Inferior Alveolar Nerve Block Anesthesia Research Articles

Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: double-blind randomized clinical trial of anesthetic efficacy

The purpose of this clinical prospective, randomized, double-blind study was to compare the anesthetic efficacy of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar nerve block anesthesia for extractions of mandibular teeth. Eighty-eight patients received intraoral inferior alveolar nerve blocks using 4% articaine with 1:100,000 epinephrine (n = 41; group 1) or without epinephrine (n = 47; group 2) for extractions of mandibular teeth. The primary objectives were differences in onset as well as in length of soft tissue anesthesia. The amount of anesthetic solution, need of a second injection, pain while injecting, pain during treatment, postoperative pain, and possible complications were surveyed. In both groups, anesthesia was sufficient for dental extractions. In group 1, a significantly faster onset of the anesthetic effect (7.2 min vs. 9.2 min; P = .001) and a significantly longer duration of soft tissue anesthesia (3.8 h vs. 2.5 h; P < .0001) were seen. There was no significant difference in the amount of anesthetic solution needed, in the need for a second injection, in the injection pain, in pain during treatment, or in postoperative analgesia. In both groups, no complications were seen. To minimize the epinephrine-induced side effects, 4% articaine without epinephrine is a suitable anesthetic agent for dental extractions in the mandible after inferior alveolar nerve block anesthesia. There could be less postoperative discomfort due to the shorter duration of anesthesia without increased postoperative pain.

A recurrent variant branch of the inferior alveolar nerve: Is it unique?

The only named branch of the inferior alveolar nerve (IAN) before it enters the mandibular foramen is the mylohyoid nerve. However, several variations have been reported in the literature. In this study, a recurrent variant branch of the IAN arising just below the origin of the mylohyoid nerve was investigated in adult Indian cadavers allotted for dissection to the first year dental students of Government Dental College, Ahmedabad (India). The dissection was performed by the lateral approach to the infratemporal fossa. The nerve was found in 12 of 35 sides (34.3%) and 8 of 18 cadavers (44.4%). Thus, in our study it was not a rare variation of the IAN, where in most cases it innervated the lateral pterygoid muscle. In some cases, it terminated in the lateral pterygoid muscle. In others, it penetrated the muscle to join the anterior or posterior division of the mandibular nerve or its branches; thus, the variant nerve in such cases might be regarded as an additional root of the IAN. Because the concerned primordia of the nerves and muscles migrate extensively during development and growth, alternative routes of migration may bring about variants like the one under study. The variant appeared to be unique in some of its features. It may be a source of neuropathic and referred pain. Failure of the conventional inferior alveolar nerve block anesthesia and the peripheral neurectomy used for the treatment of trigeminal neuralgia may be partly due to the presence of this variation.

Hypoesthesia after IAN block anesthesia with lidocaine: management of mild to moderate nerve injury

Hypoesthesia after an inferior alveolar nerve (IAN) block does not commonly occur, but some cases are reported. The causes of hypoesthesia include a needle injury or toxicity of local anesthetic agents, and the incidence itself can cause stress to both dentists and patients. This case presents a hypoesthesia on mental nerve area followed by IAN block anesthesia with 2% lidocaine. Prescription of steroids for a week was performed and periodic follow up was done. After 1 wk, the symptoms got much better and after 4 mon, hypoesthesia completely disappeared. During this healing period, only early steroid medication was prescribed. In most cases, hypoesthesia is resolved within 6 mon, but being aware of etiology and the treatment options of hypoesthesia is important. Because the hypoesthesia caused by IAN block anesthesia is a mild to moderate nerve injury, early detection of symptom and prescription of steroids could be helpful for improvement of the hypoesthesia.

