title: Comparison of injection pain, heart rate increase, and postinjection pain of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system.
abstract: The purpose of this prospective, randomized, double-blind study was to compare the pain of injection, heart rate increase, and postinjection pain of the intraligamentary injection of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine administered with a computer-controlled local anesthetic delivery system. Using a crossover design, intraligamentary injections of 1.4 mL of 4% articaine with 1:100,000 epinephrine and 1.4 mL of 2% lidocaine with 1:100,000 epinephrine were randomly administered on the mesial and distal aspects of the mandibular first molar with a computer-controlled local anesthetic delivery system in a double-blind manner at 2 separate appointments to 51 subjects. The results demonstrated the incidence of moderate pain was 14%-27% with needle insertion, with 0%-4% reporting severe pain. For solution deposition, moderate pain was reported 8%-18% of the time, with no reports of severe pain. There were no significant differences between the articaine and lidocaine solutions. Regarding heart rate changes, neither anesthetic solution resulted in a significant increase in heart rate over baseline readings. On day 1 postinjection, there was a 31% incidence of moderate/severe pain with the articaine solution and 20% incidence of moderate/severe pain with the lidocaine solution. The moderate/severe pain ratings decreased over the next 2 days. There were no significant differences between the articaine and lidocaine solutions. We concluded that the intraligamentary injection of 4% articaine with 1:100,000 epinephrine was similar to 2% lidocaine with 1:100,000 epinephrine for injection pain and postinjection pain in the mandibular first molar when administered with a computer-controlled local anesthetic delivery system. For both anesthetic solutions, heart rate did not significantly increase with the intraligamentary injection using the computer-controlled local anesthetic system.
authors.affiliation: Department of Graduate Endodontics, College of Dentistry, The Ohio State University, Columbus, Ohio 43218, USA.
authors.forename: John
authors.initials: J
authors.lastname: Nusstein
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Berlin
authors.forename: Al
authors.initials: A
authors.lastname: Reader
authors.forename: Mike
authors.initials: M
authors.lastname: Beck
authors.forename: Joel M
authors.initials: JM
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000379:methods*; D000772:Anesthesia, Local / Q000295:instrumentation*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002355:Carticaine / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005157:Facial Pain / Q000209:etiology*; D005260:Female; D006339:Heart Rate; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008012:Lidocaine / Q000008:administration & dosage*; D008297:Male; D008334:Mandible; D008875:Middle Aged; D008963:Molar; D010513:Periodontal Ligament; D011446:Prospective Studies; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D002355:Carticaine