“ It is easier to find men who will volunteer to die, than to find those who are willing to endure pain with

patience.” - Julius Caesar

ARTICAINE

IS IT TRUE…

BHAVANA .BIV BDS MEENAKSHI AMMAL DENTAL COLLEGE CHENNAI

COMPARATIVE ANALYSIS OF EFFICACY OF DIFFERENT VOLUMES OF 4% ARTICAINE HCL IN MAXILLARY INFILTRATION.

HISTORY

• 1969 - first synthesized by Rusching in Germany and marketed under the trade name Ultracain.

• 1976 - first introduced for the clinical use.• 2000 - FDA granted approval for its sale and

distribution under the trade name Septocaine as 4.0% solution with epinephrine 1: 100,000.

Malamed SF. Handbook of Local Anesthesia. 4th ed. St Louis: CV Mosby; 1997.

PHARMACOLOGY OF ARTICAINE

The only amide local anesthetic containing an ester group.

Metabolization of the drug takes place both by plasma esterases and by liver microsomal enzymes.

Same pKa and toxicity as Lidocaine.

1.5 times greater potency than Lidocaine.

Ørjan Johansen : Comparison of Articaine and lignocaine used as dental local anesthetics , May 2004

AIM OF THE STUDY

To compare the clinical efficacy of 4% Articaine in three different volumes.

MATERIALS AND METHODS

SAMPLING

• After an informed consent, volunteers who were willing to participate in the study were selected.

• Sample size : 10• Study method : Prospective Randomized

Controlled Clinical Trial

INCLUSION CRITERIA Gender : Male & Female Age : 18 – 50 years Subjects without any

systemic disorders or antecedents of complications associated with local anesthetics.

Alejandro Sierra Rebolledo, Esther Delgado Molina, Leonardo Berini Aytés , Cosme Gay Escoda : Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine n inferior alveolar nerve block during surgical extraction of impacted lower third molars , Med Oral Patol Oral Cir Bucal 2007;12:E139-44.

ELECTRIC PULP TESTER

PROCEDURE• A randomized clinical

trial was programmed to evaluate the efficiency of articaine based on volume.

• Three different volumes of articaine i.e., 0.6 ml, 0.9 ml, 1.2 ml were injected to each patient with duration of 2-3 weeks between each injection.

The local anesthetic solution was injected at the apical region of the maxillary

canine at the height of the mucobuccal fold.

AREA OF INSERTION

Malamed SF. Handbook of Local Anesthesia. 4th ed. St Louis: CV Mosby; 1997.

PARAMETERS MEASURED

Pulpal onset of local anesthetic actionPulpal duration of local anesthesiaBuccal soft tissue anesthesiaPalatal soft tissue anesthesia

Kimmo Vahatalo, Heikki Antila and Risto Lehtinen: Articaine and lignocaine for maxillary infiltration anesthesia , Anesth Prog 40:114-116 1993

The four parameters were measured after maxillary infiltration separately for:• Canine• Lateral incisor• First premolar

Pulpal anesthesia is measured using an Electric Pulp Tester.

OBJECTIVE SIGNS – WERE TAKEN AS CONFIRMATORY PARAMETERS.

Chi Square test: ‘p’ value is = 0.05

RESULTS

THE STATISTICAL ANALYSIS OF THE DATA RECORDED WAS CARRIED OUT WITH

THE ANOVA, POST HOC AND CHI-SQUARE TESTS USING THE WINDOWS SPSS VERSION16.0

STATISTICAL PACKAGE THROUGHOUT.

0.6 ml 0.9 ml 1.2 ml0

10

20

30

40

50

60

70

59

36.5

29

66.25

44

32

66.33

46.11

35CanineLateral incisorFirst premolar

VOLUME OF LOCAL ANESTHETIC

SECO

ND

S

MEAN VALUES OF PULPAL ONSET OF LOCAL ANESTHETIC ACTION

ANOVA test is significant. ‘p’ value < 0.05

Post Hoc Test for multiple comparisons shows no significant difference between 0.9 ml and 1.2 ml.

