title: 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.
abstract: OBJECTIVE
  This study compared the use of 4% articaine in association with 1:100,000 (10 mug/mL; A100) or 1:200,000 (5 mug/mL; A200) epinephrine in lower third molar removal.
  
  
  METHODS
  Fifty healthy volunteers underwent removal of symmetrically positioned lower third molars, in 2 separate appointments, under local anesthesia with either A100 or A200, in a double-blind, randomized, and crossed manner. Latency, duration of postoperative analgesia, duration of anesthetic action on soft tissues, intraoperative bleeding, and hemodynamic parameters were evaluated.
  
  
  RESULTS
  A100 and A200 presented very similar latency (1.64 +/- 0.08 and 1.58 +/- 0.08 minutes, respectively; P > .05). Identical volumes of both anesthetic solutions were used: 2.7 mL = 108 mg of articaine plus 27 mug (A100) or 13.5 mug (A200) of epinephrine. The 2 solutions provided similar duration of postoperative analgesia regardless of bone removal (around 200 minutes; P > .05). The 2 solutions also had a similar duration of anesthetic action on soft tissues (around 250 minutes; P > .05). The surgeon's rating of intraoperative bleeding was considered very close to minimal. Transient changes in hemodynamic parameters were observed, but these were neither clinically significant nor attributable to the type of anesthetic used (P > .05).
  
  
  CONCLUSIONS
  An epinephrine concentration of 1:100,000 or 1:200,000 in 4% articaine solution does not affect the clinical efficacy of this local anesthetic. It is possible to successfully use the 4% articaine formulation with a lower concentration of epinephrine (1:200,000 or 5 mug/mL) for lower third molar extraction with or without bone removal.
authors.affiliation: Bauru School of Dentistry, University of São Paulo, São Paulo, Brazil.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Santos
authors.forename: Karin C S
authors.initials: KC
authors.lastname: Modena
authors.forename: Fernando P M
authors.initials: FP
authors.lastname: Giglio
authors.forename: Vivien T
authors.initials: VT
authors.lastname: Sakai
authors.forename: Adriana M
authors.initials: AM
authors.lastname: Calvo
authors.forename: Bella L
authors.initials: BL
authors.lastname: Colombini
authors.forename: Carla R
authors.initials: CR
authors.lastname: Sipert
authors.forename: Thiago J
authors.initials: TJ
authors.lastname: Dionísio
authors.forename: Flávio A C
authors.initials: FA
authors.lastname: Faria
authors.forename: Alceu S
authors.initials: AS
authors.lastname: Trindade
authors.forename: José R P
authors.initials: JR
authors.lastname: Lauris
mesh_terms: D000293:Adolescent; D000328:Adult; D000698:Analgesia / Q000379:methods; D000766:Anesthesia, Dental / Q000379:methods; D019162:Anesthetics, Combined / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002355:Carticaine / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004347:Drug Interactions; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008334:Mandible / Q000000981:diagnostic imaging / Q000601:surgery; D008964:Molar, Third / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D018709:Statistics, Nonparametric; D013997:Time Factors; D014081:Tooth Extraction / Q000009:adverse effects; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D019162:Anesthetics, Combined; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D002355:Carticaine; D004837:Epinephrine