Skip to main content

Patient’s pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block

Abstract

Objectives

The aim of this study was to investigate the effectiveness of a local anesthetic agent comprising of 4 % articaine with 1:100,000 adrenaline, administered through an infiltration technique prior to the extraction of mandibular permanent first molar teeth.

Materials and methods

The study adopted a split mouth approach and involved patients who needed simple extractions of permanent mandibular first molar teeth on both sides. A combination of buccal and lingual infiltrations was used on one side, while the conventional inferior alveolar nerve block (IANB) technique, with a 1.8-ml cartridge of 4 % articaine with 1:100,000 epinephrine, was administered to the other. The patients’ pain perception was assessed using visual analogue scale (VAS) and verbal rating scale (VRS) after the injection, followed by extraction.

Results

As a part of the study, 104 teeth were extracted from mouths of 52 patients. The difference in pain perception was statistically insignificant (p > .05) regarding the local anesthetic injection between the two techniques. The difference in pain perception regarding the extraction between the two techniques was also statistically insignificant (p < .05).

Conclusion

No difference in pain perception between the two techniques among the study population was noted. This indicates that the extraction of permanent mandibular first molar teeth is possible without the administration of an IANB with the use of 4 % articaine with 1:100,000 epinephrine.

Clinical relevance

The buccal and lingual infiltrations are slightly less painful than the conventional IANB technique.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Haas DA (2002) An update on local anesthetics in dentistry. J Can Dent Assoc 68:546–551

    PubMed  Google Scholar 

  2. 2.

    Peterson LJ (2003) Contemporary oral and maxillofacial surgery, 4th edn. Mosby, St Louis

    Google Scholar 

  3. 3.

    Malamed SF, Gagnon S, Leblanc D (2000) Efficacy of articaine: a new amide local anesthetic. J Am Dent Assoc 131:635–642

    Article  PubMed  Google Scholar 

  4. 4.

    Van Oss GE, Vree TB, Baars AM, Termond EF, Booij LH (1989) Pharmacokinetics, metabolism, and renal excretion of articaine and its metabolite articainic acid in patients after epidural administration. Eur J Anaesthesiol 6:49–56

    PubMed  Google Scholar 

  5. 5.

    Lima JLJ, Dias-Ribeiro E, Ferreira-Rocha J, Soares R, FW C, Fan S, Sant’ana E (2013) Comparison of buccal infiltration of 4 % articaine with 1: 100,000 and 1: 200,000 epinephrine for extraction of maxillary third molars with pericoronitis: a pilot study. Anesth Prog 60:42–45 6

  6. 6.

    Oertel R, Rahn R, Kirch W (1997) Clinical pharmacokinetics of articaine. Clin Pharmacokinet 33:417–425

    Article  PubMed  Google Scholar 

  7. 7.

    Kakroudi SH, Mehta S, Millar BJ (2015) Articaine hydrochloride: is it the solution? Dent Update 42:88–90 92-93

    PubMed  Google Scholar 

  8. 8.

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

    Article  PubMed  Google Scholar 

  9. 9.

    Smyth J, Marley J (2010) An unusual delayed complication of inferior alveolar nerve block. Br J Oral Maxillofac Surg 48:51–52

    Article  PubMed  Google Scholar 

  10. 10.

    Chevalier V, Arbab-Chirani R, Tea SH, Roux M (2010) Facial palsy after inferior alveolar nerve block: case report and review of literature. Int J Oral Maxillofac Surg 39:1139–1142

    Article  PubMed  Google Scholar 

  11. 11.

    Torrnte-Castells E, Gargallo-Albiol J, Rodriguez-Baeza A, Berini-Aytes L, Gay-Escoda C (2008) Necrosis of the skin of the chin: a possible complication of inferior alveolar nerve block injection. J Am Dent Assoc 139:1625–1630

    Article  Google Scholar 

  12. 12.

    Meechan JG (2010) Infiltration for the mandible. Int Endod J 10:221–229

    Google Scholar 

  13. 13.

    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 32:296–298

    Article  PubMed  Google Scholar 

  14. 14.

    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 138:1104–1112

    Article  PubMed  Google Scholar 

  15. 15.

    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 34:11–13

    Article  PubMed  Google Scholar 

  16. 16.

    Corbett IP, Kanaa MD, Whitworth JM, Meechan JG (2008a) Articaine infiltration for anesthesia of mandibular first molars. J Endod 34:514–518

    Article  PubMed  Google Scholar 

  17. 17.

    Huskisson EC (1983) Pain measurement and assessment, Raven Press. New York, NY. IASP, Sub-committee on Taxonomy (1980). Pain terms: a list with definitions and notes on usage. Pain 8:249–452

    Google Scholar 

  18. 18.

    Kaltz J, Melzack R (1999) Measurement of pain. Surg Clin North Am 79:231–252

    Article  Google Scholar 

  19. 19.

    Hannan L, Reader A, Nist R (1999) The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 87:658–665

    Article  PubMed  Google Scholar 

  20. 20.

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

    Article  Google Scholar 

  21. 21.

