EVALUATION OF THE CLINICAL EFFICACY OF 3% MEPIVACAINE FOR CONDUCTION ANESTHESIA IN HIGH-RISK PATIENTS

Background. Adequate anesthesia in dentistry remains an unresolved clinical challenge, particularly in the anterior and mandibular premolar areas. Current standard techniques do not always account for the variability of the mental foramen anatomy and the intraosseous course of the nerve. Objective: To compare the clinical efficacy of a personalized anesthesia method using the intraosseous portion of the mental nerve and standard mental anesthesia according to S. Malamed in patients of different age and gender groups. Materials and Methods: A prospective, randomized study included 450 patients (18–70 years old) with contraindications to vasoconstrictors. The anesthetic used was 3% mepivacaine without vasoconstrictor (Scandinibsa, Spain), which was used in all cases due to contraindications to vasopressors in all included patients. The onset of local anesthesia and its distribution were determined. Statistical analysis was performed using descriptive statistics (M ±m) and the Student's t-test (t). Differences were considered significant at t ≥ 2, corresponding to p ≥ 0.95. Calculations were performed in Microsoft Office (Excel 2019). Results. The personalized technique using 3% mepivacaine provided clinically significant anesthesia 5–10 seconds earlier and with a larger coverage area (including the lingual surface) compared to the standard technique in high-risk patients. The differences are statistically significant (p < 0.05). The use of 3% mepivacaine provided a slightly faster onset of anesthesia in subgroup B compared to subgroup A (255–280 s versus 260–285 s, respectively), with an increase in time from group I to group III and from diagnosis K04.1 to K04.5. A positive aspiration test was recorded when performing classical mental anesthesia, mainly in young patients.