Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 12 , Pages 2445-2452 , December 2007

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

  • Carlos F. Santos, DDS, PhD

      Affiliations

    • Associate Professor, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • Corresponding Author InformationAddress correspondence and reprint requests to Dr Santos: Discipline of Pharmacology, Bauru School of Dentistry, University of São Paulo, Alameda Dr Octávio Pinheiro Brisolla, 9-75, Bauru, São Paulo 17012-901, Brazil
    • ,
  • Karin C.S. Modena, DDS

      Affiliations

    • Dentist, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • Fernando P.M. Giglio, DDS, MSc

      Affiliations

    • Graduate student, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • Vivien T. Sakai, DDS, MSc

      Affiliations

    • Graduate student, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • Adriana M. Calvo, DDS

      Affiliations

    • Graduate student, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • Bella L. Colombini, DDS

      Affiliations

    • Dentist, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • Carla R. Sipert, DDS, MSc

      Affiliations

    • Graduate student, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • Thiago J. Dionísio

      Affiliations

    • Undergraduate student, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • Flávio A.C. Faria, DDS, PhD

      Affiliations

    • Assistant Professor, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • Alceu S. Trindade Jr, DDS, PhD

      Affiliations

    • Professor, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
    • ,
  • José R.P. Lauris, PhD

      Affiliations

    • Assistant Professor, Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.

