Professional Documents
Culture Documents
2
, P Value
Gender 13 Females 8 Females .1115
7 Males 12 Males
No. of teeth per arch/route of
injection (success %)
10 Mandible, Gow-Gates block (90%) 11 Mandible, Gow-Gates block (72.7%) .7515
10 Maxillary infiltration block (100%) 9 Maxillary infiltration block (88.9%)
ANOVA, analysis of variance.
*Heft-Parker VAS, mean standard deviation.
There were no significant differences (P .05) between the groups.
The block was considered successful if the subjects tooth was accessed with a pain rating no greater than that considered mild pain.
Clinical Research
658 Sherman et al. JOE Volume 34, Number 6, June 2008
To ensure proper patient comfort, adequate anesthesia must be
obtained. AE is a relatively new anesthetic distributed in the United
States. There have been many claims by dentists that AE provides more
effective anesthesia than other anesthetic solutions sold in the market.
Although both anesthetic solutions showed a high rate of pulpal anes-
thesia, our study demonstrated that AE was as effective but not superior
to LE. This result corroborates the other anesthetic studies to date
comparing these 2 solutions (1, 12, 27, 33). In endodontics, it is im-
perative that profound anesthesia is obtained in symptomatic teeth be-
fore endodontic access. This study treated 10 patients in the AE group
and 11 in the LE group by using the Gow-Gates block. More research is
recommended with the Gow-Gates block with AE in teeth with irrevers-
ible pulpitis, so a clinician can make evidence-based decisions in the
choice of a dental anesthetic.
Acknowledgments
This study was supported by a Faculty research grant fromNova
Southeastern University Health Professions Division.
References
1. Malamed SF, Gagnon S, LeBlanc D. Articaine hydrochloride: a study of the safety of a
new amide local anesthetic. J Am Dent Assoc 2001;132:17785.
2. Oertel R, Rahn R, Kirch W. Clinical pharmacokinetics of articaine. Clin Pharmaco-
kinet 1997;33:41725.
3. Jakobs W, Ladwig B, Cichon P. Serum levels of articaine 2% and 4% in children.
Anesth Prog 1995;42:1135.
4. Malamed SF. Handbook of local anesthesia. 5th ed. St Louis: Mosby, 2004.
5. Wright GZ, Weinberger SJ, Friedman CS, Plotzke OB. The use of articaine local
anesthesia in children under 4 years of age: a retrospective report. Anesth Prog
1989;36:26871.
6. Moller RA, Covino BG. Cardiac electrophysiologic effects of articaine compared with
bupivicaine and lidocaine. Anesth Analg 1993;76:126673.
7. Oertel R, Ebert U, Rahn R, Kirch W. The effect of age on pharmacokinetics of the local
anesthetic drug articaine. Reg Anesth Pain Med 1999;24:5248.
8. Malamed SF, Gagnon S, Leblanc D. A comparison between articaine HCL and lido-
caine HCL in pediatric dental patients. Pediatr Dent 2000;22:30711.
9. Donaldson D, James-Perdok L, Craig BJ, Derkson GD, Richardson AS. A comparison
of Ultracaine DS (articaine HCl) and Citanest forte (prilocaine HCl) in maxillary
infiltration and mandibular nerve block. J Can Dent Assoc 1987;53:3842.
10. Haas DA, Harper DG, Saso MA, Young ER. Comparison of articaine and prilocaine
anesthesia by infiltration in maxillary and mandibular arches. Anesth Prog
1990;37:2307.
11. Haas DA, Harper DG, Saso MA, Young ER. Lack of differential effect by Ultracaine
(articaine) and Citanest (prilocaine) in infiltration anesthesia. J Can Dent Assoc
1991;57:21723.
12. Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic efficacy of articaine for
IAN in patients with irreversible pulpitis. J Endod 2004;30:56871.
13. Milles M. The missed inferior alveolar nerve block: a new look at an old problem.
Anesth Progress 1984;31:8790.
14. Madan G, Madan S, Madan A. Failure of inferior alveolar nerve block. J AmDent Assoc
2002;133:8436.
15. Hargreaves KM, Keiser K. Local anesthetic failure in endodontics: mechanisms and
management. Endod Topics 2002;1:2639.
16. Gow-Gates GA. Mandibular conduction anesthesia: a new technique using extraoral
landmarks. Oral Surg Oral Med Oral Pathol 1973;36:3218.
17. Malamed SF. The Gow-Gates mandibular block: evaluation after 4,275 cases. Oral
Surg Oral Med Oral Pathol 1981;51:4637.
18. Watson JE, Gow-Gates GAE. A clinical evaluation of the Gow-Gates mandibular block
technique. N Z Dent J 1976;72:2203.
19. Levy TP. An assessment of the Gow-Gates mandibular block for third molar surgery.
J Am Dent Assoc 1981;103:3741.
20. Robertson WD. Clinical evaluation of mandibular conduction anesthesia. Gen Dent
1979;27:4951.
21. Cruz EV, Quengua JB, Gutierrez IL, Abreu MA, Uy HG. A comparative study: classical,
Akinosi, and Gow-Gates techniques of mandibular nerve block. J Philipp Dent Assoc
1994;46:139.
22. Nusstein J, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the supple-
mental intraosseous injection of 2 % lidocaine with 1:100,000 epinephrine in irre-
versible pulpitis. J Endod 1998;24:48791.
23. Reisman D, Reader A, Nist R, Beck M, Weaver J. Anesthetic efficacy of the supple-
mental intraosseous injection of 3% mepivicaine in irreversible pulpitis. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod 1997;84:67682.
24. Lai TN, Lin CP, Kok SH, et al. Evaluation of mandibular block using a standardized
method. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:4628.
25. Hung PC, Chang HH, Yang PJ, Kuo YS, Lan WH, Lin CP. Comparison of the Gow-Gates
mandibular block and inferior alveolar nerve block using a standardized protocol.
J Formos Med Assoc 2006;105:13946.
26. Heft MW, Parker SR. An experimental basis for revising the graphic rating scale for
pain. Pain 1984;19:15361.
27. Mikesell P, Nusstein J, Reader A, Beck M, Weaver J. A comparison of articaine and
lidocaine for inferior alveolar nerve blocks. J Endod 2005;31:26570.
28. Bigby J, Reader A, Nusstein J, Beck M, Weaver J. Articaine for supplemental intraosse-
ous anesthesia in patients with irreversible pulpitis. J Endod 2006;32:10447.
29. Fernandez C, Reader A, Beck M, Nusstein J. A prospective, randomized, double-blind
comparison of bupivacaine and lidocaine for inferior alveolar nerve blocks. J Endod
2005;31:499503.
30. Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine and lidocaine mandib-
ular buccal infiltration anesthesia: a prospective randomized double-blind cross-
over study. J Endod 2006;32:2968.
31. Rosenquist J, Rosenquist K, Lee P. Comparison between lidocaine and bupivacaine as
local anesthetics with diflunisal for postoperative pain control after lower third molar
surgery. Anesth Prog 1988;35:14.
32. Binshtok AM, Bean BP, Woolf CJ. Inhibition of nociceptors by TRPV1-mediated entry
of impermeant sodium channel blockers. Nature 2007;449:60710.
33. Vahatalo K, Antila H, Lehtinen R. Articaine and lidocaine for maxillary infiltration
anesthesia. Anesth Prog 1993;40:1146.
Clinical Research
JOE Volume 34, Number 6, June 2008 Anesthetic Effectiveness of AE and LE 659