Comparative clinical evaluation of two different techniques of local anaesthesia in the posterior mandible using 4% articaine with 1 : 100,000 adrenaline

Uroš M Marjanovic; Milan Jurišić; Božidar Brković; Aleksandar Jakovljević; Biljana Miličić; Marjan Marjanović; Julija Ivanović

doi:10.2298/VSP160118200M

Uroš M Marjanovic University of Belgrade, Faculty of Dental Medicine, Clinic of Oral Surgery, Belgrade, Serbia
Milan Jurišić University of Belgrade, Faculty of Dental Medicine, Clinic of Oral Surgery, Belgrade, Serbia
Božidar Brković University of Belgrade, Faculty of Dental Medicine, Clinic of Oral Surgery, Belgrade, Serbia
Aleksandar Jakovljević University of Belgrade, Faculty of Dental Medicine, Clinic of Oral Surgery, Belgrade, Serbia
Biljana Miličić University of Belgrade, Faculty of Dental Medicine, Department of Informatics in Dentistry, Belgrade, Serbia
Marjan Marjanović University Business Academy in Novi Sad, Faculty of Dental Medicine, Clinic of Oral Surgery, Pančevo, Serbia
Julija Ivanović University of Belgrade, Faculty of Dental Medicine, Clinic of Oral Surgery, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP160118200M

Keywords: anesthesia, dental, carticaine, epinephrine, mandible,

Abstract

Background/Aim. Local infiltration anaesthesia (LIA) is significantly simpler compared to the inferior alveolar nerve block (IAB) and less unpleasant for patients. However, it is not efficient if used in posterior region of the mandible, at least with traditional local anaesthetics. The aim of this study was to compare anaesthetic efficacy of two techniques the LIA in the posterior segment of the mandible, and the IAB, using 4% articaine with 1 : 100,000 adrenaline and to note possible changes in haemodynamic parameters caused by these two techniques. Methods. Sixty pre-informed patients were divided into two study groups. Both groups received 1.8 mL of the same anaesthetic solution, 4% articaine with adrenaline 1 : 100,000, with two different techniques of local anaesthesia. The first group received the LIA in projection of root apex of the first lower molar; the second group received the IAB. The examined parameters were: changes in tooth sensitivity after 5 and 30 minutes in relation to the value recorded before administering the anaesthetics, onset of anaesthesia, width of anaesthetic field, and duration of anaesthesia. Also, the impact of the applied techniques on cardiovascular parameters was noticed. Results. The LIA group had a statistically significant decrease in sensitivity 5 minutes after application of the local anaesthetic. The decreasing trend continued between 5 and 30 minutes, although without statistical significance. There was no statistically significant difference in sensitivity changes between two groups for the first molar and the first and second premolars. However, there was a statistically significant difference in duration of local anaesthesia in favour of the IAB, while the width of anaesthetic fields was significantly higher after the LIA. Significant changes in hemodynamic parameters were not recorded within the two groups. Conclusion. The effect of the LIA on tooth sensitivity of premolars and first molar is quite satisfactory. The IAB was more effective for canine and second molar. None of the tested techniques had any significant effect on the cardiovascular parameters.

References

Meechan JG. Supplementary routes to local anaesthesia. Int En-dod J 2002; 35(11): 885−96.

Kaufman E, Weinstein P, Milgrom P. Difficulties in achieving local anesthesia. J Am Dent Assoc 1984; 108(2): 205−8.

Ashraf H, Kazem M, Dianat O, Noghrehkar F. Efficacy of arti-caine versus lidocaine in block and infiltration anesthesia ad-ministered in teeth with irreversible pulpitis: A prospective, randomized, double-blind study. J Endod 2013; 39(1): 6−10.

Afsar A, Haas DA, Rossouw PE, Wood RE. Radiographic locali-zation of mandibular anesthesia landmarks. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 86(2): 234−41.

Meechan JG. Why does local anaesthesia not work everytime? Dent Update 2005; 32(2): 66−8, 70−2.

