| research injection phase, then with regard to the pain felt during the operation and perceived after any type of treatment. It is, therefore, essential that a topical anaesthetic is used to make the injection phase as least unpleasant as possible and that the injection is performed by apply- ing the right pressure, so as not to overstretch the tissue (a cause of pain in itself) and in the right anatomical site (Figs. 2 & 3). Moreover, the recommended injection time is 1 ml/minute. Nevertheless, 84 per cent of dentists in- ject 1.8 ml in 20 seconds or less.2 A compound suitable for the planned intervention must be used in terms of du- ration of its action and, therefore, of effectiveness, paying attention also to the quantity of vasoconstrictor present and the overall patient condition. As far as the compound to be used is concerned, the absorption time and the duration time must, of course, always be carefully considered, and this must not be arbitrary, but linked to the type of extraction planned, in order to always have the most adequate pain coverage not only during the operation but also in the immediate postoperative period. Articaine is one of the most recently developed local anaesthetic drugs available to dentists worldwide and the most widely used local anaesthetic in Europe. Articaine is closer to physiological pH and therefore its onset is quicker. Owing to its higher lipo-solubility, articaine is a potent dental anaesthesia molecule, and it has a longer duration than lidocaine owing to its higher protein bind- ing. Being both an amide and an ester, its degradation starts as soon as it reaches the bloodstream, its metab- olism is quicker and, therefore, it is safer to use. It has the lowest systemic toxicity, which is why it can also be used during pregnancy. Lidocaine is one of the most widely used anaesthetics even though there are several other compounds of com- parable efficacy; these drugs differ in terms of pharma- cokinetic parameters. cations. For instance, that might contribute to the onset of dry socket, which could possibly result from an exces- sive vasoconstriction induced in the area of the interven- tion along with other possible factors. Extraction and management of the alveolus After having carried out adequate anaesthesia, the tooth or root can be extracted as planned. And obviously, as indicated, the dentist’s choice regarding the treatment of the post-extraction alveolus will reflect what needs to be done in the site involved in the extraction. After extraction, dimensional and aesthetic changes to the oral tissue occur. For this reason, it is important to contextualise the procedure (if it is not urgent) within a broader treatment plan. The reasons for an extraction can be numerous. Ac- cording to the directives of the Società Italiana di Chirur- gia Orale ed Implantare (Italian Society for oral and implant surgery), the indications that lead to the decision to extract a tooth are as follows: – the presence of ongoing dental caries that has led to a widespread destruction of the dental crown, affecting the gingival margin and making it impossible to recover the element; – irreversible apical lesions; – serious periodontal disease with non-reversible alve- olar bone loss; – fractured roots; – orthodontic treatment; – dysodontiasis of the third molars; – management of infectious loci in patients having to un- dergo radiation therapy; – immunodepressed patients; – patients having to undergo treatment with bisphospho- nates or anti-coagulants of the latest generation; and – impacted teeth or continued presence of primary teeth in the mouth. Once the extraction has been carried out, it will then For long procedures, bupivacaine is the most logical choice for its long anaesthetic duration in soft tissue, although, according to some studies, it is also the most painful during injection.3–6 be possible to opt for: 1. an immediate regenerative treatment; 2. a delayed regenerative treatment; or 3. no treatment. It should be remembered that the presence of a va- soconstrictor is often fundamental not only for good control of haemostasis, but also and above all to antag- onise the vasodilatory effect induced by any local anaes- thetic. Inadequate use of the vasoconstrictor can make a simple extraction complex if the haemostatic effect is not induced. Indeed, the administration of a high con- centration of vasoconstrictor (with the local anaesthetic) if used in an inappropriate manner (for example with an intraligamentous procedure) can create severe compli- The preservation of the alveolar process after a dental extraction is recommended to preserve the bone’s vol- ume and the soft tissue over it and to simplify the subse- quent rehabilitation. It has been widely illustrated in the literature that, every time a dental extraction is carried out, a restructuring of the bone takes place in the site of extraction, leading to a decrease in volume, accompa- nied by qualitative and quantitative changes that affect the result of a prosthetic rehabilitation, especially if it is the anterior zone that is affected, which is further impacted 08 4 2018