title: Comparison of 4% articaine and 0.5% bupivacaine anesthetic efficacy in orthodontic extractions: prospective, randomized crossover study.
abstract: OBJECTIVE
  Articaine and bupivacaine are both amide-type local anesthetic (LA) agents, of almost equal potency. However, lidocaine is considered the gold standard and is the most widely used anesthetic agent because of its potency, safety, and efficiency. Articaine is fast acting and bupivacaine is a long-lasting LA. The aim of this randomized controlled crossover clinical study was to evaluate and compare the clinical anesthetic efficacy of 4% articaine and 0.5% bupivacaine in orthodontic extractions models.
  
  
  METHODS
  Forty systemically healthy patients (age range: 10-18 years), requiring premolar extraction for orthodontic reasons (all 4 premolars) were included. Patients were categorized into two groups (4% articaine and 0.5% bupivacaine) in a crossover manner (160 premolars). Parameters recorded included: time of anesthetic onset, duration of postoperative analgesia, time to first rescue analgesic medication, and visual analog scale (VAS). At the first appointment, both upper and lower premolars were extracted on one side of the jaws (right or left). A fixed volume of 1.4 mL of 4% articaine or 0.5% bupivacaine (based on a computer-generated list) was infiltrated in the buccal vestibule (local infiltration) for extraction. At the second appointment, after a washout period of 15 days, the anesthetic agent that was not administered at the first appointment was administered in a crossover manner. Each patient was evaluated using a 100-mm VAS during and after extraction.
  
  
  RESULTS
  The results showed that 4% articaine had significantly faster onset of action and lower VAS scores when compared with bupivacaine. However, the duration of analgesia and time to first rescue analgesic medication was longer in the bupivacaine group.
  
  
  CONCLUSIONS
  Articaine seemed to have better potency and efficacy in terms of onset of action and lower pain scores compared to the bupivacaine group. Further studies are required to confirm these results.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 18, India.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Thakare
authors.affiliation: Department of Oral and Maxillofacial Surgery, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 18, India.
authors.forename: Kalyani
authors.initials: K
authors.lastname: Bhate
authors.affiliation: Department of Periodontology and Oral Implantology, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pune 18, India. Electronic address: rkathariya@gmail.com.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kathariya
mesh_terms: D000293:Adolescent; D000766:Anesthesia, Dental / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002355:Carticaine / Q000008:administration & dosage*; D002648:Child; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D014081:Tooth Extraction / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D002355:Carticaine; D002045:Bupivacaine
keywords: bupivacaine; carticaine; pain measurement; tooth extraction; visual analog pain scale