl is considered as gold standard irrigating solution. Therefore, this study was designed to explore the action of precipitate form by interaction between LA and Sodium Hypochlorite (NaOCL) on sealing of root canal obturating material. Aim: To evaluate the effect of precipitate formed by interaction of local anaesthetic solution and NaOCl on the sealing ability of root canal obturation, using a push-out bond strength test. Materials and Methods: This was an in-vitro study from October 2019 to January 2020. In this study, forty single rooted premolars were selected and were randomly distributed equally into 4 groups with 10 specimens in each group, based on the test solutions employed. All the teeth were decoronated and the root length was standardised. Group I - irrigated with saline only, Group II- treated with 2% lidocaine hydrochloride with adrenaline 1:100,000 (2% LA) followed by 3% NaOCl, Group III - 2% LA followed by saline and 3% NaOCl, Group IV- 3% NaOCl followed by saline. All root canals were than instrumented using ProTaper Universal rotary system upto F3 and obturation was done using AH plus sealer and GuttaPercha. Sealing ability was evaluated using a micro push-out bond strength, with the help of a universal testing machine and data were analysed statistically. Results: One-way analysis of variance (ANOVA) showed that there is highly significant difference among the various groups (p <0.0001). Within the experimental groups, Group II showed minimum mean push out bond strength (16.39±2.40) as compared to Group III (21.83±1.25) and Group IV (22.50±2.12). Conclusion: Interaction of LA with NaOCl forms precipitate which blocks the dentinal tubules and reduces the mean push out bond strength. It is recommended to irrigate thoroughly with saline after intrapulpal injection (2%LA) before irrigating with NaOCl.

Location of Mental Foramen in Dentate Adults using Orthopantomogram

Introduction: Understanding the anatomical variations in the position of mental foramen are significant for different dental procedures. This study identified the position of the mental foramen among a sample of Nepalese population visiting a dental college in Kathmandu. Methods: Total 417 panoramic radiographs (orthopantomograms) were selected from a total of 567 radiographs. The mental foramen location was determined by drawing imaginary line parallel with the long axis of the lower premolars . The mental foramen location was then classified into six classes. Results: In the study population, the mental foramina were located mostly between the lower premolars 163 (39.1%), followed by in line with second premolar 148 (35.5%) of the mental foramen was located under the second premolar apex. Conclusions: The study shows that the anaesthetic solution should be injected between the lower premolars or below the lower 2nd premolar in the Nepalese population for successful and secure mental nerve blocking.