Local Anaesthetic Efficacy of 4 % Articaine for Inferior Alveolar Nerve Block and Buccal Infiltration in Teeth with Irreversible Pulpitis - A Randomized, Double-Blind Clinical Trial

BACKGROUND Achieving profound pulpal anaesthesia with an inferior alveolar nerve block (IANB) in lower molars suffering irreversible pulpitis is difficult and quite challenging. In many instances, supplemental anaesthesia is required during endodontic therapy. The present study was done to evaluate the efficiency of 2 % lidocaine and 4 % articaine comparatively, as an inferior alveolar nerve block (IANB) and supplemental infiltration buccally in providing complete mandibular molar anaesthesia. METHODS This is a randomized double-blinded study. Sixty patients were categorized randomly into test group (n= 30) and control group (n= 30). Patients in the test group were anaesthetized with 4 % articaine (1:100,000 epinephrine dilution), and those in the control group were anaesthetized with 2 % lidocaine (1:80,000 epinephrine dilution). The Heft-Parker visual analog scale (HP-VAS) was utilized for rating patient’s pain during the treatment procedure. In case of pain after IANB, a supplemental buccal infiltration was given with the same anaesthetic used for IANB. Complete pain absence or mild pain was regarded as an anaesthetic efficacy, and moderate to severe pain was regarded as an anaesthetic failure. Recorded data was analyzed using the chi-square test and two proportion Z test. The set significance level was 0.05. RESULTS After an IANB, observed anaesthetic success was 56 % in the articaine (test) group and that in the lidocaine (control) group was 33 %. After buccal infiltration, it was 92 % in the articaine group and 75 % in the lidocaine group. The difference was not found significant between the two groups statistically following IANB and infiltration buccally. The overall success of articaine was 96 %, and lidocaine was 83 %. CONCLUSIONS Compared to 2 % lidocaine, 4 % articaine was found more efficient in achieving profound pulpal anaesthesia in mandibular molars suffering irreversible pulpitis after IANB and buccal infiltration though the difference was insignificant statistically. KEY WORDS Articaine, Lidocaine, Inferior Alveolar Nerve Block, Buccal Infiltration, Heft-Parker Visual Analog Scale, Irreversible Pulpitis

Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial

Background Different distraction techniques have been used in dentistry and have shown great results in managing anxious pediatric patients specially during local anesthesia administration. One of the recently invented techniques is virtual reality. The purpose of the study was to evaluate the effect of virtual reality distraction on anxiety and pain during buccal infiltration anesthesia in pediatric patients. Methods Healthy, cooperative 6- to 12-year-old children requiring buccal infiltration anesthesia were randomly assigned to a test or control group. In the test group, local anesthesia was administered while the subjects were watching a cartoon video using virtual reality goggles. Subjects in the control group watched a cartoon video on a screen during the administration of local anesthesia. To assess anxiety in both groups, heart rate was recorded using a pulse oximeter at five time points: (1) once the subject sets on the dental chair as a baseline; (2) when video is on; (3) at topical anesthesia application; (4) during needle insertion; (5) after the administration of local anesthesia. The face, legs, activity, cry, consolability (FLACC) behavioral pain assessment scale and the Wong–Baker FACES pain rating scale were used to assess pain. Results A total of 50 subjects were included with a mean age of 8.4 ± 1.46 years. Twenty-nine (58.0%) of the subjects were females. The mean heart rate at all time points except baseline was significantly higher among the test group compared to the control group. Multiple regression analysis showed that younger subjects and females had higher mean FLACC behavioral pain assessment scale scores (P = 0.034 and P = 0.004, respectively) regardless of the distraction technique used. Younger subjects and subjects with higher baseline heart rate reported higher mean Wong–Baker FACES pain rating scale score (P = 0.031 and P = 0.010, respectively), controlling for all other variables. Conclusion Female subjects and the younger age group were more likely to report higher pain scores during local anesthesia administration regardless of the type of distraction used. Trial registration The study was retrospectively registered in ClinicalTrials.gov with the identifier: NCT04483336 on 23/07/2020.

Use of bufferized dental anesthetics in dental surgery

Introduction and objective: The addition of epinephrine to the anesthetic solution reduces the pH of the solution to a range between 2.9 and 4.4.The acidity of the anesthetic may delay onset and contribute to injection pain. Objective: to determine the intensity of pain during a mandibular third molar surgery after using buffered 4% articaine with epinephrine 1:100000 in the inferior alveolar nerve block with buccal infiltration. Materials and methods: an observational and descriptive clinical study was performed. The buffered solution was alkalinized with 8.4% sodium bicarbonate with a ratio of 9:1, using a hand-mixing methodology, the sample were patients who required a mandibular third molar surgery. After standardizing the anesthetic technique, it was used the inferior alveolar nerve block followed by buccal infiltration. Results: 32 patients (20 female - 62.5% and 12 male - 37.5%), with an average age of 21.12 years (mean ± standard deviation [SD]: 21.12 ± 3.61) were admitted to the study. When assessing the pain puncture and during the injection, 94% of patients classified it as mild pain according to VAS. When evaluating the latency period, the average time was less than two minutes and the perioral soft tissue anesthesia was 62%. Only a small percentage of patients required complementary anesthesia. Conclusion: buffered 4% of articaine with epinephrine in the inferior alveolar nerve block with buccal infiltration significantly decreased onset time, injection pain and need for complementary anesthesia in third molar surgery.

Anesthetic efficacy of 4% articaine buccal infiltration in the urgency treatment of mandibular molars with symptomatic irreversible pulpitis: a randomized clinical trial

The aim of this study was to evaluate the anesthetic efficacy of the 4% articaine by the buccal infiltration technique (BI) after inferior alveolar nerve block (IANB) with 2% mepivacaine, both with 1:100,000 epinephrine, in the urgency treatment of mandibular molars with symptomatic irreversible pulpitis (SIP). This was a prospective study, with a randomized, blinded, controlled parallel clinical trial experimental design. Thirty patients diagnosed with SIP were randomly assigned, and the control group (G1) received the IANB with 1.8 mL of mepivacaine while the experimental group (G2) also received a supplemental BI with 1.8 mL of articaine. To evaluate the anesthetic efficacy, in addition to lip numbness test, the electric pulp testing (EPT) was used. Additionally, a visual analogue scale verified the presence of pain. Two-way ANOVA and Chi-square tests were applied at a significance level of 5%. There was a reduction in pain perception after the two techniques (p<0.001), with no difference between groups (p=0.479). The anesthetic efficacy was 26.6% for IANB (G1) and 40% for IANB plus BI (G2), without significant difference between the two treatments (p=0.699). The BI with 4% articaine after IANB with 2% mepivacaine, both with 1:100,000 epinephrine, did not significantly increase anesthetic success in patients with SIP.