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 Articaine abstracts

The opinions within this web page are not ours.Authors have been credited for the individual posts where they are. - www.rxroots.com
From: Ken Reed To: Frederick Barnett Date: Mon, 15 Sep 2008 16:22:49 -0700 Thank you for the invitation to speak to your residents today, I had a great time. Concerning Malamed and paresthesia (ya gotta add the CDA journal to your reading list ): From: Local Anesthetics: Dentistry's Most Important Drugs, Clinical Update 2006 (attached) At this time, there is absolutely no scientific evidence to demonstrate there is a greater risk of paresthesia associated with administration of a 4 percent local anesthetic. All reports of paresthesia have been anecdotal. Evidence-based research does not exist. Given the present level of scientific evidence or, more accurately, the lack thereof, linking 4 percent local anesthetics with an increased risk of neurotoxicity, it seems, to this author, that advisories to dentists from agencies suggesting that it might be prudent to avoid the use of articaine in mandibular nerve blocks is unjustified at this time. Allegations that 4 percent local anesthetics are associated with a greater risk of paresthesia are based solely on anecdotal reports and have no scientific justification. From: Letter to the Editor Articaine vs. Lidocaine: The Author Responds (attached) There is absolutely no scientific evidence available to support the claim that articaine is associated with a greater incidence of paresthesia (or stated more correctly, is more neurotoxic) than other local anesthetics. Yes, there is "buzz" in our profession today about the possibility of 4 percent drugs, specifically articaine, being associated with increased incidences of paresthesia. But as previously stated, there exists absolutely no scientific evidence demonstrating that this may be true. All reports and papers are anecdotal in nature. Ken Reed Thanks Fred! Yet, this has never been a problem over here. I wonder whether if articaine would have been associated with these problems if it had been invented in the US ;-) . Anyway, it was made availabe in the US after the patents expired, if I calculate correctly..... Best regards from Flensburg,Germany, Winfried, who has done about 25,000 blocks with articaine in the last 28 years and does not want to miss it Winfried, If it were invented in the US, the lawyers would be even richer than they are now ;-))) The last paper is the MOST interesting in terms of showing better results with articaine. - Fred Thanks Fred, the good thing is that I can use articain here without any stress, the bad thing is that my wife is a lawyer here and does not work for US fees ;-) .- Winfried ----------------------------------------------------------------------------------------------------- 1: Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod. 2004 Aug;30(8):568-71. PMID: 15273637 [PubMed - indexed for MEDLINE] 2: Sherman MG, Flax M, Namerow K, Murray PE. Anesthetic efficacy of the Gow-Gates injection and maxillary infiltration with articaine and lidocaine for irreversible pulpitis. J Endod. 2008 Jun;34(6):656-9. Epub 2008 Apr 25. PMID: 18498883 [PubMed - indexed for MEDLINE] 3: Mikesell P, Nusstein J, Reader A, Beck M, Weaver J. A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod. 2005 Apr;31(4):265-70. PMID: 15793381 [PubMed - indexed for MEDLINE] 4:Sierra Rebolledo A, Delgado Molina E, Berini Aytís L, Gay Escoda C. Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars. Med Oral Patol Oral Cir Bucal. 2007 Mar 1;12(2):E139-44. PMID: 17322803 [PubMed - indexed for MEDLINE] 5: Tófoli GR, Ramacciato JC, de Oliveira PC, Volpato MC, Groppo FC, Ranali J. Comparison of effectiveness of 4% articaine associated with 1: 100,000 or 1: 200,000 epinephrine in inferior alveolar nerve block. Anesth Prog. 2003;50(4):164-8. PMID: 14959904 [PubMed - indexed for MEDLINE] 6: Evans G, Nusstein J, Drum M, Reader A, Beck M. A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations. J Endod. 2008 Apr;34(4):389-93. Epub 2008 Feb 7. PMID: 18358883 [PubMed - indexed for MEDLINE] 7:Haase A, Reader A, Nusstein J, Beck M, Drum M. Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block. J Am Dent Assoc. 2008 Sep;139(9):1228-35. PMID: 18762633 [PubMed - in process]
1 Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis.
Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Department of Oral Surgery, Oral Pathology, and Anesthesiology, The Ohio State University, Columbus, OH 43218, USA.

The purpose of this prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine to 2% lidocaine with 1:100,000 epinephrine for inferior alveolar nerve blocks in patients experiencing irreversible pulpitis in mandibular posterior teeth. Seventy-two emergency patients diagnosed with irreversible pulpitis of a mandibular posterior tooth randomly received, in a double-blind manner, 2.2 ml of 4% articaine with 1:100,000 epinephrine or 2.2 ml of 2% lidocaine with 1:100,000 epinephrine using a conventional inferior alveolar nerve block. Endodontic access was begun 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as none or mild pain (Visual Analogue Scale recordings) on endodontic access or initial instrumentation. The success rate for the inferior alveolar nerve block using articaine was 24% and for the lidocaine solution success was 23%. There was no significant difference (p = 0.89) between the articaine and lidocaine solutions. Neither solution resulted in an acceptable rate of anesthetic success in patients with irreversible pulpitis.


