{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T09:03:17Z","timestamp":1792746197941,"version":"4.5.0"},"reference-count":40,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2018,2,21]],"date-time":"2018-02-21T00:00:00Z","timestamp":1519171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int Endodontic J"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    The acidic nature of commercial local anaesthetics (\n                    <jats:styled-content style=\"fixed-case\">LA<\/jats:styled-content>\n                    s) can cause pain during infiltration and delay the onset of anaesthesia. It is suggested that adjusting the\n                    <jats:styled-content style=\"fixed-case\">pH<\/jats:styled-content>\n                    of anaesthetic agents could minimize these effects. This systematic review aimed to evaluate the efficacy of buffered\n                    <jats:styled-content style=\"fixed-case\">LA<\/jats:styled-content>\n                    s in reducing infiltration pain and onset time during dental procedures.\n                    <jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>\n                    , Embase, Scopus and Scielo databases were searched up to April 2017. Randomized controlled trials comparing buffered and unbuffered\n                    <jats:styled-content style=\"fixed-case\">LA<\/jats:styled-content>\n                    s for intraoral injections were included. Risk of bias was assessed using the Cochrane Collaboration tool. Data upon injection pain and onset time were pooled in a random\u2010effects model. Subgroup analyses compared normal and inflamed tissues, and terminal infiltrations and inferior alveolar nerve (\n                    <jats:styled-content style=\"fixed-case\">IAN<\/jats:styled-content>\n                    ) blocks. Meta\u2010regressions were performed to explain heterogeneity. Fourteen articles were included in this review. Lidocaine with epinephrine was the most used anaesthetic combination. Nonlidocaine studies (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a02) were not pooled in the meta\u2010analysis. Buffered lidocaine did not result in less pain during intraoral injections: mean difference \u22126.4 (95%\n                    <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                    \u221212.81 to 0.01) units in a 0\u2013100 scale. Alkalinized lidocaine did not reduce the onset time in normal tissues when terminal infiltration techniques were used, but resulted in a more rapid onset for\n                    <jats:styled-content style=\"fixed-case\">IAN<\/jats:styled-content>\n                    blocks (\u22121.26\u00a0min) and in inflamed tissues (\u22121.37\u00a0min); however, this change may not be clinically relevant, considering the time required to prepare the buffered agent. Studies performed using other anaesthetic salts did not show robust and clinically significant results in favour of alkalinization.\n                  <\/jats:p>","DOI":"10.1111\/iej.12899","type":"journal-article","created":{"date-parts":[[2018,1,29]],"date-time":"2018-01-29T15:56:33Z","timestamp":1517241393000},"page":"862-876","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["The effect of adjusting the\n                    <scp>pH<\/scp>\n                    of local anaesthetics in dentistry: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"51","author":[{"given":"P. V.","family":"Aulestia\u2010Viera","sequence":"first","affiliation":[{"name":"Department of Stomatology School of Dentistry University of S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Braga","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry School of Dentistry University of S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1413-0004","authenticated-orcid":false,"given":"M. A.","family":"Borsatti","sequence":"additional","affiliation":[{"name":"Department of Stomatology School of Dentistry University of S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,2,21]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.33899\/rden.2004.164884","article-title":"Effectiveness of pH adjusted lidocaine versus commercial lidocaine for maxillary infiltration anesthesia","volume":"4","author":"Al\u2010Sultan FA","year":"2004","journal-title":"Al\u2010Rafidain Dental Journal"},{"key":"e_1_2_7_3_1","doi-asserted-by":"crossref","first-page":"71","DOI":"10.33899\/rden.2006.40218","article-title":"A clinical evaluation on the alkalization of local anesthetic solution in periapical surgery","volume":"6","author":"Al\u2010Sultan A","year":"2006","journal-title":"Al\u2010Rafidain Dental Journal"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2017.03.015"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2014.07.039"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2013.07.008"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.02.007"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bdj.4806226"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0304-3959(03)00176-3"},{"key":"e_1_2_7_10_1","first-page":"Cd006581","article-title":"Adjusting the pH of lidocaine for reducing pain on injection","author":"Cepeda MS","year":"2010","journal-title":"The Cochrane Database of Systematic Reviews"},{"key":"e_1_2_7_11_1","first-page":"74","article-title":"Effect of a new local anesthetic buffering device on pain reduction during nerve block injections","volume":"63","author":"Comerci AW","year":"2015","journal-title":"General Dentistry"},{"key":"e_1_2_7_12_1","first-page":"24","article-title":"Pain reduction in local anesthetic administration through pH buffering","volume":"70","author":"Crose VW","year":"1991","journal-title":"Journal of the Indiana Dental Association"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1442-2026.2003.00413.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.4103\/0259-1162.167846"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/229255031202000207"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/AAP.0b013e31819a12a6"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joen.2015.06.017"},{"key":"e_1_2_7_18_1","volume-title":"Cochrane handbook for systematic reviews of interventions version 5.1.0. 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