Could one injection lidocaine 2% with epinephrine provide palatal anesthesia in the removal of maxillary third molars?

This summary is based on the scientific report published in Anesthesia Progress: Buccal Injection of 2% Lidocaine With Epinephrine for the Removal of Maxillary Third Molars (Fall 2013)

Sunil Yadav, MDS, Ajay Verma, MDS, and Akash Sachdeva, MDS

Context

Achieving excellent local anesthesia is the key to many dental treatments. The removal of maxillary third molars is one of the most frequently performed procedures by dental surgeons.

According to the literature, for the removal of maxillary third molars, anesthetic solution should be administered as either a greater palatine nerve block or local palatal infiltration plus either a posterior alveolar nerve block or a buccal infiltration. (1)

Initially there was inadequate evidence in the literature to support maxillary third molar removal with only buccal infiltration of local anesthesia, (2) but now more studies have evaluated the bucco-palatal diffusion of local anesthesia in extractions with only buccal vestibular
anesthesia, without palatal complementation. (3, 4)

Some claim that articaine has a higher potential of diffusibility through soft and hard tissues, precluding palatal injection when maxillary third molars are extracted. (3, 2) In a comparative study between articaine and lidocaine, both solutions presented similar behavior and properties. (5)

Purpose of the Study

To demonstrate if 2% lidocaine hydrochloride with 1 : 200,000 epinephrine could provide palatal anesthesia in maxillary tooth removal with a single buccal injection.

Key Findings

• 2% lidocaine hydrochloride with 1 : 200,000 epinephrine has adequate anesthesia to perform maxillary third molar extraction and that in fact in most cases supplemental palatal injection may not be necessary.
• Removal of erupted maxillary third molars without palatal injection may be possible by depositing 2 mL of 2% lidocaine hydrochloride with 1 : 200,000 epinephrine to the buccal vestibule of the tooth.

References

1. Malamed SF. Handbook of Local Anesthesia. 5th ed. St Louis, Mo: Mosby; 2004.
2. Li Q. Anesthetizing the anterior palatine nerve through the maxillary tuberosity. Quintessence Int. 1989; 20:925.
3. Uckan S, Dayangac E, Araz K. Is permanent maxillary tooth removal without palatal injection possible? Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:733–735.
4. Sierra Rebolledo A, Delgado Molina E, Berini Ayt´ıs L, Gay Escoda C. Comparative study of the anesthetic efficacy of 4% articaine versus 2% lidocaine in inferior alveolar nerve block during surgical extraction of impacted lower third molars. Med Oral Patol Oral Cir Bucal. 2007;12:E139–E144.
5. Dimitroulis G. Handbook of Third Molar Surgery. Oxford, United Kingdom: Wright; 2001.

Do you have any particular question on this topic? Do you have any comments or suggestions? Email us at oasisdiscussions@cda-adc.ca

You are invited to comment on this post and provide further insights by posting in the comment box which you will find by clicking on “Post a reply” below. You are welcome to remain anonymous and your email address will not be posted.