仅行唇颊侧浸润麻醉拔除上颌牙镇痛效果分析

目的讨论拔除上颌恒牙时不给予腭侧麻醉的可行性。方法拔除双侧上颌恒牙的患者63例,进行双侧对照试验,试验组予4%盐酸阿替卡因（含1∶100000肾上腺素）1.7mL唇颊侧前庭沟浸润麻醉,5min后拔牙;对照组颊侧注射同前,同时腭侧追加上述局麻药0.4mL浸润麻醉,5min后拔牙。所有患者麻醉后和拔牙后分别完成注射及拔牙疼痛视觉模拟量表（visual analogue scale,VAS）和语言评价量表（verbal response scale,VRS）测试。结果注射疼痛评价VAS值试验组为（26.3±8.1）mm,对照组为（37.9±6.7）mm,二者差异有统计学意义（P〈0.05）;拔牙疼痛评价VAS值试验组为（15.3±6.9）mm,对照组为（13.3±5.7）mm,两组差异无统计学意义（P〉0.05）,所有患者认为拔牙为“可接受”。结论上颌恒牙拔除行腭侧浸润麻醉给患者带来更多不适,仅行4%盐酸阿替卡因唇颊侧浸润麻醉拔牙的方法可行。     

阿替卡因麻醉下拔除上颌恒磨牙不施行腭侧注射麻醉的可行性

目的探讨拔除上颌恒磨牙时单用阿替卡因进行颊侧注射不施行腭侧注射的可行性。方法选择2007年5-7月在四川省人民医院口腔科就诊的104例需拔除上颌恒磨牙的患者为研究对象，38例患者为双侧上颌均有恒磨牙需要拔除，选择其中一侧作为试验牙，另一侧作为对照牙；两侧磨牙分2次拔除，间隔时间为7 d。66例患者为单侧上颌恒磨牙拔除，将需拔除牙作为试验牙，以前的拔牙经历作为对照。试验组由颊侧前庭沟注射点注入1.7 mL盐酸阿替卡因，对照组除颊侧注射外，在腭侧同时注射2%盐酸利多卡因0.25 mL。麻醉5 min后拔除患牙。由患者填写视觉模拟量表，对疼痛打分。结果试验组上颌恒磨牙麻醉成功率为96.2%，对照组上颌恒磨牙麻醉成功率为97.1%，二者之间的差异无统计学意义（P>0.05）。结论在上颌恒磨牙的拔除中，阿替卡因颊侧注射麻醉后能达到较好的麻醉效果，可以不进行腭侧麻醉。     

采用不同麻醉方法拔除上前磨牙的临床对比

目的 比较拔除上前磨牙时采用单牙无痛局部麻醉系统(STA)行牙周韧带(PDL)内注射麻醉和常规金属注射器颊腭双侧局部浸润麻醉在注射及拔牙过程中疼痛情况和麻醉效果.方法 选择100例因为正畸需要拔除双侧上前tEi磨牙的患者为研究对象,随机选择其中一侧作为试验牙,另一侧作为对照牙:实验组应用计算机控制STA进行盐酸阿替卡因PDL内注射麻醉,对照组采用常规金属注射器进行盐酸阿替卡因颊腭双侧局部浸润麻醉.麻醉5 min后进行拔牙手术.利用直观模拟标度尺(VAS)及问卷获得患者麻醉注射及拔牙时的痛觉数据和颊部软组织是否麻木不适数据.结果 实验组和对照组麻醉注射疼痛感觉VAS值分别是(0.4011±0.556)、(4.1038 4±1.512),两组注射疼痛感觉比较差异有统计学意义(P<0.01);而实验组与对照组在麻醉镇痛成功率方面比较差异无统计学意义(P>0.05);实验组只有2%患者有颊侧软组织麻木不适感,而对照组100%患者有颊侧软组织麻木不适感,两者差异有统计学意义(P<0.01).结论 在上前磨牙拔除中.应用STA-PDL注射麻醉可以达到良好的麻醉效果,同时麻醉注射时疼痛轻微,对邻近颊部软组织功能影响小,麻醉药物用量较少.     

