Skip to main content

Advertisement

SpringerLink
Log in

Is the only buccal infiltration anesthesia enough for extraction of mandibular anterior incisors and premolar teeth? A split-mouth randomized clinical trial

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objectives

The issue of needing additional lingual injection in extractions of mandibular premolar and incisors is still not clarified. The aim of this study is to investigate whether it is necessary to perform lingual injection in addition to buccal infiltration anesthesia in mandibular incisors and premolar teeth extractions.

Materials and methods

Sixty-six patients who admitted to our clinic for the removal of bilateral mandibular anterior teeth were included in the present study. Patients were divided into two groups. The experimental group received only 1.5 ml of 2% lidocaine with 1:80,000 epinephrine by injection into the buccal vestibule of the tooth. The control group received 1.5 ml of 2% lidocaine with 1:80,000 epinephrine by buccal injection into the buccal side and 0.3 ml same lidocaine solution injected into the lingual side of the tooth. After 5 min, tooth was extracted and each patient was asked to record the intensity of injection and extraction pain by 0–100 mm and a 10-point Visual Analogue Scale (VAS) and six-pointed Face Pain Scale (FPS).

Results

The injection pain scores were significantly higher in terms of the VAS 0–10 point and 0–100 mm and FPS in the control group to which additional lingual injections were applied than the experimental group (p < 0.05). No statistically significant differences were found in all three scales between the groups in terms of extraction pain (p > 0.05). The mean extraction pain scores were lower in the experimental group according to the three scales. No additional anesthetic injection and post-operative complications were observed in all patients.

Conclusions

The extraction of mandibular incisors and premolar teeth can only be done with only the buccal infiltration.

Clinical relevance

In the extraction of mandibular anterior teeth, it can be performed with less anesthetic amount without the need for an additional lingual injection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Malamed FS (2012) Handbook of local anesthesia, 6th edn. Mosby, St Louis, MO

    Google Scholar 

  2. Meechan JG (2011) The use of the mandibular infiltration anesthetic technique in adults. J Am Dent Assoc 142(Suppl 3):19S–24S

    Article  Google Scholar 

  3. Haas DA, Harper DG, Saso MA, Young ER (1990) Comparison of articaine andprilocaine anaesthesia by infiltration in maxillary and mandibular arches. Anesth Prog 37(5):230–237

    PubMed  PubMed Central  Google Scholar 

  4. Clafey E, Reader A, Nusstein J, Beck M, Weaver J (2004) Anesthetic efcacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 30(8):568–571

    Article  Google Scholar 

  5. Aggarwal V, Jain A, Debipada K (2009) Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis. J Endod 35(7):925–929

    Article  Google Scholar 

  6. Meechan JG (2010) Infiltration anesthesia in the mandible. Dent Clin North Am 54(4):621–629

    Article  Google Scholar 

  7. Wong MK, Jacobsen PL (1992) Reasons for local anesthesia failures. J Am Dent Assoc 123(1):69–73

    Article  Google Scholar 

  8. El-Kholey KE (2017) Anesthetic efficacy of 4% articaine during extraction of the mandibular posterior teeth by using inferior alveolar nerve block and buccal infiltration techniques. J Maxillofac Oral Surg 16(1):90–95

    Article  Google Scholar 

  9. Jung IY, Kim JH, Kim ES, Lee CY, Lee SJ (2008) An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod 34(1):11–13

    Article  Google Scholar 

  10. Bataineh AB, Alwarafi MA (2016) Patient’s pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block. Clin Oral Invest 20(8):2241–2250

    Article  Google Scholar 

  11. El-Kholey KE (2013) Infiltration anesthesia for extraction of mandibular molars. J Oral Maxillofac Surg 71(10):1658.e1–1658.e5

    Article  Google Scholar 

  12. Narayanan JV, Gurram P, Krishnan R, Muthusubramanian V, Kannan VS (2017) Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars. Oral Maxillofac Surg 21(3):295–299

    Article  Google Scholar 

  13. Majid OW, Muhammad ZA (2019) Effectiveness of articaine buccal infiltration anesthesia for mandibular premolar extraction: A randomized, double-Blind, placebo-controlled clinical trial. J Oral Maxillofac Surg 77(9):1784–1789

    Article  Google Scholar 

  14. Bataineh AB, Al-Sabri GA (2017) Extraction of maxillary teeth using articaine without a palatal injection: a comparison between the anterior and posterior regions of the maxilla. J Oral Maxillofac Surg 75(1):87–91

    Article  Google Scholar 

  15. Kandasamy S, Elangovanb R, Johnb RR, Kumar CN (2015) Removal of maxillary teeth with buccal 4% articaine without using palatal anesthesia: a comparative double blind study. J Oral Maxillofac Surg Med Pathol 27(2):154–158

    Article  Google Scholar 

  16. Isik K, Kalayci A, Durmus E (2011) Comparison of depth of anesthesia in different parts of maxilla when only buccal anesthesia was done for maxillary teeth extraction. Int J Dent 2011:575874

    Article  Google Scholar 

  17. Bataineh AB, Nusair YM, Al-Rahahleh RQ (2019) Comparative study of articaine and lidocaine without palatal injection for maxillary teeth extraction. Clin Oral Investig 23(8):3239–3248

    Article  Google Scholar 

  18. Uckan S, Dayangac E, Araz K (2006) Is permanent maxillary tooth removal without palatal injection possible? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102(6):733–735

    Article  Google Scholar 

  19. Fan S, Chen WI, Yang ZH, Huang ZQ (2009) Comparison of the efficiencies of permanent maxillary tooth removal performed with single buccal infiltration versus routine buccal and palatal injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 107(3):359–363