파노라마 방사선 사진을 이용한 한국인 소아의 하악공 위치에 대한 연구

본 연구는 소아에서의 성공적인 하치조신경 전달 마취를 위한 정보를 얻기 위해 파노라마 방사선 사진에서 한국인 소아의 하악공 위치를 분석하였다. 총 240명의 7-15세의 파노라마 방사선 사진을 수집하여, 연령에 따라 7-8세, 9-10세, 11-12세, 13-15세의 하위 그룹으로 나누었으며 각 그룹은 남녀 각 30명씩을 포함하였다. 좌우측의 하악공으로부터 하악절흔, 악각전절흔, 하악지 전연, 하악지 후연까지의 최단거리와 교합평면까지의 수직거리를 측정하였으며, 하악공으로부터 하악절흔과 악각전절흔의 거리의 비와 하악공으로부터 하악지 전연과 하악지 후연의 비를 계산하였다. 연구 결과는 다음과 같다. 1) 하악공의 하악지 내 상대적 위치는 남녀 모두에서 연령 증가에 따라 전방으로 이동하는 경향이 관찰되나, 수직적인 위치는 연령과 유의한 상관관계를 보이지 않았다. 2) 하악공의 교합평면과의 상대적인 위치는 연령 증가에 따라 교합평면 하방에서 상방으로 이동하였으며, 연령과 높은 상관관계를 나타내었다(p<0.05). 3) 여자보다 남자에서 하악공이 교합평면을 기준으로 더 상방에, 하악지 내 전후방 및 수직적으로는 하악지의 후상방에 위치하여 성별에 따른 차이를 보였다(p<0.05). The aim of this study was to evaluate the position of the mandibular foramen in panoramic radiographs of Korean children to provide information for successful inferior alveolar nerve block anesthesia. 240 panoramic radiographs of 7 to 15-year-old boys and girls were analyzed. The subjects were divided into 4 groups in boys and girls according to their age.; 7-8, 9-10, 11-12 and 13-15 years old. The shortest distances from the center of the mandibular foramen to the anterior border of ramus, to the posterior border of ramus, to the antegonial notch and to the mandibular notch and the perpendicular distances from the center of the mandibular foramen to the occlusal plane were measured. The following results were obtained. 1) Although the relative position of the mandibular foramen in the ramus of mandible tended to move anteriorly for both genders with age, the vertical position did not correlate with age. 2) The mandibular foramen moved upward in relation to the occlusal plane with age, and showed statistically significant correlation with age(p<0.05). 3) The mandibular foramina of boys, when compared to those of girls, were located more superiorly in relation to the occlusal plane and more superiorly and posteriorly in the ramus of mandible.

Effect of painless anesthesia instrument coordinated with nursing intervention during single tooth anesthesia for mandibular impacted tooth extraction

Objective To investigate the effect of nursing intervention coordinated with painless anesthesia instrument during single tooth anesthesia for mandibular impacted tooth extraction.Methods 120 patients of mandibular impacted tooth extraction were randomly divided into two groups:the experimental group (60 cases) was given anesthetic by the WAND single tooth anesthesia while the control group (60 cases) was given conventional inferior alveolar nerve block anesthesia.Both groups received routine nursing,while the experimental group was given additional nursing intervention.Blood pressure (BP),pulse and heart rate (HR) of the patients were measured at various time intervals.The value of visual analogue scale (VAS) was also recorded and evaluated.Results The VAS score of the experimental group ( 1.582 ± 1.025 ) was significantly lower than that of the control group (4.935 ±7.513) and the difference was statistically significant.There was no significant difference of BP and HR of the experimental group before and after the anesthesia.Systolic pressure of the control group during the three stages of anesthesia and pest-operation was ( 116.18 ± 10.83),( 130.36 ± 10.15 ),( 131.66 ± 8.90),( 116.94 ± 10.29) mmHg,respectively.There was significant difference among the four intervals (F =126.735,P ＜ 0.01 ),DBP among the four intervals was statistically significant( P ＜0.01 ),HR was no difference( P ＞0.05).Significant differences were found of the changes of BP and HR at various timing of anesthesia between the two groups ( P ＜ 0.05 ).Conclusions The WAND single tooth anesthesia and effective nursing intervention produced a significantly lower pain score and safer anesthesia range than conventional inferior alveolar nerve block anesthesia. Key words: Impacted tooth; Nursing intervention; Painless anesthesia instrument; Inferior alveolar nerve block anesthesia

