Inferior Alveolar Nerve Block Injection Research Articles

Onset of action and duration of efficacy of inferior alveolar nerve block versus single lingual subperi-osteal injection of 4% articaine in mandibular second molars: A randomized clinical trial

Onset of action and duration of efficacy of inferior alveolar nerve block versus single lingual subperi-osteal injection of 4% articaine in mandibular second molars: A randomized clinical trial

Anaesthetic efficacy of incorporating different additives into lidocaine for the inferior alveolar nerve block: A systematic review with meta-analysis and trial sequential analysis.

Incorporating an additive into lidocaine is a method to enhance the efficacy of the inferior alveolar nerve block (IANB) in mandibular posterior teeth. To assess the efficacy of incorporating additives into lidocaine in the success rate of IANB for teeth with the diagnosis of normal pulp (NP) or symptomatic irreversible pulpitis (SIP). Randomized controlled trials (RCTs) assessing the incorporation of additives into lidocaine on the pulpal anaesthesia success rate of mandibular posterior teeth were searched in PubMed, Scopus, Web of Science, Ovid, EBSCO, Embase, and Cochrane databases up to 1 December 2021. The risk of bias (RoB) was assessed by the Cochrane Risk of Bias Tool. A random-effects model was employed to calculate the pooled risk ratio (RR) with a 95% confidence interval (CI), using STATA 16. The trial sequential analysis (TSA) was applied to calculate the required information size (RIS). The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach was used to assess the certainty of the evidence. Of 6966 records retrieved initially, 14 trials (8 for NP and 6 for SIP groups) were included in qualitative and quantitative syntheses. All trials were categorized as low and unclear RoB for NP and SIP groups, respectively. In the NP group, with 307 participants, no significant effect was observed for additives incorporated into lidocaine (RR: 0.84; 95% CI: 0.53-1.32; I2 =98%). Subgroup analysis revealed that adding mannitol led to a higher success rate (RR=1.24; 95% CI: 1.15-1.34; I2 =7.16%). In the SIP group, with 434 participants, no significant effect was shown when the additives were incorporated (RR=1.22; 95% CI: 0.98-1.52; I2 =0%). Likewise, in subgroup analysis, incorporating mannitol or sodium bicarbonate demonstrated no significant effect (RR=1.76; 95% CI: 0.93-3.32; I2 =18.41% and RR=1.06; 95% CI: 0.65-1.72; I2 =53.5%, respectively). TSA revealed that the outcome was "inconclusive" for each group. The certainty of the evidence was graded as "very low" and "low" for NP and SIP groups, respectively. The very low to low certainty of evidence indicated that incorporating additives into lidocaine did not increase the efficacy of IANB and supplemental injections are still necessary to help practitioners achieve painless dentistry. PROSPERO database (CRD42020132585).

Cryotherapy as an adjunct to inferior alveolar nerve block in Symptomatic Irreversible Pulpitis: A randomised controlled clinical trial

: To evaluate and compare the effect of two approaches of cryotherapy for improving the success rate of Inferior alveolar nerve block and reduction of pain during access opening in mandibular molars with symptomatic irreversible pulpitis.: Thirty patients diagnosed with symptomatic irreversible pulpitis were selected based on inclusion and exclusion criteria to participate in the study. 3 groups were designed; Group 1(Control group) - inferior alveolar nerve block(IANB) with lignocaine (2%) adrenaline (1:80000), Group 2(IANB+ small ice pack)-inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + small ice packs (wrapped in sterile gauze); Group 3 (IANB+Endo Ice) -inferior alveolar nerve block with lignocaine (2%) adrenaline (1:80000) + Endo Ice application. Patients were randomly allocated to any one of the groups: The level of preoperative pain was recorded using the Numeric visual analogue scale (VAS). Endodontic therapy was done 15 minutes after the IANB injection. The level of intra operative pain during access opening was recorded again using the same scale. If the patients reported moderate or severe pain during the procedure, the IANB was defined as “unsuccessful,” and a supplementary injection was administered.: There was statistically significant difference found in pain reduction among 3 groups (p=0.01). Post hoc analysis revealed significant difference between Group 1(Control) and Group 2(IANB+ small ice pack) with (p=0.003). Overall success rate of IANB was found to be 66.66 %.: Both the techniques of intraoral cryotherapy exhibited improved pain reduction as well as increased the success rate of IANBs in mandibular molar teeth with SIP. Hence based on the results obtained, it is suggested that cryotherapy can serve as a useful adjunct to anaesthesia during endodontic procedures.

