Lingual supplementation may not be required after articaine buccal infiltration anesthesia for lower molar extraction: A clinical comparative study
Abstract
Purpose: To investigate the anesthetic effectiveness of buccal infiltration (BI) versus buccal plus lingual infiltration (BI+LI) of 4% articaine for intra-alveolar extraction of erupted mandibular molar teeth
Material and Methods: Eighty patients were included in this prospective clinical study. They were randomly divided into 1 of 2 equal groups: the 1st group received BI of 4% articaine 1.8 ml and LI of 0.5 ml, while the 2nd group received 4% articaine 1.8 ml BI plus 0.5 ml LI of normal saline. Another 1.8 ml articaine BI was given if initial anesthesia was inadequate. Outcome variables included pain, which was rated by patients at 3 intervals using visual analogue scale, and lingual anesthesia and patients' satisfaction which were measured using 5-score verbal rating scale. Data analyses used were descriptive statistics, t test, χ2 test, and Pearson's correlation coefficient. P-value value less than 0.05 was considered significant
Results: There were 46 females and 34 males and the mean age was 35.3 years. All outcome variables were comparable between the two study groups (p˃0.05). Anesthesia was successful in 78% and 88% of cases in the (BI) and (BI+LI) groups respectively with no significant difference (p=0.2392). The mean articaine volume used was 2.5 ml and 2.87 ml respectively without significant difference (p=0.090).
Conclusion: The anesthetic efficacy of (BI) alone and (BI+LI) of 4% articaine was comparable. When given in an adequate dose, articaine (BI) alone could be justified as an anesthetic option for the intra-alveolar extraction of mandibular molar teeth.
References
[2]. Majid OW, Muhammad ZA: Effectiveness of Articaine Buccal Infiltration Anesthesia for Mandibular Premolar Extraction: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. J Oral Maxillofac Surg 2019; 77:1784-1789
[3]. Malamed SF: Is the mandibular nerve block passé? J Am Dent Assoc 2011; 142 (suppl):3S-7S
[4]. Meechan JG: Infiltration anesthesia in the mandible. Dent Clin North Am 2010; 54:621-9
[5]. Malamed SF: Handbook of Local Anesthesia (ed 6). New York, NY, Elsevier Health Sciences, 2012; p274
[6]. Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind crossover study. J Endod 2006; 32:296-298
[7]. Robertson D, Nusstein J, Reader A, Beck M, McCartney M. The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc 2007; 138:1104-1112
[8]. Corbett IP, Kanaa MD, Whitworth JM, Meechan JG. Articaine infiltration for anesthesia of mandibular first molars. J Endod 2008; 34:514-518
[9]. Martin M, Nusstein J, Drum M, Reader A, Beck M. Anesthetic 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; 37:588-592
[10]. Jung IY, Kim JH, Kim ES, Lee CY, Lee SJ. An evaluation of buccal infiltrations and inferior alveolar blocks in pulpal anesthesia for mandibular first molars. J Endod 2008;34:11-13
[11]. Poorni S, Veniashok B, Senthilkumar AD, Indira R, Ramachandran S. Anaesthetic efficacy of four percent articaine for pulpal anaesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: A prospective randomized double-blind clinical trial. J Endod 2011; 37: 1603-1607
[12]. Dou L, Luo J, Yang D, Wang Y. The effectiveness of an additional lingual infiltration in the pulpal anesthesia of mandibular teeth: a systematic review. Quintessence Int. 2013; 44:457–464
[13]. Abdullah WA, Khalil H, Sheta S. Articaine (4%) Buccal Infiltration versus Lidocaine (2%) Inferior Alveolar Nerve Block for Mandibular Teeth Extraction in Patients on Warfarin Treatment. J Anesth Clin Res 2014; 5:1-4