Clinical anatomy of inferior alveolar nerve block anesthesia

Clinical anatomy of inferior alveolar nerve block anesthesia

Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester

J Korean Assoc Oral Maxillofac Surg 2011;37:464-9) Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester Myong-Suk Ku, Jin Wook Kim, Young Hoon Jeon, Tae Geon Kwon, Sang Han Lee Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea Introduction: As dental implant surgery is becoming increasingly popular, it has become one of the causes for the hypesthesia of the inferior alveolar nerve, along with other surgical procedures, such as a third molar extraction. In addition, it tends to cause legal problems between the operator and patient. Therefore, there must be a proper method that is reliable, objective and economical to assess the nerve impairment. For this reason, an attempt was made to use an Electric Pulp Tester to assess inferior alveolar nerve block anesthesia. Materials and Methods: Thirty patients were tested. Electric pulp testing of the lower jaw skin was performed at the three different times, before anesthesia, at the onset of sensory changes and after 15 minutes waiting from the onset, and on the 10 points of the chin, which produced 10 sections on the skin area. Results: Twenty seven patients (90%) could feel the electric stimulus on the chin at all 10 points before local anesthesia and the scores represent the statistical differences between the right and left points except R4 and L4. After anesthesia, the difference between the right and left points (L3-R3, L4-R4, L5-R5) increased significantly with time but two points (L2, R2) showed no significant difference. The scores on the left chin (L3, L4, L5) increased, whereas the other points (R1-R5, L1, L2) showed no significant differences. Conclusion: This study highlights the potential clinical use of an electric pulp tester for an assessment of inferior alveolar nerve impairment.

Is supraperiosteal infiltration anesthesia safe enough to prevent inferior alveolar nerve during posterior mandibular implant surgery?

There is no agreement on using inferior alveolar nerve (IAN) block or supraperiosteal infiltration anesthesia during dental implant surgery in the posterior mandibular region. The aim of this study was to evaluate the effectiveness of supraperiosteal infiltration anesthesia on posterior mandibular region during dental implant surgery. In this study 52 implants were inserted under supraperiosteal infiltration anesthesia in 29 patients. After the surgery, patients were instructed to note their pain and/or painless dyscomfort on the visual analogue scale (VAS). Their pressure pain threshold (PPT) scores were evaluated by mechanical algometer. The distance between the apical end of the implants and IAN was measured by using calipers on postoperatif panoramic radiographs. 50 implants to 27 patients had been able to place without pain under supraperiosteal infiltration. Implants which were placed at the mandibular second premolar and first molar region had been able to place with free of pain with supraperiosteal infiltration. There was no relationship among the distance between the apical ends of the implants and IAN with intraoperative discomfort of the patients. VAS scores during implant placement at the second premolar region were relatively higher than at the first and second molar region. Supraperiosteal infiltration anesthesia is a safe and effective method for posterior mandibular implant surgery. However the length of the implant should be determined carefully to avoid possible damage to IAN during implant placement under supraperiosteal infiltration anesthesia.

The effect of orally administered ketamine on requirement for anesthetics and postoperative pain in mandibular molar teeth with irreversible pulpitis