    Article  Google Scholar 

  20. Kumaresan R, Srinivasan B, Pendayala S (2015) Comparison of the effectiveness of lidocaine in permanent maxillary teeth removal performed with single buccal infiltration versus routine buccal and palatal injection. J Maxillofac Oral Surg 14(2):252–257

    Article  Google Scholar 

  21. Sculz KF, Altman DG, Moher D, CONSORT Group (2011) CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 9(8):672–677

    Article  Google Scholar 

  22. Milgrom P, Coldwell SE, Getz T, Weinstein P, Ramsay DS (1997) Four dimensions of fear of dental injections. J Am Dent Assoc 128(6):756–766

    Article  Google Scholar 

  23. Ege B, Ege M, Koparal M, Alan H (2020) Comparison of the anesthetic efficiency of lidocaine and tramadol hydrochloride in orthodontic extractions: a split-mouth, prospective, randomized, double- blind study. J Oral Maxillofac Surg 78(1):52–62

    Article  Google Scholar 

  24. Khoury JN, Mihailidis S, Ghabriel M, Townsend G (2011) Applied anatomy of the pterygomandibular space: improving the success of inferior alveolar nerve blocks. Aust Dent J 56(2):112–121

    Article  Google Scholar 

  25. 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):1104–1112

    Article  Google Scholar 

  26. Kanaa MD, Whitworth JM, Corbett IP, Meechan JG (2006) Articaine and lidocaine mandibular buccal infiltration anesthesia: a prospective randomized double-blind cross-over study. J Endod 32(4):296–298

    Article  Google Scholar 

  27. Abdulwahab M, Boynes S, Moore P, Seifikar S, Al-Jazzaf A, Alshuraidah A, Zovko J, Close J (2009) The efficacy of six local anesthetic formulations used for posterior mandibular buccal infiltration anesthesia. J Am Dent Assoc 140(8):1018–1024

    Article  Google Scholar 

  28. Nydegger B, Nusstein J, Reader A, Drum M, Beck M (2014) Anesthetic comparisons of 4% concentrations of articaine, lidocaine, and prilocaine as primary buccal infiltrations of the mandibular first molar: a prospective randomized, double-blind study. J Endod 40(12):1912–1916

    Article  Google Scholar 

  29. Rayatia F, Noruzihab A, Jabbarian R (2018) Efficacy of buccal infiltration anaesthesia with articaine for extraction of mandibular molars: a clinical trial. Br J Oral Maxillofac Surg 56(7):607–610

    Article  Google Scholar 

  30. Awal DH, Yilmaz Z, Osallan S, Renton T (2017) Articaine-only buccal infiltrations for mandibular molar extractions: an alternative to inferior dental nerve blocks. Dent Update 44(9):838–845

    Article  Google Scholar 

  31. Fowler S, Drum M, Reader A, Beck M (2016) Anesthetic success of an inferior alveolar nerve block and supplemental articaine buccal infiltration for molars and premolars in patients with symptomatic irreversible pulpitis. J Endod 42(3):390–392

    Article  Google Scholar 

  32. Majid OW, Ahmed AM (2018) The Anesthetic efficacy of articaine and lidocaine in equivalent doses as buccal and non-palatal infiltration for maxillary molar extraction: a randomized, double-blinded, placebo-controlled clinical trial. J Oral Maxillofac Surg 76(4):737–743

    Article  Google Scholar 

  33. Somuri AV, Rai AB, Pillai M (2013) Extraction of permanent maxillary teeth by only buccal infiltration of articaine. J Maxillofac Oral Surg 12(2):130–132

    PubMed  Google Scholar 

  34. Vasconcellos RJ, Vasconcelos BC, Genu PR (2008) Influence of local anesthethics with adrenalina 1:100.000 in basic vital constants during third molar surgery. Med Oral Patol Oral Cir Bucal 13(7):E431–E437

    PubMed  Google Scholar 

  35. Briggs M, Closs JS (1999) A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopedic patients. J Pain Symptom Manag 18(6):438–446

    Article  Google Scholar 

  36. Bigby J, Reader A, Nusstein J, Beck M, Weaver J (2006) Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis. J Endod 32(11):1044–1047

    Article  Google Scholar 

  37. Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill Pain Questionnaire (MPQ), short-form McGill Pain Questionnaire (SF-MPQ), chronic Pain Grade scale (CPGS), short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Res (Hoboken) 63(11):S240–S252

    Article  Google Scholar 

  38. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: comparison of six methods. Pain 27(1):117–126

    Article  Google Scholar 

  39. Karcioglu O, Topacoglu H, Dikme O, Dikme O (2018) A systematic review of the pain scales in adults: which to use? Am J Emerg Med 36(4):707–714

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Adıyaman University, 02200, Adıyaman, Turkey

    Bilal Ege

  2. Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Gaziantep University, Gaziantep, Turkey

    Mehmet Demirkol

Authors
  1. Bilal Ege
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mehmet Demirkol
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: B.E., M.D.

Literature search: M.D., B.E.

Data collection (before blinding): B.E.

Outcome assessment and data analysis: B.E., M.D.

Manuscript preparation, editing and review: M.D., B.E.

Corresponding author

Correspondence to Bilal Ege.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the Helsinki declaration and its later amendments or comparable ethical standards. And the study was approved by the Ethics Committee of Adıyaman University Ethics Committee (Approval number: 2019-15-1)

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ege, B., Demirkol, M. Is the only buccal infiltration anesthesia enough for extraction of mandibular anterior incisors and premolar teeth? A split-mouth randomized clinical trial. Clin Oral Invest 25, 3077–3085 (2021). https://doi.org/10.1007/s00784-020-03628-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-020-03628-3

Keywords

Search

Navigation