Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
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Aug 2018

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"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : ZC23 - ZC26 Full Version

Comparison of Efficacy and Patient Response between 2% Lidocaine and 4% Articaine during Routine Dental Extractions

Published: March 1, 2022 | DOI:
Saba Nasreen, Shubham Kumar, Ritesh Vatsa, Kumar Pushpanshu, Mukesh Kumar, Devleena Bhowmick

1. Senior Resident, Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. 2. Senior Resident, Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. 3. Assistant Professor, Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. 4. Associate Professor, Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. 5. Assistant Professor, Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. 6. Senior Lecturer, Department of Oral Medicine and Radiology, PDM Dental College and Research Institute, Jhajjar, Haryana, India.

Correspondence Address :
Dr. Shubham Kumar,
Senior Resident, Department of Dentistry, Sri Krishna Medical College and Hospital,
Muzaffarpur, Bihar, India.


Introduction:Local Anaesthetic (LA) agents are chemicals that reversibly block the transmission of action potential of nerve membrane. Lidocaine has established itself as the gold-standard owing to its excellent clinical properties with minimal side effects. Articaine, a relatively newer LA agent is reported to have better clinical properties than lidocaine.

Aim: To compare and evaluate the differences in total volume of LA agent used, onset of subjective symptoms and objective signs, total duration of anaesthesia achieved and postoperative pain assessment with 2% lidocaine and 4% articaine during routine dental extractions.

Materials and Methods: This randomised clinical study was conducted by the Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, from October 2020 to February 2021. A total of 200 patients (107 females and 93 males) requiring mandibular molar extraction were included in the study. The patients were randomly divided into two study groups. Group-I patients were administered with 2% lidocaine while group-II patients were administered with 4% articaine. Complete demographic and clinical details of all the patients were recorded. The volume of LA agent used, onset time for subjective symptoms and objective signs and total duration of anaesthesia was recorded. Postoperative pain was recorded on Visual Analogue Scale (VAS) on a scale of 0 to 10. All the variables were recorded in Microsoft excel sheet and were analysed by Statistical Package for the Social Sciences (SPSS) version 21 software. A two-tailed p-value less than 0.05 (p<0.05) was considered statistically significant.

Results: A total of 200 patients participated in the study, where group-I patients (49 males and 51 females) had a mean age of 34.79±10.43 years and group-II patients (44 males and 56 females) had a mean age of 35.41±11.39 years. Statistically insignificant differences (p>0.05) were obtained for the following parametersvolume of LA agent used, onset time of subjective symptoms, onset time of objective signs and postoperative VAS scores. A statistically significant difference (p<0.05) was observed for total duration of anaesthesia.

Conclusion: Both 2% lignocaine and 4% articaine are equally effective LA agents in patients undergoing mandibular molar extractions. However, 2% articaine exhibited significantly higher duration of total anaethesia when compared to 2% lidocaine.


Inferior alveolar nerve block, Local anaesthetic agents, Mandibular first molar extraction, Visual analogue scale

Local anaesthesia has been defined as a loss in sensation in a circumscribed area of the body caused by depression of excitation in nerve endings or inhibition of the conduction process in peripheral nerves (1). Lidocaine (lignocaine) was the first amide linked LA agent synthesised in 1943 and has extensively been evaluated and documented for its effectiveness and safety profile. It is the most widely used LA agent and is considered as the gold standard. It is available as plain or in combination of varying concentration of vasoconstrictors that offers many clinical advantages (2),(3).

Another amide linked LA agent, articaine was first synthesised in 1969 and is being used worldwide safely with well documented studies (2),(4),(5). The molecular structure of articaine has a linked ester group, which facilitates its metabolism by plasma estrases as well as liver microsomal enzymes. Though, classified as short acting LA, it offers prolonged anaesthetic duration only to be surpassed by ultra-long acting agent such as bupivacaine (5). It is also reported to have superior diffusability through hard tissues (6). Though, many studies have been carried out in the past to compare both the LA agents, there is scant number of published data available for the local population of Bihar (4),(5). Therefore, the present study was designed to assess the efficacy and patient response to these two LA agents in patients undergoing routine dental extraction procedures.

Material and Methods

This randomised clinical study was conducted at Department of Dentistry, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India, from October 2020 to March 2021 in accordance with revised Helsinki Declaration of 1975 after obtaining approval from the Institutional Ethical Committee vide letter number 25/20 (IEC, SKMCH).

