Conventional Inferior Alveolar Nerve Block Research Articles

Comparative evaluation of intraligamentary injection and traditional inferior alveolar nerve block in endodontic management of mandibular molar with symptomatic irreversible pulpitis: A randomized double-blinded clinical trial

Background: Intraligamentary anesthesia (ILA) injection using a single-tooth anesthesia (STA) system has been used as a supplementary technique for pulpal anesthesia in cases of irreversible pulpitis. Aims and Objective: The current clinical trial was undertaken to assess and compare the effectiveness of the conventional inferior alveolar nerve block (IANB) and the ILA technique utilizing the STA system for endodontic management of mandibular molars presenting symptomatic irreversible pulpitis. Materials and Methods: Patients diagnosed with symptomatic irreversible pulpitis inmandibular molar were allocated into two groups: Group I IANB (n=30) and Group II- STA system (n=30). The onset of anesthesia was evaluated using the electric pulp test, whereas for pain perception the Heft-Parker Visual Analog Scale score was recorded before, during, and after anesthesia. Post-anesthetic pain was recorded at 3 h, 24 h, and 1 week. The collected data was evaluated for effectiveness pain perception, and acceptability of the anesthetic technique, using appropriate statistical tests. Results: The mean time of onset for the Group II STA system (2.93±1.80) was significantly higher (P=0.0001) than Group I IANB (1.40±0.86). Pain at the site of injection was insignificant (P>0.05) between both groups. The severity of pain during the root canal procedure was significantly different (P<0.0001) in both cohorts. For both groups, the patient’s acceptance of the anesthetic procedure was statistically insignificant (P=0.21). Conclusions: The STA system reported similar effectiveness in terms of effectiveness, pain perception, and acceptability of anesthetic technique when compared to IANB. Hence, the primary anesthetic treatment for conducting endodontic procedures on molars with symptomatic irreversible pulpitis appears to be the utilization of the ILA-employing STA system.

Anesthetic Efficacy of Endo-Ice and Intrapulpal Ice Sticks After Inferior Alveolar Nerve Block in Symptomatic Irreversible Pulpitis: A Randomized Controlled Study.

There is a dearth of studies to assess the effectiveness of cryotherapy as a possible adjuvant in anesthesia. Therefore, this study aimed to compare the impact of pretreatment intraoral ice packs, application of Endo-ice, and a combination of Endo-ice and intrapulpal ice sticks use on the effectiveness of pulpal anesthesia as an adjunct in the management of pain and dental anxiety in mandibular second molars with symptomatic irreversible pulpitis (SIP) against traditional inferior alveolar nerve block (IANB) technique. The randomized controlled double-blind clinical study comprised of 200 subjects within the age group of 20-45 years with SIP involving mandibular second molars and divided into four groups of 50 each. Conventional IANB was administered in group 1. Intraoral compact ice packs, Endo-ice, and combined use of Endo-ice and intrapulpal ice sticks were employed following conventional IANB in groups 2, 3, and 4, respectively. The intensity of pain and anxiety before and after the intervention was documented using Heft-Parker visual analog scale (HP-VAS) and Corah's Dental Anxiety Scale-Revised (DAS-R). The average age of the overall study sample was 30.8±2.08 years, and the differences in age and gender distribution were found to be statistically insignificant. The mean HP-VAS scores on access opening and pulpectomy, using ANOVA paired with Tukey's post hoc multiple comparison tests were evaluated to be statistically highly significant (p<0.001). The greatest reduction in HP-VAS score was observed in group 4 receiving combined use of both Endo-ice and intrapulpal ice sticks. While the pretreatment DAS-R score was determined to be statistically insignificant between groups, group 1 subjects had the highest DAS-R score postoperatively (p<0.001). The effectiveness of pulpal anesthesia was found to be 84%, 96%, 92%, and 98% for groups 1 through 4, respectively, and demonstrated a statistically significant difference. The combined use of Endo-ice and intrapulpal ice sticks used as an adjuvant to local anesthesia (LA) was found to be significantly effective in lowering pain compared to the control groups in molars with SIP. Cold administration before and during the procedure was more effective than conventional LA in lowering intraoperative anxiety. Furthermore, the use of Endo-ice and intrapulpal cold after IANB significantly improves the effectiveness of pulpal anesthesia in mandibular second molars with SIP.