Todorović L, Petrović V, Avramović K, Stajčić Z. Anesthesia in den-tistry. Belgrade: Zavod za udžbenike i nastavna sredstva; 1990. (Serbian)

Arrow P. A comparison of articaine 4% and lignocaine 2% in block and infiltration analgesia in children. Aust Dent J 2012; 57(3): 325−33.

Becker DE, Reed KL. Essentials of local anaesthetic pharmacol-ogy. Anesth Prog 2006; 53(3): 98−108; quiz 109−10.

Malamed S. What's new in local anaesthesia. SAAD Dig 2009; 25: 4−14.

Yapp KE, Hopcraft MS, Parashos P. Articaine: A review of the literature. Br Dent J 2011; 210(7): 323−9.

Poorni S, Veniashok B, Senthilkumar AD, Indira R, Ramachandran S. Anesthetic efficacy of four percent articaine for pulpal anes-thesia by using inferior alveolar nerve block and buccal infiltra-tion techniques in patients with irreversible pulpitis: a prospec-tive randomized double-blind clinical trial. J Endod 2011; 37(12): 1603−7.

Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine and lidocaine mandibular buccal infiltration anaesthesia: A pro-spective randomized double-blind cross-over study. J Endod 2006; 32(4):296-8.

Jafarzadeh H, Abbott PV. Review of pulp sensibility tests. Part II: Electric pulp tests and test cavities. Int Endod J 2010; 43(11): 945−58.

Grossman LI. Endodontic Practice. 9th ed. Philadelphia, PA: Lea & Febiger; 1978.

Mumford JM, Bjorn H. Problems in electric pulp testing and dental algesimetry. Int Dent J 1962; 12: 161−79.

Malamed SF, Gagnon S, Leblanc D. Efficacy of articaine: A new amide local anesthetic. J Am Dent Assoc 2000; 131(5): 635−42.

Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic effi-cacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 2004; 30(8): 568−71.

Clark S, Reader A, Beck M, Meyers WJ. Anesthetic efficacy of the mylohyoid nerve block and combination inferior alveolar nerve block/mylohyoid nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 87(5): 557−63.

Nusstein J, Reader A, Beck FM. Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks. Gen Dent 2002; 50(4):372−5; quiz 376−7.

Mikesell P, Nusstein J, Reader A, Beck M, Weaver J. A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod 2005; 31(4): 265−70.

Malamed SF. Handbook of Local Anaesthesia. 4th ed. St. Lou-is: Mosby-Year Book; 1997.

Kanaa MD, Whitworth JM, Meechan JG. A Comparison of the Efficacy of 4% Articaine with 1: 100,000 Epinephrine and 2% Lidocaine with 1: 80,000 Epinephrine in Achieving Pulpal An-aesthesia in Maxillary Teeth with Irreversible Pulpitis. J Endod 2012; 38(3): 279−82.

Robertson D, Nusstein J, Reader A, Beck M, McCartney M. The an-aesthetic efficacy of articaine in buccal infiltration of mandibu-lar posterior teeth. J Am Dent Assoc 2007; 138(8): 1104−12.

Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine buc-cal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endod J 2009; 42(3): 238−46.

Haas DA, Harper DG, Saso MA, Young ER. Lack of differential effect by Ultracaine (articaine) and Citanest (prilocaine) in infil-tration anaesthesia. J Can Dent Assoc 1991; 57(3): 217−23.

Martin M, Nusstein J, Drum M, Reader A, Beck M. Anaesthetic efficacy of 1.8 ml versus 3.6 ml of 4% articaine with 1: 100 000 epinephrine as a primary buccal infiltration of the mandibular first molar. J Endod 2011; 37(5): 588−92.

Dummer PM, Tanner M, Mccarthy JP. A laboratory study of four electric pulp testers. Int Endod J 1986; 19: 161−71.

Dummer PM, Tanner M. The response of carefree, unfilled teeth to electrical excitation: A comparison of two new pulp testers. Int Endod J 1986; 19: 172−7.

Reiss HL, Furedi A. Significance of the pulp test as revealed in microscopic study of the pulps of 130 teeth. Deiitat Cosmos 1993; 75: 272−83.