Manta Kalliopi, Dabarakis Nikolaos, Lillis Theodoros, Fotopoulos Ioannis
Department of Dentoalveolar Surgery, Surgical implantology and Roentgenology, Aristotle University, Thessaloniki, Greece.
J Dent Anesth Pain Med. 2023 Jun;23(3):135-141. doi: 10.17245/jdapm.2023.23.3.135. Epub 2023 May 26.
The limited studies on the effect of buffering on the clinical efficacy of articaine have reported controversial results. The purpose of this study was to clinically compare the pain of injection, anesthetic success, onset, and duration of pulpal anesthesia of buffered 4% articaine with epinephrine 1:100000 versus a non-buffered 4% articaine with epinephrine 1:100000 formulation for buccal infiltration of the mandibular first molar.
Sixty-three volunteers were enrolled in the study. All volunteers received two injections consisting of a single mandibular first molar buccal infiltration with 1.8 ml of 4% articaine with epinephrine 1:100000 and 1.8 ml of 4% articaine with epinephrine 1:100000 buffered with 8.4% sodium bicarbonate. The infiltrations were applied in two separate appointments spaced at least one week apart. After injection of the anesthetic solution at the examined site, the first molar was pulp-tested every 2 min for the next 60 min.
Successful pulpal anesthesia was recorded in 69.8% of cases using non-buffered articaine solution and 76.2% of cases using buffered articaine solution, with no significant difference between the formulations (P = 0.219). The mean time of anesthesia onset for the volunteers with successful anesthetic outcome in both formulations (n = 43) was 6.6 ± 1.6 min for the non-buffered articaine solution and 4.5 ± 1.6 min for the buffered solution, which differed significantly (P = 0.001). In the same volunteers, the mean duration of pulpal anesthesia was 28.4 ± 7.1 min for non-buffered articaine solution and 30.2 ± 8.5 min for buffered articaine solution, with no significant difference between the formulations (P = 0.231). Considering the pain of injection, regardless of the anesthetic success, the mean values of VAS were 11.3 ± 8.2 mm for the non-buffered articaine solution and 7.8 ±6.5 mm for the buffered articaine solution, which differed significantly (P = 0.001 < 0.05).
According to the present study, 4% articaine with epinephrine can benefit from buffering and provide better anesthetic behavior, with improved onset and less pain during injection.
关于缓冲对阿替卡因临床疗效影响的研究有限，且报告的结果存在争议。本研究的目的是在临床上比较缓冲的4%阿替卡因与1:100000肾上腺素制剂和未缓冲的4%阿替卡因与1:100000肾上腺素制剂在下颌第一磨牙颊侧浸润时的注射疼痛、麻醉成功率、起效时间和牙髓麻醉持续时间。
63名志愿者参与了本研究。所有志愿者均接受两次注射，分别是用1.8毫升4%阿替卡因与1:100000肾上腺素制剂进行单一下颌第一磨牙颊侧浸润，以及用1.8毫升4%阿替卡因与1:100000肾上腺素制剂并用8.4%碳酸氢钠缓冲后进行单一下颌第一磨牙颊侧浸润。两次浸润在至少间隔一周的两次单独就诊时进行。在检查部位注射麻醉溶液后，在接下来的60分钟内每2分钟对第一磨牙进行一次牙髓测试。
使用未缓冲的阿替卡因溶液时，69.8%的病例记录到牙髓麻醉成功；使用缓冲的阿替卡因溶液时，76.2%的病例记录到牙髓麻醉成功，两种制剂之间无显著差异（P = 0.219）。在两种制剂中麻醉均成功的志愿者（n = 43）中，未缓冲的阿替卡因溶液的平均麻醉起效时间为6.6±1.6分钟，缓冲溶液的平均麻醉起效时间为4.5±1.6分钟，两者差异显著（P = 0.001）。在同一组志愿者中，未缓冲的阿替卡因溶液的平均牙髓麻醉持续时间为28.4±7.1分钟，缓冲的阿替卡因溶液的平均牙髓麻醉持续时间为30.2±8.5分钟，两种制剂之间无显著差异（P = 0.231）。考虑到注射疼痛，无论麻醉是否成功，未缓冲的阿替卡因溶液的视觉模拟评分（VAS）平均值为11.3±8.2毫米，缓冲的阿替卡因溶液的VAS平均值为7.8±6.5毫米，两者差异显著（P = 0.001 < 0.05）。
根据本研究，4%阿替卡因与肾上腺素制剂经缓冲后可获益，并能提供更好的麻醉效果，起效更快且注射时疼痛减轻。
