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DOI: 10.4103/1305-7456.156811
Comparison of speed of action and injection discomfort of 4% articaine and 2% mepivacaine for pulpal anesthesia in mandibular teeth: A randomized, double-blind cross-over trial
Publication History
Publication Date:
04 September 2019 (online)
ABSTRACT
Objective: To compare the injection pain and speed of local anesthetic effect induced by tissue infiltration of mepivacaine 2% with epinephrine 1:100,000 versus articaine 4% with epinephrine 1:100,000 in securing mandibular first molar pulp anesthesia. Materials and Methods: Totally, 25 patients were recruited in a crossover, randomized, double-blind study. Each subject received injections of mepivacaine 2% with epinephrine 1:100,000 as inferior alveolar nerve block (IANB) supplemented with either articaine 4% with epinephrine 1:100,000 (septocaine) or mepivacaine 2% buccal infiltration (BI) injection on two visits. The time of first numbness to associated lip, tongue and tooth was recorded by asking the participant directly and using electrical pulp tester. Anesthetic success was considered when two consecutive maximal stimulation on pulp testing readings without sensation. The patients rated the pain of infiltration using a 100 mm visual analog scale immediately after receiving each injection. The pain scores were compared using the paired t-test. Results: There were significant differences in the meantime of first numbness to associated lip and tooth of volunteers between mepivacaine and articaine BI groups P = 0.03 and 0.002. Volunteers in articaine group recorded earlier lip and teeth numbness than those in mepivacaine group. There were significant differences between the mean pain scores for volunteers in the post IANB and postbuccal injection groups (t-test: P <0.001). Mepivacaine IANB injection was significantly more painful than articaine/mepivacaine buccal injection. Conclusions: About 4% articaine was faster than 2% mepivacaine (both with 1:100,000 adrenaline) in anesthetizing the pulps of lower molar teeth after BIs. Earlier lip and teeth numbness were recorded in articaine group. Articaine and mepivacaine BIs were more comfortable than mepivacaine IANB injections.
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Key words:
Articaine - buccal infiltration - inferior alveolar nerve block - mandibular permanent teeth - mepivacaine
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Conflict of Interest
None declared.
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REFERENCES
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- 2 Meechan JG. Supplementary routes to local anaesthesia. Int Endod J 2002; 35: 885-96
- 3 Matthews R, Drum M, Reader A, Nusstein J, Beck M. Articaine for supplemental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior alveolar nerve block fails. J Endod 2009; 35: 343-6
- 4 Rogers BS, Botero TM, McDonald NJ, Gardner RJ, Peters MC. Efficacy of articaine versus lidocaine as a supplemental buccal infiltration in mandibular molars with irreversible pulpitis: A prospective, randomized, double-blind study. J Endod 2014; 40: 753-8
- 5 Monteiro MR, Groppo FC, Haiter-Neto F, Volpato MC, Almeida JF. 4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: A randomized clinical study. Int Endod J 2015; 48: 145-52
- 6 Brandt RG, Anderson PF, McDonald NJ, Sohn W, Peters MC. The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: A meta-analysis. J Am Dent Assoc 2011; 142: 493-504
- 7 Jung IY, Kim JH, Kim ES, Lee CY, Lee SJ. An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod 2008; 34: 11-3
- 8 Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endod J 2009; 42: 238-46
- 9 Dudkiewicz A, Schwartz S, Laliberté R. Effectiveness of mandibular infiltration in children using the local anesthetic Ultracaine (articaine hydrochloride). J Can Dent Assoc 1987; 53: 29-31
- 10 Pedlar J. Re: Prolonged paraesthesia following inferior alveolar nerve block using articaine. Br J Oral Maxillofac Surg 2003; 41: 202
