A Prospective Study to Assess the Efficacy of 4% Articaine, 0.5% Bupivacaine and 2% Lignocaine Using a Single Buccal Supraperiosteal Injection for Maxillary Tooth Extraction

Abstract

Introduction: The aim of this study was to demonstrate if articaine hydrochloride administered alone as a single buccal infiltration in maxillary tooth extraction can provide adequate palatal anesthesia as compared to buccal and palatal injection using lidocaine and bupivacaine. Materials and Methods: A prospective double-blinded trial was conducted on 150 patients who required maxillary tooth extraction. The patients were divided into three different groups consisting of 50 patients each. Each group was administered with 4% articaine into buccal vestibular mucosa of the tooth to be extracted, 2% lignocaine and 0.5% bupivacaine was injected into buccal and palatal side of the tooth to be extracted, respectively. Following the tooth extraction, all patients were asked to complete a 10-score Visual Analog Scale (VAS) and 5-score facial pain scale (FPS) to assess the pain on extraction. Results: According to the VAS and FPS scores, the pain on extraction between buccal infiltration of articaine and the routine buccal and palatal infiltration of lignocaine was statistically significant. Conclusion: The routine use of a palatal injection for extraction of maxillary teeth may not be required when articaine is used as a local anesthetic solution.

Can Single Buccal Infiltration With 4% Articaine Induce Sufficient Analgesia for the Extraction of Maxillary Teeth? A Systematic Literature Review

“…The studies evaluated procedural pain during the extraction of upper permanent maxillary teeth except that of Chandrasekaran et al [43], which included the lower anterior teeth. Five studies -Bataineh et al [35], Kumar et al [36], Saravanan et al [38], Chandrasekaran et al [43], and Phyo et al [47] evaluated procedural pain during the extraction using a subjective score, the visual analog scale (VAS), while the sixth Chandrasekaran et al [43] used an objective score, the facial pain scale (FPS). Bataineh et al [35] found that 62% of the patients (31) in the lidocaine group reported mild pain and 60% (30) patients in the articaine group while 34% of patients (17) in each group reported moderate pain and 4% (two) of the patients in the lidocaine group and 6% (three) of those in the articaine group reported severe pain.…”

“…The risk of bias (Figure 2 ) was evaluated for each study following the Cochrane guidelines [ 20 ]. Most of the studies involved randomization [ 23 , 29 , 31 , 35 - 38 , 46 - 48 , 51 , 53 ], with four exceptions [ 21 , 28 , 43 , 5 ]. Most also involved allocation concealment, again with four exceptions [ 28 , 45 , 46 , 51 ].…”

“…The single-blinded design was followed in the studies by Somuri et al [ 21 ], Fan et al [ 29 ], Luqman et al [ 31 ], Bataineh et al [ 35 ], and Saravanan et al [ 38 ]. The studies by Lima Jr et al [ 23 ], Sandilya et al [ 37 ], Chandrasekaran et al [ 43 ], Phyo et al [ 47 ], Rayati et al [ 48 ], and Al-Mahalawy et al [ 53 ] used a double-blinded design, and that by Kumar et al [ 36 ] used a triple-blinded design. The other studies, by Bataineh et al [ 28 ], Uckan et al [ 45 ], Sochenda et al[ 46 ], and Iyengar et al [ 51 ] did not specify the design.…”

“…Five of the studies evaluated procedural pain during the extraction of maxillary teeth for the comparison of single buccal infiltration of 4% articaine with single buccal infiltration of 2% lidocaine Bataineh et al [ 35 ], Kumar et al [ 36 ], Saravanan et al [ 38 ], Chandrasekaran et al [ 43 ], Rayati et al [ 48 ]. In one study by Phyo et al [ 47 ], the comparison was between 4% articaine and 4% lidocaine.…”

The potential of articaine as new generation of local anesthesia in dental clinics: A review

“…[29] Bupivacaine is an amide anesthetic and a so-called “long-acting” local anesthetic with a long duration of action and residual analgesia. [30] The long-acting anesthetic and analgesic effects of bupivacaine make the operation comfortable, but prolonged anesthesia in soft tissues is uncomfortable for patients. [31] It has been reported that articaine has better clinical effects than bupivacaine, with shorter latency, less bleeding, shorter soft tissue anesthesia time, better anesthesia efficacy, and lower anesthetic dose than bupivacaine.…”