Comparison of Clinical Efficacy and Postoperative Analgesia using 0.75% Ropivacaine, 4% Articaine with Epinephrine and 2% Lidocaine With Epinephrine in Orthodontic Extraction of Premolars- A Double-Blind, Randomized Study
Keywords:Ropivacaine, Articaine, Orthodontic extractions, Lidocaine
AIM & OBJECTIVE- The present study aims to assess and compare the efficacy of 0.75% ropivacaine with 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in removal of maxillary and mandibular premolars for orthodontic reasons.
MATERIAL & METHODS- The present study was conducted in 150 patients, divided in three equal groups who underwent extraction of maxillary and mandibular premolar simultaneously. For the extraction of maxillary premolars initially buccal infiltration (0.5ml) was given and then palatal infiltration (0.2ml) of same local anesthetic was given only if required after a waiting period of 5 minutes. However, for mandibular premolars inferior alveolar nerve block 1.2ml of local anesthetic solution & 0.5ml for lingual nerve block was given. If the patient complains of pain on objective assessment even after 5 minutes, 0.5ml buccally was given for mandibular tooth.
RESULTS- On objective evaluation, onset of action of the anesthetic agent among patients who were given only buccal infiltration for extraction of maxillary premolars, was shortest in Articaine group followed by lidocaine group and then ropivacaine group. However, additional palatal anesthesia was required maximally in lidocaine group, followed by articaine group and then ropivacaine group. The mean time for recovery from complete anesthesia in both maxilla and mandible was shortest in lidocaine group, followed by articaine group and the longest time for ropivacaine group
CONCLUSION- To conclude, as the onset of 4% articaine with 1:100000 was fastest, earlier tooth extraction could be done in this group and can be considered as an alternative to lidocaine. Ropivacaine being a long acting local anesthetic along with its intrinsic vasoconstriction property, is also recommended for long duration surgical procedures and in medically compromised patients where the use of epinephrine is contraindicated.