Comparing intraosseous computerized anaesthesia with inferior alveolar nerve block in the treatment of symptomatic irreversible pulpitis: A randomized controlled trial.

The aim of this study was to compare the cardiovascular effects [heart rate, oxygen saturation (SpO2 ), systolic and diastolic blood pressure] and the anaesthetic efficacy of intraosseous computerized anaesthesia (ICA) versus inferior alveolar nerve block (IANB) in Symptomatic irreversible pulpitis (SIP). The study protocol was registered with ClinicalTrials.gov (NCT03802305). In a randomized, prospective clinical trial, 72 mandibular molar teeth with SIP were randomly allocated to conventional IANB injection (n = 36) or ICA injection (n = 36), both with 1.8 mL of 4% articaine with 1:100 000 epinephrine. The primary objective was to assess the cardiovascular parameters (heart rate, oxygen saturation, blood pressure) before, during and after the anaesthesia. The secondary objectives were to compare ICA with IANB for success and postoperative outcomes for up to 3 days. The maximum increase in heart rate in the ICA group was greater than in the IANB. Other cardiovascular parameters did not show differences throughout the clinical procedure. There were no statistically significant differences (p > .05) between groups for sex, age, or anxiety. The total success rate of ICA (91.43%) was significantly higher (p = .0034) than that of IANB (69.44%). This study establishes that ICA is safe and efficient in the first intention for the treatment of SIP of the mandibular molar.

Evaluation of Intraligamentous and Intraosseous Computer-Controlled Anesthetic Delivery Systems in Pediatric Dentistry: A Randomized Controlled Trial.

Computer-controlled local anesthetic delivery systems (CDS) represent one of the resources that have progressed the most in recent years, but their efficacy and applicability in pediatric dentistry is still the subject of certain controversies. This randomized, controlled, split-mouth clinical trial assessed two CDS in children (n = 100) with deep caries in the temporary dentition that required invasive therapeutic procedures, using inferior alveolar nerve block as the gold standard. Half of the patients (n = 50) underwent the intraligamentary technique (Wand STA®) on one side of the mouth and conventional inferior alveolar nerve block on the contralateral side, while the other half (n = 50) underwent the intraosseous technique (QuickSleeper®) on one side of the mouth and conventional inferior alveolar nerve block on the contralateral side. The following were considered covariates: age, sex, type of dental procedure and the applied local anesthesia system. The outcome variables were the pain caused by the anesthesia injection, the physical reaction during the anesthesia injection, the need for anesthetic reinforcement, pain during the therapeutic procedure, the overall behavior during the visit, the postoperative morbidity and, lastly, the patient's preference. In conclusion, we confirmed the efficacy of intraligamentary and intraosseous techniques administered using a CDS for conducting invasive dental treatments in children, their advantages compared with inferior alveolar nerve block in terms of less pain generated by the anesthesia injection and less postoperative morbidity, as well as the pediatric patients' preference for CDS versus conventional techniques.

EFFICACY OF 4% ARTICAINE BUCCAL INFILTRATION VERSUS INFERIOR ALVEOLAR NERVE BLOCK FOR MANDIBULAR MOLARS WITH SYMPTOMATIC IRREVERSIBLE PULPITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

To compare the anesthetic efficacy of buccal infiltration (BI) using 4% articaine vs 4% articaine or 2% lidocaine inferior alveolar nerve block (IANB) for mandibular molars with symptomatic irreversible pulpitis. PubMed, Cochrane, Web of Science, Scopus, and ClinicalTrials.gov were searched using MESH terms and specific keywords. Included articles were Randomized Clinical Trials (RCTs), which compared 4% articaine BI vs conventional IANB in terms of the efficacy of pulpal anesthesia and success rate. The quality assessment of included studies was done according to the Cochrane risk of bias assessment tool. Studies were quantitatively assessed using fixed or random effect models. Out of 756 articles, 5 RCT studies were included with a total number of 500 patients: 231 in 4% articaine BI group, 150 in 2% lidocaine IANB group, and 119 in 4% articaine IANB group. Our meta-analysis results showed that patients anesthetized with 4% articaine BI had a similar success rate compared to 2% lidocaine IANB [pooled RD: 0.14 (95% CI, -0.01 to 0.29); P = .08]. Similarly, there was non-significant difference when compared to 4% articaine IANB [RD:-0.01 (95% CI, -0.13 to 0.11; P = .86)]. Patients anesthetized with 4% articaine BI presented comparable pain scores compared to IANB (4% articaine or 2% lidocaine) [pooled MD: -0.14 (95% CI, -0.38 to 0.11); P = .27]. Regarding quality assessment, 3 studies were considered to have a low risk of bias, one study has an unclear risk of bias, and one study has a high risk of bias. 4% articaine BI showed comparable results in terms of pain relief and success rate in comparison with 2% lidocaine IANB or 4% articaine IANB. However, due to the limited number and small sample size of included studies, these findings should be considered carefully, and further studies are required to confirm our findings.

