Articaine and epinephrine for lower third molar extraction

Articaine and epinephrine for lower third molar extraction Background.—Adding vasoconstrictors to local anesthetic agents has provided better quality and duration of anesthesia, avoided excessive bleeding intraoperatively, and diminished the systemic toxicity compared to using the anesthetics alone. Articaine 4% with 1:100,000 epinephrine has provided for longer analgesia and anesthesia compared to 2% mepivacaine with epinephrine. An investigation compared the clinical efficacy of 4% articaine plus 1:100,000 (A100) or 1:200,000 epinephrine (A200) for patients having symmetrically positioned lower third molars removed. Methods.—The 50 volunteers had their lower third molars removals accomplished at two appointments. At one they had A100, at the other A200 in a double-blind randomized, crossed format. Osteotomies were performed in 23 patients but not needed in the other 27 patients. Evaluations looked at latency, duration of analgesia postoperatively, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic measures. Results.—The volume of agent used did not vary significantly between the two solutions. The latency of the two groups did not differ significantly, with 1.64 minutes for A100 and 1.58 minutes for A200. The quality of anesthesia, mean duration of surgeries, duration of anesthetic action on the soft tissues, and duration of postoperative analgesia were also comparable. Surgeons ranked the intraoperative bleeding as very close to minimal. The hemodynamic parameters demonstrated transient changes, but they were not

clinically significant and did not relate to the type of anesthetic being used. Neither agent produced any adverse reactions. Discussion.—Both of the epinephrine concentrations in 4% articaine solution achieved good clinical efficacy with no adverse effects. Either would be useful for third molar extractions.

Clinical Significance.—Much has been written about the optimal concentration of vasoconstrictor in local anesthetics. In this study, both concentrations produced comparable levels and durations of analgesia. Clinicians noted no significant difference in hemostasis, at least for third molar removal.

Santos CF, Modena KCS, Giglio FPM, et al: Epinephrine concentration (1:100,000 or 1:200,000) does not affect the clinical efficacy of 4% articaine for lower third molar removal: A double-blind, randomized, crossover study. J Oral Maxillofac Surg 65:2445-2452, 2007 Reprints available from CF Santos, Discipline of Pharmacology, Bauru School of Dentistry, Univ of Sa˜o Paulo, Alameda Dr Octa´vio Pinheiro Brisolla, 9-75, Bauru, Sa˜o Paulo 17012-901, Brazil: e-mail: [email protected]

Dental Materials Volumetric contraction in restoration materials Background.—The resin-based materials used in tooth-colored restorations shrink during polymerization, which can cause a gap with the cavity walls, deflection or fracture of the tooth structure, or fracture of the restoration itself. Various glass-ionomer cements (GICs) and resinmodified glass-ionomers (RMGIs) are now available for use as linings, adhesives, or restorations. The volumetric setting contraction values for a range of GICs and RMGIs

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Dental Abstracts

and for various resin-based materials were tested, the hypothesis being that the materials used for restorations had comparable values despite differences in their setting mechanisms. Methods.—The materials tested include three conventional (nonlight cured) GICs; two restorative, one lining consistency, and one adhesive/lining consistency