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

Abstract

Background: This research evaluated the numbness produced by lignocaine at an equal or higher concentration than that of 4% articaine through a single point of injection for maxillary third molar surgery. This randomized double-blind study was conducted to compare the anesthetic efficiency of 4% lignocaine with that of 4% articaine in impacted maxillary third molar surgery using a single buccal infiltration alone. Methods: The study participants were 30 healthy patients requiring the bilateral surgical removal of symmetrically-positioned maxillary third molars. Using a split-mouth design, each patient randomly received buccal infiltration of 1.7 ml of 4% lignocaine and 1.7 ml of 4% articaine during two separate appointments. After 15 minutes of anesthetic injection, surgery was performed by the same surgeon using a consistent technique on both sides. Pinprick test pain scores of the buccal and palatal gingiva of the maxillary third molar after 10 minutes and 15 minutes latencies, pain scores during the surgery, the need for supplemental anesthesia, and patients' satisfaction with anesthetic efficiency were recorded. Surgery performed without supplemental anesthesia was categorized as successful. Results: The success rates of 4% lignocaine and 4% articaine (83.34% vs. 86.67%, P = 1.00) were not significantly different. Only 5 cases (4 cases in the articaine group and 1 case in the lignocaine group) reported mild pain and pressure sensation (NRS ≤ 1) on probing at the palatal side after 15 minutes of latency (P = 0.25). The pain scores of maxillary third molar surgery in the two groups were not significantly different (P > 0.05). Moreover, the statistical analysis confirmed the comparable patient satisfaction of two study groups (P = 0.284). Conclusion: This study provides evidence that single buccal infiltrations of 4% lignocaine and 4% articaine have comparable anesthetic efficacy and success rates for impacted maxillary third molar surgery. Both 4% lignocaine and 4% articaine can produce effective palatal anesthesia and pain control using buccal infiltration alone after 15 minutes of latency.

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.…”

“…Most also involved allocation concealment, again with four exceptions [ 28 , 45 , 46 , 51 ]. Blinding of the participants was done in more than half of the studies the exceptions being [ 21 , 28 , 31 , 35 , 45 - 46 , 51 ], while there was no clear blinding of the outcome in more than half the exceptions being [ 23 , 29 , 36 - 38 , 47 ]. None of the studies reported observing attrition bias, reporting bias, or any other bias.…”

“…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 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.…”

“…Chandrasekaran et al [ 43 ] reported that 49 of the 50 patients in the articaine group had successful extraction and in only one patient, the extraction was not possible while only two of the 50 patients in the lidocaine group had successful extractions. Phyo et al [ 47 ], one of the studies that used the VAS to evaluate pain, reported that 86.67% (26) of the patients in the articaine group underwent tooth extractions without the need for a supplemental injection while 13.33% (four) did not. In the lidocaine group, 83.3% (25) of the patients underwent extraction without the need for supplemental injection while 16.7% (five) did not.…”