Achieving successful anesthesia and pain control in a predictable, efficient manner is a challenge in the endodontic treatment of vital inflamed lower molars. The aim of this study was to evaluate the effect of oral ketamine on the dosage of local anesthetics required and postoperative pain management for irreversibly inflamed mandibular molars. In this randomized double-blind placebo-controlled clinical trial, 36 patients with irreversibly inflamed mandibular molars were randomly divided into two groups of 18. Ten mg of ketamine dissolved in 20 ml of fruit juice was administered orally to patients in the experimental group. The control group was given 20 ml of fruit juice alone as a placebo. After 30 min, inferior alveolar nerve block (IANB) anesthesia was induced using one cartridge of 2% lidocaine and 1:100000 epinephrine. Teeth were tested after 5 to 10 min using an electrical pulp tester. In patients showing a positive response, another IANB injection was applied, and the total number of anesthetic cartridges used was recorded. Postoperative pain was evaluated using a visual analogue scale (VAS). In addition, use of analgesic in the first 24 h after treatment was monitored using a questionnaire. Data were analyzed by t test using SPSS software. There were no significant differences in age or gender between the two groups. The number of anesthetic cartridges used in the ketamine group was significantly less than that in the control group (P = 0.003). Furthermore, postoperative pain in the ketamine group was significantly lower (P = 0.019). Also the number of analgesic tablets taken in the ketamine group was significantly lower (P = 0.011). It can be concluded that a low dose of ketamine might be beneficial for enhancing the effect of local anesthetics.

The Effect of Premedication with Ibuprofen and Indomethacin on the Success of Inferior Alveolar Nerve Block for Teeth with Irreversible Pulpitis

Introduction Achieving pulp anesthesia with irreversible pulpitis is difficult. This study evaluated whether nonsteroidal anti-inflammatory drugs assist local anesthesia. Methods In a randomized double-blinded clinical trial, 150 patients (50 per group) with irreversible pulpitis were given placebo, 600 mg ibuprofen, or 75mg indomethacin 1 hour before local anesthesia. Each patient recorded their pain score on a visual analog scale before taking the medication, 15 minutes after anesthesia in response to a cold test, during access cavity preparation and during root canal instrumentation. No or mild pain at any stage was considered a success. Data were analyzed by the chi-square and analysis of variance tests. Results Overall success rates for placebo, ibuprofen, and indomethacin were 32%, 78%, and 62%, respectively (p < 0.001). Ibuprofen and indomethacin were significantly better than placebo (p < 0.01). There was no difference between ibuprofen and indomethacin (p = 0.24). Conclusions Premedication with ibuprofen and indomethacin significantly increased the success rates of inferior alveolar nerve block anesthesia for teeth with irreversible pulpitis.

Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis

Conventional inferior alveolar nerve block (IANB) has a poor success rate in inflamed pulps. Three alternative techniques of providing anesthesia to mandibular molars were evaluated and compared with conventional IANB. Ninety-seven adult volunteer subjects, actively experiencing pain, participated in this prospective, randomized, double-blinded study. Twenty-five patients received Gow-Gates mandibular conduction block anesthesia, 24 patients received "high" Vazirani-Akinosi inferior alveolar nerve block, 26 received only buccal-plus-lingual infiltrations, and 22 patients (control) received conventional IANB anesthesia. Endodontic access preparation was initiated after 15 minutes of anesthesia. Pain during treatment was recorded using a Heft-Parker visual analog scale. Success was recorded for "none" or "mild" pain. Statistical analysis using nonparametric McNemer tests showed that Gow-Gates gave a success rate of 52%, which was statistically higher than control IANB (36%) (P < .05). Vazirani-Akinosi and infiltrations gave 41% and 27% success rates, respectively, with no statistically significant differences from control IANB. Gow-Gates mandibular conduction anesthesia may increase the success rates in patients with irreversible pulpitis compared with conventional IANB. None of the techniques provided acceptable success rates.

Randomized, Double-blind, Comparative Clinical Trial on the Efficacy of 4% Articaine and 2% Lidocaine in Inferior Alveolar Nerve Block Anesthesia

Randomized, Double-blind, Comparative Clinical Trial on the Efficacy of 4% Articaine and 2% Lidocaine in Inferior Alveolar Nerve Block Anesthesia

Diplopia after inferior alveolar nerve block anesthesia: Report of 2 cases and literature review

Inferior alveolar nerve block (IANB) anesthesia is one of the most common procedures in the dental clinic. Although this procedure is well known for its safety, complications can still occur. An ocular complication such as diplopia, loss of vision, or ophthalmoplegia is very rare, but once it happens, both the dentist and patient can be perplexed by the unexpected circumstance, and the doctor-patient trust may be harmed. We experienced 2 cases of diplopia after IANB anesthesia. This report describes the cause and diagnosis of the associated symptoms and includes a review of the literature.

