Anesthetic Efficacy of a Combination of 0.5 M Mannitol Plus 36.8 mg of Lidocaine With 18.4 μg Epinephrine in Maxillary Infiltration: A Prospective, Randomized, Single-Blind Study

Abstract

The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of lidocaine with epinephrine compared to lidocaine with epinephrine plus 0.5 M mannitol in maxillary lateral incisor infiltrations. Forty-one subjects randomly received 2 maxillary lateral infiltrations consisting of a 1.84-mL solution of 36.8 mg lidocaine with 18.4 lg epinephrine (control solution) and a 2.90-mL solution of 36.8 mg lidocaine with 18.4 lg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) in 2 separate appointments spaced at least 1 week apart. The maxillary lateral incisor was blindly electric pulp-tested in 2-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (a reading of 80) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all pulpal anesthesia readings (at output of 80) over the 60-minute test period. Pain during solution deposition and postoperative pain were also measured. The results demonstrated that a 2.90-mL solution of 36.8 mg lidocaine with 18.4 lg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) was not statistically significantly superior to a 1.84-mL solution of 36.8 mg lidocaine with 18.4 lg epinephrine. The pain of solution deposition was lower with the lidocaine/mannitol formulation. Postoperative pain was not statistically significantly different between the lidocaine/mannitol formulation and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to a lidocaine with epinephrine formulation was not significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol in the maxillary lateral incisor.

Present status and future directions—Mechanisms and management of local anaesthetic failures

“…Adding mannitol to 2% lidocaine with 1:100 000 epinephrine significantly reduced pain on injection for maxillary lateral incisors (Younkin et al, 2014). In contrast, adding diphenhydramine significantly increased pain on injection (Willett et al, 2008).…”

“…Employing healthy pulps could be a potential shortcoming since the level of anxiety may be different between healthy individuals and patients who are suffering from severe pain such as irreversible pulpitis (Edwards et al, 1999). Furthermore, the use of a single‐blinded method may result in detection and performance bias (Aggarwal et al, 2011b, 2012b; Younkin et al, 2014).…”

“…In contrast to mandibular posterior teeth, mannitol significantly reduced anaesthesia success rates in maxillary lateral incisors (Younkin et al, 2014).…”

“…It has been reported that adding mannitol to lidocaine with epinephrine provided either significantly lower or no significant impacts on injection pain (Kreimer et al, 2012; Wolf et al, 2011; Younkin et al, 2014). However, pain on injection has not been investigated when mannitol was added to 4% articaine (Shakoui et al, 2019).…”

Effect of three different rotary instrumentation systems on postinstrumentation pain: A randomized clinical trial

“…Various studies have been conducted to understand the effect of different clinical approaches such as use of different local anesthetics,[ 5 6 ] premedication,[ 7 ] and irrigants and irrigation devices[ 8 ] on the intra- and post-operative pain. Root canal preparation technique and cross-sectional design of the instruments play a role in the extrusion of debris.…”