Anesthetic Success Rate of Inferior Alveolar Nerve Block for Mandibular Molars with Symptomatic Irreversible Pulpitis in Women Taking Antidepressants.

This study sought to evaluate the success rate of inferior alveolar nerve block (IANB) during the endodontic management of mandibular molars with symptomatic irreversible pulpitis in women taking selective serotonin reuptake inhibitor (SSRI) antidepressants. Ninety adult female patients over 18 years of age who were diagnosed with symptomatic irreversible pulpitis of a mandibular molar were recruited in this study. The patients were equally assigned to SSRI user group (including citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), who had taken an SSRI, and non-SSRI user group, who had not taken any SSRIs at all. All patients in both groups received 3.6 mL of 2% lidocaine with 1:80,000 epinephrine using conventional IANB injection. Access cavity was prepared 15 min after the injection. Lip numbness was necessary for all patients. Success was determined as no or mild pain upon access cavity preparation and/or instrumentation based on the Heft-Parker visual analog scale recordings. Data were analyzed using the chi-square test Mann-Whitney U test, and t-test. The success rate was 55.6% for SSRI users and 44.4% for non-SSRI users, and no statistically significant difference was observed between the two groups (x 2=1.1, P=0.292). Based on the results of this study, taking SSRI antidepressants could not affect the anesthetic success rate of IANB for mandibular molars with symptomatic irreversible pulpitis in women.

COMPARISON OF CLINICAL EFFICACY OF MANDIBULAR NERVE ANESTHESIA

Introduction: Being the best at managing pain is an essential but difficult aim for oral and maxillofacial surgeons. The relatively high rate of failure of the inferior alveolar nerve block (IANB) may be attributed to a variety of factors. The capacity of the different mandibular nerve block procedures to address the precise causes of IANB failure is what makes them valuable.&#x0D; Objective: This research compared the effectiveness of Gow-Gates Nerve Block Technique with Conventional Inferior Alveolar Nerve Block Technique for Mandibular Nerve Anesthesia.&#x0D; Results: The average time it took for anaesthesia to start for the traditional inferior alveolar block approach was 3 minutes, 17 seconds, but the average time it took for the Gow-Gates technique was much longer, at 4 minutes, 15 seconds.&#x0D; Conclusion: The results of the current investigation found no statistically significant differences between the Gow Gates approach as well as the traditional inferior alveolar nerve block in terms of anaesthetic efficacy.

RCT on the effectiveness of the intraligamentary anesthesia and inferior alveolar nerve block on pain during dental treatment

ObjectiveTo compare the effectiveness and complications of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) during injection and dental treatment of mandibular posterior teeth.Materials and methodsIn this randomized, prospective clinical trial, 72 patients (39 males, 33 females), scheduled for dental treatment of mandibular posterior teeth, were randomly allocated to ILA group (n = 35) received ILA injection or IANB group (n = 37) received the conventional IANB. Our primary outcome was to assess pain and stress (discomfort) during the injection and dental treatment, using the numeric rating scale (NRS) from 0 to 10 (0 = no pain, 10= the worst pain imaginable), whereas recording 24-h postoperative complications was our secondary outcomes.ResultsPatients in ILA group reported significantly less pain during injection when compared with IANB group (p = 0.03), while pain during dental treatment was similar in both groups (p = 0.2). Patients in both groups also reported similar law values of discomfort during treatment (p = 0.7). Although no signs of nerve contact or any other postoperative complications were observed, five patients in IANB group (none in ILA group) reported temporary irritations.ConclusionThis study showed equivalent effectiveness of both intraligamentary anesthesia and conventional inferior alveolar nerve block, for pain control during routine dental treatment of mandibular posterior teeth. Nevertheless, ILA showed significantly less pain during injection. No major postoperative complications in both groups were observed.Clinical relevanceILA could be considered as an effective alternative for routine dental treatment.Trial registrationNCT04563351

