A clinical evaluation on the alkalization of local anesthetic solution in periapical surgery

Abstract

Aims: To assess the effect of alkalization of local anesthetic solution for the purpose of enhancing its efficiency in periapical surgery. Materials and Methods: A total sample of 80 patients, all needing periapical surgery on one or more of their upper anterior tooth (teeth) was subjected to this trial. For the purpose of comparison, the sample was randomly divided into two groups based on the local anesthetic solution that they were to receive before surgery. The first group(control) included those patients who received the commercially available local anesthetic solution with a standard pH of 3.5.The second group (trial group) included those patients who received a pH adjusted local anesthetic solution at 7.2 (using sodium bicarbonate).Prior to, and at the completion of intended surgery, the following data were recorded: Pain during injection, onset of achievement of surgical anesthesia, pain during operation and the duration of operation itself. Results: A significant difference in regard to onset of achievement of surgical anesthesia between both groups was noticed with a faster onset in group two where the patients received a pH adjusted local anesthetic solution when compared to control group where the patients received the commercially available local anesthetic solution. Also, less pain on deposition of solution was noticed in the second group as well as less pain score levels were recorded during operation in regard to the same group. Conclusion: The pH adjusted local anesthetic solutions may provide certain advantages when compared to the commercially available local anesthetic solutions regarding enhancement of anesthetic efficiency, reduced pain on injection as well as during surgery.

The effect of adjusting the pH of local anaesthetics in dentistry: a systematic review and meta‐analysis

“…4b). The only study conducted in inflamed tissue (Al-Sultan et al 2006) also reported a significant reduction in onset time (Fig. 4a).…”

“…Moreover, all the studies were randomized and double-blinded, except for one study that did not specify blinding (Shyamala et al 2016). Eight studies with a cross-over or split-mouth design (Lem 1991, Primosch & Robinson 1996, Whitcomb et al 2010, Hobeich et al 2013, Malamed et al 2013, Comerci et al 2015, Shurtz et al 2015, Phero et al 2017 tested experimental and control conditions in the same person, whereas six studies had a parallel design (Al-Sultan et al 2006, Kashyap et al 2011, Balasco et al 2013, Harreld et al 2015, Schellenberg et al 2015, Shyamala et al 2016. Pain was measured on a variety of scales (Table 2), whilst the onset of anaesthesia was assessed by electric pulp testing (Whitcomb et al 2010, Hobeich et al 2013, Shurtz et al 2015 or soft tissue probing (Al-Sultan et al 2006, Kashyap et al 2011, Shyamala et al 2016.…”

“…In five studies, the oral mucosa was anaesthetized with a topical anaesthetic (benzocaine) before infiltration (Balasco et al 2013, Comerci et al 2015, Harreld et al 2015, Schellenberg et al 2015, Shurtz et al 2015. One study was carried out in patients with periapical lesions (Al-Sultan et al 2006); two studies were performed in patients with abscesses (Balasco et al 2013, Harreld et al 2015, and one study was performed in patients with pulpitis (Schellenberg et al 2015). Patients in the other studies were considered to have normal local tissue conditions.…”

“…The buffer agent used in all the studies was sodium bicarbonate (SB). The buffered anaesthetic solution was always prepared immediately before injection, manually (Lem 1991, Primosch & Robinson 1996, Al-Sultan et al 2006, Whitcomb et al 2010, Kashyap et al 2011, Phero et al 2017 or using a precision mixing device (Balasco et al 2013, Hobeich et al 2013, Malamed et al 2013, Comerci et al 2015, Harreld et al 2015, Schellenberg et al 2015, Shurtz et al 2015, Shyamala et al 2016. The most frequent buffer concentration was 8.4%, which was used in 12 studies.…”

Comparison of Pain Perception and Latency with Alkalinization of 2% Lidocaine Using 8.4% Sodium Bicarbonate: A Randomized Controlled Study

“…This result demonstrates that alkalinized LA provides more comfort on injection compared to nonalkalinized solution. Studies conducted by Al-Sultan et al, Kashyap et al, Schellenberg, and Saatchi et al 9,[11][12][13] had shown success results, demonstrating no or less pain with alkalinization, whereas studies by Chopra et al, Whitcomb et al, and Hobeich et al 4,14,15 showed low success in pain reduction.…”