Pain and Anxiety Control: An Online Study Guide

The Editorial Board of the Journal of Endodontics has developed a literature-based study guide of topical areas related to endodontics. This study guide is intended to give the reader a focused review of the essential endodontic literature and does not cite all possible articles related to each topic. Although citing all articles would be comprehensive, it would defeat the idea of a study guide. This section will cover pain theories and dentin hypersensitivity, referred pain, oral pain not of dental origin, barodontalgia, local anesthetics, long-acting local anesthetics, intrapulpal anesthesia, intraligamentary anesthesia, intraosseous anesthesia, inferior alveolar nerve block anesthesia, Gow-Gates anesthesia technique, Vazirani-Akinosi anesthesia technique, second-division block anesthesia technique, endodontic postoperative pain, effect of occlusal adjustment on endodontic pain, paresthesia associated with periradicular pathosis, analgesics, sedation, and endodontic flare-ups.

The Effect of Preoperative Acetaminophen or a Combination of Acetaminophen and Ibuprofen on the Success of Inferior Alveolar Nerve Block for Teeth with Irreversible Pulpitis

This study compared preoperative administration of acetaminophen or a combination of acetaminophen and ibuprofen versus placebo for potential increased effectiveness of inferior alveolar nerve (IAN) block anesthesia. There were 40 patients with irreversible pulpitis randomly assigned to a drug or placebo group. Thirty minutes after ingestion of medication, an IAN block was administered. A cold test was done 15 minutes after the block, and if the patients had no sensitivity, endodontic therapy was initiated. If the patient had no pain on access, the IAN was recorded as successful. If the patient had sensitivity to cold or to the access procedure, it was recorded as a failure. Overall success was 60% for all three groups. Success was 71.4% for the acetaminophen group, 75.9% for the acetaminophen and ibuprofen group, and 46.2% for the placebo group. There was no significant difference between the groups; however, there was a trend toward higher success in the medication groups.

The anesthetic efficacy of 4 percent articaine 1:200,000 epinephrine: Two controlled clinical trials

The authors conducted two double-blinded, randomized, multicenter clinical trials to determine the efficacy and clinical anesthetic characteristics of 4 percent articaine hydrochloride (HCl) with 1:200,000 epinephrine (A200) as compared with those of 4 percent articaine HCl with 1:100,000 epinephrine (A100) and 4 percent articaine HCl without epinephrine (Aw/o). During separate testing sessions, members of the authors' research team used three articaine study formulations to induce either inferior alveolar nerve block anesthesia (Trial 1) or maxillary infiltration anesthesia (Trial 2). In each trial, subjects received, in a randomized sequence, each of the three formulations to determine efficacy (success rate) and anesthetic characteristics (onset time and duration). The authors evaluated pulpal anesthesia via subjects' response to electric pulp testing (EPT). A total of 126 subjects were enrolled in the two studies (63 subjects in each trial). In both mandibular and maxillary trials, the success rates for inducing profound anesthesia (EPT score > 80), the mean onset times and the mean durations of anesthesia were similar for both epinephrine-containing formulations (A200 and A100). In subjects who received the formulation containing no epinephrine (Aw/o), the success rate for profound anesthesia was significantly less. These studies demonstrated that the inclusion of epinephrine in 4 percent articaine anesthetic formulations is essential for achieving profound anesthesia. The authors found that the A200 formulation provided a level of pulpal anesthesia comparable with that of the A100 formulation.

