Comparison of the Effectiveness of Lidocaine in Permanent Maxillary Teeth Removal Performed with Single Buccal Infiltration Versus Routine Buccal and Palatal Injection

Abstract

Purpose For many dental patients, palatal injection proves to be a very traumatic experience. Diverse methods have been suggested to reduce the discomfort of palatal injection. Nevertheless, the reliability of these methods is not obviously evident and they are not found to be universally effective. The desirable method to evade pain during palatal injection is just not to have one. Hence, the present study aims at investigating if lidocaine hydrochloride could provide palatal anesthesia in maxilla when only a buccal infiltration anesthesia is done for teeth extraction. Patients and Methods One hundred and fifty patients requiring extraction of maxillary teeth were included in the study. Patients were randomly allotted to two groups, study and control. Patients in study group received a single buccal infiltration of 1.5 mL of lidocaine with epinephrine for extraction of maxillary teeth. Patients in control group received 1.5 mL of buccal and 0.3 mL of palatal infiltration of lidocaine with epinephrine for the extraction. After achieving adequate palatal anesthesia the tooth was extracted with consistent technique. Pain level experienced by the patients during injection procedure and during tooth extraction was rated in an 11-point pain rating scale. Time taken to achieve palatal anesthesia following a single buccal infiltration of anesthetic solution was evaluated by regular pin-prick evaluation of palatal tissues. Results The overall success rate of palatal anesthesia achieved with a single buccal infiltration is 81.3 %. The success rate reduced as we proceed from anterior to posterior maxilla. Time taken to achieve successful palatal anesthesia by single buccal infiltration is 7-9 min. Conclusion The extraction of permanent maxillary anterior teeth and premolars is possible by depositing local anesthesia to the buccal vestibule of the tooth without palatal supplementation. However, the extraction of permanent maxillary posterior teeth with similar technique would result in fewer success rates suggesting its avoidance.

Single buccal infiltration of high concentration lignocaine versus articaine in maxillary third molar surgery

“…Fan et al [17] and Kumaresan et al [18] indicated that routine palatal injection yielded significantly more discomfort than BI. The mean injection pain of BI alone was 0.91 (NRS), which falls in the mild pain category [18]. This was consistent with the values found in our study.…”

Anesthetic efficacy and safety of 2% lidocaine hydrochloride with 1:100,000 adrenaline and 4% articaine hydrochloride with 1:100,000 adrenaline as a single buccal injection in the extraction of maxillary premolars for orthodontic purposes

“…The property of diffusion makes it suitable for a single buccal injection in avoiding a painful palatal injection [ 5 6 8 ]. However, there is insufficient literature regarding the diffusion of lidocaine, which is a commonly used drug and considered as the gold standard [ 4 9 ]. Therefore the present study was conducted to compare the efficacy and safety of 2% lidocaine HCl with 1:100,000 adrenaline and 4% articaine HCl with 1:100,000 adrenaline using single buccal infiltration for the extraction of bilateral maxillary premolars, with the hypothesis that there would be no significant difference amongst the two local anesthetic agents used as a single buccal infiltration technique in all outcome measures.…”

“…The washout period between the interventions on both sides was 14 days. Other studies have reported a success rate of 92% in buccal infiltration with lidocaine for orthodontic extractions in the premolar region without a palatal injection [ 4 12 ].…”

“…Amongst all the local anesthetic techniques, palatal injection is the most painful as the palatal mucosa is highly dense and has firm adherence to the underlying bone. The maxillary bone is porous, this facilitates diffusion of the anesthetic solution from the buccal to the palatal aspect obviating the need for a palatal injection [4]. Various studies have claimed that articaine diffuses through the soft and hard tissues more reliably than other local anesthetic agents [5,6,7,8].…”

“…Various studies have claimed that articaine diffuses through the soft and hard tissues more reliably than other local anesthetic agents [ 5 6 7 8 ]. Only a few studies have evaluated the diffusivity of lidocaine [ 9 4 ].…”