Deutsche zahnarztliche Zeitschrift最新文献

Neurosensory disturbances of the third branch of the trigeminal nerve occur in rare cases without any operative treatment near the nerve involved. The most frequently affected nerve branches are the inferior alveolar nerve and the lingual nerve. We examined the problem of intraneural injection of local-anaesthetic solutions in an experimental study on animals. After intraneural injection of Articain (4%)-solution in the ischiadic nerve of Wistar rats and the lingual nerve of cats no toxic lesions were observed. It can be assumed that neurosensory disturbances caused by intraneural local-anaesthetic injection are the result of intraneural haematomas with consecutive fibrosis.

With the administration of local anaesthetics is to expect in dependence of the vasoconstrictor a different cardiovascular reaction. An addition of epinephrine 0.001% directs a rise of the heart rate and a drop of the diastolic blood pressure; after norepinephrine 0.005% the heart rate shows a decrease and at the same time there is an increase of the systolic and diastolic blood pressure. The alterations caused by exogenous catecholamines are superposed by alterations caused by emotional stress (injection, tooth extraction). The endogenous alterations always take place in the same way.

83 adults undergoing dental surgical procedures in local anesthesia were monitored continuously with a pulse oximeter for hypoxemia. 30 patients received as premedication either a combination of a neuroleptic drug and an opiate or a benzodiazepine. There was a drop in the oxygen saturation in 80% of the patients with premedication but only in 66% of the patients without. There were statistical highly significant more periods of hypoxemia in patients with premedication compared to the others. (1548 periods versus 659 periods p less than 0.001). The kind of premedication/sedation does not influence the number of hypoxic episodes. We conclude that especially patients with premedication should only be treated by surgeons with sufficient clinical experience in coping with emergency situations.

According to the literature vascular lesions are reported in 6% of intraoral conduction anesthesia. A possible consequence is the intraarterial injection of catecholamin added local anesthetic. Due to a long lasting angiospasm necrosis of local mucosae and extraoral skin are possible. In a young female patient extraoral necrosis of parts of the skin of the lower lip and intraoral mucosa appeared, following intraoral conduction anesthesia. Subsequently a scar persisted needing a plastic cicatricotomy. Moreover sensitivity in the area of distribution of the mental nerve was deranged.

Gutta-percha points often crack off when inserted in small and curved root canals before they have reached the full length of the canal. The goal of this investigation was to determine the relative rigidity of standardized gutta-percha points from different producers. It seems that not only significant differences between gutta-percha points of various producers, but also distinct variations between gutta-percha points from the same producer were detected. Several reasons for the differing rigidity of gutta-percha points are discussed.

The results of this study of the behavior of anesthetics following ionic application showed great differences in terms of depth and duration of action. This is obviously attributable to different molecular structures resulting in variable rates of transport within the tissues.

Aim of this study was to show the time course of plasma concentrations of 2% lignocaine with adrenalin at a concentration of 1:100,000. Four retinated third molars were removed in one session in 23 patients. For local anaesthesia in each patient we used 10 ml of Xylocaine 2% (Astra), which is commonly used in dentistry. The plasma-concentration was measured for the first 30 minutes after injection of the local anaesthetic using high pressure liquid chromatography (HPLC). Our results suggest that partially intravascular injection could not be avoided although careful aspiration was carried out before injecting. Neither subjective nor objective adverse central nervous effects were seen in our patients. Nevertheless we consider a peripheral intravenous cannula and ECG-monitoring strongly recommended in all major operations under local anaesthesia.

The aim of the study was to explore retrospectively the risks of ambulatory treatment under local anaesthesia during dental operations of elderly patients. Anaesthetic care was divided into control and therapeutical measures. Among the previous disorders the hypertension and its sequelae proved to be the main risk factors. The need of anaesthetic intervention doubled, when the time of operation exceeded 30 min. Due to good interdisciplinary cooperation, 99.3% of the operations took their proper course.

In a field study, the reduction in the anaesthetic effectiveness of Articain was investigated in relation to various influencing parameters. Both in the ZMK-Klinik (Dental Hospital) of Würzburg as well an in various independent practices, the local anaesthetic Articain was given to over 2000 patients in the course of dental treatment. With 12.1% of all test-subjects, inspite of the initial positive effectiveness upon application of the nerve-blocking anaesthetic, touch sensitivity and/or painfulness was established in the area concerned. Statistical evaluations of the recorded data of the test-subjects investigated showed a significantly higher quota of anaesthetic failure in the case of heavy cigarette consumption, chronic exposure to inhaled toxins as well as in the case of the intake of medicines of certain pharmaceutical types. Apart from that, a connection was also established between reduction in the effectiveness of the local anaesthetic and various treatments as well as the way in which the local anaesthetic was applied and the site of injection. Possible causes will be presented and discussed in relation to information from the literature on the subject.

Failure of local anesthetics is a common problem in dentistry. A sample of 210 dental practitioners was chosen at random and asked to evaluate the significance of anesthesia failure, comparing different injecting techniques. A standardized questionnaire, including a visual analogue scale for quantitative data, was distributed among the participants. The frequency of failure was indicated by most of the participants at 2% to 5% total. Considerably higher assessments were apparent in endodontics and abscess incisions. Rates of failure were said to be low in infraorbital nerve block, average in infiltration anesthesia and high in mandibular nerve block. These preliminary results indicate that a reliable anesthetic in dental treatment cannot always be provided.