Efficacy of a conventional inferior alveolar nerve block compared to the Vazirani–Akinosi and Gow-Gates techniques for mandibular anesthesia

Background: The conventional inferior alveolar nerve block (IANB) cannot be employed in clinical scenarios with trismus. In addition, it is a blind procedure, so failure to follow the ideal anatomical landmarks and improper positioning of the needle may result in anesthesia failure. This study evaluated whether the Vazirani–Akinosi (VA) and Gow-Gates (GG) techniques for mandibular anesthesia have superior outcomes in the form of fewer positive aspirations and rapid onset of action, as well as better anesthetic attainment. Objective: The objective of this study was to evaluate the anesthetic efficacy and associated complications of a conventional IANB compared to the VA and GG techniques. Method: The study involved 300 patients divided randomly into three groups of 100 patients each. Group I received mandibular anesthesia through the GG technique, Group II received mandibular anesthesia through the VA technique, and Group III received mandibular anesthesia through a conventional IANB. The onset of action, incidence of positive aspiration, and success of the anesthetic technique were assessed in all patients. Result: The Group II patients showed superior anesthetic success (97%) that was significantly different from the results of Groups I and III (P = 0.0241). The mean value of the onset of anesthesia was longer in Group I than in the other two groups. A significant difference was seen between the GG and VA techniques (P = 0.0001*) and between the GG and conventional IANB techniques (P = 0.0001*). Conclusion: The VA technique is considerably superior to either the GG or the conventional IANB techniques in terms of the onset of action and anesthesia success. Positive aspirations are encountered relatively more frequently with the conventional IANB technique.

Failure of molar anesthesia in endodontics : A systematic review

Introduction: Failure of molar anesthesia is commonly encountered in our clinical practice ranging around 15% in normal pulps and 44%–81% in inflamed pulps. Effective pain management is challenging in such situations. The aim of the present systematic review was to enlist the reasons for local anesthesia failure in mandibular molars during root canal treatment and to assess the effectiveness of supplementary methods along with the conventional inferior alveolar nerve block (IANB) in achieving profound anesthesia. Materials and Methods: A literature search on Pubmed and Google scholar database from the year 1990–2020 was conducted using the keywords: “Molar anesthesia,” “Local anesthesia failure,” “Hot tooth,” “irreversible pulpitis.” The articles pertaining to the failure of IANB during endodontic treatment of mandibular molars and the techniques for the improved success of molar anesthesia were reviewed. The data were analyzed in terms of author, year, type of study design, study population and type of intervention, method of assessment of outcome, outcome assessed, result and clinical recommendations. Results: The search yielded 9090 articles, from which the specific articles relevant to the topic were reviewed. The articles were reviewed independently by two authors. Finally, a total of 7 randomized controlled trials fulfilling the eligibility criteria were analyzed and subjected to qualitative assessment. Conclusion: The failure of IANB could be attributed to several reasons such as anatomical variations, Operator Technique, Presence of inflammation, and Psychological reasons. In addition, there is a positive association in using adjuncts for achieving effective anesthesia in mandibular molars.

Stumbling block for inferior alveolar nerve block in predoctoral students: An analytical observational study and review of literature of mandibular nerve block techniques.

