The efficacy of six local anesthetic formulations used for posterior mandibular
buccal infiltration anesthesia.
Author(s): Abdulwahab M, Boynes S, Moore P, Seifikar S, Al-Jazzaf A, Alshuraidah A, Zovko J,
Close J.
Affiliation(s): Department of Dental Anesthesiology, School of Dental Medicine, University of
Pittsburgh, Pittsburgh, PA 15261, USA mna3@pitt.edu
Publication date & source: 2009, J Am Dent Assoc. , 140(8):1018-24
OBJECTIVE: The authors conducted a randomized, double-blind clinical trial to
evaluate pulpal anesthesia achieved after mandibular infiltration of five
commonly marketed dental local anesthetic formulations as compared with a control
formulation of lidocaine with epinephrine.
METHODS: The authors evaluated 2 percent lidocaine with 1:100,000 epinephrine
(L100) against 4 percent articaine with 1:100,000 epinephrine (A100), 4 percent
articaine with 1:200,000 epinephrine (A200), 4 percent prilocaine with 1:200,000
epinephrine (P200), 3 percent mepivacaine without vasoconstrictor (Mw/o) and 0.5
percent bupivacaine with 1:200,000 epinephrine (B200). This repeated-treatment
trial involved 18 healthy participants. The investigators administered mandibular
infiltration injections (six sessions per participant) of 0.9 milliliters of
anesthetic into the buccal fold adjacent to the distal root of the mandibular
first molar. The authors determined anesthetic efficacy across a 20-minute period
by measuring changes in sensory threshold to electrical pulp test (EPT)
stimulation.
RESULTS: Twelve female and six male participants (mean age, 24.9 years; range,
18-53 years) completed the study. The maximum mean increase from baseline of EPT
measurements for the six formulations were 43.5 percent for L100, 44.8 percent
for B200, 51.2 percent for P200, 66.9 percent for A200, 68.3 percent for Mw/o and
77.3 percent for A100 (A100 versus L100, P = .029). Adverse reactions were minor
and not formulation dependent.
CONCLUSIONS AND CLINICAL IMPLICATIONS: The authors found that mandibular
infiltration with 0.9 mL of the tested dental anesthetics could induce only
partial pulpal anesthesia, a level likely to be inadequate for most dental
procedures. When compared with L100, only the A100 induced statistically greater
pulpal anesthesia after mandibular buccal infiltration.
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