Khan S R, Qazi S R
Institute of Dentistry, CMH Lahore Medical College, Lahore, Pakistan.
Department of Oral & Maxillofacial Surgery, Institute of Dentistry, CMH Lahore Medical College, Lahore, Pakistan.
Eur J Dent Educ. 2017 Nov;21(4):e39-e42. doi: 10.1111/eje.12215. Epub 2016 Jun 21.
Palatal infiltration of local anaesthesia (LA) for maxillary tooth extractions is painful. One of the techniques for reducing the discomfort of this injection is to avoid it altogether. Given enough time, LA administered only as buccal infiltration diffuses to reach and anaesthetise the palatal tissues. The aim of this double-blind randomised controlled trial was to test the hypothesis that buccal infiltration alone of LA by dental students should be adequate for maxillary tooth extractions.
Fifty adult patients presenting for single-tooth maxillary extractions were randomly allocated between two groups. The control group received palatal injections of 0.1 ml 2% lidocaine with 1:100,000 adrenaline, whilst the experimental group received a similar amount of saline (placebo). Extractions performed without further administration of LA were categorised as successful.
Palatal infiltration of lidocaine with adrenaline was significantly more effective than saline (P = 0.002). Overall buccal infiltration alone was successful in 28% patients, with a 40% success rate in the posterior maxilla.
Results suggest that dental students should, as a matter of routine, extract maxillary teeth with both buccal and palatal infiltration of LA, whilst buccal infiltration alone may be considered in the posterior maxilla.
对上颌牙齿拔除术进行腭部局部麻醉注射很疼。减少这种注射不适感的一种方法是完全避免它。如果有足够的时间，仅作为颊部浸润给予的局部麻醉剂会扩散并麻醉腭部组织。这项双盲随机对照试验的目的是检验牙科学生仅进行颊部浸润局部麻醉对上颌牙齿拔除术是否足够的假设。
五十名前来进行单颗上颌牙齿拔除术的成年患者被随机分配到两组。对照组接受在腭部注射0.1毫升含1:100,000肾上腺素的2%利多卡因，而实验组接受等量的生理盐水（安慰剂）。未进一步给予局部麻醉剂而进行的拔牙术被归类为成功。
含肾上腺素的利多卡因腭部浸润明显比生理盐水更有效（P = 0.002）。总体而言，仅颊部浸润在28%的患者中成功，在上颌后部成功率为40%。
结果表明，牙科学生在进行上颌牙齿拔除术时，常规应采用颊部和腭部浸润局部麻醉，而上颌后部仅进行颊部浸润也可考虑。
