With a quick onset, 4% Citanest Plain provides effective anesthesia for both infiltration and nerve block techniques without the use of epinephrine.
When a patient cannot tolerate epinephrine but needs a fast-acting dental anesthetic, Dentsply Sirona’s 4% Citanest Plain is a viable option, according to Dr. Mihaela Popa, a member of the Dental Product Shopper evaluator team. “I needed a product that could give a quick anesthesia, and this solved my problem,” Dr. Popa said after testing the anesthetic in her practice for 4 weeks. “I like the predictability of this product,” she added. Because of the quick onset, Dr. Popa said she can see more patients and perform more procedures in a day, which ultimately improves a practice’s bottom line.
Indicated for nerve block or infiltration techniques, 4% Citanest Plain DENTAL (Prilocaine HCI Injection, USP) is a sterile, non-pyrogenic isotonic solution that contains a local anesthetic agent and is administered parenterally by injection. Available in boxes of 50 cartridges, each 1.8 mL cartridge of Citanest Plain is pre-sterilized and color-coded with a black band.
Citanest Plain provides anesthesia for both infiltration and nerve block techniques. According to Dentsply Sirona, the average time of onset is less than 2 minutes for infiltration injection and less than 3 minutes when used for inferior alveolar nerve block.
Calling it good for cases where fast onset is desired, Dr. Ray Morse said Citanest Plain sets in very quickly and even allowed him to begin procedures a couple minutes earlier than usual. Some of Dr. Thomas Walker’s patients mentioned how quickly it worked, and he found it produced very effective anesthesia with rapid onset without the addition of epinephrine. Dr. R.J. Sondkar agreed that the material provided a quick onset and noted that it had no side effects on patients who are epinephrine sensitive. “It worked quickly and effectively,” New York dentist Dr. Alfred Bassin shared. Dr. Amir Esfandiari said he liked the predictable onset and that it reduces a patient’s cardiac risk factor during anesthesia.
Duration and Effectiveness
For infiltration injection, Dentsply Sirona reports that Citanest’s average soft-tissue duration is approximately 2 hours, and it has been found to provide complete anesthesia for procedures lasting an average of 20 minutes. When used for inferior alveolar nerve block, average duration of soft-tissue anesthesia is approximately 2.5 hours. The anesthetic exits the circulation faster than most other local anesthetics, according to Dentsply Sirona.1
Dr. Esfandiari called Citanest very effective with good efficacy, and added that it is “predictable to work every time.” Dr. Walker noted, “It produced very rapid onset with adequate duration to complete most procedures on the mandible via a block. For longer procedures via infiltration the epinephrine is needed.” A few dentists suggested a longer duration, while Dr. Andre Kanarki said it was very effective and performed better than his usual anesthetic.
In order to improve patient safety and comfort, Citanest Plain contais no epinephrine, which eliminates any possible negative side effects caused by adrenaline. “[Citanest Plain] allowed me to use adequate mandibular anesthesia without epinephrine and its possible side effects,” said Dr. Walker. He said the anesthetic worked very well to allay the apprehension of a patient with an epinephrine phobia and made it much easier to treat the situation. Dr. Sondkar reported that an advantage to using Citanest Plain is that “it can be used on almost all patients” and is “especially safer for patients with hypertension.”
To ensure smooth movement during injection and to reduce discomfort, Citanest’s plunger and cartridge are both coated with silicon. The needle is also free from natural rubber latex in order to reduce potential allergic reactions. Noting that there was “less sting for the initial injection,” Dr. Abraham Jaskiel said the injection was “comfortable for patients” and good for those with high blood pressure or who are pregnant. California dentist Dr. Artin Manoukian said Citanest was easily administered, had fewer adverse effects, was helpful in treating patients with complex medical histories, and caused fewer allergy concerns. Dr. Partha Mukherji of Texas reported that Citanest helped alleviate epinephrine-sensitive patients’ anxiety with short-term profound anesthesia.
Calling it a “great anesthesia without the usual worries about epinephrine,” Dr. Kanarki said he would purchase Citanest Plain in the future. “If it is price comparable to [my current product], then I would purchase it instead,” Dr. Walker remarked, noting that he would recommend it to colleagues. “Overall, [Citanest Plain is] a very good anesthetic for 90% of dental procedures,” Dr. Walker concluded.
1. Handbook of local Anesthesia by Stanley F. Malamed, 6th Ed, Chapter 4