4%阿替卡因与2%利多卡因对上后牙不可复性牙髓炎患者麻醉效果的比较

对40例上颌后牙不可复性牙髓炎患者分组后分别使用4%阿替卡因与2%利多卡因进行颊侧注射麻醉。比较两药在开髓时的麻醉成功率。结果显示阿替卡因与利多卡因组间存在明显差异：4%阿替卡因在上后牙的颊侧注射麻醉中效果优于2%利多卡因。     

两种不同下牙槽神经阻滞麻醉方法用于下颌阻生第三磨牙拔除术的对比研究

目的：探讨一种更加有效的下齿槽神经阻滞麻醉的方法。方法：随机选取需翻瓣去骨法拔除下颌阻生第三磨牙患者150例。实验组50例,采用Gow-Gates法阻滞麻醉,对照一组50例,采用下颌支内侧隆突阻滞麻醉,对照二组在采用对照组一的方法注射后保留少量局麻药加用患牙颊侧近远中及舌侧三点浸润麻醉。采用VAS评分法观察疼痛情况。三组病例均使用阿替卡因肾上腺素注射液。结果：与对照一组相比,采用Gow-Gates法阻滞麻醉的病例疼痛明显减轻,但是与对照二组相比,该法没有明显优势。结论：传统的下颌支内侧隆突阻滞麻醉加用局部浸润麻醉可以有效提高下牙槽神经阻滞麻醉的成功率,达到与Gow-Gates阻滞麻醉相同的麻醉效果。     

阿替卡因与甲哌卡因在老年人磨牙牙髓治疗中的临床效果比较

目的：比较阿替卡因和甲哌卡因在老年人口腔局部麻醉的临床效果。方法：将346例急慢性牙髓炎老年患者随机分成2组进行局部浸润麻醉,对其注射时疼痛、牙髓治疗时麻醉效果、上下颌的麻醉差异进行观察分析。结果：甲哌卡因和阿替卡因在注射时的疼痛程度无显著性差异。相同颌位时,甲哌卡因和阿替卡因的局部浸润麻醉效果无显著性差异;而在不同颌位时,甲哌卡因和阿替卡因对上颌磨牙的麻醉效果均优于下颌磨牙。结论：阿替卡因和甲哌卡因注射疼痛小,麻醉效果相似。     

阿替卡因在拔牙术中的应用

许多就诊的拔牙患者总是把拔牙治疗与疼痛联系在一起。我们在临床中处理此类患者除语言安慰、诱导外 ,使用了碧兰麻 ,即阿替卡因加肾上腺素 ( 1:10 0 0 0 0 ) ,收到了良好的效果。1　材料与方法2 0 0 0年 5月至 11月间 ,5 3例需要拔牙的患者来我院就诊 ,主观畏痛。其中男 3 0例 ,女 2 3例。年龄 6～ 5 6岁。用含40 ｇ/Ｌ阿替卡因加 1/10 0 0 0 0肾上腺素及配套注射器 ,采取唇(颊 )、腭 (舌 )侧根尖区局部粘膜下浸润麻醉 ,注入量前牙每侧约 0 .5ｍｌ,后牙每侧约 1ｍｌ。注药后 10ｍｉｎ后进行患牙拔除。共拔除患牙 5 8个 ,其中上颌磨牙 (包括…     

拔除上颌牙不施行腭侧注射麻醉的临床研究

目的探讨拔除上颌牙不行腭侧注射麻醉的可行性。方法选择700例需要拔除上颌牙的患者为研究对象,将其随机分为2组,试验组500例,对照组200例。拔牙时试验组患者只行颊侧的局部麻醉;对照组患者采用传统的麻醉方法,比较2组患者的麻醉效果。结果1)试验组患者麻药注射时的疼痛明显小于对照组,其差异有统计学意义(P<0.05);2)试验组患者与对照组患者在拔牙手术时的疼痛无明显的差异(P>0.05)。结论在上颌牙的拔除中只行颊侧的局部麻醉能达到较好的麻醉效果,可以不进行腭侧麻醉。     

颊侧浸润麻醉对上颌磨牙麻醉效果的临床观察

目的：比较颊侧浸润麻醉与传统阻滞麻醉对上颌磨牙牙髓的麻醉效果。方法：选择因上颌磨牙深龋或牙髓炎患者,患牙在局麻下行去龋或开髓、拔髓操作。麻药为含1：80000肾上腺素的2%利多卡因。患者随机分为A、B、C三组,每组各100例。A组采用颊侧黏膜下浸润麻醉,剂量1.8ml;B组采用与A组相同的黏膜下浸润麻醉,剂量0.9ml;C组采用传统阻滞麻醉,剂量1.8ml。以视觉模拟评分法（VAS）对注射和操作的疼痛程度进行评分,以Kruskal-Wallis方法检验各组间差异。结果：①Kruskal-Wallis检验显示注射疼痛,组间有统计学差异（p〈0.05）,而操作疼痛,组间无统计学差异（p〉0.05）;②Nemenyi法进一步比较各组间注射疼痛的差异,A组与B组无显著性差异（p〉0.05）,而A组与C组、B组和C组之间存在显著性差异（p〈0.05）。结论：对于上颌磨牙的麻醉,颊侧浸润麻醉（1.8ml或0.9ml）与传统的阻滞麻醉在操作疼痛评分中无显著性差异,但是注射疼痛显著低于阻滞麻醉。提示0.9ml含1：80000肾上腺素的2%利多卡因颊侧浸润麻醉即可获得较好的上颌磨牙牙髓麻醉效果。     

