Olley Ryan C, Renton Tara F, Frost Peter
Senior Lecturer and Honorary Consultant in Restorative Dentistry, School of Dentistry, University Hospital Wales, Heath Park Cardiff, CF14 4XY, UK; Clinical Academic and Specialist in Prosthodontics, Faculty of Dentistry, Oral and Craniofacial Sciences, King´s College London, UK; Dentist and Specialist in Prosthodontics, Dental Practices, Essex, UK.
Professor and Honorary Consultant in Oral Surgery, King´s College London, UK.
Br Dent J. 2021 Feb 11. doi: 10.1038/s41415-020-2350-8.
Introduction Intraligamentary local anaesthesia (ILA) with articaine is described as an effective alternative to inferior alveolar nerve block (IANB) for extraction of posterior teeth in the mandible, with reduced risk of complications.Aim To investigate ILA with 4% articaine and conventional syringe as a unique method for providing tooth extractions in the posterior mandible.Materials and methods All consecutive teeth to be extracted in the posterior mandible were recruited to the study, within exclusion criteria, between 2002 and 2017 in one London NHS and private dental practice. Four percent articaine was given by ILA with a conventional syringe slowly at two points lingual and two points buccal adjacent to each tooth. Extraction procedures were all performed flapless. Heavily broken-down teeth (n = 43) were extracted by sectioning of roots, guttering and elevation with luxators using socket preservation techniques. Demographic, quantitative and qualitative data were collected at initial appointments and up to 15 years at review.Results The median age was 64 years (interquartile range 17). Teeth extracted included 272 mandibular molars and second premolars, due to periodontal disease (34%), irreversible pulpitis (29%) or posterior tooth fracture (27%). The majority of extractions were second molars (44%), followed by first molars (29%), second premolars (17%) and third molars (10%). Sufficient anaesthesia was achieved within five minutes for all extractions. Procedures lasted less than 30 minutes. Patient feedback reported that the extraction using ILA was quicker than expected and painless, with limited anaesthesia of tissues other than the teeth to be extracted. Numeric rating scale (NRS) scores for pain (0-10) were all less than 3. No complications were recorded.Conclusion The ILA anaesthetic technique is effective for the purpose of a broad range of posterior tooth extractions in the mandible and within certain clinical parameters. It mitigates risks, including nerve injury and cardiovascular disturbances, associated with repeated IANB. This is the largest study of its kind and is conducted in primary care.
引言 阿替卡因进行的韧带内局部麻醉（ILA）被认为是下颌后牙拔除时下牙槽神经阻滞（IANB）的一种有效替代方法，并发症风险更低。
目的 研究使用4%阿替卡因和传统注射器进行ILA作为下颌后牙拔牙的独特方法。
材料和方法 2002年至2017年期间，在伦敦一家国民保健服务（NHS）和私人牙科诊所，将所有符合纳入标准且计划在下颌后牙区拔除的连续牙齿纳入研究。使用传统注射器在每颗牙齿相邻的舌侧两点和颊侧两点缓慢进行ILA给予4%阿替卡因。拔牙程序均采用无瓣技术。对于严重龋坏的牙齿（n = 43），采用牙根分段、槽沟法并用脱位器抬起，同时采用牙槽窝保存技术进行拔除。在初次就诊时及随访长达15年期间收集人口统计学、定量和定性数据。
结果 中位年龄为64岁（四分位间距17）。拔除的牙齿包括272颗下颌磨牙和第二前磨牙，病因包括牙周病（34%）、不可复性牙髓炎（29%）或后牙骨折（27%）。大多数拔牙为第二磨牙（44%），其次是第一磨牙（29%）、第二前磨牙（17%）和第三磨牙（10%）。所有拔牙在5分钟内均实现了充分麻醉。手术持续时间不到30分钟。患者反馈称，使用ILA拔牙比预期更快且无痛，除待拔除牙齿外的组织麻醉范围有限。疼痛的数字评分量表（NRS）评分（0 - 10）均小于3。未记录到并发症。
结论 ILA麻醉技术对于下颌多种后牙拔除目的且在特定临床参数范围内是有效的。它降低了与重复IANB相关的风险，包括神经损伤和心血管干扰。这是同类研究中规模最大的一项，且在初级保健环境中开展。