Introduction:Dentists earnestly try to practice painless treatment. Conventional inferior alveolar nerve block technique is preferred by most of the dentists despite its various modifications.However its failure rate as per literature is quite high. Inexperienced dentists face difficulty in obtaining effective anesthesia. This may be due to limited access to inferior alveolar nerve,greater density of alveolar bone,bulky soft tissues,damage to nerve or due to risk of intravascular injection.Aim:The aim of this study is to review and clinically assess the factors causing difficulty or failure of inferior alveolar nerve block in predoctoral students and to review the mandibular nervve blocks.Material and methods:Dental interns of riyadh elm university were monitored during administration of inferior alveolar nerve block for difficulty factors influencing inferior alveolar nerve block. Onset of anesthesia, efficacy anesthesia of inferior alveolar nerve, lingual nerve and long buccal nerve were ascertained. Difficulty index was used to assess the “item difficulty” with a score of 0.0 which indicates that none of the dental interns anesthetised correctly to 1.0 suggesting all the dental interns anesthetised correctly.Results:Complete failure of inferior alveolar nerve block was noticed in 2.4% of predoctoral students. The most common cause for inferior alveolar nerve block failure was attributed to the difficulty in palpating the landmarks (77%), 22% of the patients refused multiple needle penetrations,and 19% of inferior alveolar nerve block failure was due to the fear of potential complications by the predoctoral students.Conclusion:Clinical skill of predoctoral students need adequate training in nerve blocks. Revising the current literature on alternative inferior alveolar nerve block techniques or use of evidence based dentistry to update and practice alternative nerve block techniques would aid in improving the clinical skills and treatment outcome which would therefore enable to remove the stumbling blocks in successful anesthesia.

Anesthetic efficacy of Gow-Gates versus inferior alveolar nerve block for irreversible pulpitis: a systematic quantitative review.

This review aimed to assess and compare the outcomes of the anesthetic efficacy of inferior alveolar nerve block (IANB) and Gow-Gates mandibular nerve block (GGMNB) in patients with symptomatic irreversible pulpitis. A descriptive systematic review of quantitative research was conducted wherein the “Preferred Reporting Items for Systematic Reviews (PRISMA)” was adopted, and the Problem/Patient/Population, Intervention/Indicator, Comparison, Outcome (PICO) criteria were used to structure the research question. A literature search was performed using PubMed/Medline, Cochrane Library, Google Scholar, and Ovid. Selection criteria were applied for populations over nine years of age, of either sex, with irreversible pulpitis, and articles published in English regarding conventional IANB or IANB and Gow-Gates techniques between 2009 and 2019. Prospective randomized clinical trials or randomized controlled trials were included in the review, in which anesthetic efficacy or success was measured. After screening, four articles were included. Three studies were randomized clinical trials, and two were randomized controlled trials. The validity and reliability of the individual studies were examined. There was evidence of the higher efficacy of the GGMNB technique than that of the IANB technique. However, both techniques can be mastered through training.

A comparative study for a novel technique for the inferior alveolar nerve block versus the conventional technique

Although conventional (Halsted) inferior alveolar nerve block is the most applied nerve block in Dentistry, it is still the most frustrating with high failure rates up to13% or even higher due to inconsistent intraoral landmarks. So, the current study aims at comparing a novel technique for the inferior alveolar nerve block (IANB) depending on extraoral landmarks with the conventional technique. The study group patients received IANB employing the novel technique. The novel technique depended entirely on extraoral consistent landmarks which were the base of the columella, the outer canthus of the right and the left eye, and the upper lip. In the control group, the conventional technique was applied. The success rate and the onset, the duration, and the depth of anaesthesia were assessed. Complications were recorded. While the novel technique achieved higher success rate (98.68%) than the conventional technique (88.16%), the differences with regards with all other parameters to assess the local anaesthesia were statistically insignificant. The novel technique provides the clinicians with a new tool that might be a reliable substitute for the conventional technique since the former depends entirely on extraoral consistent landmarks, which also might account for its simplicity, accuracy, and high success rate.

Single-insertion technique for anesthetizing the inferior alveolar nerve, lingual nerve, and long buccal nerve for extraction of mandibular first and second molars: a prospective study.