富血小板纤维蛋白对下颌第三磨牙拔除术后疼痛影响的临床研究

目的:通过临床对照研究验证富血小板纤维蛋白(platelet-rich fibrin, PRF)对下颌第三磨牙拔除后创口疼痛的影响。方法:对需要同期拔除双侧下颌第三磨牙的正畸患者,采用自身对照研究,实验侧拔牙后拔牙窝填塞PRF,对照侧拔牙窝内不做任何填塞,仅由血凝块自然充填。使用视觉模拟评分表(visual analogue scale, VAS)测得患者拔牙后连续6 d的疼痛数值,评估PRF对下颌第三磨牙拔除后创口疼痛的影响。结果:下颌第三磨牙拔除术后1～5 d,拔牙窝内填塞PRF实验侧的疼痛强度较对照侧减轻,同一时间点两组拔牙后疼痛强度值差异具有统计学意义。结论:PRF应用于下颌第三磨牙拔牙创,可减轻患者的拔牙术后疼痛。     

Extraction of Permanent Maxillary Teeth by Only Buccal Infiltration of Articaine

Objective

The aim of this study is to demonstrate whether articaine hydrochloride administered alone as a single buccal infiltration in maxillary tooth removal, can provide favourable palatal anesthesia as compared to buccal and palatal injection of lidocaine.

Study Design

The study population consisted of 30 patients who were undergoing orthodontic treatment, and who required bilateral extraction of maxillary permanent premolars as per their orthodontic treatment plan. On the experimental side, 4 % articaine/HCl was injected into the buccal vestibule of the tooth to be extracted. On the control side, 2 % lignocaine HCl was injected both into the buccal and the palatal side of the tooth to be extracted. Following tooth extraction all patients completed a 100-mm visual analogue scale (VAS) and faces pain scale (FPS) to rate 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 insignificant.

Conclusions

The routine use of a palatal injection for the removal of permanent maxillary premolar teeth may not be required when articaine/HCl is used as the local anesthetic.     

Comparison of the efficacy of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 buccal infiltration for single maxillary molar extraction: a double-blind,randomised, clinical trial

The present study was designed to compare the efficiency of 4% articaine with epinephrine 1:100,000 and 2% lidocaine with epinephrine 1:100,000 in providing adequate anaesthesia for maxillary molar extraction with buccal infiltration only. In this randomised, double-blind clinical trial, 139 patients who needed maxillary molars extracting were enrolled. Individuals were randomly divided into two groups of 2% lidocaine with epinephrine 1:100,000 treated by buccal infiltration without palatal injection and 4% articaine with epinephrine 1:100,000 treated with the same method. Then, teeth were extracted and the pain assessed. During the extraction of teeth, 90.63% of patients in the lidocaine-treated group and 36% of patients in the articaine-treated group experienced pain (p<0.0001). In other words, the rates of successful anaesthesia with lidocaine and articaine buccal infiltration were 9.38% and 64%, respectively. Despite the better performance of articaine, it seems that some factors such as bone thickness and anatomical variations among individuals, besides the condition of the tooth, affects articaine’s level of efficiency in each case.     

Comparison of the buccal injection versus buccal and palatal injection for extraction of permanent maxillary posterior teeth using 4% articaine: a split mouth study

In spite of the development of modern injection techniques, palatal injection is still a painful experience for patients. A plethora of techniques has been tested to reduce this. One such technique that has been claimed to work is administering articaine on the buccal side alone for the extraction of maxillary teeth due to its ability to diffuse through soft and hard tissues more reliably than other local anaesthetics. This split mouth study evaluated the efficacy of 4% articaine with 1:100000 adrenaline to avoid the painful palatal injection for bilateral permanent maxillary tooth extraction in 50 patients. The 100mm 10 point Visual Analog Scale/Wong Baker Facial Pain Scale was used to rate the amount of pain felt on injection, on probing the tissues prior to, or during, extraction, and one hour postoperatively. Although the buccal injection alone resulted in lower pain while injecting the anaesthetic, it did not result in the absence of pain before tooth extraction as has been suggested by various studies. A total of 74% patients required a palatal injection on the study side. We conclude that in most cases, when using a buccal injection alone, one cannot rely on the diffusion of articaine for effective palatal anaesthesia. Despite this, we suggest that as an initial option in young patients, the operator can consider avoiding the painful palatal injection by the use of articaine to prevent aversion to dental treatment. Postoperatively, the difference in pain levels was not statistically significant and no patient showed signs of lesions at the injection sites.     