Abcès sous condylien : complication rare d’une anesthésie locale

Ninety percent of oro-facial infections arise from a dental origin. The remaining 10% are the consequence of oro-pharyngeal, cutaneous or iatrogenic problems, such as in the present case. A 24-year-old patient consulted the emergency room because of a left mandibular swelling, accompagnied by trismus. Four days earlier, extraction of the 38 was performed under inferior alveolar nerve block anesthesia. A first drainage by vestibular approach was performed under general anesthesia. Because of the absence of improvement, a CT-scan was performed and an abscess localized at the base of the condyle, surrounding the posterior margin of the mandible, very high above the lingula. Outcome was favourable after a second surgery. Formation of an abscess very high above the lingula, around the condylar neck is rarely reported in the literature. In this patient it was certainly a complication resulting from the injection of local anesthesic with a vasoconstrictor. CT-scan should be performed to guide diagnosis in the event of an unusual course after the first surgical procedure and an adequate antibiotic regimen.

Effect of inferior alveolar nerve block anaesthesia on the lower teeth

The aims of this study were to investigate the effects on pulpal blood flow and anaesthesia in mandibular teeth during inferior alveolar nerve block anaesthesia using 2% lignocaine with 1:80,000 adrenaline in 10 adult human subjects. Local anaesthetic solution was delivered close to the inferior alveolar nerve at the mandibular foramen using a standardized nerve block technique. The pulpal blood flow of the canine and first permanent molar was monitored by a laser Doppler flowmeter. At selected times pulpal anaesthesia was tested with an electric pulp tester. The injection of 2 ml of solution caused a decrease in pulpal blood flow in both teeth in every subject. The reduction in blood flow was of shorter duration than pulpal and soft tissue anaesthesia. A period of increased blood flow following the period of reduction was noted in several subjects. The mean reduction in pulpal blood flow in the canine at 15 min was 48% and lasted for a mean of 93 min. In contrast, the mean reduction in pulpal blood flow in the molar at 15 min was 25% and of 72 min mean duration. The mean duration of pulpal anaesthesia was 114 min in the canine compared with 88 min in the molar. Full soft tissue anaesthesia lasted for a mean of 151 min, whereas complete recovery took 255 min. This study indicated that lignocaine and adrenaline in block anaesthesia acted not only at the site of injection but also within the individual teeth.

An electrophysiological study of the pathways of pulpal nerves from mandibular teeth in the cat

To explain failure of inferior alveolar nerve block anaesthesia, many works have suggested that some nerves supplying the mandibular teeth may travel by other routes; e.g. via branches of the cervical, facial, buccal, lingual and mylohyoid nerves. These nerves as well as the mental nerves were examined in the cat, using electrophysiological techniques, to establish whether they contain axons supplying the pulps of lower teeth. Electrodes were placed in ipsilateral and contralateral mandibular teeth and on the above nerves so that the response could be recorded in a nerve during electrical stimulation of a tooth and vice versa. In 10 of the 12 animals some pulpal nerve fibres travelled with the ipsilateral lingual nerve. These fibres most commonly supplied the incisor teeth and appeared to enter the lingual surface of the mandible near to the teeth which they supplied. In one animal, the lingual nerve contained fibres supplying a contralateral central incisor. No pulpal fibres could be demonstrated in any of the other nerves examined. The mylohyoid nerve carried sensory fibres from an area of skin beneath the mandible; the presence of afferent nerve fibres in the facial nerve was confirmed.

Objective signs of inferior alveolar nerve anesthesia in exodontia

Objective determination of the adequacy of inferior alveolar nerve anesthesia is difficult. A dependable objective test based upon clinical observation of hundreds of patients during extraction of mandibular teeth, is presented. Following routine inferior alveolar nerve block anesthesia, time is allowed for subjective signs of “tingling” of the lower lip. Fully aware that the patient may respond to pressure in the absence of pain, the tooth to be extracted is tested. Gradual pressure of increasing intensity is applied with extracting forceps for 3 seconds, then suddenly released, providing a sudden stimulus. If the patient immediately moves or “jumps,” this response indicates inadequate anesthesia. If the patient does not respond to the sudden release of pressure, that tooth can be removed painlessly even though the patient may still respond to pressure.