***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Clinical effectiveness of the double-blind administration of 1 and 2 % lidocaine solutions was evaluated for restorative and surgical procedures on primary molars of children 4.5 to 10.5 years old . This effectiveness was measured by changes in the child 's heart rate , the child 's self report of pain , and the operator 's assessment of the anesthesia 's effectiveness . Although the incidence of anesthetic failure was higher for the 1 % solution ( 31.3 % ) than for the 2 % solution ( 11.1 % ) , no statistically significant difference between the solutions was found . During the performance of pulpotomies and extraction s , a higher failure rate was recorded for the 1 % solution ( 62.5 % ) than for the 2 % solution ( 28.6 % ) , but these differences were not statistically significant . For minor restorative procedures , the 1 % solution was equally successful in achieving anesthesia . The results suggested that 1 % lidocaine should be used when multiple minor procedures are performed and potential toxicity in the young dental patient is a concern In the GRADE approach , r and omized trials start as high- quality evidence and observational studies as low- quality evidence , but both can be rated down if most of the relevant evidence comes from studies that suffer from a high risk of bias . Well-established limitations of r and omized trials include failure to conceal allocation , failure to blind , loss to follow-up , and failure to appropriately consider the intention-to-treat principle . More recently recognized limitations include stopping early for apparent benefit and selective reporting of outcomes according to the results . Key limitations of observational studies include use of inappropriate controls and failure to adequately adjust for prognostic imbalance . Risk of bias may vary across outcomes ( e.g. , loss to follow-up may be far less for all-cause mortality than for quality of life ) , a consideration that many systematic review s ignore . In deciding whether to rate down for risk of bias -- whether for r and omized trials or observational studies -- authors should not take an approach that averages across studies . Rather , for any individual outcome , when there are some studies with a high risk , and some with a low risk of bias , they should consider including only the studies with a lower risk of bias OBJECTIVES The purpose of the study was to compare children 's reactions to  inferior alveolar nerve injection with traditional syringe and periodontal ligament injection with a computerized device ( W and ) ; and to assess the efficacy of the anesthesia and their reaction after treatment . METHOD AND MATERIAL S Twenty-five children , aged 6 to 10 years , participated in the study . The contralateral primary m and ibular second molars were treated in 2 separate visits with r and om use of either the W and or traditional syringe injection . The pain perception levels for each step were assessed with El and Color Scale during the preparation . A Mann-Whitney U test was performed to compare the results . The patients were asked their preference of technique after the treatment . RESULTS When pain was measured immediately after injection , the traditional syringe was found to be more painful than injections with the W and ( P < .05 ) . Pain scores with the W and injections were found to be significantly ( P < .05 ) higher than those with traditional inferior alveolar nerve injections at the end of the restoration . The overwhelming majority of patients favored the periodontal ligament injection with the W and . CONCLUSION The W and technique provided significantly lower pain scores during the periodontal ligament injection . However , the pain scores during the treatment were significantly higher compared with the inferior alveolar nerve injections . Most of the patients stated that they preferred the periodontal ligament injection with the W and to the traditional inferior alveolar nerve injection PURPOSE Three identical single-dose , r and omized , double-blind , parallel-group , active-controlled multicenter studies were conducted to compare the safety and efficacy of articaine HCl ( 4 % with epinephrine 1:100,000 ) to that of lidocaine HCl ( 2 % with epinephrine 1:100,000 ) in patients aged 4 years to 79 years , with subgroup analysis on subjects 4 to < 13 years . METHODS Fifty subjects under the age of 13 years were treated in the articaine group and 20 subjects under the age of 13 were treated with lidocaine . Subjects were r and omized in a 2:1 ratio to receive articaine or lidocaine .  