Discussion
mandibular anterior teeth, paresthesia, pain, infection, intraoperative pain, mandibular incisors
INFILTRATION, NEUROLOGICAL DISORDER, PARESTHESIA, INFECTION, ANESTHETIC COMPLICATIONS
The goal of this study was to assess the effectiveness of using either 4% articaine or 2% lidocaine as a single labial infiltration for intraoperative pain management during mandibular anterior teeth extraction without an additional lingual injection. This will aid in the proper selection of the ideal local anesthetic agent that will achieve a higher and more predictable success rate. This goal was determined clinically using the pain control effectiveness during extraction, which was assessed subjectively using the VAS following extraction.Results of this study proved the effectiveness of solitary labial infiltration anesthesia without an additional lingual injection for the extraction of mandibular anterior teeth, where all the subjects in the study and control groups tolerated the extraction without the need for re-administration of additional local anesthesia. These findings are in agreement with those of Ege & Demirkol, where they concluded that the extraction of mandibular incisors and premolars could be achieved with a single buccal infiltration of 2% lidocaine [Results of this study have proved the superiority of articaine over lidocaine for the only buccal infiltration anesthesia in the anterior mandibular area where the pain score during extraction showed a statistically significant decrease in the articaine group compared to that of the lidocaine group. This superiority has been proven in several previous clinical studies and systematic reviews comparing the two agents in other intraoral locations using various infiltration and block techniques [Results of this study regarding the comparison of the mean VAS between groups during extraction based on tooth type showed that there was no significant difference between the articaine and lidocaine in pain score during extraction of the mandibular central and lateral incisors, while there was a significant difference in favor of articaine during the extraction of mandibular canines. This finding could be attributed to the increased buccolingual thickness of bone in the canine region, which requires a local anesthetic agent with higher bony and soft tissue diffusion properties [In this study, the safety of articaine was established, where none of the patients reported any post-operative anesthetic complications. These results could be attributed to the technique utilized in this study, which is a supra-periosteal infiltration of the dental branches of the mandibular incisive nerve with no affection of the mental nerve. These findings support the use of articaine as a solitary buccal infiltration technique in the mandibular anterior region instead of inferior alveolar or mental nerve blocks, as no incidence of paresthesia has been reported in the literature when using the infiltration technique [Attempts were taken in this study to reduce the confounding factors, as the study outcomes are mainly subjective. Individuals having a local infection, neurological disorder, or taking analgesics one day before from extraction were excluded to avoid any effect on the pain perception. Furthermore, the study adopted a split-mouth design, and the participants and the operator were blinded from the utilized type of local anesthesia.However, the study has a limitation that includes the sequential administration of anesthesia, which could increase the possibility of period effects, and the inability to eliminate the patient’s psychological pain tolerance during the second injection. This could result in potentially biased pain perception. Further clinical studies, confined to the posterior region of the mandible and addressing the same concept of only buccal infiltration without lingual injection, may be required to assess the effect of increased bucco-lingual bone width on the effectiveness of articaine penetration ability in this region.