A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia.

Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients’ reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.

Comparing the Efficacy of Premedication with Ibuprofen in Combination with an Inferior Alveolar Nerve Block and Primary Buccal Infiltration in Mandibular Molars with Irreversible Pulpitis: A Triple-blinded Randomized Clinical Trial.

This study aimed to determine the success rate of the combination of buccal infiltration (BI) and inferior alveolar nerve block (IANB) injections in irreversible pulpitis in mandibular molars after premedication with ibuprofen. From 132 patients participated in the study, 120 patients were included. One hour before root canal treatment, patients with mandibular molars with symptomatic irreversible pulpitis received either a 600 mg ibuprofen capsule or a placebo. All patients received 2% lidocaine with 1:80000 epinephrine and 4% articaine with 1:100000 epinephrine for IANB and BI, respectively. Patients' pain was evaluated using the Heft-Parker visual analog scale during the preparation of access cavity, exposure of pulp, and instrumentation of root canal. The success of anesthesia was defined as the absence of pain or mild pain. The Chi-square and t-test were employed for data analysis. The difference between patient age and gender in the two groups was not significant (P>0.05). The anesthesia success rate was 85% in the premedicated and 70% in the placebo group, with statistically significant results (P=0.049). Based on this triple-blinded randomized clinical study, mandibular molars with irreversible pulpitis were not thoroughly anesthetized by a combination of IANB+BI after premedication with ibuprofen (600 mg), even though anesthesia success was improved significantly by ibuprofen premedication.

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.

A rare case report and review of the literature: partial Horner's syndrome and unusual neurological complications after inferior alveolar nerve block

Background: Inferior alveolar nerve block (IANB) is frequently applied in mandibular dental procedures. Neurological complications develop very rarely due to IANB, and most of the complications are temporary. Case Presentation: We present a 79-year-old man with partial Horner's syndrome, hyperlacrimation, aphonia, dysphagia, severe cough, and foreign body sensation in the throat after IANB. All symptoms disappeared 3 hours after local anesthetic injection. Conclusion: It was aimed to investigate the underlying pathophysiological causes of complications together with clinical and anatomical data. Neuronal blockade of the carotid plexus, nervus laryngeus superior and inferior can develop after IANB. In addition, it is critical to accurately determine the IANB injection site in obese and thick-short neck patients.

Efficacy of four local anaesthesia protocols for mandibular first molars with symptomatic irreversible pulpitis: A randomized clinical trial.

To examine the efficacy rate of four anaesthetic protocols in mandibular first molars with symptomatic irreversible pulpitis (SIP). One hundred and sixty patients with a diagnosis of SIP were included in this randomized clinical trial. Patients were randomly allocated into four treatment groups (N=40) according to the administered technique: Group 1 (IANB): standard inferior alveolar nerve block (IANB) injection; Group 2 (IANB+IO): standard IANB followed by a supplemental intraosseous infusion (IO) injection; Group 3 (IANB+PDL): standard IANB followed by a supplemental periodontal ligament (PDL) injection; Group 4 (IANB+BI): standard IANB followed by a supplemental buccal infiltration. Patients rated pain intensity using a verbal rating scale when the root canal treatment procedure was initiated, that is, during caries removal, access preparation and pulpectomy. Heart rate changes were recorded before, during and after each injection. The anaesthetic efficacy rates were analysed using chi-square tests, age differences using one-way anova, gender differences using Fischer Exact tests whilst heart rate changes were analysed using Kruskal-Wallis tests. Statistical significances were set at p<.05level. All the included patients were analysed. No differences in the efficacy rate were found in relation to the age or gender of the participants amongst the study groups (p>.05). IANB+IO injections had a significantly higher efficacy rate (92.5%) when compared to other techniques (p<.05), followed by IANB+PDL injections (72.5%), IANB+BI injections (65.0%), with no significant differences between the IANB+PDL or IANB+BI injections (p>.05). IANB injection alone had a significantly lower rate (40%) compared to the other techniques (p<.05). A transient but significant rise in the heart rate was recorded in 60% (24/40) of patients who received the IANB+IO injection compared to other groups (p<.05). Inferior alveolar nerve block injection alone did not reliably permit pain-free treatment for mandibular molars with SIP. The use of an additional IO supplemental injection provided the most effective anaesthesia for patients requiring emergency root canal treatment for SIP in mandibular posterior teeth.