    Oulis CJ, Vadiakas GP, Vasilopoulou A (1996) The effectiveness of mandibular infiltration compared to mandibular block anesthesia in treating primary molars in children. Pediatr Dent 18:301–305

    PubMed  Google Scholar 

  22. 22.

    Sharaf AA (1997) Evaluation of mandibular infiltration versus block anesthesia in pediatric dentistry. J Dent Child 64:276–281

    Google Scholar 

  23. 23.

    Meechan JG, Kanaa MD, Corbett IP (2006) Pulpal anaesthesia for mandibular permanent first molar teeth: a comparison of buccal and buccal plus lingual infiltration injections. Int Endod J 39:764–769

    Article  PubMed  Google Scholar 

  24. 24.

    Kirsch A (1985) Ultracaine product monograph. Hoechst Canada Inc, Montreal

    Google Scholar 

  25. 25.

    Schulze-Husman M. 1974 Experimental evaluation of the new local anesthetic ultracaine in dental practice. Dissertation, Bonn, West Germany;

  26. 26.

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

    Article  Google Scholar 

  27. 27.

    Meechan JG, Jaber AA, Corbett IP, Whitworth JM (2011) Buccal versus lingual articaine infiltration for mandibular tooth anaesthesia: a randomized controlled trial. Int Endod J 44:676–681

    Article  PubMed  Google Scholar 

  28. 28.

    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 102:733–735

    Article  PubMed  Google Scholar 

  29. 29.

    Wagenknech LE, Burke GL, Perkins LL, Haley NJ, Friedman GD (1992) Misclassification of smoking status in the cardiac study: a comparison of self-report with serum cotinine levels (abstract). Am J Pub Heal 82:33–36

    Article  Google Scholar 

  30. 30.

    Padhye M, Girotra C, Shah P (2009) Comparison of Efficacy of 4 % articaine with 1:100,000 adrenaline to that of 2 % lignocaine with 1:80,000 adrenaline in exodontia cases. Scientific J l3:1–5

    Google Scholar 

  31. 31.

    Budenz AW (2003) Local anesthetics in dentistry: then and now. J Calif Dent Assoc 31:388–396

    PubMed  Google Scholar 

  32. 32.

    Tortamano IP, Siviero M, Costa CG, Buscariolo IA, Armonia PL (2009) A comparison of the anesthetic efficacy of articaine and lidocaine in patients with irreversible pulpitis. J Endod 35:165–168

    Article  PubMed  Google Scholar 

  33. 33.

    Lima-Júnior JL, Dias-Ribeiro E, de Araújo TN (2009) Evaluation of the buccal vestibule-palatal diffusion of 4 % articaine hydrochloride in impacted maxillary third molar extractions. Med Oral Patol Oral Cir Bucal 14:e129–e132

    PubMed  Google Scholar 

  34. 34.

    Nakanishi O, Haas DA, Ishikawa T, Kameyama S, Nishi M (1996) Efficacy of mandibular topical anesthesia varies with the site of administration. Anesth Prog 43:14–19

    PubMed  PubMed Central  Google Scholar 

  35. 35.

    Robison SF, Mayhew RB, Cowan RD, Hawley RJ (1984) Comparative study of deflection characteristics and fragility of 25, 27, and 30 gauge short dental needles. Journal of the Am Dent Assoc 109:920–924

    Article  Google Scholar 

  36. 36.

    Oliveira PC, Volpato MC, Ramacciato JC, Ranali J (2004) Articaine and lignocaine efficiency in infiltration anaesthesia: a pilot study. Br Dent J 197:45–46

    Article  PubMed  Google Scholar 

  37. 37.

    Jakobs W, Ladwig B, Cichon P, Ortel R, Kirch W (1995) Serum levels of articaine 2 % and 4 % in children. Anesth Prog 42:113–115

    PubMed  PubMed Central  Google Scholar 

  38. 38.

    Fan S, Chen WL, Pan CB (2009) Anesthetic efficacy of inferior alveolar nerve block plus buccal infiltration or periodontal ligament injections with articaine in patients with irreversible pulpitis in the mandibular first molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 108:89–93

    Article  Google Scholar 

  39. 39.

    Badcock ME, Gordon I, McCullough MJ (2007) A blinded randomized controlled trial comparing lignocaine and placebo administration to the palate for removal of maxillary third molars. Int J Oral Maxillofac Surg 36:1177–1182

    Article  PubMed  Google Scholar 

  40. 40.

    Unruh AM 1996 Gender variations in clinical pain experience. 65:123–167

  41. 41.

    Phillips JL, Weller RN, Kulild JC (1990) The mental foramen: size, orientation, and positional relationship to the mandibular second premolar. J Endod 16:221–223

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Anwar B. Bataineh.

Ethics declarations

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 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Funding

This study received no funding.

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bataineh, A.B., Alwarafi, M.A. Patient’s pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block. Clin Oral Invest 20, 2241–2250 (2016). https://doi.org/10.1007/s00784-016-1712-8

Download citation

Keywords

  • Infiltration
  • Inferior alveolar nerve block
  • Articaine
  • Mandibular first molar
  • Tooth extraction