Gow-Gates Technique Research Articles

Teaching Alternatives to the Standard Inferior Alveolar Nerve Block in Dental Education: Outcomes in Clinical Practice

Surveys were sent to Harvard School of Dental Medicine students and graduates from the classes of 2000 through 2006 to determine their current primary means of achieving mandibular anesthesia. Orthodontists and orthodontic residents were excluded. All subjects received clinical training in the conventional inferior alveolar nerve block and two alternative techniques (the Akinosi mandibular block and the Gow-Gates mandibular block) during their predoctoral dental education. This study tests the hypothesis that students and graduates who received training in the conventional inferior alveolar nerve block, the Akinosi mandibular block, and the Gow-Gates mandibular block will report more frequent current utilization of alternatives to the conventional inferior alveolar nerve block than clinicians trained in the conventional technique only. At the 95 percent confidence level, we estimated that between 3.7 percent and 16.1 percent (mean=8.5 percent) of clinicians trained in using the Gow-Gates technique use this injection technique primarily, and between 35.4 percent and 56.3 percent (mean=47.5 percent) of those trained in the Gow-Gates method never use this technique. At the same confidence level, between 0.0 percent and 3.8 percent (mean=0.0 percent) of clinicians trained in using the Akinosi technique use this injection clinical technique primarily, and between 62.2 percent and 81.1 percent (mean=72.3 percent) of those trained in the Akinosi method never use this technique. No control group that was completely untrained in the Gow-Gates or Akinosi techniques was available for comparison. However, we presume that zero percent of clinicians who have not been trained in a given technique will use the technique in clinical practice. The confidence interval for the Gow-Gates method excludes this value, while the confidence interval for the Akinosi technique includes zero percent. We conclude that, in the study population, formal clinical training in the Gow-Gates and Akinosi injection techniques lead to a small but significant increase in current primary utilization of the Gow-Gates technique. No significant increase in current primary utilization of the Akinosi technique was found.

Plasma catecholamine concentrations and hemodynamic responses to vasoconstrictor during conventional or Gow-Gates mandibular anesthesia

The literature supports that systemic responses to injected vasoconstrictors depend on the volume and concentration administered, patient's age and health status, as well as site of injection. Thus, the influence of mandibular anesthesia technique on hemodynamic and plasma responses to epinephrine-containing local anesthetics was investigated. Conventional or Gow-Gates anesthesia with 2% lidocaine and epinephrine, 1:100,000, was performed in 18 subjects who required third molar extraction. A control group of 9 subjects was submitted to conventional anesthesia with plain 3% mepivacaine. Blood pressure, heart rate, and plasma catecholamines were measured. Analysis of variance showed that plasma epinephrine level after conventional lidocaine anesthesia was significantly elevated (P < .01), while there was no difference between the Gow-Gates and control groups. The hemodynamic parameters did not demonstrate correlation to the injection technique. Presumably, there was less exogenous epinephrine absorption in the Gow-Gates technique than in the conventional mandibular anesthesia injection.

Mandibular Block Injections - The Inner Game

This paper is a sequel to a previous article published in the April 1998 issue of this journal (1). Whereas the earlier work concentrated largely on the anatomy and geometry of the Gow-Gates block, the present paper is more directed towards the mental barriers encountered when a clinician is confronted by a whole new set of conceptual demands. Paradoxically, the concepts underlying the Gow-Gates technique are almost diametrically opposite to what has traditionally been taught in dental schools in relation to the inferior alveolar nerve block. The author's central hypothesis is that the explanation for indifferent results experienced by dentists in their first attempts at the Gow-Gates technique lies primarily in mindsets acquired from experience with the inferior alveolar block. It is suggested that the subconscious mind can be as powerful a determinant of human behaviour as the conscious mind, a position more in line with the findings of Freud and Jung than with the cognitivist vogue enthusiastically embraced by contemporary academic psychologists. It is further postulated that the subconscious is amenable to conscious guidance, a skill that can be enhanced by practice.

Design and preliminary evaluation of an extraoral Gow-Gates guiding device

Incidence of unsuccessful anesthesia with the Gow-Gates mandibular block may be greater than that for the inferior alveolar nerve block until the administrator gains experience with this technique. The aim of this study was to develop a support instrument for the Gow-Gates mandibular block in an attempt to make the described procedure easier and more precise, especially for beginners. In a preliminary clinical experiment 40 patients were anesthetized with this new device; a control group of 40 patients was anesthetized without the instrument. The operators were 80 dental students without previous clinical experience in the Gow-Gates technique. In the experimental group 39 (97.5%) of the 40 patients were provided with complete anesthesia. In the control group 31 (77.5%) of the 40 patients were completely anesthetized. It appears that the new device allows a great level of success with the Gow-Gates mandibular block, irrespective of the clinical experience of the operator.