Comparison of infiltration (INF) and inferior alveolar nerve block (IANB) injection techniques in bilateral therapeutic removal of mandibular premolars.

Background. The present study aimed to evaluate and compare the anesthetic effect of infiltration (INF) and inferior alveolar nerve block (IANB) techniques for bilateral therapeutic extraction of mandibular premolars. Methods. One hundred patients requiring bilateral therapeutic removal of mandibular premolars were included in the study. For the extraction of the mandibular right premolar tooth, INF was used, and after one week, the mandibular left premolar tooth was extracted using the IANB. The effect of anesthesia between the two techniques was compared and evaluated by ANOVA using SPSS. Results. INF was successful in 78% of cases, whereas IANB was successful only in 22% of cases. Furthermore, INF had a significantly better anesthetic effect than IANB (P < 0.05). During pain assessment during the anesthetic drug injection and the procedure, two patients in the INF and five patients in the IANB group reported minimal pain during extraction (P > 0.05). The onset of the anesthetic effect was faster in the INF group, while the duration of the effect was longer in the IANB group. Conclusion. INF was a more efficacious local anesthetic technique with high success rate than the IANB technique.

Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual infiltration using articaine in mandibular molars with irreversible pulpitis: a preliminary prospective randomized single-blind clinical trial.

This study was designed as a prospective randomized single-blind clinical trial to compare the anesthetic efficacy of inferior alveolar nerve block (IANB), IANB plus buccal infiltration, and IANB plus lingual infiltration of 4% articaine with 1:100,000 epinephrine in mandibular molars with irreversible pulpitis. Sixty healthy volunteers who had a first or second mandibular molar diagnosed with irreversible pulpitis participated in the present study. This study was composed of three arms for the first molar and three arms for the second molar. Subjects in test arm A received two IANB injections (3.6 mL). Subjects in test arm B received 1.8 mL IANB injection plus 1.8 mL buccal infiltration. Subjects in test arm C received 1.8 mL IANB injection plus 1.8 mL lingual infiltration. Articaine (4%) with 1:100,000 epinephrine was used for all injections. The subject's pain during access preparation and pulp extirpation was recorded on the Heft-Parker visual analog scale. Success was defined as "none" or "mild" pain during treatment. Kruskal-Wallis test was used to compare pain categories in three groups of interventions for each mandibular molar. IANB with a supplemented buccal infiltration provided more success than IANB alone or IANB plus lingual infiltration, in first molars (P = .019). There were no significant differences between the three injection techniques in second molars (P = .795). Adding a supplemental buccal infiltration to a standard IANB was more successful in providing pain-free treatment for patients experiencing irreversible pulpitis in mandibular first molars.

Effectiveness of an interactive training software on the accuracy of inferior alveolar nerve block (IANB) injection at a preclinical level (pilot study).

Effectiveness of an interactive training software on the accuracy of inferior alveolar nerve block (IANB) injection at a preclinical level (pilot study).

Nitrous Oxide/Oxygen Effect on IANB Injection Pain and Mandibular Pulpal Anesthesia in Asymptomatic Subjects.

The inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia. Nitrous oxide may increase the success of the IANB. The purpose of this investigation was to study the effect of nitrous oxide/oxygen (N2O/O2) on IANB injection pain and mandibular pulpal anesthesia in asymptomatic subjects. One hundred five asymptomatic subjects received an IANB after the administration of N2O/O2 or room air/oxygen (air/O2) at 2 separate appointments. After the IANB, subjects rated their level of pain for each phase of the injection (needle insertion, needle placement, and solution deposition) using a Heft Parker visual analog scale. Pulpal anesthesia was evaluated with an electric pulp tester for 60 minutes. The mean pain rating for all 3 injection phases showed a statistically significant reduction in pain when N2O/O2 was used compared with Air/O2 (P < .05). Odds ratios demonstrated a statistically significant increase in IANB success for the N2O/O2 group compared with the air/O2 group. N2O/O2 administration statistically decreased pain for all 3 injection phases of the IANB. In addition, nitrous oxide statistically increased the likelihood of pulpal anesthesia for posterior mandibular teeth. However, the incidence of pulpal anesthesia was not 100%.

Anaesthetic Efficacy of 4% Articaine in Comparison with 2% Lidocaine as Intraligamentary Injections after an Ineffective Inferior Alveolar Nerve Block in Mandibular Molars with Irreversible Pulpitis: A Prospective Randomised Triple-Blind Clinical Trial.

The objective of the current study was to compare the anaesthetic efficacy of supplemental intraligamentary (IL) injection of 4% articaine with that of 2% lidocaine in the mandibular first and second molars with irreversible pulpitis after an ineffective inferior alveolar nerve block injection (IANB) using the same anaesthetic in a randomised triple-blind clinical trial. Seventy-six adult patients, who were diagnosed with irreversible pulpitis in the mandibular first or second molars, were divided into 2 groups and received IANB randomly. In patients with lip numbness, anaesthesia was evaluated with the cold and electrical pulp (EPT) tests, and if the reported number on EPT was below 100, supplemental IL injection was administered using the same anaesthetic. The teeth were retested after 5 minutes. The Heft–Parker visual analogue scale was used to evaluate pain after IANB and IL injections. Statistical analysis was performed using repeated measures ANOVA, chi-square, and independent-sample and paired-sample t-tests. The results showed that there was no significant difference in the success rates of supplemental IL and IANB injections between articaine and lidocaine. Furthermore, there was no significant difference in the success rates of supplemental IL injection with lidocaine between the mandibular first and second molars. However, there was a significant difference in the success rates of supplemental IL injection with articaine between the mandibular first and second molars. Moreover, supplemental IL injections indicated no significant difference in the anaesthetic efficacy between articaine and lidocaine; nevertheless, they were more effective in the mandibular second molars, especially with articaine.

Association between psychological factors and pain perception in patients with symptomatic irreversible pulpitis during endodontic treatment

Aim: To investigate the association of pain perception of inferior alveolar nerve (IAN) block injection and access cavity preparation with psychological factors in patients undergoing endodontic treatment. Methodology: In this observational study, out of 208 patients who had lower molar with symptomatic irreversible pulpitis, 165 patients completed the study. Psychological factors comprising anxiety, depression and personality traits were evaluated by Hospital Anxiety and Depression scale and short form of NEO Five-Factor Inventory. Procedural pain comprising needle insertion and anesthesia solution deposition during IAN block injection as well as access cavity preparation was rated based on the Heft-Parker visual analog scale. Binary logistic regression was used to determine odd ratio (OR) with 95% confidence interval (CI). Results: The mean (standard deviation) age of patients was 34.63 (12.42) in which, females comprised 72.7% (n=120). Considering the psychological factors, the anxious and depressed individuals constituted 38.8 % and 32.7% of the participants, respectively. By adjusting the socio-demographic factors, depression score during needle injection and anesthetic solution deposition were the risk factors for higher levels of pain (OR=1.12; 95% CI=1.03_1.29 and OR=1.13; 95% CI=1.05_1.32 respectively). Among the personality traits, just neuroticism at needle insertion and anesthetic solution deposition associated with higher levels of pain (OR=1.11; 95% CI=1.02_1.28 and OR=1.09; 95% CI=1.01_1.20 respectively). Conclusions: Coupling with the effect of physiological aspects (depression and neuroticism) on the perception of pain at the needle insertion and anesthetic solution during IAN block injection, a multidisciplinary effort both by dentists and by psychologists might improve dental services for some patients.

