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4% Articaine and 2% Lignocaine for Surgical Removal of Third Molar by Mandibular Nerve Block: A Randomized Clinical Trial for Efficacy and Safety

  • Shruthi Saralaya
  • Sahana B. Adirajaiah
  • Venkatesh Anehosur
Original Article
  • 24 Downloads

Abstract

Objective

Articaine entered clinical use in 1976; however, evidence basis for articaine’s reputation is not entirely clear. The aim of the study is to compare and analyze 4% articaine with 1:100,000 epinephrine and 2% lignocaine with 1:100,000 epinephrine in patients operated for mandibular third molar impaction with respect to efficacy and safety, time of onset and duration of anesthesia and duration of postoperative analgesia.

Methods

The study was done on fifty patients requiring surgical extraction of mandibular third molar; randomly divided into two groups of 25 each, receiving 4% articaine hydrochloride with 1:100,000 epinephrine and 2% lignocaine hydrochloride with 1:100,000 epinephrine. Difficulty index for extraction, volume, onset and duration of anesthesia and duration of postoperative analgesia were recorded. Pain was assessed using Heft-Parker VAS. The data were analyzed using appropriate statistical analysis.

Results

The mean onset time for articaine and lignocaine is 3.16 ± 0.55 and 3.2 ± 0.48 min, respectively. Articaine group experienced statistically significant longer period of analgesia and duration of action 289.04 ± 40 and 361.88 ± 40 min, respectively, as compared to lignocaine which is 144.2 ± 12 and 197.44 ± 25 min, respectively. No statistical difference between the two groups with regard to pain experience.

Conclusion

4% Articaine is more potent and has longer duration of action with better postoperative analgesia and could be considered as an alternative to lignocaine in clinical practice. With management of postoperative pain being the critical component of patient care, clinical trials are required to develop long acting local anesthetic with increased postoperative analgesia effect.

Keywords

4% Articaine hydrochloride 2% Lignocaine hydrochloride Postoperative analgesia 

Notes

Acknowledgements

Author would like to thank Dr. Srinath Thakur, Principal, SDM College of Dental Sciences Dharwad and Dr. Niranjan Kumar, Medical Director, SDM Craniofacial Research Centre, Dharwad for the encouragement and facilities provided. Author would also thank Dr. Abhijit Joshi, Associate Professor, Department of Oral and Maxillofacial Surgery, SDM College of Dental Sciences Dharwad for his constant support.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standard

Ethical approval taken by the Institutional Review Board (IRB No. 2013/P/OS/22).