[14]. Bataineh AB, Alwarafi MA: Patient’s pain perception during mandibular molar extraction with articaine: A comparison study between infiltration and inferior alveolar nerve block. Clin Oral Invest 2016; 20:2241-2250
[15]. El-Kholey KE: Anesthetic efficacy of 4% articaine during extraction of the mandibular posterior teeth by using inferior alveolar nerve block and buccal infiltration techniques. J Maxillofac Oral Surg 2017; 16:90-95
[16]. Narayanan JV, Gurram P, Krishnan R, Muthusubramanian V, Kannan VS. Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars. Oral Maxillofac Surg 2017; 21:295-9
[17]. El-Kholey KE: Infiltration anesthesia for extraction of mandibular molars. J Oral Maxillofac Surg 2013; 71:1658.e1-e5
[18]. Sawang K, Chaiyasamut T, Kiattavornchareon S, Pairuchvej V, Bhattarai BP, Wongsirichat N. Double versus single cartridge of 4% articaine infiltration into the retro-molar area for lower third molar surgery. J Dent Anesth Pain Med. 2017; 17: 121–127
[19]. Sawadogo A, Coulibaly M, Quilodran C, Bationo R, Konsem T, Ella B. Success rate of first attempt 4% articaine para-apical anesthesia for the extraction of mandibular wisdom teeth. J Stomatol Oral Maxillofac Surg 2018; 119: 486-488
[20]. Awal DH, Yilmaz Z, Osailan S, Renton T. Articaine-only buccal infiltrations for mandibular molar extractions: An alternative to inferior dental nerve blocks. Dent Update 2017; 44:838-845
[21]. Rayatia F, Noruzihab A, Jabbarian R: Efficacy of buccal infiltration anaesthesia with articaine for extraction of mandibular molars: A clinical trial. Br J Oral Maxillofac Surg 2018; 56:607-610
[22]. Muhammad ZA, Abdullah RM, Majid OW. Articaine improves anesthetic achievement for exodontia performed by undergraduate dental students: A clinical comparative study. J Dent Educ 2021; 85:1702-1709
[23]. Meechan JG, Kanaa MD, Corbett IP, Steen IN, Whitworth JM. Pulpal anaesthesia for mandibular permanent first molar teeth: a double-blind randomized cross-over trial comparing buccal and buccal plus lingual infiltration injections in volunteers. Int Endod J 2006; 39: 764-769
[24]. Yamadaa H, Satob T, Fukayama H. Diffusion patterns of anesthetic solution in the infiltration anesthesia depending on injection sites in the mandible of rats. Oral Science International 2011; 8: 50-54
[25]. Bartlett G, Mansoor J. Articaine buccal infiltration vs lidocaine inferior dental block – a review of the literature. Br Dent J 2016; 220: 117-120
[26]. Swasty D, Lee JS, Huang JC, Maki K, Gansky SA, Hatcher D, Miller AJ.. Anthropometric Analysis of the Human Mandibular Cortical Bone as Assessed by Cone-Beam Computed Tomography. J Oral Maxillofac Surg 2009; 67:491-500
[27]. Flanagan D. The effectiveness of articaine in mandibular facial infiltrations. Local Reg Anesth. 2016; 9: 1-6
[28]. Meechan JG, Jaber AA, Corbett IP. Buccal versus lingual articaine infiltration for mandibular tooth anaesthesia: a randomized controlled trial. Int Endod J 2011; 44:676-681.
[29]. Pabst L, Nusstein J, Drum M, Reader A, Beck M. The efficacy of a repeated buccal infiltration of articaine in prolonging duration of pulpal anesthesia in the mandibular first molar. Anesth Prog 2009; 56:128-134.
[30]. Malamed S F, Gagnon S, Leblanc D. Efficacy of articaine: a new amide local anaesthetic. J Am Dent Assoc 2000; 131: 635-642.
[31]. Currie CC, Meechan JG, Whitworth JM, Corbett IP. Is mandibular molar buccal infiltration a mental and incisive nerve block? A randomized controlled trial. J Endod 2013; 39:439-43
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. © 2024.