Efficacy was determined on a gross scale immediately following the procedure by having both the subject and investigator rate the pain experienced by the subject during the procedure using a visual analog scale ( VAS ) . Safety was evaluated by measuring vital signs before and after administration of anesthetic ( 1 and 5 minutes post-medication and at the end of the procedure ) and by assessing adverse events throughout the study . Adverse events were elicited during telephone follow-up at 24 hours and 7 days after the procedure . RESULTS Pediatric patients received equal volumes , but higher mg/kg doses , of articaine than lidocaine during both simple and complex dental procedures . Pain ratings : Articaine : VAS ( Visual Analogue Scale ) scores ( from 0 to 10 cm ) by patients 4 to < 13 years of age were 0.5 for simple procedures and 1.1 for complex procedures , and average investigator scores were 0.4 and 0.6 for simple and complex procedures , respectively . Lidocaine : patients 0.7 ( simple ) and 2.3 ( complex ) ; investigators 0.3 ( simple ) and 2.8 ( complex ) . Adverse events : No serious adverse events related to the articaine occurred . The only adverse event considered related to articaine was accidental lip injury in one patient . CONCLUSIONS VAS scores indicate that articaine is an effective local anesthetic in children and that articaine is as effective as lidocaine when measured on this gross scale . Articaine 4 % with epinephrine 1:100,000 is a safe and effective local anesthetic for use in pediatric dentistry . Time to onset and duration of anesthesia are appropriate for clinical use and are comparable to those observed for other commercially available local anesthetics BACKGROUND Lidocaine is the gold st and ard anaesthetic solution that has been used since its inception into dentistry till date . Around 80 % of failures have been reported when lignocaine has been used for inferior alveolar nerve block in children and adults with irreversible pulpitis . There is a need to use newer drugs which are available which have been reported to be effective like lignocaine , such as articaine . Although articaine has been used in adults , literature supporting its use in children is sparse . AIM The purpose of this study is to compare the anaesthetic efficacy of 4 % articaine buccal infiltration and 2 % lignocaine inferior alveolar nerve block in children with irreversible pulpitis . It also aims to assess the need for supplemental intrapulpal injections . MATERIAL S AND METHODS This study was design ed as a r and omized double-blind cross over trial comparing the anaesthetic effectiveness of 4 % articaine with 1:100,000 epinephrine in buccal infiltration and 2 % lignocaine IAN block anaesthesia . The study subject and the pediatric dentist performing the pulpectomy procedures were blinded to the study . A sample size of 40 subjects in the age group of 5 - 8 y was included in the study . RESULTS The onset of anaesthesia with 4 % articaine was faster as compared to 2 % lignocaine . The duration of anaesthesia with articaine infiltration was shorter . The need for supplemental injection in the articaine group was less . CONCLUSION Four percent articaine infiltration can be used in children with irreversible pulpitis . It can be used to replace the IAN block in children thereby reducing the post anaesthetic complications like lip biting BACKGROUND The authors compared the safety and efficacy of 4 percent articaine with epinephrine 1:100,000 with 2 percent lidocaine with epinephrine 1:100,000 . METHODS In three identical r and omized , double-blind , multicenter trials , subjects 4 to 80 years of age received either 4 percent articaine with epinephrine 1:100,000 or 2 percent lidocaine with epinephrine 1:100,000 for simple or complex dental procedures . In each trial , the authors r and omized the subjects in a 2:1 ratio to receive articaine or lidocaine .  Efficacy was determined by both subject and investigator using a visual analog scale , or VAS . The authors used the Kruskal-Wallis test to analyze the data . RESULTS A total of 882 subjects received articaine , and 443 received lidocaine .  