Avetikov D. S., Lokes K. P., Bilash S. M., Pronina O. M., Steblovskyi D. V.

DENTISTRY

Scentific article

The using of modern anesthetics allows avoiding a lot of complications during and after anesthesia, but there are still a number of questions that depend on the use of a specific anesthetic. First of all, it is the effect of the anesthetic on the processes of microcirculation in the dental pulp, blood pressure, heart rate, quality and duration of anesthesia. Researches by several authors have shown that not all anesthetics of the amide group meet the requirements given above. One of them, which is successfully used at the modern level, is Ubistesin, the use of which and its effect on the above parameters became the subject of our research.The purpose of this study was to determine the changes in the pulp microcirculation and evaluate the quality of anesthesia of the molars and premolars pulp of the lower jaw after the introduction of a 4% solution of Ubistesin during dental treatment of adolescent children. 30 adolescents (15 boys and 15 girls) aged 14-16 years with a diagnosis of medium and deep caries of molars and premolars of the mandible were included in the study. Preparation of the carious cavity in all patients was performed under mandibular anesthesia to exclude the inferior alveolar and lingual nerves. The technique of pulp rheoplethysmography was used: according to the MP protocol, mandibular molars and premolars were measured before the injection as initial baseline data. Sensitivity was measured by electro-odontography before the injection of Ubistesin, 1, 2, 5, 7, 10 minutes after the injection and after that at 5-minute intervals until the sensitivity of the tooth returned to the initial data with simultaneous measurement of pressure and heart rate. It was found that after the introduction of Ubistesin, the MP in the molars slightly increased from 4.52±0.68 perfusion minutes (PM) before the injection to 4.95±0.37 PM 5 after the injection. In the mandibular first molars of all subjects, no significant changes in microcirculation were recorded during the first 20 minutes after injection (P=0.062). Molar blood flow reached its highest digital value of 8.14±2.27 PM at 40 minutes after injection and decreased to baseline. In premolars, this indicator decreased from 5.16±3.63 PM before injection to 4.06±2.34 PM 10 minutes after injection in each child. Complete pulpal anesthesia was successfully achieved in both mandibular first molars and premolars after Ubistesin administration. At 15- to 35-minute intervals, all patients had complete pulpal anesthesia of both mandibular molars and premolars (mean EPT score = 72). The average time of onset of pulp anesthesia in molars was 7.94±1.86 min. The average duration of pulp anesthesia in molars was 85.92±39.14 min. In premolars, the average time of onset of pulp anesthesia was 8.11±1.56 min., and the average duration of pulp anesthesia was 83.17±42.70 min. It is noteworthy that our study confirmed the minimal effect of Ubistesin injection on changes in blood pressure and heart rate in adolescent children due to the low dose of adrenaline in the solution of this anesthetic. Thus, this technique of anesthesia can be considered safe for anesthesia of the teeth of the lower jaw.

mandibular anesthesia,rheoplethysmography,mandible,microcirculation,Ubistesin.

1. Kim C, Hwang KG, Park CJ. Local anesthesia for mandibular third molar extraction. J Dent Anesth Pain Med. 2018 Oct;18(5):287-294. 
2. Naidu S, Loughlin P, Coldwell SE, Noonan CJ, Milgrom P. A randomized controlled trial comparing mandibular local anesthesia techniques in children receiving nitrous oxide-oxygen sedation. Anesth Prog. 2004;51(1):19-23. 
3. Yu F, Xiao Y, Liu H, Wu F, Lou F, Chen D, et al. Evaluation of Three Block Anesthesia Methods for Pain Management During Mandibular Third Molar Extraction: A Meta-analysis. Sci Rep. 2017;7:40987.
4. Shukla RH, Tiku A. Correlation of Mandibular Foramen to Occlusal Plane as a Clinical Guide for Inferior Alveolar Nerve Block in Children: A Digital Panoramic Radiographic Study. Contemp Clin Dent. 2018;9(3):372-375.
5. Kiani M, Pankevych AI, Lokes KP, Skikevich M. Circumstance for removal of impacted mandibular second and third molars teeth. Visnyk problem biolohiyi i medytsyny. 2016;1(4):360-365.
6. Chenchugopal M, Mungara J, Venumbaka NR, Elangovan A, Vijayakumar P, Rajendran S. In vivo Evaluation of 4% Articaine and 2% Lignocaine Intraligamentary Injection Administered with Single Tooth Anesthesia-Wand. Contemp Clin Dent. 2017 Apr-Jun;8(2):315-320.
7. Gupte SH, Kalra RD, Dcruz TM, Kamble S, Patnaik RS. Comparative Evaluation of Effectiveness of 2% Lignocaine Hydrochloride with Clonidine Hydrochloride versus 2% Lignocaine Hydrochloride with Adrenaline Bitartrate as Local Anesthetic for Adult Patients Undergoing Surgical Extraction of Impacted Mandibular Third Molars: A Randomized Controlled Clinical Study. Contemp Clin Dent. 2021 JulSep;12(3):308-312. 
8. Yanko N, Khmil O, Kaskova L, Vashchenko I. Advanced endodontic developments in pulpectomy of primary teeth. Wiadomosci lekarskie (Warsaw, Poland:1960). 2016;69(2):223-227.
9. Pronina OМ, Koptev MM, Bilash SМ, Yeroshenko GA. Response of hemomicrocirculatory bed of internal organs on various external factors exposure based on the morphological research data. Svit medytsyny ta biolohiyi. 2018;1(63):153-7. DOI: 10.26.724/2079-8334-2018-1- 63-153-157.
10. Karm MH, Park FD, Kang M, Kim HJ, Kang JW, Kim S, et al. Comparison of the efficacy and safety of 2% lidocaine HCl with different epinephrine concentration for local anesthesia in participants undergoing surgical extraction of impacted mandibular third molars. Medicine (Baltimore). 2017 May;96(21):e6753. 
11. Samdrup T, Kijsamanmith K, Vongsavan K, Rirattanapong P, Vongsavan N. The effect of inferior alveolar nerve block anesthesia of 4% articaine and epinephrine 1:100,000 on blood flow and anesthesia of human mandibular teeth. J Dent Sci. 2021 Jan;16(1):249-255.
12. Boychenko OM, Moshelʹ TM, Popovych IYU. Hrupy ryzyku patsiyentiv na stomatolohichnomu pryyomi z obtyazhenym alerholohichnym anamnezom. Problemy bezperervnoyi medychnoyi osvity ta nauky. 2021;1(41):59-62. [in Ukrainian].

«Bulletin of problems biology and medicine» Issue 4 (167), 2022 year, 334-339 pages, index UDK 616.314.18:615.212-053.2

10.29254/2077-4214-2022-4-167-334-339