Introduction
systemic disease, ’s mouth, numbness, dementia, Infections, pain, psychosis, tooth loss, Orofacial neurological symptoms.4, pain.6
SYSTEMIC DISEASE, CREST, ANAPHYLACTIC REACTION, INFECTIONS
Local anesthesia (LA) is of great significance for modern medicine and dentistry and is applied so often (Material and Method- Study PatternThe population of the study consists of all patients, who were planned to be applied implants in the zone distal to the mental foramen, between February 4, 2019, and March 7, 2022, at each of the two participating clinics. Two surgeons following the same surgical protocol at two different university hospital with similar settings and properties participated to the study. Procedures were explained to the participants and all of them signed consent forms prior to participating in the study. The study was approved by Pamukkale University Ethical Committee (E-60116787-020-201307). All procedures performed in this study comply with the ethical standards of the institutional and/or national research committees and the 2013 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. A normal healthy patients and patients with mild systemic disease were included the study. Patients who have any hormonal condition, who use any medication, who need further surgery that can change the perception of pain, and who will be sedated because they cannot indicate pain perception, were excluded from the study.Inclusion Criteria:1) Patients with systematic conditions are classified as ASA Class I and Class II (2) The patients who need one implant at least due to posterior mandibular tooth loss at least 2mm distal to the mental foramen.Exclusion Criteria:1) Pregnancy, lactation, and taking contraceptive pills.2) Oversensitivity or anaphylactic reactions which contraindicate the intervention.3) Orofacial neurological symptoms.4) Infections at the operation zone.5) Psychotropic medicine, sedative, or NSAI use which can alter the sense of pain.6) Pathological mental conditions (dementia, psychosis) and lack of cooperation.7) Advanced surgical necessities (GBR, split crest, vertical regeneration, block graft, etc.)8) Operations carried out with conscious sedation.9) Patients who do not want to sign consent.Participants were randomly assigned to one of the 2 treatment groups (lidocaine and articaine) following a simple software-generated random number procedure via the “List Randomizer” application (https://www.random.org.lists). The primary outcome of the study was to measure the patients’ perception of pain during anesthesia administration and surgery, using a numerical rating scale (VAS) from 0 (no pain) to 10 (the worst pain imagine) (- InterventionsThe first group was administered 40mg/ml articaine hydrochloride and 0.006mg/ml epinephrine hydrochloride (Ultracain D-S, Sanofi, Paris, France), and the second group was applied 20mg/ml lidocaine hydrochloride and 0.0125 mg/ml epinephrine based anesthesia (Jetokain, Adeka, Turkey). In both groups, operations took less than 60 minutes after the anesthesia. Procedures that lasted longer than 60 minutes and procedures that required advanced surgical applications for implant surgery were excluded from the study. Periosteal integrity was tried to be maintained but the patient’s periosteal integrity which could not be maintained was noted. IANB was applied via a 2 ml capacity 27-G 50 mm standard dental syringe. The patient’s mouth was opened as much as possible so that the raphe pterygomandibularis between the musculus buccinator and musculus constrictor pharynges superior could be seen clearly. From the front edge of the ramus mandibularis, the overlying soft tissue was removed via a mouth mirror. The needle was pushed to the slightly lateral part of the middle zone of the pterygomandibular raphe and contacted the bone.
Flow diagram generated in accordance with CONSORT 2010 guidelines.Then it was slightly pulled and aspirated, and the anesthetic agent was injected. To the participants of both groups, all of the anesthetic agents in the ampoule were injected. Following the injection, if numbness could not be achieved in the lips, a second injection was applied. No extra INF was applied to the buccal zone. Upon achieving adequate numbness, a standard implant placing procedure was followed. With the purpose of exposing the bone, the mucoperiosteal flap was elevated and the zone in which the implant would be placed was drilled at 800-1200 rpm and cooled with saline in accordance with the producer company’s guidelines. Then the implants were screwed to the bone with a pressure of 35nm of torque. Following this step, flaps were primarily closed via 4/0 non-absorbable monofilament polypropylene sutures (Monoprolen, Boz, Ankara, Turkey).- Data AnalysisWith the purpose of reaching reliability power and confidence levels of 95% and to be able to calculate the pain strength at around d = 0.50, the size of the sample was thought to be 184 patients at least 92 patients per group (