Vergleich der anästhetischen Wirkung von Lidocain 2% und Articain 2% zur Leitungsanästhesie des Nervus alveolaris inferior bei kleineren zahnärztlich-chirurgischen Eingriffen - randomisierte prospektive klinische Studie

Abstract

Objectives: The purpose of this clinical prospective, randomized, double-blinded trial was to compare the anesthetic efficacy of 2% lidocaine and 2% articaine in inferior alveolar nerve block for minor oral surgery, comprising extraction of mandibular teeth or mandibular dental implant placement. Material and methods: 90 patients received local anesthesia by inferior alveolar nerve block for the treatment of 121 cases of affected premolars and molars for extraction or dental implant placement in the respective regions. In total 100 mandibular teeth needed to be extracted and 21 dental implants were inserted. In 53 cases (43,8%) lidocaine 2% and in 68 cases (56,2%) articaine 2% was administered. Primary research goal was to compare the anesthetic efficacy between lidocaine 2% and articaine 2% by quantitative pain measurements (VAS) and qualitative anesthetic success evaluation (complete/sufficient vs. insufficient/none). Secondary, the need of additional aesthesia, differences in pulpal anesthesia (onset and depth) examined with a pulp vitality tester (min), as well as the duration of the postoperative soft tissue anesthesia (min) were evaluated. Furthermore, pain while injecting (VAS), pain during the treatment (VAS) and eventual complaints or complications were analyzed. Results: Both solutions showed sufficient anesthesia for tooth extraction as well as dental implant placement without significant difference for anesthetic success between articaine 2% and lidocaine 2% (p=0,383). Additional anesthesia was significant more often necessary with lidocaine 2% (p=0,25). The onset of anesthesia was significantly shorter using articaine 2% compared to lidocaine 2% (3,5 min vs. 7,1 min; p<0,001). Soft tissue anesthesia with articaine 2% lasted significantly longer than with lidocaine 2% (183,54 min vs. 141,32 min; p<0,001). Significant differences in favor of articaine 2% were found regarding lower pain ratings during the injection (2,19 vs. 5,74; p<0,001) and lower intraoperative pain (p=0,02). For both local anesthetics, complaints as well as complications such as pain, swelling, hematoma and bleeding or prolonged numbness were seen. No significant association with one of the solutions was found. Conclusion: Articaine 2% gives equal anesthetic success, but lower intraoperative pain compared with lidocaine 2%. Furthermore articaine 2% shows clinical advantages over lidocaine 2% in terms of fewer additional anesthesia, shorter onset and lower injection pain. Clinical relevance: For mandibular tooth extraction and mandibular dental implant placement articaine 2% should be preferred over lidocaine 2%.