In vivo comparison of postoperative pain using two different techniques for local anesthesia in single-sitting root canal treatment

Aim: This in vivo split-mouth randomized control trial was carried out to study and compare the incidence of postoperative pain associated with single-sitting endodontic treatment using inferior alveolar nerve block and intraligamentary injection as primary anesthetic technique.Methods: A total of 30 patients with bilateral symptomatic irreversible pulpitis in mandibular molars were selected to be included in the study. In each subject, molar in one quadrant was randomly assigned to Group 1 (intraligamentary injection), and the molar in the opposite quadrant was assigned to Group 2 (inferior alveolar nerve block). The root canal procedures for the patients were carried out in single sittings under rubber dam using hand ProtaperTM system, 2.5% sodium hypochlorite as irrigant alternating with normal saline and obturation by the lateral condensation technique. A questionnaire employing Visual Analog Scale (VAS) for pain assessment was given to the patient and instructions on how to fill the form were given. VAS scores for every tooth treated in every patient were recorded before beginning treatment and after completion of treatment for each tooth. The patients were recalled after 2 days, and the scores were analyzed. The results were tabulated and statistically analyzed for incidence and degree of pain.Results: Group 1 and Group 2 showed a steady reduction in postoperative pain from 4 h to 48 h as seen in the mean VAS scores. Comparison between the two groups at each time interval showed a difference which was statistically insignificant (P > 0.05).Conclusion: There is no difference in the incidence of postoperative pain when either inferior alveolar nerve block or intraligamentary injection is employed as the primary technique for achieving anesthesia during single-sitting root canal treatment.

Hemodynamic changes in pediatric dental patients using 2% lignocaine, buffered lignocaine, and 4% articaine in pediatric dental procedures

Background: The purpose of this study was to compare the hemodynamic changes (blood pressure, heart rate and oxygen saturation) when using three different local anesthetic agents such 2% Lignocaine with 1:200,000 epinephrine, Buffered Lignocaine and 4% Articaine with 1:200,000 epinephrine with inferior alveolar nerve block in pediatric dental patients.Methods: A double blind crossover study was designed where in 48; 5-10 year old patients received three sections of inferior alveolar nerve block injections in three appointments which scheduled one week apart. Blood pressure, heart rate and oxygen saturation was measured before and after administration.Results: When applying three factors ANOVA, no statistically significant difference was found between Lignocaine and Buffered Lignocaine, Buffered Lignocaine and Articaine in all the three parameters(P > 0.05 ).Conclusion: This findings in hemodynamic changes from this study reveals that all the three anesthetic agents are safe in children aged 5-10 years.

Anesthetic efficacy of primary and supplemental buccal/lingual infiltration in patients with irreversible pulpitis in human mandibular molars: a systematic review and meta-analysis.

Achieving profound anesthesia in mandibular molars with irreversible pulpitis is a tedious task. This review aimed at evaluating the success of buccal/lingual infiltrations administered with a primary inferior alveolar nerve block (IANB) injection or as a supplemental injection after the failure of the primary injection in symptomatic and asymptomatic patients with irreversible pulpitis in human mandibular molars. The review question was “What will be the success of primary and supplemental infiltration injection in the endodontic treatment of patients with irreversible pulpitis in human mandibular molars?” We searched electronic databases, including Pubmed, Scopus, and Ebsco host and we did a comprehensive manual search. The review protocol was framed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. We included clinical studies that evaluated and compared the anesthetic outcomes of primary IANB with primary and/or supplementary infiltration injections. Standard evaluation of the included studies was performed and suitable data and inferences were assessed. Twenty-six studies were included, of which 13 were selected for the meta-analysis. In the forest plot representation of the studies evaluating infiltrations, the combined risk ratio (RR) was 1.88 (95% CI: 1.49, 2.37), in favor of the secondary infiltrations with a statistical heterogeneity of 77%. The forest plot analysis for studies comparing primary IANB + infiltration versus primary IANB alone showed a low heterogeneity (0%). The included studies had similar RRs and the combined RR was 1.84 (95% CI: 1.44, 2.34). These findings suggest that supplemental infiltrations given along with a primary IANB provide a better success rate. L'Abbe plots were generated to measure the statistical heterogeneity among the studies. Trial sequential analysis suggested that the number of patients included in the analysis was adequate. Based on the qualitative and quantitative analyses, we concluded that the infiltration technique, either as a primary injection or as a supplementary injection, given after the failure of primary IANB, increases the overall anesthetic efficacy.