J Endod. 2004 Aug;30(8):568-71.
PMID: 15273637 [PubMed - indexed for MEDLINE]

2 Anesthetic efficacy of the Gow-Gates injection and maxillary infiltration with articaine and lidocaine for irreversible pulpitis.
Sherman MG, Flax M, Namerow K, Murray PE. Department of Endodontics, Nova Southeastern University, Fort Lauderdale, Florida 33328, USA.

The aim of this randomized, double-blinded study was to compare the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine (AE) with 2% lidocaine with 1:100,000 epinephrine (LE) for Gow-Gates blocks and maxillary infiltrations in patients experiencing irreversible pulpitis in mandibular and maxillary posterior teeth. Forty patients diagnosed with irreversible pulpitis of a posterior tooth randomly received either AE or LE by using a Gow-Gates injection or maxillary infiltration. Endodontic access was initiated after no response to Endo-ice 15 minutes after solution deposition. Success was defined as none to mild pain on a visual analogue scale after access. Chi-square and analysis of variance statistical tests were used to analyze the data. Successful endodontic treatment substantially reduced the assessment of pulpitis pain by patients (analysis of variance, P < .0001). Overall anesthetic success in both dental arches was 87.5%. Anesthetic success was not influenced by tooth arch (chi(2), P > .7515) or gender (chi(2), P > .1115). AE proved to be as effective but not superior to LE (P > .6002). These results demonstrated the similar anesthetic effectiveness of AE and LE when used during the endodontic treatment of teeth diagnosed with irreversible pulpitis.


J Endod. 2008 Jun;34(6):656-9. Epub 2008 Apr 25.
PMID: 18498883 [PubMed - indexed for MEDLINE]

3 A comparison of articaine and lidocaine for inferior alveolar nerve blocks.
Mikesell P, Nusstein J, Reader A, Beck M, Weaver J Department of Endodontics, The Ohio State University, Columbus, OH, USA.

The purpose of this prospective, randomized, double-blind study was to compare the degree of pulpal anesthesia obtained with 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks. Using a crossover design, inferior alveolar nerve blocks were randomly administered, in a double-blind manner, using 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine, at two separate appointments, to 57 subjects. A pulp tester was used to test for anesthesia, in 4-min cycles for 60 min, of the molars, premolars, central, and lateral incisors. Anesthesia was considered successful when two consecutive 80 readings were obtained within 15 min and the 80 reading was continuously sustained for 60 min. Using the articaine solution, successful pulpal anesthesia ranged from 4 to 54% from the central incisor to the second molar. Using the lidocaine solution, successful pulpal anesthesia ranged from 2 to 48%. There was no significant difference (p > 0.05) between the articaine and lidocaine solutions. We concluded that 4% articaine with 1:100,000 epinephrine was similar to 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks.



J Endod. 2005 Apr;31(4):265-70.
PMID: 15793381 [PubMed - indexed for MEDLINE]

4 Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars.
Sierra Rebolledo A, Delgado Molina E, Berini Aytís L, Gay Escoda C. University of Barcelona Dental School, Barcelona, Spain.

BACKGROUND: A comparative study is made of the anesthetic efficacy of 4% articaine versus 2% lidocaine, both with epinephrine 1:100,000, in truncal block of the inferior alveolar nerve during the surgical extraction of impacted lower third molars.

STUDY DESIGN: A randomized double-blind clinical trial was conducted of 30 patients programmed for the bilateral surgical extraction of symmetrical lower third molars in the context of the Master of Oral Surgery and Implantology (University of Barcelona, Barcelona, Spain). Following the obtainment of informed consent, two operators performed surgery on an extemporaneous basis, using as local anesthetic 4% articaine or 2% lidocaine with the same concentration of vasoconstrictor (epinephrine 1:100,000). The study variables for each anesthetic were: latency (time to action) and duration of anesthetic effect, the amount of anesthetic solution used, and the need of re-anesthetize the surgical zone. A visual analog scale was used to assess pain during surgery, and thus subjectively evaluate the anesthetic efficacy of the two solutions.

RESULTS: Statistically significant differences (p = 0.003) were observed in the mean duration of anesthetic effect (220.86 min. for 4% articaine vs. 168.20 min. for 2% lidocaine). Latency, the amount of anesthetic solution and the need to re-anesthetize the surgical field showed clinical differences in favor of articaine, though statistical significance was not reached. The pain scores indicated similar anesthetic efficacy with both solutions. CONCLUSIONS: The results obtained suggest that 4% articaine offers better clinical performance than 2% lidocaine, particularly in terms of latency and duration of the anesthetic effect. However, no statistically significant differences in anesthetic efficacy were recorded between the two solutions.