References

  1. 1.
    Budenz AW (2003) Local anesthetics in dentistry: then and now. J Calif Dent Assoc 31(5):388–396PubMedGoogle Scholar
  2. 2.
    Snoeck M (2012) Articaine: a review of its use for local and regional anesthesia. Local Reg Anesth 5:23–33CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kalia V, Supreet, Kaur R (2011) Comparitive evaluation of onset and duration of anesthesia of 4% articaine versus 2% lidocaine with epinephrine 1:100000 during exodontia. Indian J Compr Dent Care 1(1):19–24Google Scholar
  4. 4.
    Kambalimath HD, Dolas SR et al (2013) Efficacy of 4% articaine and 2% lidocaine: a clinical study. J Maxillofac Oral Surg 12(1):3–10CrossRefPubMedGoogle Scholar
  5. 5.
    Katayal V (2010) The efficacy and safety of articaine versus lignocaine in dental treatments: a meta-analysis. J Dent 38:307–317CrossRefGoogle Scholar
  6. 6.
    Shruthi R, Kedarnath NS, Mamatha NS, Rajaram P, BhadraShetty D (2013) Articaine for surgical removal of impacted third molar—a comparison with lignocaine. J Int Oral Health 5(1):48–53PubMedPubMedCentralGoogle Scholar
  7. 7.
    Bali A, Bali D et al (2013) Is pederson index a true predictive difficulty index for impacted mandibular third molar surgery? A meta-analysis. J Maxillofac Oral Surg 12(3):359–364CrossRefPubMedGoogle Scholar
  8. 8.
    Robertson D, Nusstein J, Reader A, Beck M, McCartney M (2007) The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. J Am Dent Assoc 138(8):1104–1112CrossRefPubMedGoogle Scholar
  9. 9.
    Silva LCF, Santos TS, Santos JAS et al (2012) Articaine versus lidocaine for third molar surgery: a randomized clinical study. Med Oral Patol Oral Cir Bucal 17(1):e140–e145CrossRefPubMedGoogle Scholar
  10. 10.
    Malamed SF, Gagnon S, Leblanc D (2005) Efficacy of articaine: a new amide local anesthetic. Quintessence Int 36(3):197–201Google Scholar
  11. 11.
    Rebolledo AS, Molina ED, Aytés LB et al (2007) 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 12:139–144Google Scholar
  12. 12.
    Berlin J, Nusstein J, Beck M et al (2005) Efficacy of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 99:361–366CrossRefPubMedGoogle Scholar
  13. 13.
    Moore PA, Boynes SG, Heresh EV et al (2006) The anesthetic efficacy of 4 percent articaine 1:200,000 epinephrine: two controlled clinical trials. J Am Dent Assoc 137(11):1572–1581CrossRefPubMedGoogle Scholar
  14. 14.
    Costa CG, Tortamano IP, Rocha RG, Francischone CE, Tortamano N (2005) Onset and duration periods of articaine and lidocaine on maxillary infiltration. Quintessence Int 36:197–201PubMedGoogle Scholar
  15. 15.
    Malamed SF (2004) Hand book of local anesthesia, 5th ed, Chapter 4. Elsevier Mosby, St. Louis Missouri, pp 55–63Google Scholar
  16. 16.
    Liu W, Yang X, Li C et al (2013) Adverse drug reactions to local anesthetics: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 115:319–327CrossRefPubMedGoogle Scholar
  17. 17.
    Dirks J, Moiniche S, Hilsted KL, Dahl JB (2002) Mechanisms of postoperative pain: clinical indications for a contributon of central neuronal sensitization. Anesthesiology 97(6):1591–1596CrossRefPubMedGoogle Scholar
  18. 18.
    Gordon SM, Dionne RA, Brahim J, Jabir F, Dubner R (1997) Blockade of peripheral neuronal barrage reduces postoperative pain. Pain 70(2–3):209–215CrossRefPubMedGoogle Scholar
  19. 19.
    Colombini BL, Modena KC et al (2006) Articaine and mepivacaine efficacy in postoperative analgesia for lower third molar removal: a double-blind, randomized, crossover study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:169–174CrossRefPubMedGoogle Scholar
  20. 20.
    Chawla J, Pandilwar PK, Kumar P, Sonowal ST (2016) Comparison of anesthetic efficacy of 4% articaine with 2% lignocaine in surgical extraction of mandibular third molars: a double blinded randomised controlled clinical trial. Int J Curr Res 8(9):39066–39070Google Scholar
  21. 21.
    Rakhshan V (2015) Common risk factors for postoperative pain following the extraction of wisdom teeth. J Korean Assoc Oral Maxillofac Surg 41:59–65CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Gregorio LVL, Giglio FPM, Vivien T (2008) Sakai V T. A comparison of the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine (both with 1:200,000 epinephrine) for lower third molar removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 106:19–28CrossRefPubMedGoogle Scholar
  23. 23.
    Puchades MS, Pérez MAV, Castellon EV et al (2012) Bupivacaine 0.5% versus articaine 4% for the removal of lower third molars—a crossover randomized controlled trial. Med Oral Patol Oral Cir Bucal 17(3):e462–e468CrossRefGoogle Scholar

Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2018

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial Surgery & Department of Craniofacial Surgery and Research CentreSDM College of Dental SciencesDharwadIndia
  2. 2.Department of Oral and Maxillofacial SurgeryCoorg Institute of Dental SciencesVirajpet, MadikeriIndia

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