Clinical efficacy of lignocaine with epinephrine for mini-implant placement in the maxilla

OBJECTIVES: To evaluate the clinical effectiveness of 0.5 ml of 2% lignocaine with 1:200,000 epinephrine when infiltrated in the maxillary posterior buccal segment compared with 20% benzocaine gel applied topically near the site of mini-implant placement.

MATERIALS AND METHODS: Seventeen patients were recruited based on the eligibility criteria namely healthy individuals without allergies and who were not on any medication within the age group of 15-28 years belonging to both genders.
All patients required bilateral buccal mini-implants for orthodontic anchorage in the maxillary posterior region between the maxillary second premolar and maxillary first permanent molar. Each patient received approximately 0.5 gm of topical anaesthetic (20% benzocaine) administered with cotton applicator on one side. The mini-implant was placed after 5 minutes upon administration of the topical anaesthetic. Thirty minutes later 0.5 ml of infiltrative anaesthetic (2% lignocaine with 1:200,000 epinephrine) was injected on the other side in the buccal vestibule near the site of mini-implant placement. The mini-implant was placed after 5 minutes. The two different anaesthetic were alternated between the right and left side for each consecutive patient.
Outcome measure was assessed using a pain rating scale. The pain response was evaluated during drilling (T1), during mini-implant placement (T2), five minutes after mini-implant placement (T3), 10 minutes after placement (T4) and 15 minutes after placement (T5) on both sides.
Descriptive statistics were calculated for pain scores obtained during and after the mini-implant procedure and at different time point namely 5 minutes, 10 minutes and 15 minutes after mini-implant placement. A factorial repeated measures analysis of variance was used to determine any differences.
Pearson’s correlation co-efficient was done to determine the correlation between age and pain score.

RESULTS: The mean age of the patient was 18.93±3.12 years. 20% benzocaine was inadequate to provide sufficient anaesthesia in three patients who had to be excluded from the study. Statistical analysis of the remaining patients in both the groups showed a mean pain score ranging from 2 to 2.71 at T1, T2 and T3 and 1 to 1.36 at T4 and T5 indicating that some pain was encountered irrespective of the type of anaesthetic. Infiltrative anaesthetic was slightly better than the topical anaesthetic, especially at T4 and T5.
Comparison of pain scores did not show any statistical significance between the two anaesthetic at the five different time points (T1, P = 0.85; T2, P = 0.81; T3, P = 1.00; T4, P = 0.28; T5, P = 0.56).
There was no statistically significant correlation between pain response and age or gender.

CONCLUSIONS: Although infiltration of 0.5 ml of 2% lignocaine with 1:200,000 epinephrine is better than topical application of 20% benzocaine, it appears to be inadequate to alleviate pain completely during mini-implant placement. Increasing the volume of infiltrative anaesthetic may be considered.

CLINICAL SIGNIFICANCE: It is preferable to use infiltrative anaesthetic compared to topical anaesthetic for placement of mini-implant in the maxillary posterior buccal segment to minimise pain and reduce patient anxiety during the mini-implant placement procedure.

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