Injection pain of prilocaine plain, mepivacaine plain, articaine with epinephrine, and lidocaine with epinephrine

In a double-blind study design, 1,391 consecutive patients in a general dental practice received one of four different local anesthetics (articaine with epinephrine, lidocaine with epinephrine, mepivacaine plain, or prilocaine plain) via a maxillary buccal infiltration, palatal infiltration, or inferior alveolar block injection. The anesthetics were administered under clinical conditions by one of two dentists. Immediately after receiving the injection, patients rated the pain from each injection on a ten-point scale. The pain response was analyzed according to the dentist administering the injection, the location of injection, the patient's gender, and the type of anesthetic administered. Injection of prilocaine plain produced significantly lower pain scores than lidocaine with epinephrine, mepivacaine plain, or articaine with epinephrine.     

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

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.     

The pharmacokinetics and cardiovascular effects of high-dose articaine with 1:100,000 and 1:200,000 epinephrine

OBJECTIVES: The authors conducted a randomized, double-blind, two-way crossover clinical trial to compare the pharmacokinetics and cardiovascular effects of 11.9 milliliters of 4 percent articaine hydrochloride (HCl) plus 1:100,000 epinephrine (A100) with those of 11.9 mL of 4 percent articaine HCl plus 1:200,000 epinephrine (A200). METHODS: During two testing sessions, the authors administered injections of A100 and A200 over a seven-minute period (in one-cartridge doses unless otherwise noted): maxillary right first molar infiltration, maxillary left first molar infiltration, maxillary right first premolar infiltration, maxillary left first premolar infiltration, right inferior alveolar injection, left inferior alveolar injection, right long buccal infiltration (one-half cartridge) and left long buccal infiltration (one-half cartridge). They analyzed venous blood samples for articaine levels. They used noninvasive acoustic tonometry to measure a variety of cardiovascular parameters over a two-hour period. RESULTS: Plasma concentration curves of articaine over time were similar for both solutions, with peak concentrations and times to maximum concentration being 2,037 nanograms per milliliter and 22 minutes for A100 and 2,145 ng/mL and 22 minutes for A200. At the 10-minute point, the mean systolic blood pressure and heart rate were significantly elevated (P < .05) with A100 versus A200. CONCLUSIONS: Maximum dose recommendations for the A100 solution also can be applied to the A200 solution. A200 produces less cardiovascular stimulation than does A100. CLINICAL IMPLICATIONS: A200 is as safe as A100, and may be preferable to A100 in patients with cardiovascular disease and in those taking drugs that reportedly enhance the systemic effects of epinephrine.     

Differences in the degree of infiltration of local anesthesia according to the site of injection in rats

This study was conducted for morphological and quantitative evaluation of the diffusional pattern of infiltration anesthesia according to the site of injection. The maxillary first molar of rats was anesthetized by local infiltration of 100 microL of 2% lidocaine containing trypan blue at a distance of 2 mm from the palatal mucogingival junction or mucobuccal fold over the root apex of the maxillary first molar. The frozen sections were prepared in order to measure the volume of the anesthetics using volume-calculating software. On the palatal side, the anesthetic infiltrated the submucosal layer at an infiltration volume of 0.51 +/- 0.78 mm(3). On the buccal side, the solution entered the space formed by the masseter muscles, the arcus zygomaticus, and the lacrimal gland, at an infiltration volume of 23.80 +/- 13.16 mm(3). The results indicate the infiltration volume depends on the injection site and that insufficient anesthesia or unnecessary numbness is expected.     

Lack of differential effect by Ultracaine (articaine) and Citanest (prilocaine) in infiltration anaesthesia

It has been claimed that anaesthesia of mandibular pulpal and lingual soft tissue, as well as maxillary palatal soft tissue, results following buccal infiltration of the local anaesthetic Ultracaine (articaine HC1). However, this has never been scientifically proven and the aim of this investigation was to test these claims by comparing articaine to a standard anaesthetic, Citanest (prilocaine HC1). In order to study this, a double blind, randomized trial was conducted in healthy adult volunteers. In these subjects, the ability to induce maxillary and mandibular anaesthesia following buccal infiltration with articaine (as compared to prilocaine given contralaterally), was determined by measuring sensation to electrical stimulation at the tooth, buccal and lingual soft tissue at each of the four non-carious, non-restored, second molars. Results showed that there were no statistically significant differences between articaine and prilocaine in their ability to induce anaesthesia for any tissue at any of the six sites (p greater than 0.05) as determined by chi-square analysis. Analysis of effect on sensation for 25 minutes post-administration also failed to demonstrate a difference between the two drugs. Therefore, these data are not consistent with superior anaesthesia efficacy by articaine at any site, including the mandibular pulpal, lingual or maxillary palatal tissues, in the second molars studied.