Sample size calculation: The formula used to calculate the sample size required for this study at 95% confidence interval and 80% power of study was: n=2(Zα/2+Zβ)2 * σ2/d2 where, Zα/2=1.96 for a confidence level (α) of 95%, Zβ=0.84 for power of 80%, σ=standard deviation and d=size of the effect clinically worthwhile to detect (7). Using the above formula, a sample size of 96 patients per group was calculated and it was increased to nearest 100 to include 200 patients in the study (Table/Fig 1).

Inclusion criteria: Systemically healthy patients aged 18-60 years without any co-morbidity who needed extraction of carious mandibular molars were included in the study.

Exclusion criteria: Individuals with grossly decayed teeth, teeth with periodontal problems/bone loss, presence of periapical pathology/sinus opening, impacted teeth and root stumps were excluded from the study.

A total of 200 such patients (107 females and 93 males) were selected from the outpatient pool and were randomly divided into two groups with 100 patients in each group:

Group-I: 100 patients underwent dental extraction under 2% lidocaine (Lignospan™, 2% lidocaine hydrochloride and epinephrine 1:1,00,000, Septodont, Canada)

Group-II: 100 patients underwent dental extraction under 4% Articaine (Septanest™, 4% articaine hydrochloride and epinephrine 1:1,00,000, Septodont, France)

Study Procedure

In this single blinded study, complete demographic profile and clinical details of all the patients were recorded. Local anaesthesia was achieved by Inferior Alveolar Nerve Block (IANB), Lingual Nerve Block and Long Buccal Nerve Block by a single operator. The mean duration of onset of subjective symptoms and objective signs were recorded and the mean amount of anaesthetic solution used was recorded. After the onset of objective signs, the tooth was extracted using least traumatic approach by a single operator. Postoperative instructions were explained to the patients and five days medication (amoxicillin 500 mg TDS and aceclofenac 100 mg BD) was prescribed.

Pain was recorded on VAS on a scale of 0 to 10 with 0 indicating no pain and 10 indicating worse pain after the completion of procedure (6). The patients were made to wait in the waiting area for postoperative follow-up and to access the duration of action of each LA agent.

Statistical Analysis

All the results were recorded in Microsoft Excel Sheet and were analysed by Statistical Package for the Social Sciences (SPSS) version 21 (IBM Corp., Chicago, Illinois, USA). Student t-test was used for evaluation of level of significance. A two-tailed p-value less than 0.05 (p<0.05) was considered statistically significant.


The comparative demographic characteristics (age and sex) for both the groups has been summarised in (Table/Fig 2). The mean age of the group-I patients was 34.79±10.43 years while that for group-II patients was 35.41±11.39 years. The onset of subjective symptoms in group-I and group-II patients was found to be 85.07±16.84 seconds and 83.76±13.79 seconds respectively while that for objective signs was found to be 180.84±14.57 seconds and 182.22±14.53 seconds, respectively. Intergroup comparison for these parameters yielded non-significant results p=0.54 and p=0.50, respectively as shown in (Table/Fig 3).

The average duration of anaesthesia for group-I and group-II patients came around 191.46±6.88 minutes and 194.70±9.16 minutes respectively which was significantly higher (p=0.0052) for group-II patients (Table/Fig 3). The average amount of LA agent used for both the groups was 2.21±0.41 mL for group-I and 2.14±0.38 mL for group-II patients. Statistically insignificant (p>0.05) difference was evidenced in the mean amount of anaesthetic solution used for both the groups (Table/Fig 3).

The mean postoperative VAS for group-I patients was 2.59±1.33 while that for group-II patients was 2.42±1.28. Non-significant (p>0.05) differences were obtained while comparing the mean VAS for both the study groups (Table/Fig 4).


Establishment of good LA effect is one of the important prerequisite before carrying out any invasive dental procedure. For a mandibular molar extraction, IANB technique is used with a suitable anaesthetic agent. However, the possibility of failure of IANB even with experienced operators ranges from 31-41% for mandibular first and second molars (8). In general, surgical anaesthesia requires the use of higher concentrations and doses. When a less intense block is demanded, the use of a lower concentration is intimated. The volume and concentration of the drug used for anaesthetic effect will affect the spread and extent of anaesthesia (6),(9),(10). The present study was undertaken to measure the efficacy of two different LA solutions and patient’s response in persons undergoing mandibular molar extraction procedures.

