The efficacy of an elevated concentration of lidocaine HCl in impacted lower third molar surgery

Abstract

BackgroundThere have been few studies on the effect of an elevated concentration of lidocaine hydrochloride in the surgical removal of an impacted lower third molar. This study aimed to examine the efficacy of 4% lidocaine along with 1:100,000 epinephrine compared to 2% lidocaine along with 1:100,000 epinephrine as inferior alveolar nerve block for the removal of an impacted lower third molar.MethodsThis single-blind study involved 31 healthy patients (mean age: 23 y; range: 19-33 y) with symmetrically impacted lower third molars as observed on panoramic radiographs. Volunteers required 2 surgical interventions by the same surgeon with a 3-week washout period. The volunteers were assigned either 4% lidocaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine as local anesthetic during each operation.ResultsWe recorded the time of administration, need for additional anesthetic administration, total volume of anesthetic used. We found that the patient's preference for either of the 2 types of local anesthetic were significantly different (P < 0.05). However, the extent of pulpal anesthesia, surgical duration, and duration of soft tissue anesthesia were not significantly different.ConclusionsOur study suggested that inferior alveolar nerve block using 4% lidocaine HCl with 1:100,000 epinephrine as a local anesthetic was clinically more effective than that using 2% lidocaine HCl with 1:100,000 epinephrine; the surgical duration was not affected, and no clinically adverse effects were encountered.

Anesthetic Efficiency of Articaine Versus Lidocaine in the Extraction of Lower Third Molars: A Meta-Analysis and Systematic Review

“…In terms of the heterogeneity of each outcome, this can be explained by the formulation and dosage of anesthetic solution. Ping et al 33 suggested that IANB using 4L100 was more effective than that using 2L100, and epinephrine is an excellent vasoconstrictor with varying degrees of efficiency, depending on the concentration of epinephrine added to lidocaine. 34 Three studies reported that the dosage of anesthesia could affect the efficiency of anesthesia, in that a greater volume could increase anesthetic efficiency.…”

4% lidocaine versus 4% articaine for inferior alveolar nerve block in impacted lower third molar surgery

“…A previously published study used a 3-4 week interval between the first and second surgeries for patients with bilateral lower third molar surgery [ 3 4 12 ]. Therefore, we chose a 3-week interval between the surgeries in this study so that postoperative sequelae of the local anesthetic injection, such as pain and numbness, were reduced.…”

“…In many previous studies, researchers have tried to manipulate the physical and chemical properties of local anesthetics to improve their effectiveness when used for the inferior alveolar nerve (IAN) block. Researchers have compared different types and volumes [ 2 3 4 ] of local anesthetics and have modified the concentration of the buffering agent in the local anesthetic cartridge. Previous studies have commonly reported on the onset, duration of action, and success rate of pulpal anesthesia observed with the different methods [ 5 6 7 8 9 10 11 ].…”

“…Ping et al [ 2 3 4 ] studied the efficacy and hemodynamic changes of high concentration (4%) lidocaine and 2% lidocaine; however, no studies have compared 4% lidocaine with 4% articaine.…”

Success rates of the first inferior alveolar nerve block administered by dental practitioners

“…A 27-gauge needle (30 mm) and self-aspirating syringes with a local anesthetic solution (4% articaine with adrenaline 1:100,000 [1 cartridge = 1.7 ml]) were used. The standard IANB technique was followed [ 3 4 5 ]. The anesthetic was injected into the pterygomandibular space, while the axis of the syringe barrel was parallel and was placed on the occlusal surfaces of the mandibular teeth.…”