NERVUS ALVEOLARİS İNFERİOR BLOKAJINDA KLASİK, GOW-GATES VE AKİNOSİ TEKNİKLERİNİN KARŞILAŞTIRILMALI OLARAK DEĞERLENDİRİLMESİ-COMPARATIVE EVALUATION OF THE CONVENTIONAL, GOW-GATES AND AKINOSI TECHNIQUES IN INFERIOR ALVEOLAR NERVE BLOCK

Ozet Sunulan calismada Nervus Anahtar sozcukler: Nervus alevolarIs Abstract Tiiis double-blind, randomised study compared the effectiveness of the Conventional, Gozv-Gatesand Akinosi, madi-bularblock injection techniques in 192 requiring anesthesia for took extraction. Criteria for evaluation were as follows: pain experienced during injection (determined by using verbal and visual analogue scalas), the frequency of positive aspiration, nerves anesthetised with a single injection within 5 and 10 minutes, and pain exerienced during tooth extraction (determined by using verbal and visual analogue scalas). Results showed the conventional block technique was die mostpainfid method when the pain experienced during injection was considered. Conventional, Gow-Gates and Aliinosi techniques, respectively, yielded 17.18%, 3.12%, and 9.37% positive aspirations. Onset of anesthesia was sligthly faster with conventional than with die Gow-Gates and Akinosi injection, but there were no significant differences among the techniques at 10 minutes. Tlie overall success rate of inferior alveolar nerve anethesia with a single injection to be 87.5% in theconventional, 95.3% intthe Gow-Gates and 90.6% in the Afunosi groups. These values were not found to be significant statistically. It was concluded that the Gow-Gates technique was more effective in blocking not only die inferior alveolar nerve but also oilier related nerves such as long buccal, auriculotemporal and mylohyoid nerves which may be played a role in the innervation of the lower morals. Althoung, conventional technique was faster and equally effective in blocking of the inferior alveolar nerve, it yielded more positive aspirations than others. Key words: Inferior alveolar nerve, mandibular anesthesia, conventional block injection technique, Gow-Gates technique, Akinosi technique alveolaris inferior blokaji amaciyla uygulanan Klasik, Gow-Gates ve Akinosi inaii-dibuler anestezi teknikleri, alt birinci ve ikinci molar dislerine cekim endikasyonu konulan 192 hastada karsilastirmali olarak incelendi. Cift-kor ve rastgele (randomize) olarak yurutulen calismada enjeksiyonun verdigi agri, pozitif aspirasyon, bloke olan sinirler ve dis cekiminin verdigi agri kriterleri degerlendirildi. Enjeksiyonun verdigi agrinin klasik yontemde en fazla oldugu, Akinosi tekniginin bunu takip ettigi, Gow-Gates tekniginde ise en az oldugu gozlendi. Pozitif aspirasyon degerleri klasik teknikte %17.18, Gow-Gates tekniginde %3.12 ve Akinosi tekniginde %9.37 olarak bulundu. Nervus alveolaris inferIorun on dakika icerisindeki blokaj orani, klasik teknikteki %87.5, Gow-Gates tekniginde %95.3, Akinosi tekniginde ise %90.6 olarak tespit edildi. Dis cekimi esnasinda duyulan agri incelendiginde, Gow-Gates tekniginin en derin anesteziyi sagladigi, Akinosi tekniginde ise en fazla agri duyuldugu izlendi. inferior, mandi-buler anestezi, klasik teknik, Gow-Gates teknigi, Akinosi Teknigi.

Temporary paralysis of cranial nerves III, IV, and VI after a Gow-Gates injection

A case of temporary complete paralysis of cranial nerves III, IV, and VI, after a Gow-Gates injection is reported. The proposed explanations for the mechanisms of occurrence are described. Although the Gow-Gates technique has many advantages, it is not without complications. To avoid such complications, it is important to take the following precautions when using the Gow-Gates technique: because of the proximity of the internal maxillary artery (accessory and middle meningeal) and the pterygoid plexus of veins, and because the anesthetic is injected quickly, it is paramount that careful aspiration be performed before administration of the local anesthesia; injections should be on or within 1 mm to 2 mm of the condylar neck.

A comparative study of the Gow-Gates technique and a standard technique for mandibular anesthesia

A comparative study was made of the Gow-Gatestechnique and the standard inferior alveolar nerve block. Forty subjects received both injections and various tests were performed 10 min after injection. The results demonstrated no significant differences between the two injection techniques, except in response to the question concerning subjective tongue numbness. Both techniques achieved a high rate of subjective numbness in the subjects' perception of overall numbness and lip numbness. Objective testing showed that only 38% of the subjects receiving the standard injection and 35% of the subjects receiving the Gow-Gates technique gave no response to the electric pulp tester at the maximum output (80/80). A comparative study was made of the Gow-Gatestechnique and the standard inferior alveolar nerve block. Forty subjects received both injections and various tests were performed 10 min after injection. The results demonstrated no significant differences between the two injection techniques, except in response to the question concerning subjective tongue numbness. Both techniques achieved a high rate of subjective numbness in the subjects' perception of overall numbness and lip numbness. Objective testing showed that only 38% of the subjects receiving the standard injection and 35% of the subjects receiving the Gow-Gates technique gave no response to the electric pulp tester at the maximum output (80/80).

The Gow-Gates mandibular block: Evaluation after 4,275 cases

The Gow-Gates mandibular block, introduced in the United States in 1973, represents the first new approach to intraoral regional anesthesia in many years. The technique is being taught at most United States dental schools. This article presents a clinical evaluation of the Gow-Gates technique after 5 years of application and more than 4,000 cases. Advantages of this technique over the conventional inferior alveolar nerve block include a greater success rate, decreased positive aspiration rate, and fewer postinjection problems.

Appendix: Some anatomic aspects of the Gow-Gates technique for mandibular anesthesia

Appendix: Some anatomic aspects of the Gow-Gates technique for mandibular anesthesia