Fowler Sara, Drum Melissa, Reader Al, Nusstein John, Beck Mike
Assistant Professor and Predoctoral Director, Division of Endodontics, The Ohio State University, Columbus, Ohio.
Associate Professor and Graduate Program Director, Division of Endodontics, The Ohio State University, Columbus, Ohio.
Anesth Prog. 2019 Spring;66(1):14-19. doi: 10.2344/anpr-65-04-03.
The purpose of this study was to determine anesthetic success in adjacent teeth following a primary infiltration of the maxillary lateral incisor and first molar using 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Three hundred eight asymptomatic subjects received an infiltration of a cartridge of 2% lidocaine with 1:100,000 epinephrine over the maxillary lateral incisor (163 subjects) or first molar (145 subjects). Pulpal anesthesia of the injected tooth and adjacent mesial and distal teeth was monitored with the electric pulp tester in 2-minute cycles for a total of 60 minutes. No response from the subject at the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Comparisons of the odds of pulpal anesthesia (defined as an 80/80 response to electric pulp testing over 60 minutes) between the experimentally injected tooth and adjacent teeth were analyzed using mixed-models, repeated-measures logistic regression. When compared with the lateral incisor infiltration, the adjacent mesial tooth (central incisor) and distal tooth (canine) achieved statistically lower anesthetic success. When compared with the first molar, the mesial tooth (second premolar) did not differ statistically. However, significant differences were shown between the first molar and the second molar, with the distal tooth (second molar) achieving a statistically higher rate of pulpal anesthesia, which was related to a better duration of anesthesia. For asymptomatic patients, local anesthesia of the adjacent mesial (central incisor) and distal (canine) teeth to the infiltrated lateral incisor had lower pulpal anesthetic success. Because standard infiltration anesthesia of the lateral incisor is of short duration, repeating the infiltration at 30 minutes will result in a high incidence of pulpal anesthesia for 60 minutes. Local anesthesia of the adjacent distal tooth to the first molar (second molar) had a statistically higher rate of total pulpal anesthesia than the infiltrated first molar due to the longer duration of pulpal anesthesia. However, if pulpal anesthesia is required for 60 minutes in the first and second molars, the clinician may need to add an additional infiltration to ensure anesthesia.
本研究的目的是确定在上颌侧切牙和第一磨牙初次浸润注射1.8毫升含1:100,000肾上腺素的2%利多卡因后，相邻牙齿的麻醉成功率。308名无症状受试者在上颌侧切牙（163名受试者）或第一磨牙（145名受试者）上接受了一针含1:100,000肾上腺素的2%利多卡因浸润注射。使用牙髓电活力测试仪以2分钟为一个周期，对注射牙齿及相邻的近中牙和远中牙进行牙髓麻醉监测，共监测60分钟。以受试者在牙髓测试仪最大输出值（80读数）时无反应作为牙髓麻醉的标准。使用混合模型、重复测量逻辑回归分析实验注射牙齿与相邻牙齿之间牙髓麻醉几率（定义为60分钟内对牙髓电测试的80/80反应）的比较。与侧切牙浸润相比，相邻的近中牙（中切牙）和远中牙（尖牙）的麻醉成功率在统计学上较低。与第一磨牙相比，近中牙（第二前磨牙）在统计学上无差异。然而，第一磨牙和第二磨牙之间显示出显著差异，远中牙（第二磨牙）的牙髓麻醉率在统计学上更高，这与更好的麻醉持续时间有关。对于无症状患者，浸润注射侧切牙相邻的近中（中切牙）和远中（尖牙）牙齿的牙髓麻醉成功率较低。由于侧切牙的标准浸润麻醉持续时间较短，在30分钟时重复浸润将导致60分钟内牙髓麻醉的发生率较高。第一磨牙相邻的远中牙（第二磨牙）的局部麻醉，由于牙髓麻醉持续时间较长，其牙髓完全麻醉率在统计学上高于浸润注射的第一磨牙。然而，如果第一磨牙和第二磨牙需要60分钟的牙髓麻醉，临床医生可能需要额外增加一次浸润注射以确保麻醉效果。