ObjectivesAppropriate and accurate local anesthetic (LA) techniques are indispensable in the field of oral and maxillofacial surgery to obtain a satisfactory outcome for both the operating surgeon and the patient. When used alone, the inferior alveolar nerve block (IANB) technique requires supplemental injections like long buccal nerve block for extraction of mandibular molars leading to multiple traumatic experiences for the patient. The aim of this study was to anesthetize the inferior alveolar, lingual, and long buccal nerves with single-needle penetration requiring a minimal skillset such as administering a conventional IANB through introduction of the Benny Joseph technique for extraction of mandibular molars.Materials and MethodsThis was a prospective study conducted in the Department of Oral and Maxillofacial Surgery, Kunhitharuvai Memorial Charitable Trust (KMCT) Dental College, Calicut, India. The duration of the study was 6 months, from June to November 2017, with a maximum sample size of 616 cases. The LA solution was 2% lignocaine with 1100,000 adrenaline. The patients were selected from a population in the range of 20 to 40 years of age who reported to the outpatient department for routine dental extraction of normally positioned mandibular right or left first or second molars.ResultsOf the 616 patients, 42 patients (6.8%) required re-anesthetization, a success rate of 93.2%. There were no complications such as hematoma formation, trismus, positive aspiration, and nerve injuries. None of the cases required re-anesthetization in the perioperative period.ConclusionThe Benny Joseph technique can be employed and is effective compared with conventional IANB techniques by reducing trauma to the patient and also requires less technique sensitivity.

Comparison of three anesthetic techniques for the removal of posterior mandibular teeth with 2% lidocaine: a systematic review

The present systematic review aimed to evaluate whether the IANB (conventional inferior alveolar nerve block) technique is superior to the VA (Vazirani-Akinosi) or GG (Gow-Gates) techniques for anesthesia in the removal of posterior mandibular teeth. This systematic review was structured according to the PICO strategy, adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist, and was recorded on the international prospective register of systematic reviews (PROSPERO-CRD42020153130). Studies were included based on the eligibility criteria and data from the included studies were collected by one author, while another reviewed the compilation. Eight studies were included, all of which were randomized controlled trials. Three studies tested the techniques by exclusively performing lower third molar removal; the others covered other posterior lower teeth. All studies used the same local anesthetic and the same vasoconstrictor: lidocaine 2% with epinephrine/adrenaline. A total of 1056 patients were evaluated. Some differences were observed between the techniques. Because of the heterogeneity between studies, clinical trials with more specific methodologies, such as comparisons of GG and VA with IANB for mandibular tooth removal, and the same clinical homogeneity will be worthwhile. A systematic review of which anesthetic technique is most effective for mandibular teeth removal may positively impact the population's life. There are no systematic reviews which approach this theme in a well-structured perspective.

Clinical evaluation of efficacy of transcortical anesthesia for the extraction of impacted mandibular third molars: a randomized controlled trial.

BackgroundThis study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery.MethodsThis prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer.ResultsThirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013).ConclusionThe IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

Comparison of lidocaine with articaine buccal injection in reducing complications following impacted mandibular third molar surgery: a split-mouth randomized clinical trial.

BackgroundComplications following impacted third molar surgery significantly affect patients' quality of life during the immediate postoperative period. This study aimed to achieve the proper anesthesia method by comparing the effect of the application of lidocaine alone with the application of lidocaine and articaine simultaneously in reducing the complications during and following impacted mandibular third molar surgery.MethodsThe study design was a split-mouth double-blind randomized clinical trial. The study was conducted on 13 patients (26 samples) referred for elective surgical removal of bilateral impacted mandibular third molar with similar difficulty on both sides. Each patient underwent similar surgical procedures on two separate appointments. Each patient randomly received 2% lidocaine for conventional inferior alveolar nerve block and 4% articaine for local infiltration before the surgery on one side (group A) and 2% lidocaine alone (for both block anesthesia and infiltration) before the surgery on the other side (group B). Intraoperative and postoperative variables for both groups were established and statistically analyzed.ResultsThe findings showed that pain on the first day after surgery in group A was significantly lower than that in group B. The patients in group A mentioned experiencing less discomfort following the surgery. The increased horizontal swelling on the first and third days following surgery and oblique swelling on the seventh day in patients in group B were statistically significant.ConclusionChoosing an appropriate anesthetic drug for oral surgery, specifically impacted third molar surgery, is dependent on the clinician's opinion, however; it seems that the combination of lidocaine and articaine may control the patient's pain significantly better than lidocaine alone.