The present study reported a mean onset time of subjective symptoms in group-I (lidocaine 2%) and group-II (articaine 4%) patients to be 85.07±16.84 seconds and 83.76±13.79 seconds, respectively, while the objective signs were elicited by 180.84±14.57 seconds and 182.22±14.53 seconds, respectively. Another split-mouth study reported onset of subjective symptoms at 1.40 minutes and 1.35 minutes and objective signs after 2.15 minutes and 2.12 minutes for 2% lidocaine and 4% articaine groups, respectively (11).

The duration of anaesthetic effect is directly proportional to the degree of protein binding of the LA agent. It is also determined by the accuracy of nerve block technique and the concentration of vasoconstrictor present (11). The mean duration of anaesthesia achieved in the 2% lidocaine group and 4% articaine group was recorded to be 191.46±6.88 minutes and 194.70±9.16 minutes, respectively with significantly higher duration of action for articaine group. Boonsiriseth K et al., reported a mean duration of 258.82 minutes and 287.55 minutes for 4% lidocaine and 4% articaine (12), where the statistical differences between the study groups were insignificant. Other studies however claimed significantly longer duration of anaesthesia with 4% articaine as compared to 2% lidocaine (13),(14), which is in accordance to the findings of the present study. This could be attributed to the fact that articaine is concentrated by 100 times on the alveolus compared to systemic circulation; thereby offering prolonged duration of anaesthesia (5).

In the present study, the mean amount of LA used for lidocaine group and articaine group was 2.21±0.41 mL and 2.14±0.38 mL, respectively. Though, the amount of articaine used was less compared to lignocaine, it was statistically insignificant. Similarly, in the study by Kambalimath DH et al., the mean amount of LA used for IANB was 1.86 mL and 1.73 mL for lignocaine and articaine with statistically insignificant difference (11). In the present study, apart from IANB, lingual and long buccal nerve blocks were also administered.

Pain has been defined as an unpleasant emotional experience usually incited by a noxious stimulus and transmitted over a specialised neural network to the central nervous system where it is interpreted as such (15). The present study reported a mean postoperative VAS score of 2.59±1.33 and 2.42±1.28 in lidocaine group and articaine group respectively with statistically insignificant differences. While Jain NK et al., reported significantly lower postoperative VAS for articaine group compared to lidocaine group for impacted mandibular 3rd molars (13), Kambalimath DH et al., reported non significant differences in VAS for both the groups following IANB (11). Ghazalgoo A et al., reported significantly lesser postoperative pain in articaine group compared to lignocaine group after endodontic treatment of mandibular 1st molars at 4 hours, 6 hours, 12 hours and 18 hours (16). Tortamano IP et al., reported a greater degree of pain absence during pulpectomy of mandibular posterior teeth with articaine compared to lidocaine (17). Zhang A et al., in a meta-analysis reported insignificant difference in intraoperative pain between the two groups (14).

Various researchers who compared the efficacy of 2% lidocaine/lignocaine with 4% articaine for extraction of teeth using nerve block or infiltration technique eventually concluded that articaine might provide faster onset and increased duration of anaesthesia, however no significant differences in patient’s pain score was present between the group (Table/Fig 5) (12),(13),(18),(19),(20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30).

Though, lidocaine has a well established safety profile documented over years, articaine on the other has few concerns pertaining to development of Methemoglobinemia, neuropathy, paresthesia and allergic reactions (11). Malamed SF et al., reported incidence of 22% and 20% adverse events in articaine group and lignocaine group and concluded that articaine is safe and effective LA agent for use in clinical dentistry (31). In the present study, none of the patients reported any incidence of adverse events for both the groups.


The limitations of the present study include only the use of mandibular nerve block technique in adult patients. The study could have been more insightful if it were used in split-mouth design. Also, the effects of both anaesthetic agents were not evaluated for the maxillary nerve blocks.


Within the limits of the present study, no significant differences were evident for both the study groups with respect to the total amount of anaesthetic agent used, onset of subjective symptoms and objective signs in the existing patient pool. However, 4% articaine exhibited significantly higher duration of total anaesthesia when compared to 2% lidocaine. No adverse events were reported for both the groups. The authors concluded that both 2% lignocaine and 4% articaine anaesthetic solutions are equally effective in clinical dental practice.


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DOI and Others

DOI: 10.7860/JCDR/2022/48796.16128

Date of Submission: Jan 31, 2021
Date of Peer Review: Mar 24, 2021
Date of Acceptance: Jan 24, 2022
Date of Publishing: Mar 01, 2022

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Feb 02, 2021
• Manual Googling: Jan 11, 2022
• iThenticate Software: Feb 03, 2022 (16%)

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