Exploring the potential differences local anesthesia in dental treatment by pharmacokinetic approaches

Abstract

Objective: Mastering the characteristics of local anesthetic techniques is essential for dentists to make appropriate anesthetic protocols. Different from the supraperiosteal infiltration anesthesia, periodontal ligament anesthesia appears to provide faster onset and shorter duration, and has the potential to be the first-choice for supplemental anesthesia according to clinical observations. However, there has been few fundamental scientific data to support it. Here, we aimed to explore the differences between periodontal ligament and supraperiosteal infiltration anesthesia in view of pharmacokinetics. Materials and Methods: A total of 10 participants were sequentially administered 0.3ml of 4% articaine with 1:100,000 epinephrine by periodontal ligament, supraperiosteal and intravenous injection in 3 cohorts, with a wash-out period of 1 week. Serial blood samples were collected for pharmacokinetic evaluation. Meanwhile, we initially explored the anesthesia effect and safety for these local anesthesia approaches. Results: The pharmacokinetic parameters of articaine by periodontal ligament and supraperiosteal injection were as follows: AUC_0-t (55.5 and 67.3 h·ng/mL), C_max (192.6 and 142.5ng/mL), t_1/2 (26.8 and 28.5 min) and CL/F (254.3 and 161.6 L/h). There was no significant statistical difference in these pharmacokinetic parameters except for T_max (1.0 vs 10.0 min), which may be closely related to the onset of action. The bioavailability obtained by intravenous injection as reference were 55.7% and 66.9% respectively. Conclusions: Our study may explain that periodontal ligament anesthesia had faster onset than supraperiosteal infiltration anesthesia in view of pharmacokinetics, and provided initial evidence that periodontal ligament anesthesia could be the first-choice for supplemental anesthesia. Clinical Relevance: This study provided the novel approach to explore the local anesthetic effect from the pharmacokinetic characteristics of systemic circulation. Based on our results, the dentists would benefit from the perception of the difference between periodontal ligament and supraperiosteal infiltration anesthesia, as this information might capture important scientific information when managing the dental anesthesia technique. Additionally, periodontal ligament anesthesia presented a faster onset of action than supraperiosteal infiltration anesthesia, which would be the first choice for supplemental anesthesia.