Effectiveness Of Pre-operative Oral Medication of Ibuprofen and Ketorolac on Anesthetic Efficacy of Inferior Alveolar Nerve Block with Irreversible Pulpitis: Randomized Controlled Trial

Background and objectivesPain is the primary reason that dental patients seek endodontic therapy. The inferior alveolar nerve block (IANB) is the most frequently used mandibular injection technique for achieving local anesthesia for endodontic treatment. However, the IANB does not always result in successful pulpal anesthesia. Therefore, the purpose of this study was to determine the effects of preoperative administration of both ibuprofen and ketorolac on the efficacy of the IANB in patients with irreversible pulpitis.MethodsA total of 60 patients diagnosed with irreversible pulpits of a mandibular posterior tooth randomly received identical capsules of either 400 mg ibuprofen or 20 mg ketorolac or a placebo 1 hour before the administration of a conventional IANB. Access was initiated after profound lip numbness was achieved. Success was defined as no, mild, moderate, or severe pain (verbal rating scale recordings) on accessing the dentin, pulp, and debridement.ResultsKetorolac was associated with superior efficacy in pain reduction when compared with ibuprofen and placebo in all parameters, namely the dentin, pulp, and canal debridement.Interpretation and conclusionIn conclusion, for mandibular posterior teeth, a preoperative dose of 400 mg of ibuprofen or 20 mg of ketorolac showed a statistically significant increase in the success of the IANB in patients with irreversible pulpitis.

Comparison of Patient Comfort During the First Stage of Conventional Versus Modified Two-Stage Inferior Alveolar Nerve Blocks in Pediatric Patients.

Our aim was to compare the comfort of pediatric patients during the first stage of the conventional 2-stage inferior alveolar nerve block (IANB) versus the modified 2-stage IANB. This was a parallel group, single-blinded, randomized controlled trial. Pediatric patients meeting the inclusion criteria were randomly allocated to 1 of the 2 groups receiving IANB, group 1 (31 subjects) utilized a conventional 2-stage technique, and group 2 (33 subjects) utilized a modified 2-stage approach. Patient comfort was assessed indirectly by 2 observers using the Face, Legs, Activity, Cry, Consolability (FLACC) scale during the first stage of the injections. FLACC score data between the 2 groups were analyzed using the chi-square test, and interobserver reliability was measured using kappa statistics. During the first stage of the injections, lower FLACC scores of 0 indicating a relaxed/comfortable patient experience were found in 57.6% of group 2 subjects compared with only 25.8% group 1 subjects, which was a statistically significant difference (p-value .013). Interobserver reliability assessed using kappa coefficients (κ = 0.812) indicated excellent agreement. FLACC scores for the pediatric patients during the first stage of the modified 2-stage IANB technique were significantly lower than during the first stage of the conventional 2-stage IANB technique.

EFFICACY OF INTRA-MASSETERIC AND SUBMUCOSAL DEXAMETHASONE INJECTION IN SURGICAL EXTRACTION OF IMPACTED LOWER THIRD MOLAR.

Objectives: To determine the efficacy of intra-masseteric and submucosal dexamethasone injection to minimize the postoperative discomfort after the surgical extraction of impacted lower third molar. Study Design: Cross sectional study (Comparative). Setting: Department of Oral &amp; Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical &amp; Health Sciences Jamshoro / Hyderabad. Period: January 2017 to June 2017. Subjects and Methods: All surgical extractions were done under local anaesthesia by giving conventional inferior alveolar nerve block. An envelope mucoperiosteal flap was raised to expose the third molar. Then tooth was extracted. After the removal of tooth any sharp bone was smoothened by bone filer and the socket was washed and sutured. The severity of pain was recorded by using Visual Analogue Scale from 0 (no pain) to 10 (worst pain) described as mild, moderate or severe. Degree of swelling was measured by facial size through Amin and laskin criteria which was measured in millimeters. Mouth opening was measured by interincisal distance through ruler (35-45mm normal value). Results: From sixty four patients it was observed that the minimum age was 28.03+6.12 years. There were 35 male patients and 29 female patients. When Chi square test was applied, there was a significant association found between Groups (A and B). By using independent sample t-test, it was observed that there was a significant association found in both groups concerning facial swelling (Facial size in mm) having p-value 0.00. When the independent t-test was applied on the data, there was a significant association found in Group A and B regarding mouth opening (in mm) having p-value 0.001. Conclusions: Dexamethasone has a good efficacy for reducing the postoperative symptoms including severe pain, facial swelling and trismus after the surgical extraction of impacted lower third molar. The better outcomes perceived when it was administered submucosally.