Clinical and practical use of domestic and imported articaine during difficult clinical situations during maxillofacial surgery in outpatient dentistry: case study

Relevance. The study aimed to compare the depth of anaesthesia, effectiveness, and hemostasis when using two articaine-based drugs: «Articaine-Binergia with epinephrine» 1:200000 and «Ubistesin forte» 1:100000, using a clinical case of the removal of tooth buds 38 and 48 in the lower jaw under conscious sedation in a patient with pronounced dental phobia. Articaine drugs, domestic «Articaine-Binergia with epinephrine» 1:200000 and imported «Ubistesin forte» 1:100000, are approved for use in the Russian Federation. The novelty of this study lies in the application of drugs from the same group of different manufacturers on the same patient under symmetrical clinical conditions by one specialist at the same level of trauma. No such studies were found in the literature.

Objective. The aim of this study was to compare the effectiveness of domestic and imported analogues of local anaesthetics based on articaine in a single patient. The methodological objective is to assess the depth of anaesthesia, effectiveness, and hemostasis, as well as the patient’s subjective sensations and level of dental anxiety.

Materials and methods. A review of the clinical case allows for the assessment of patients' subjective sensations during sedation with preserved consciousness against the background of taking sedative drugs and central analgesics using the «painno pain» scale. The level of dental anxiety was also determined using the Corah's Dental Anxiety Scale. Sedative drugs were used at doses that did not provide complete anaesthesia in the surgical intervention area, allowing the patient to clearly respond to pain stimuli during local, particularly conductive anaesthesia.

Results. Under conditions of intravenous sedation with preserved consciousness, pain sensations are mitigated when local anaesthesia is ineffective, thereby reducing the patient’s psychological discomfort. The use of «Articaine-Binergia with epinephrine» 1:200000 and «Ubistesin forte» 1:100000 allowed for an objective comparison of their effectiveness and safety.

Conclusions. Stable hemodynamic indicators on the monitors indicate high-quality anaesthesia and the absence of pain sensations; otherwise, the indicators on the monitor would have fluctuated. The data obtained confirm that both articaine-based drugs have similar effectiveness and provide an adequate level of anaesthesia in clinical intervention conditions, reducing the patient's anxiety and discomfort. One clinical case is not definitive; therefore, further research with a larger amount of statistical data is required.

1. Martin E, Nimmo A, Lee A, Jennings E. Articaine in dentistry: an overview of the evidence and me- ta-analysis of the latest randomised controlled trials on articaine safety and efficacy compared to lidocaine for routine dental treatment. BDJ Open. 2021 Jul 17;7(1):27. doi: 10.1038/s41405-021-00082-5. Erratum in: BDJ Open. 2021 Aug 11;7(1):29. doi: 10.1038/s41405-021-00085-2.

2. Karelov AE, Vasilieva GN, Semkichev VA, Dimitrienko AI, Marova NG, Vasilev YI. Articaine using for out-hospital patients with side effects to lidocaine: a pilot study. Russian Journal of Anesthesiology and Reanimatology. 2022;(2):41-46. (In Russ.) https://doi.org/10.17116/anaesthesiology202202141

3. Bessonov SN, Put SA, Skukhtorov VV. Advantages of multimodal anesthesia in the rehabilitation of patients with various types of maxillofacial pathologies. Proceedings of the conference "Modern aspects of complex dental rehabilitation of patients with defects of the maxillofacial region", 2023:17-20 (ISBN): 978-5-903252-54-1..

4. Rabinovich S.A., Vasiliev Yu.L. “Local anesthesia. History and modernity”: textbook. M .: Poli Media Press, 2016. 178 p.

5. O'Halloran M. The use of anaesthetic agents to provide anxiolysis and sedation in dentistry and oral surgery. Australas Med J. 2013 Dec 31;6(12):713-8. doi: 10.4066/AMJ.2013.1836.

6. de Souza Santos S, Bonatto MS, Mendes PGJ, et al. Efficacy of analgesia promoted by lidocaine and articaine in third molar extraction surgery. A splitmouth, randomized, controlled trial. Oral and Maxillofacial Surgery. 2024 Jun;28(2):919-924. DOI: 10.1007/s10006-024-01223-4.