• Myong-Hwan Karm, Fiona Daye Park, Moonkyu Kang, Hyun Jeong Kim, Jeong Wan Kang, Seungoh Kim, Yong-Deok Kim, Cheul-Hong Kim, Kwang-Suk Seo, Kyung-Hwan Kwon, Chul-Hwan Kim, Jung-Woo Lee, Sung-Woon Hong, Mi Hyoung Lim, Seung Kwan Nam, and Jae Min Cho.
• aDepartment of Dental Anesthesiology bDepartment of Dental Anesthesiology and Dental Research Institute, Seoul National University School of Dentistry cDepartment of Oral & Maxillofacial Surgery, Yonsei University College of Dentistry, Seoul dDepartment of Dental Anesthesiology, Dankook University College of Dentistry, Dankook University, Cheonan-si, Chungnam eDepartment of Oral and Maxillofacial Surgery, School of Dentistry, Pusan National University and Institute of Translational Dental Sciences, Pusan National University fDepartment of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University and Dental Research Institute, Pusan National University Dental Hospital, Yangsan, Gyeongnam gCollege of Dentistry, Wonkwang University, Iksan city, Jeonbuk hDepartment of Oral and Maxillofacial Surgery, Dankook University College of Dentistry, Dankook University, Cheonan-si, Chungnam iDepartment of Oral & Maxillofacial Surgery, Kyung Hee University Dental Hospital Kyung Hee University School of Dentistry, Seoul jR&D Center, Huons Co. Ltd., College of Pharmacy, Hanyang University, Ansan-si, Kyeonggi-do, Republic of Korea.
• Medicine (Baltimore). 2017 May 1; 96 (21): e6753.

BackgroundThe most commonly impacted tooth is the third molar. An impacted third molar can ultimately cause acute pain, infection, tumors, cysts, caries, periodontal disease, and loss of adjacent teeth. Local anesthesia is employed for removing the third molar. This study aimed to evaluate the efficacy and safety of 2% lidocaine with 1:80,000 or 1:200,000 epinephrine for surgical extraction of bilateral impacted mandibular third molars.MethodsSixty-five healthy participants underwent surgical extraction of bilateral impacted mandibular third molars in 2 separate visits while under local anesthesia with 2% lidocaine with different epinephrine concentration (1:80,000 or 1:200,000) in a double-blind, randomized, crossover trial. Visual analog scale pain scores obtained immediately after surgical extraction were primarily evaluated for the 2 groups receiving different epinephrine concentrations. Visual analog scale pain scores were obtained 2, 4, and 6 hours after administering an anesthetic. Onset and duration of analgesia, onset of pain, intraoperative bleeding, operator's and participant's overall satisfaction, drug dosage, and hemodynamic parameters were evaluated for the 2 groups.ResultsThere were no statistically significant differences between the 2 groups in any measurements except hemodynamic factors (P >.05). Changes in systolic blood pressure and heart rate following anesthetic administration were significantly greater in the group receiving 1:80,000 epinephrine than in that receiving 1:200,000 epinephrine (P ≤.01).ConclusionThe difference in epinephrine concentration between 1:80,000 and 1:200,000 in 2% lidocaine liquid does not affect the medical efficacy of the anesthetic. Furthermore, 2% lidocaine with 1:200,000 epinephrine has better safety with regard to hemodynamic parameters than 2% lidocaine with 1:80,000 epinephrine. Therefore, we suggest using 2% lidocaine with 1:200,000 epinephrine rather than 2% lidocaine with 1:80,000 epinephrine for surgical extraction of impacted mandibular third molars in hemodynamically unstable patients.

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