The authors found no statistical differences between the groups ( P = .05 ) . They also compared drug volumes for both articaine and lidocaine groups ( 2.5 milliliters + /- 0.07 st and ard error of mean , or SEM , vs. 2.6 mL + /- 0.09 SEM for simple procedures and 4.2 mL + /- 0.15 SEM vs. 4.5 mL + /- 0.21 SEM for complex procedures ) . The procedures ' duration s were comparable for both the articaine and lidocaine groups . The authors found no statistical difference between the two treatment groups ( P = .05 ) with respect to subject or investigator pain ratings using the VAS ; the mean pain scores determined by both patients and investigators for all groups tested were less than 1.0 . CONCLUSIONS The authors found that 4 percent articaine with epinephrine 1:100,000 was well-tolerated in 882 subjects . It also provided clinical ly effective pain relief during most dental procedures and had a time to onset and duration of anesthesia appropriate for clinical use and comparable to those observed for other commercially available local anesthetics . CLINICAL IMPLICATION S Pain control is a major component of patient comfort and safety . Local anesthetics form the backbone of pain control techniques in dentistry . Four percent articaine with epinephrine is an amide local anesthetic that will meet the clinical requirements for pain control of most dental procedures in most patients BACKGROUND Articaine administered through buccal infiltration ( BI ) has been suggested as providing adequate posterior m and ibular analgesia . This study compared the efficacy of articaine 4 % with 1:100 000 adrenaline ( test ) and lignocaine 2 % with 1:80 000 adrenaline ( control ) , delivered either through an inferior alveolar nerve block ( IANB ) or BI for routine restorative procedures in m and ibular posterior teeth among children . METHODS Children enrolled within the Western Australian School Dental Service and in need of restorative care on contralateral m and ibular posterior teeth were eligible . Consenting children were r and omly allocated to test and control techniques , and to type of local anaesthetic . Using the faces pain scale , pain reports from analgesia administration and from dental treatment were elicited . Analgesia success and pain reports were compared by anaesthetic technique and type . RESULTS Fifty-seven children were recruited into the study ; 29 allocated to IANB . Analgesia success for IANB 100 % ; BI 67 % ; p < 0.001 . Analgesia success for BI with articaine 71 % ; lignocaine 64 % , p > 0.05 . Analgesia success was associated with fewer reports of painful dental treatment , p = 0.005 . CONCLUSIONS There was higher success and less painful treatment with IANB . There was no statistically significant difference in local analgesia success between articaine and lignocaine when delivered via BI This article introduces the approach of GRADE to rating  quality of evidence .  GRADE specifies four categories-high , moderate , low , and very low-that are applied to a body of evidence , not to individual studies . In the context of a systematic review , quality reflects our confidence that the estimates of the effect are correct . In the context of recommendations , quality reflects our confidence that the effect estimates are adequate to support a particular recommendation . R and omized trials begin as high- quality evidence , observational studies as low quality . " Quality " as used in GRADE means more than risk of bias and so may also be compromised by imprecision , inconsistency , indirectness of study results , and publication bias . In addition , several factors can increase our confidence in an estimate of effect . GRADE provides a systematic approach for considering and reporting each of these factors . GRADE separates the process of assessing quality of evidence from the process of making recommendations . Judgments about the strength of a recommendation depend on more than just the quality of evidence PURPOSE The purpose of this study was to compare pain , efficacy and postoperative complications of anesthesia in first primary m and ibular molars anesthetized with either intraligamentary ( IL ) or supraperiosteal ( SP ) anesthesia  using a computer-controlled delivery system ( CCDS ) . STUDY DESIGN This r and omized , controlled-crossover , blind clinical trial was conducted with 90 children requiring bilateral extraction , pulpotomy or restorative treatment of first m and ibular primary molars . A CCDS was used to deliver IL anesthesia to 1 deciduous tooth and SP anesthesia to the contralateral tooth in each patient . Severity of pain and efficacy of anesthesia during the treatments were evaluated using the Wong-Baker Faces Pain Rating Scale ( PRS ) and comfort and side effects were assessed using post-injection and post-treatment question naires . Data were analyzed using χ2 and Mann-Whitney U tests . RESULTS According to PRS scores , pain levels during extraction were significantly higher with IL when compared to SP . Patients reported significantly less pain during needle 
    Output:
    
This reported inferior alveolar nerve block to be more effective than buccal infiltration for dental treatment of m and ibular molars , while no differences were found regarding pharmacological agents .
Conclusions At present , there is insufficient evidence in support of any pharmacologic agent or injection technique as being superior compared to others .