Med Oral Patol Oral Cir Bucal. 2007 Mar 1;12(2):E139-44.
PMID: 17322803 [PubMed - indexed for MEDLINE]

5 Comparison of effectiveness of 4% articaine associated with 1: 100,000 or 1: 200,000 epinephrine in inferior alveolar nerve block.
Tófoli GR, Ramacciato JC, de Oliveira PC, Volpato MC, Groppo FC, Ranali J. Piracicaba Dental School, University of Campinas, São Paulo, Brazil.

This comparative study using 20 healthy volunteers evaluated the anesthetic efficacy of 4% articaine in association with 2 different concentrations of epinephrine, 1:200,000 (G1) and 1:100,000 (G2). The first premolars were tested with a pulp tester to verify the anesthesia induced by the inferior alveolar nerve block. The following parameters were measured: period of latency (PL; interval between the end of anesthetic injection and absence of response to the maximum output--80 reading--of the pulp tester); complete pulpal anesthesia (CPA; period in which the subject had no response to maximal output of the pulp tester 80 reading); partial anesthesia (PA; interval between the first reading below 80 and the return to basal levels); and the anesthesia of the soft tissues (AST; period of time from onset of anesthesia until the return to normal sensation of the lip). The Wilcoxon test (alpha = 0.05) was used to analyze the data. No significant difference was found regarding PL (P = .47), CPA (P = .88), PA (P = .46), and AST (P = .85). The results indicated that both solutions presented the same clinical effectiveness in blocking the inferior alveolar nerve.



Anesth Prog. 2003;50(4):164-8.
PMID: 14959904 [PubMed - indexed for MEDLINE]

6 A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations.
Evans G, Nusstein J, Drum M, Reader A, Beck M. Division of Endodontics, The Ohio State University, Columbus, USA.

The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in maxillary lateral incisors and first molars. Eighty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of one cartridge of 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine at two separate appointments spaced at least 1 week apart. In maxillary lateral incisors, articaine exhibited a significantly higher anesthetic success rate of 88% when compared with a 62% success rate with lidocaine. In maxillary first molars, articaine had a similar success rate to lidocaine (78% vs 73%), and there was no significant difference between the two solutions. In conclusion, a maxillary infiltration of 4% articaine with 1:100,000 epinephrine statistically improved anesthetic success when compared with 2% lidocaine with 1:100,000 epinephrine in the lateral incisor but not in the first molar.



J Endod. 2008 Apr;34(4):389-93. Epub 2008 Feb 7.
PMID: 18358883 [PubMed - indexed for MEDLINE]

7 Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block.
Haase A, Reader A, Nusstein J, Beck M, Drum M.

BACKGROUND: The authors conducted a prospective, randomized, double-blind, crossover study comparing the degree of pulpal anesthesia achieved by means of mandibular first molar buccal infiltrations of two anesthetic solutions: 4 percent articaine with 1:100,000 epinephrine and 2 percent lidocaine with 1:100,000 epinephrine after an inferior alveolar nerve (IAN) block with the use of 4 percent articaine with 1:100,000 epinephrine. METHODS: Seventy-three blinded adult subjects randomly received buccal infiltrations at the first molar site with a cartridge of 4 percent articaine with 1:100,000 epinephrine at one appointment and a cartridge of 2 percent lidocaine with 1:100,000 epinephrine at another appointment after receiving a standard IAN block with the use of 4 percent articaine with 1:100,000 epinephrine in a crossover design. After the injections, the authors used an electric pulp tester to test the first molar for anesthesia in three-minute cycles for 60 minutes. They considered anesthesia to be successful when two consecutive 80 readings were obtained within 10 minutes of the IAN block and infiltration injection, and the 80 reading was sustained continuously through the 60th minute.

RESULTS: The authors found that with the use of the 4 percent articaine formulation, successful pulpal anesthesia occurred 88 percent of the time for the first molar. With the 2 percent lidocaine formulation, successful pulpal anesthesia occurred 71 percent of the time. The results show a significant difference (P < .05) between the articaine and lidocaine formulations.

CONCLUSION AND CLINICAL IMPLICATIONS: For a mandibular buccal infiltration of the first molar after a standard IAN block, 4 percent articaine with 1:100,000 epinephrine resulted in a higher success rate (88 percent) than did 2 percent lidocaine with 1:100,000 epinephrine (71 percent success rate).

J Am Dent Assoc. 2008 Sep;139(9):1228-35.
PMID: 18762633 [PubMed - in process]