References 

  1. Hawkins JM, Moore PA. Local anesthesia: Advances in agents and techniques. Dent Clin North Am. 2002;46:719
  2. Brown RS, Rhodus NL. Epinephrine and local anesthesia revisited. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100:401
  3. Knoll-Köhler E, Fortsch G. Pulpal anesthesia dependent on epinephrine dose in 2% lidocaine: A randomized controlled double-blind crossover study. Oral Surg Oral Med Oral Pathol. 1992;73:537
  4. Naftalin LW, Yagiela JA. Vasoconstrictors: Indications and precautions. Dent Clin North Am. 2002;46:733
  5. Roszkowski MT, Swift JQ, Hargreaves KM. Effect of NSAID administration on tissue levels of immunoreactive prostaglandin E2, leukotriene B4, and (S)-flurbiprofen following extraction of impacted third molars. Pain. 1997;73:339
  6. Bouloux GF, Punnia-Moorthy A. Bupivacaine versus lidocaine for third molar surgery: A double-blind, randomized, crossover study. J Oral Maxillofac Surg. 1999;57:510
  7. Brkovic B, Todorovic L, Stojic D. Comparison of clonidine and epinephrine in lidocaine anaesthesia for lower third molar surgery. Int J Oral Maxillofac Surg. 2005;34:401
  8. Dionne RA, Lepinski AM, Gordon SM, et al. Analgesic effects of peripherally administered opioids in clinical models of acute and chronic inflammation. Clin Pharmacol Ther. 2001;70:66
  9. Kumar R, Rao SN. Local anaesthetic for minor oral surgical procedures: Review. Indian J Dent Res. 2000;11:163
  10. Mestre Aspa R, Carrera Grano I, Berini Aytes L, et al. Pulse oximetry monitoring during lower third molar extraction: A comparative study of three local anesthetics with epinephrine 1:100,000. Med Oral. 2001;6:195
  11. Bremerich A, Hierl T. Conscious midazolam sedation in third molar surgery: Aspects of post-operative patient evaluation. Acta Stomatol Belg. 1995;92:101
  12. Carrera I, Mestre R, Berini L, et al. Alterations in monitored vital constants induced by various local anesthetics in combination with different vasoconstrictors in the surgical removal of lower third molars. Bull Group Int Rech Sci Stomatol Odontol. 2000;42:1
  13. Colombini BL, Modena KCS, Calvo AM, et al. Articaine and mepivacaine efficacy in postoperative analgesia for lower third molar removal: A double-blind, randomized, crossover study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:169
  14. Knoll-Köhler E, Knöller M, Brandt K, et al. Cardiohemodynamic and serum catecholamine response to surgical removal of impacted mandibular third molars under local anesthesia: A randomized double-blind parallel group and crossover study. J Oral Maxillofac Surg. 1991;49:957
  15. Sack U, Kleemann PP. Intraoral conduction anesthesia with epinephrine-containing local anesthetics and arterial epinephrine plasma concentration. Anesth Pain Control Dent. 1992;1:77
  16. Costa CG, Tortamano IP, Rocha RG, et al. Onset and duration periods of articaine and lidocaine on maxillary infiltration. Quintessence Int. 2005;36:197
  17. Tofoli GR, Ramacciato JC, de Oliveira PC, et al. Comparison of effectiveness of 4% articaine associated with 1:100,000 or 1:200,000 epinephrine in inferior alveolar nerve block. Anesth Prog. 2003;50:164
  18. Hersh EV, Giannakopoulos H, Levin LM, et al. The pharmacokinetics and cardiovascular effects of high-dose articaine with 1:100,000 and 1:200,000 epinephrine. J Am Dent Assoc. 2006;137:1562
  19. Moore PA, Boynes SG, Hersh EV, et al. The anesthetic efficacy of 4 percent articaine 1:200,000 epinephrine: Two controlled clinical trials. J Am Dent Assoc. 2006;137:1572
  20. Sisk AL. Comparison of etidocaine and lidocaine for control of intra- and post-operative bleeding and pain. J Oral Maxillofac Surg. 1986;44:16
  21. Lemay H, Albert G, Helie P, et al. Ultracaine in conventional operative dentistry. J Can Dent Assoc. 1984;50:703
  22. Cowan A. Clinical assessment of a new local anesthetic agent, carticaine. Oral Surg Oral Med Oral Pathol. 1977;43:174
  23. Oertel R, Berndt A, Kirch W. Saturable in vitro metabolism of articaine by serum esterases: Does it contribute to the persistence of the local anesthetic effect?. Reg Anesth. 1996;21:576
  24. Vree TB, Gielen MJ. Clinical pharmacology and the use of articaine for local and regional anaesthesia. Best Pract Res Clin Anaesthesiol. 2005;19:293
  25. Oertel R, Rahn R, Kirch W. Clinical pharmacokinetics of articaine. Clin Pharmacokinet. 1997;33:417
  26. Sveen K. Effect of the addition of a vasoconstrictor to local anesthetic solution on operative and postoperative bleeding, analgesia and wound healing. Int J Oral Surg. 1979;8:301
  27. Buckley JA, Ciancio SG, McMullen JA. Efficacy of epinephrine concentration in local anesthesia during periodontal surgery. J Periodontol. 1984;55:653
  28. Siebrands CC, Friederich P. Inhibition of HERG channels by the local anaesthetic articaine. Eur J Anaesthesiol. 2007;24:148
  29. Haas DA, Lennon D. A 21-year retrospective study of reports of paresthesia following local anesthetic administration. J Can Dent Assoc. 1995;61:319
  30. Hillerup S, Jensen R. Nerve injury caused by mandibular block analgesia. Int J Oral Maxillofac Surg. 2006;35:437
  31. Yagiela JA. Recent developments in local anesthesia and oral sedation. Compend Contin Educ Dent. 2004;25:697
  32. Hintze A, Paessler L. Comparative investigations on the efficacy of articaine 4% (epinephrine 1:200,000) and articaine 2% (epinephrine 1:200,000) in local infiltration anaesthesia in dentistry: A randomised double-blind study. Clin Oral Invest. 2006;10:145
  33. Potocnik I, Tomsic M, Sketelj J, et al. Articaine is more effective than lidocaine or mepivacaine in rat sensory nerve conduction block in vitro. J Dent Res. 2006;85:162
  34. Gortzak RA, Oosting J, Abraham-Inpijn L. Blood pressure response to routine restorative dental treatment with and without local anesthesia: Continuous noninvasive blood pressure registration with a finger manometer. Oral Surg Oral Med Oral Pathol. 1992;73:677
  35. Troullos ES, Goldstein DS, Hargreaves KM, et al. Plasma epinephrine levels and cardiovascular response to high administered doses of epinephrine contained in local anesthesia. Anesth Prog. 1987;34:10
  36. Montebugnoli L, Servidio D, Miaton RA, et al. Heart rate variability: A sensitive parameter for detecting abnormal cardiocirculatory changes during a stressful dental procedure. J Am Dent Assoc. 2004;135:1718
  37. Daublander M, Muller R, Lipp MD. The incidence of complications associated with local anesthesia in dentistry. Anesth Prog. 1997;44:132
  38. Meechan JG. Aspiration during dental local anesthesia. Dent Update S21. 1988;

PII: S0278-2391(07)00521-6

doi: 10.1016/j.joms.2007.04.020

Journal of Oral and Maxillofacial Surgery
Volume 65, Issue 12 , Pages 2445-2452 , December 2007

Article Tools

* Image Usage & Resolution