Restorative Dentistry & Endodontics

Research Article

Anesthetic efficacy in vital asymptomatic teeth using different local anesthetics: a systematic review with network meta-analysis: Amy Kia Cheen Liew, Yi-Chun Yeh, Dalia Abdullah, Yu-Kang Tu; Restor Dent Endod 2021;46(3):e41. Published online July 21, 2021; DOI: https://doi.org/10.5395/rde.2021.46.e41

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Objectives

This study aimed to evaluate the efficacy of various local anesthesia (LA) in vital asymptomatic teeth.

Materials and Methods

Randomized controlled trials comparing pulpal anesthesia of various LA on vital asymptomatic teeth were included in this review. Searches were conducted in the Cochrane CENTRAL, MEDLINE (via PubMed), EMBASE, ClinicalTrials.gov, Google Scholar and 3 field-specific journals from inception to May 3, 2019. Study selection, data extraction, and risk of bias assessment using Cochrane Risk of Bias Tool were done by 2 independent reviewers in duplicate. Network meta-analysis (NMA) was performed within the frequentist setting using STATA 15.0. The LA was ranked, and the surface under the cumulative ranking (SUCRA) line was plotted. The confidence of the NMA estimates was assessed using the CINeMA web application.

Results

The literature search yielded 1,678 potentially eligible reports, but only 42 were included in this review. For maxillary buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than lidocaine 2% with epinephrine 1:100,000 (odds ratio, 2.11; 95% confidence interval, 1.14–3.89). For mandibular buccal infiltration, articaine 4% with epinephrine 1:100,000 was more efficacious than various lidocaine solutions. The SUCRA ranking was highest for articaine 4% with epinephrine when used as maxillary and mandibular buccal infiltrations, and lidocaine 2% with epinephrine 1:80,000 when used as inferior alveolar nerve block. Inconsistency and imprecision were detected in some of the NMA estimates.

Conclusions

Articaine 4% with epinephrine is superior when maxillary or mandibular infiltration is required in vital asymptomatic teeth.

Citations

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Case Report

Hypoesthesia after IAN block anesthesia with lidocaine: management of mild to moderate nerve injury: Sungjoo Moon, Seung-Jong Lee, Euiseong Kim, Chan-Young Lee; Restor Dent Endod 2012;37(4):232-235. Published online November 21, 2012; DOI: https://doi.org/10.5395/rde.2012.37.4.232

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Hypoesthesia after an inferior alveolar nerve (IAN) block does not commonly occur, but some cases are reported. The causes of hypoesthesia include a needle injury or toxicity of local anesthetic agents, and the incidence itself can cause stress to both dentists and patients. This case presents a hypoesthesia on mental nerve area followed by IAN block anesthesia with 2% lidocaine. Prescription of steroids for a week was performed and periodic follow up was done. After 1 wk, the symptoms got much better and after 4 mon, hypoesthesia completely disappeared. During this healing period, only early steroid medication was prescribed. In most cases, hypoesthesia is resolved within 6 mon, but being aware of etiology and the treatment options of hypoesthesia is important. Because the hypoesthesia caused by IAN block anesthesia is a mild to moderate nerve injury, early detection of symptom and prescription of steroids could be helpful for improvement of the hypoesthesia.

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Original Articles

Effect of local anesthesia on pulpal blood flow in mechanically stimulated teeth: Wan-Sik Chu, Seung-Ho Park, Dong-Kuk Ahn, Sung Kyo Kim; J Korean Acad Conserv Dent 2006;31(4):257-262. Published online January 14, 2006; DOI: https://doi.org/10.5395/JKACD.2006.31.4.257

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Abstract

The aims of the study were to evaluate the effect of epinephrine-containing local anesthetics on pulpal blood flow (PBF) and to investigate its effect on cavity preparation-induced PBF change. PBF was recorded using a laser Doppler flowmeter (Perimed Co., Sweden) from canines of nine cats under general anesthesia before and after injection of local anesthetics and after cavity preparation. 2% lidocaine hydrochloride with 1 : 100,000 epinephrine was administered by local infiltration given apical to the mandibular canine at the vestibular area and the same volume of isotonic saline was injected on the contralateral tooth as a control. A round carbide bur was operated at slow speed with isotonic saline flushing to grind spherical cavities with increasing depth through the enamel and into the dentin on both teeth. The obtained data was analyzed with paired t-test.

Cavity preparation caused significant increase of PBF (n = 9, p < 0.05). Local infiltration of lidocaine with epinephrine resulted in decreases of PBF (n = 9, p < 0.05), whereas there was no significant change of PBF with the physiologic saline as a control. Cavity preparation on tooth anesthetized with lidocaine with epinephrine caused significantly less increase of PBF than in control tooth (p < 0.05).

Therefore, the result of the present study demonstrates that local infiltration of 2% lidocaine with 1 : 100,000 epinephrine effectively reduces PBF increase caused by cavity preparation.

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The influence of epinephrine concentration in local anesthetics on pulpal and gingival blood flows: Jae-Sang Lee, Sung-Kyo Kim; J Korean Acad Conserv Dent 2003;28(6):475-484. Published online November 30, 2003; DOI: https://doi.org/10.5395/JKACD.2003.28.6.475

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Citations

Citations to this article as recorded by

Biologic response of local hemostatic agents used in endodontic microsurgery
Youngjune Jang, Hyeon Kim, Byoung-Duck Roh, Euiseong Kim
Restorative Dentistry & Endodontics.2014; 39(2): 79. CrossRef
Cardiovascular effect of epinephrine in endodontic microsurgery: a review
Youngjune Jang, Euiseong Kim
Restorative Dentistry & Endodontics.2013; 38(4): 187. CrossRef
Effect of local anesthesia on pulpal blood flow in mechanically stimulated teeth
Wan-Sik Chu, Seung-Ho Park, Dong-Kuk Ahn, Sung Kyo Kim
Journal of Korean Academy of Conservative Dentistry.2006; 31(4): 257. CrossRef

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