‘p’ value = 0.136, > 0.05

0.6 ml 0.9 ml 1.2 ml0

10

20

30

40

50

60

21

41

54

11.25

37

53

8.33

36.11

48.2

CanineLateral incisorFirst premolar

VOLUME OF LOCAL ANESTHETIC

MIN

UTE

SMEAN VALUE OF PULPAL DURATION OF LOCAL

ANESTHETIC ACTION

ANOVA test is significant. ‘p’ value < 0.05

Post Hoc Test for multiple comparisons shows significant mean difference.

‘p’ value < 0.05

0.6 ml 0.9 ml 1.2 ml0%

10%20%30%40%50%60%70%80%90%

100%100% 100% 100%

0% 0%

30% Buccal soft tissue anesthesiaPalatal soft tissue anesthesia

VOLUME OF LOCAL ANESTHETIC

% W

ITH

IN G

ROU

P

SOFT TISSUE ANESTHESIA IN RELATION TO CANINE

Chi-Square test – ‘p’ value < 0.05

0.6 ml 0.9 ml 1.2 ml0%

10%20%30%40%50%60%70%80%90%

100%

70%

100% 100%

0% 0%

20%

Buccal soft tissue anesthesiaPalatal soft tissue anesthesia

VOLUME OF LOCAL ANESTHETIC

% W

ITH

IN G

ROU

PSOFT TISSUE ANESTHESIA IN RELATION TO

LATERAL INCISOR

Chi-Square test – ‘p’ value < 0.05

Chi-Square test – ‘p’ value = 0.117(> 0.05 )

0.6 ml 0.9 ml 1.2 ml0%

10%20%30%40%50%60%70%80%90%

100%80%

100% 100%

0% 0%10%

Buccal soft tissue anesthesiaPalatal soft tissue anesthesia

VOLUME OF LOCAL ANESTHETIC

% W

ITH

IN G

ROU

P

SOFT TISSUE ANESTHESIA IN RELATION TO FIRST PREMOLAR

Chi-Square test – ‘p’ value < 0.05

Chi-Square test – ‘p’ value = 0.117(> 0.05 )

CONCLUSION

1.2 ml of 4% Articaine HCL was found to be effective over

0.6 ml and 0.9 ml

SO ITS TRUE

Bennett CR: Monheim’s local anesthesia and pain control in dental practice, ed 7, St Louis, 1983, Mosby.

Meechan JG, Kanaa MD, Corbett IP, Steen IN, Whitworth JM.:Pulpal anesthesia for mandibular permanent first molar teeth: a double-blind randomized cross-over trial

comparing buccal and buccal plus lingual infiltration injections in volunteers. Int Endod J 2006; 39(10):764 9.

Malamed SF, Gagnon S, Leblanc D. Safety of articaine: A new amide local anesthetic. J Am Dent Assoc 132:177-86, 2001.

Stanley F. Malamed, DDS. Local Anesthetics: Dentistry’s most important drugs, Clinical update 2006

Kimmo Vahatalo, Heikki Antila and Risto Lehtinen: Articaine and lignocaine for maxillary infiltration anesthesia , Anesth Prog 40:114-116 1993

Alejandro Sierra Rebolledo, Esther Delgado Molina, Leonardo Berini Aytés , Cosme Gay Escoda : Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine n inferior alveolar nerve block during surgical extraction of impacted lower

third molars , Med Oral Patol Oral Cir Bucal 2007;12:E139-44.

Dr. Sree Kumar.K , MDS , MFDS RCPS (Glas)

Dr. Neelakandan.R.S, MDS, Professor & HOD

Department of oral and maxillofacial surgery

Dr. Reuben Joseph, MDS

Department of Endodontics and conservative dentistry

Dr. Preetha

Department of preventive and community dentistry

Mrs. Gloria

Asiya Ahmed Ali, IV BDS

Dr. P.Jayakumar, Principal

Dr. Ambalavanan, Vice Principal

STILL A LONG WAY TO GO...