- 11 Hawkins JM, Moore PA. Local anesthesia: Advances in agents and techniques. Dent Clin North Am 2002; 46: 719-32 , ix
- 12 Gazal G, Fareed M, Zafar MS. Effectiveness of gaseous and intravenous inductions on children's anxiety and distress during extraction of teeth under general anesthesia. Saudi J Anaesth 2015; 9: 33-36
- 13 Oliveira PC, Volpato MC, Ramacciato JC, Ranali J. Articaine and lignocaine efficiency in infiltration anaesthesia: A pilot study. Br Dent J 2004; 197: 45-6
- 14 Wynn RL, Bergman SA, Meiller TF. Paresthesia associated with local anesthetics: A perspective on articaine. Gen Dent 2003; 51: 498-501
- 15 Lipp M, Daublander M. The German experience of articaine. In: Proceedings of the International Symposium on Local Analgesia in Dentistry. London: Faculty of General Dental Practitioners; 1999: 21-2
- 16 Sloss DR. Articaine in dental practice. In: Proceedings of the International Symposium on Local Analgesia in Dentistry. London: Faculty of General Dental Practitioners; 1999: 23-4
- 17 Stanley M. Handbook of Local Anesthesia. 5th ed.. US Elsevier: Mosby; 2004
- 18 Gupta PK, Hopkins PM. Effect of concentration of local anaesthetic solution on the ED50 of bupivacaine for supraclavicular brachial plexus block. Br J Anaesth 2013; 111: 293-6
- 19 Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod 2012; 38: 421-5
- 20 Meechan JG. The use of the mandibular infiltration anesthetic technique in adults. J Am Dent Assoc 2011; 142: 19S-24
- 21 Kambalimath DH, Dolas RS, Kambalimath HV, Agrawal SM. Efficacy of 4% Articaine and 2% Lidocaine: A clinical study. J Maxillofac Oral Surg 2013; 12: 3-10
- 22 Thakare A, Bhate K, Kathariya R. Comparison of 4% articaine and 0.5% bupivacaine anesthetic efficacy in orthodontic extractions: Prospective, randomized crossover study. Acta Anaesthesiol Taiwan 2014; 52: 59-63
- 23 Ashraf H, Kazem M, Dianat O, Noghrehkar F. Efficacy of articaine versus lidocaine in block and infiltration anesthesia administered in teeth with irreversible pulpitis: A prospective, randomized, double-blind study. J Endod 2013; 39: 6-10
- 24 Dou L, Luo J, Yang D. Anaesthetic efficacy of supplemental lingual infiltration of mandibular molars after inferior alveolar nerve block plus buccal infiltration in patients with irreversible pulpitis. Int Endod J 2013; 46: 660-5
- 25 Kämmerer PW, Palarie V, Daubländer M, Bicer C, Shabazfar N, Brüllmann D. et al. Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: Double-blind randomized clinical trial of anesthetic efficacy. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113: 495-9
- 26 Beena JP. Dental subscale of children's fear survey schedule and dental caries prevalence. Eur J Dent 2013; 7: 181-5
- 27 Alsarheed M. Children's Perception of Their Dentists. Eur J Dent 2011; 5: 186-90
- 28 Gazal G, Bowman R, Worthington HV, Mackie IC. A double-blind randomized controlled trial investigating the effectiveness of topical bupivacaine in reducing distress in children following extractions under general anaesthesia. Int J Paediatr Dent 2004; 14: 425-31
Correspondence:
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REFERENCES
- 1 Idris M, Sakkir N, Naik KG, Jayaram NK. Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study. J Conserv Dent 2014; 17: 432-5
- 2 Meechan JG. Supplementary routes to local anaesthesia. Int Endod J 2002; 35: 885-96
- 3 Matthews R, Drum M, Reader A, Nusstein J, Beck M. Articaine for supplemental buccal mandibular infiltration anesthesia in patients with irreversible pulpitis when the inferior alveolar nerve block fails. J Endod 2009; 35: 343-6
- 4 Rogers BS, Botero TM, McDonald NJ, Gardner RJ, Peters MC. Efficacy of articaine versus lidocaine as a supplemental buccal infiltration in mandibular molars with irreversible pulpitis: A prospective, randomized, double-blind study. J Endod 2014; 40: 753-8
