Comparative analysis of intraperiodontal and intraseptal anaesthesia quality in healthy individuals and patients with diabetes mellitus type 2

Lokalna anestezija u stomatologiji se najčešće postiže standardnim, lokalnim intraoralnim anestezijama kao što su sprovodna i infiltrativna. U izvesnom broju slučajeva, pomenutim anestezijama se ne može obezbediti potpuna bezbolnost. Iz tog razloga, primenom dopunske anestezije, kao što je intraseptalna anestezija (ISA) i intraperiodontalna anestezija (IPA), postiže se adekvatna bezbolnost. Pokazano je da se ove vrste dopunskih anestezija, koje pripadaju intraosealnim anestezijama, mogu koristiti i kao samostalne anestezije. Poseban problem za primenu intraoralnih anestezija, kao i drugih vrsta anestezija, predstavljaju pacijenti sa dijabetes melitusom (DM), zbog postojanja mikrovaskularnih oštećenja krvnih sudova koji ishranjuju nerve i poremećaja u sprovođenju nervnih impulsa. Cilj: Cilj ove doktorske disertacije bio je da se ispitivanjem dozne zavisnosti 0,4, 0,6 i 0,8 ml 4% artikaina sa epinefrinom (1:100,000) (Ar +Ep) odredi efikasna i bezbedna doza ovog anestetika za ISA i IPA primenom kompjuterski kontrolisanog oslobađanja lokalnog anestetika (CCLADS), kako kod zdravih pacijenata, tako i kod pacijenata DM tip 2. Materijal i metod: U ovoj kliničkoj studiji učestvovalo je 204 zdrava ispitanika (ASA I) i 80 pacijenata sa DM tip 2 (ASA II i III). Zdravi ispitanici su bili podeljeni u 2 velike grupe: ISA (104 ispitanika) i IPA (100 ispitanika). Svaka od ove dve grupe bila je podeljena na po tri podgrupe po 30 anesteziranih zuba, u zavisnosti od primenjene količine Ar + Ep, kako u gornjoj, tako i u donjoj vilici. Ispitivani zubi su bili gornji lateralni sekutić i donji prvi premolar, koji su bili indikovani za ekstrakciju. Primenjene pomoću sistema za kompjuterski kontrolisano oslobađanje lokalnog anestetika (Computer-Controlled Local Anaesthetic Delivery System - CCLADS, Anaeject®, Septodont, Francuska), kod zdravih ispitanika, doze Ar + Ep su iznosile: 0,4 ml (16 mg + 4 μg), 0,6 ml (24 mg + 6 μg) i 0,8 ml (32 mg + 8 μg). Pacijenti sa DM tip 2 su bili podeljeni takođe u 2 grupe: ISA (38 pacijenata sa ukupno 60 ispitivanih zuba u obe vilice - 30 ispitivanih zuba u svakoj vilici), i IPA (42 pacijenta sa ukupno 60 ispitivanih zuba u obe vilice - po 30 ispitivanih zuba u svakoj vilici). U okviru ovih grupa primenjena je doza Ar + Ep koja se pokazala klinički efikasnom i bezbednom kod zdravih ispitanika. Uspešnost, latentni period i trajanje anestezije pulpe praćeni su električnim testom stimulacije zubne pulpe (pulp test) (Vitality Scanner Model 2006®, Sybron Endo, SAD)...In dentistry, local anesthesia is usually obtained by standard, local intraoral anesthesia, such as block and infiltration. In some cases, complete painless procedure could not be obtained with previously mentioned anesthesia. Therefore, using additional anaesthesia, such as intraseptal (ISA) and periodontal ligament (IPA), adequate pain control is achieved. It has been shown that these two additional anesthesia, which belong to intraosseal anesthesia, could be used as primary anesthesia. Special problem for intraoral anesthesia, and also for other types of anesthesia, are patients with diabetes mellitus type 2 (DM type 2), because they have microvascular damage of blood vessels which feed nerves and diminish nerve impulse conduction. Aim: The aim of this doctoral dissertation was evaluation of dose dependency among 0,4, 0,6 and 0,8 ml of 4% articaine with 1:100,000 epinephrine (Ar + Ep) for ISA and IPA, achieved by computer - contolled local anesthetic delivery system (CCLADS), and finding effective and safe dose in healthy individuals and patients with DM type 2. Material and method: This clinical study included 204 healthy individuals (ASA I) and 80 patients with DM type 2 (ASA II and ASA III). Healthy individuals were divided in two big groups: ISA (104 individuals) and IPA (100 individuals). These two groups were devided into three subgroups of 30 anesthetized teeth, depending on the used dose of Ar + Ep, in upper and lower jaw. Selected teeth, upper lateral incisor and lower first premolar, were indicated for extraction. Used with Computer – controlled local anesthetic delivery system (CCLADS, Anaeject®, Septodont , France), in healthy individuals, doses of Ar + Ep were: 0,4 ml (16 mg + 4 μg), 0,6 ml (24 mg + 6 μg) i 0,8 ml (32 mg + 8 μg). Patients with DM type 2 were also devided in two groups: ISA (38 patients with 60 tested teeth in both jaws – 30 teeth each jaw), IPA (42 patients with 60 tested teeth – 30 teeth each jaw). Within these groups (DM type 2 patients), the dose of Ar + Ep which had been shown clinically effective and safe in healthy individuals, was used. Success rate, onset and duration of pulpal anesthesia were recorded with the electric pulp tester (pulp test) (Vitality Scanner Model 2006®, Sybron Endo, USA). The width of anesthetic field and soft tissue anesthesia duration were recorded with pinprick test. Cardiovascular (KV) parameters: systolic, diastolic, mean arterial pressure and heart rate, were measured by digital monitor (Wrist Blood Pressure Monitor, Model R3 Intellisense, Prizma, Kragujevac) and monitoring aparatus (Datex-Engstrom AS/3, Helsinki, Finland), before anesthesia, during anesthesia, such as 5, 10 15, and 30 minutes after anesthesi