Buffered 4% Articaine as a Primary Buccal Infiltration of the Mandibular First Molar: A Prospective, Randomized, Double-blind Study

Shurtz, Ryan; Nusstein, John; Reader, Al; Drum, Melissa; Fowler, Sara; Beck, Mike

doi:10.1016/j.joen.2015.05.005

Cited by 33 publications

(44 citation statements)

References 32 publications

(59 reference statements)

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“…Moreover, all the studies were randomized and double-blinded, except for one study that did not specify blinding (Shyamala et al 2016). Pain was measured on a variety of scales (Table 2), whilst the onset of anaesthesia was assessed by electric pulp testing (Whitcomb et al 2010, Hobeich et al 2013, Shurtz et al 2015 or soft tissue probing (Al-Sultan et al 2006, Kashyap et al 2011, Shyamala et al 2016. Pain was measured on a variety of scales (Table 2), whilst the onset of anaesthesia was assessed by electric pulp testing (Whitcomb et al 2010, Hobeich et al 2013, Shurtz et al 2015 or soft tissue probing (Al-Sultan et al 2006, Kashyap et al 2011, Shyamala et al 2016.…”

Section: Resultsmentioning

confidence: 99%

“…Lidocaine was used as the anaesthetic agent in 12 studies; bupivacaine was used in one study (Shyamala et al 2016), and articaine was used in one study (Shurtz et al 2015). These two nonlidocaine studies were not pooled in the meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…All of the studies used epinephrine as the vasoconstrictor. The buffered anaesthetic solution was always prepared immediately before injection, manually (Lem 1991, Primosch & Robinson 1996, Al-Sultan et al 2006, Whitcomb et al 2010, Kashyap et al 2011, Phero et al 2017 or using a precision mixing device (Balasco et al 2013, Hobeich et al 2013, Malamed et al 2013, Comerci et al 2015, Harreld et al 2015, Schellenberg et al 2015, Shurtz et al 2015, Shyamala et al 2016. One study was carried out in patients with periapical lesions (Al-Sultan et al 2006); two studies were performed in patients with abscesses (Balasco et al 2013, Harreld et al 2015, and one study was performed in patients with pulpitis (Schellenberg et al 2015).…”

Section: Resultsmentioning

confidence: 99%

“…One explanation for this uncomfortable sensation is the acidic nature of commercially available local anaesthetics (pH 4.5, approximately), which are adjusted to this pH to prolong shelf life (Hogan et al 2011, Malamed et al 2013, Harreld et al 2015, Schellenberg et al 2015, Shurtz et al 2015. One explanation for this uncomfortable sensation is the acidic nature of commercially available local anaesthetics (pH 4.5, approximately), which are adjusted to this pH to prolong shelf life (Hogan et al 2011, Malamed et al 2013, Harreld et al 2015, Schellenberg et al 2015, Shurtz et al 2015.…”

Section: Introductionmentioning

confidence: 99%

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The effect of adjusting the pH of local anaesthetics in dentistry: a systematic review and meta‐analysis

2018

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The acidic nature of commercial local anaesthetics (LAs) can cause pain during infiltration and delay the onset of anaesthesia. It is suggested that adjusting the pH of anaesthetic agents could minimize these effects. This systematic review aimed to evaluate the efficacy of buffered LAs in reducing infiltration pain and onset time during dental procedures. MEDLINE, Embase, Scopus and Scielo databases were searched up to April 2017. Randomized controlled trials comparing buffered and unbuffered LAs for intraoral injections were included. Risk of bias was assessed using the Cochrane Collaboration tool. Data upon injection pain and onset time were pooled in a random-effects model. Subgroup analyses compared normal and inflamed tissues, and terminal infiltrations and inferior alveolar nerve (IAN) blocks. Meta-regressions were performed to explain heterogeneity. Fourteen articles were included in this review. Lidocaine with epinephrine was the most used anaesthetic combination. Nonlidocaine studies (n = 2) were not pooled in the meta-analysis. Buffered lidocaine did not result in less pain during intraoral injections: mean difference -6.4 (95% CI -12.81 to 0.01) units in a 0-100 scale. Alkalinized lidocaine did not reduce the onset time in normal tissues when terminal infiltration techniques were used, but resulted in a more rapid onset for IAN blocks (-1.26 min) and in inflamed tissues (-1.37 min); however, this change may not be clinically relevant, considering the time required to prepare the buffered agent. Studies performed using other anaesthetic salts did not show robust and clinically significant results in favour of alkalinization.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The effect of adjusting the pH of local anaesthetics in dentistry: a systematic review and meta‐analysis

2018

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“…In literature, there are many studies reported that the superiority of articaine over other local anesthetic agents. [789101112] This statement was explained by the fact that the articaine has great lipid-solubility and potency allowing an increased entry into the neurons. [34] An epinephrine-free anesthetic solution of articaine 4% can be used as a possible option in short dental routine treatments instead of using vasoconstrictor-containing local anesthetics.…”

Section: Introductionmentioning

confidence: 99%

Comparison of onset anesthesia time and injection discomfort of 4% articaine and 2% mepivacaine during teeth extractions

et al. 2017

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Objective:To investigate the speed of action and injection discomfort of 4% articaine and 2% mepivacaine for upper teeth extractions.Materials and Methods:Forty-five patients were included in the articaine 4% group, and 45 in the mepivacaine 2% control group. After all injections, soft and hard tissue numbness was objectively gauged by dental probe at intervals of 15 s. Furthermore, the discomfort of the injections were recorded by the patients after each treatment on standard 100 mm visual analog scales, tagged at the endpoints with “no pain” (0 mm) and “unbearable pain” (100 mm).Results:There were significant differences in the meantime of first numbness to associated palatal mucosa and tooth of patients between mepivacaine and articaine buccal infiltration (BI) groups P = 0.01 and 0.01. Patients in the articaine group recorded earlier palatal mucosa and teeth numbness than those in the mepivacaine group. With regards to the discomfort of the needle injections, palatal injection was significantly more painful than BI (t-test: P < 0.001). Articaine buccal injection was significantly more painful than mepivacaine buccal injection (t-test: P <0.001). However, articaine palatal injection was less painful than articaine BI. Clinically, anesthesia onset time was faster in anterior upper teeth than upper middle and posterior teeth.Conclusions:BIs with 4% articaine was faster in achieving palate and teeth anesthesia than 2% mepivacaine for extraction of upper maxillary teeth. Patients in mepivacaine BI and articaine palatal injection groups reported less pain with needle injection. Failure of anesthesia was noticeable with maxillary multiple-rooted teeth.

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Local Anesthesia in Dentistry

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Buffered 4% Articaine as a Primary Buccal Infiltration of the Mandibular First Molar: A Prospective, Randomized, Double-blind Study

Cited by 33 publications

References 32 publications

The effect of adjusting the pH of local anaesthetics in dentistry: a systematic review and meta‐analysis

The effect of adjusting the pH of local anaesthetics in dentistry: a systematic review and meta‐analysis

Comparison of onset anesthesia time and injection discomfort of 4% articaine and 2% mepivacaine during teeth extractions

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