title: Maxillary posterior teeth removal without palatal injection -truth or myth: a dilemma for oral surgeons.
abstract: BACKGROUND
  Pain control is one of the most important factors for successful treatment. Each new measure to control pain has been looked as miraculous act at the initial stages. The improvements in agents and techniques for local anaesthesia are probably the most important advances in dental science to have occurred in the past years.
  
  
  OBJECTIVE
  To evaluate 4% articaine hydrochloride against 2% lignocaine hydrochloride anaesthesia in providing adequate palatal anaesthesia in maxillary posterior regions, without the need for a palatal block.
  
  
  METHODS
  Healthy patients above 15 y of age and requiring bilateral extraction of their maxillary posterior teeth were included in this crossover study. The exclusion criteria included medical history of cardiovascular and kidney diseases, gastrointestinal bleeding or ulceration, allergic reactions to local anaesthetic, pregnancy or current lactation.
  
  
  METHODS
  Eighty patients, requiring bilateral extraction of their teeth due to various reasons were enrolled for this study. Each patient received both lignocaine and articaine anaesthetic in equivalent dose at two different appointments. Maxillary infiltration technique was used for extraction of maxillary posterior teeth at both the appointments. A 170-mm Heft Parker visual analogue scale was used to assess the pain on the palatal mucosa after buccal infiltration of either anaesthetic agent. Blood pressure, Pulse rate and electrocardiographic monitoring were done during the procedure. Adverse effects during the study period were also monitored.
  
  
  METHODS
  Data was analysed by Z-test and student's t-test.
  
  
  RESULTS
  Pain scores on probing palatal mucosa after buccal infiltration of the anaesthetic were more for lignocaine as compare to articaine and it was statistically significant (p <.001). However, for hemodynamic parameters and electrocardiographic monitoring, there was no statistically significant difference in blood pressure, pulse rate and electrocardiograph before and after the completion of extraction (p > 0.05).
  
  
  CONCLUSIONS
  Four percent articaine offers better clinical performance than 2% Lignocaine, particularly in terms of providing adequate palatal anaesthesia with only buccal infiltration.
authors.affiliation: Senior Demonstrator, Department of Pharmacology, Mahatma Gandhi Medical College & Hospital , Jaipur, India .
authors.forename: Kopal
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Reader, Department of Oral & Maxillofacial Surgery, Rajasthan Dental College , Jaipur, India .
authors.forename: Amit
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Ex. Professor & Head, Department of Pharmacology, JLN Medical College , Ajmer, India .
authors.forename: Ml
authors.initials: M
authors.lastname: Aseri
authors.affiliation: PG Student, Department of Pharmacology, Mahatma Gandhi Medical College & Hospital , Jaipur, India .
authors.forename: Angelika
authors.initials: A
authors.lastname: Batta
authors.affiliation: Reader, Department of Oral & Maxillofacial Surgery, Rajasthan Dental College , Jaipur, India .
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.affiliation: Senior Lecturer, Department of Oral & Maxillofacial Surgery, Rajasthan Dental College , Jaipur, India .
authors.forename: Dinesh
authors.initials: D
authors.lastname: Pilania
authors.affiliation: Senior Lecturer, Department of Oral & Maxillofacial Surgery, Rajasthan Dental College , Jaipur, India .
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Kumar Sharma
keywords: Articaine; Heft-Parker visual analogue scale; Lignocaine; Maxillary buccal infiltration; Palatal anaesthesia