- 5 Monteiro MR, Groppo FC, Haiter-Neto F, Volpato MC, Almeida JF. 4% articaine buccal infiltration versus 2% lidocaine inferior alveolar nerve block for emergency root canal treatment in mandibular molars with irreversible pulpits: A randomized clinical study. Int Endod J 2015; 48: 145-52
- 6 Brandt RG, Anderson PF, McDonald NJ, Sohn W, Peters MC. The pulpal anesthetic efficacy of articaine versus lidocaine in dentistry: A meta-analysis. J Am Dent Assoc 2011; 142: 493-504
- 7 Jung IY, Kim JH, Kim ES, Lee CY, Lee SJ. An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod 2008; 34: 11-3
- 8 Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endod J 2009; 42: 238-46
- 9 Dudkiewicz A, Schwartz S, Laliberté R. Effectiveness of mandibular infiltration in children using the local anesthetic Ultracaine (articaine hydrochloride). J Can Dent Assoc 1987; 53: 29-31
- 10 Pedlar J. Re: Prolonged paraesthesia following inferior alveolar nerve block using articaine. Br J Oral Maxillofac Surg 2003; 41: 202
- 11 Hawkins JM, Moore PA. Local anesthesia: Advances in agents and techniques. Dent Clin North Am 2002; 46: 719-32 , ix
- 12 Gazal G, Fareed M, Zafar MS. Effectiveness of gaseous and intravenous inductions on children's anxiety and distress during extraction of teeth under general anesthesia. Saudi J Anaesth 2015; 9: 33-36
- 13 Oliveira PC, Volpato MC, Ramacciato JC, Ranali J. Articaine and lignocaine efficiency in infiltration anaesthesia: A pilot study. Br Dent J 2004; 197: 45-6
- 14 Wynn RL, Bergman SA, Meiller TF. Paresthesia associated with local anesthetics: A perspective on articaine. Gen Dent 2003; 51: 498-501
- 15 Lipp M, Daublander M. The German experience of articaine. In: Proceedings of the International Symposium on Local Analgesia in Dentistry. London: Faculty of General Dental Practitioners; 1999: 21-2
- 16 Sloss DR. Articaine in dental practice. In: Proceedings of the International Symposium on Local Analgesia in Dentistry. London: Faculty of General Dental Practitioners; 1999: 23-4
- 17 Stanley M. Handbook of Local Anesthesia. 5th ed.. US Elsevier: Mosby; 2004
- 18 Gupta PK, Hopkins PM. Effect of concentration of local anaesthetic solution on the ED50 of bupivacaine for supraclavicular brachial plexus block. Br J Anaesth 2013; 111: 293-6
- 19 Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod 2012; 38: 421-5
- 20 Meechan JG. The use of the mandibular infiltration anesthetic technique in adults. J Am Dent Assoc 2011; 142: 19S-24
- 21 Kambalimath DH, Dolas RS, Kambalimath HV, Agrawal SM. Efficacy of 4% Articaine and 2% Lidocaine: A clinical study. J Maxillofac Oral Surg 2013; 12: 3-10
- 22 Thakare A, Bhate K, Kathariya R. Comparison of 4% articaine and 0.5% bupivacaine anesthetic efficacy in orthodontic extractions: Prospective, randomized crossover study. Acta Anaesthesiol Taiwan 2014; 52: 59-63
- 23 Ashraf H, Kazem M, Dianat O, Noghrehkar F. Efficacy of articaine versus lidocaine in block and infiltration anesthesia administered in teeth with irreversible pulpitis: A prospective, randomized, double-blind study. J Endod 2013; 39: 6-10
- 24 Dou L, Luo J, Yang D. Anaesthetic efficacy of supplemental lingual infiltration of mandibular molars after inferior alveolar nerve block plus buccal infiltration in patients with irreversible pulpitis. Int Endod J 2013; 46: 660-5
- 25 Kämmerer PW, Palarie V, Daubländer M, Bicer C, Shabazfar N, Brüllmann D. et al. Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: Double-blind randomized clinical trial of anesthetic efficacy. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 113: 495-9
- 26 Beena JP. Dental subscale of children's fear survey schedule and dental caries prevalence. Eur J Dent 2013; 7: 181-5
- 27 Alsarheed M. Children's Perception of Their Dentists. Eur J Dent 2011; 5: 186-90
- 28 Gazal G, Bowman R, Worthington HV, Mackie IC. A double-blind randomized controlled trial investigating the effectiveness of topical bupivacaine in reducing distress in children following extractions under general anaesthesia. Int J Paediatr Dent 2004; 14: 425-31