Relative position of mandibular foramen in 4–9-year-old children: A retrospective study

Introduction: Most common nerve block used in children is the inferior alveolar nerve block (IANB) for anesthetizing mandibular teeth. Therefore, knowledge of the location of the mandibular foramen is necessary for a successful IANB anesthesia. Aim: The study aimed to correlate the position of mandibular foramen in relation to the mandibular occlusal plane and the deepest point of the coronoid notch as a clinical guide for IANB injection in 4–9-year-old children. Materials and Methods: One-hundred orthopantamographs were analyzed and divided into two groups; Group 1 (4–6 years) and Group 2 (7–9 years). The orthopantamographs were traced on the acetate paper using a radiograph viewer and measurements were taken from mandibular lingula (ML) to the occlusal plane and to the deepest point of the coronoid notch. Results: Statistical analysis of the data revealed that there was a significant difference in mean distance between the two groups on both sides by measuring the position of ML to the mandibular occlusal plane and to the deepest point of the coronoid notch. Intergroup comparison of the distance from ML to the deepest point of the coronoid notch on the right and left sides shows a statistically significant difference (P

Local anaesthesia for surgical extraction of mandibular third molars: a systematic review and network meta-analysis.

Pain management for the extraction of the mandibular third molar is a challenge as compelling evidence in comparative anaesthetics is currently lacking. Thorough literature searches took place in PubMed, ScienceDirect, CENTRAL, Embase, Web of Science, CBM, and CNKI. Thirty-three trials were meta-analysed using a Bayesian statistical approach within the random-effects model. Grading of Recommendations Assessment, Development, and Evaluation was performed to determine the overall quality of evidence across all comparisons. In terms of success rate, an inferior alveolar nerve block (IANB) injection of 2% lidocaine with epinephrine was less effective than a combined injection of buccal infiltration (BI) and lingual infiltration (LI) with a 4% articaine (RR = 0.85 [0.75, 0.96], P = 0.611). According to visual analogue scale (VAS), 2% lidocaine-IANB with epinephrine caused higher VAS scores than 4% articaine-IANB with epinephrine (MD = 0.84 [0.28, 1.40], P = 0.057), whereas 0.5% levobupivacaine-IANB showed lower scores than 2% lidocaine-IANB (MD = - 1.62 [- 2.97, - 0.28], P = 0.045). Also, 2% lidocaine-IANB with epinephrine presented longer latency than both 4% articaine-IANB with epinephrine (MD = 39.44 [16.97, 61.90], P < 0.001) and 4% articaine-BI + LI with epinephrine (MD = 164.41 [16.23, 312.58], P < 0.001); 4% articaine-IANB with epinephrine produced shorter latency than 0.5% bupivacaine-IANB with epinephrine (MD = - 42.92 [- 70.28, - 15.56], P = 0.106); 0.75% ropivacaine-IANB caused shorter onset of action compared with 2% lidocaine-IANB (MD = - 40.88 [- 65.50, - 16.26], P < 0.001). In addition, 2% lidocaine-IANB with epinephrine produced significantly shorter duration than both 4% articaine-IANB with epinephrine (MD = - 47.33 [- 57.88, -36.77], P = 0.265) and 2% mepivacaine-IANB with epinephrine (MD = - 10.01 [- 19.59, - 0.44], P = 0.769). The duration of action triggered by 4% articaine-IANB with epinephrine was shorter compared with 0.5% bupivacaine-IANB with epinephrine (MD = - 64.17 [- 74.65, - 53.69], P = 0.926). Both 0.5% levobupivacaine-IANB and 0.75% ropivacaine-IANB produced longer duration of action than 2% lidocaine-IANB (MD = 333.70 [267.33, 400.07], P < 0.001) and (MD = 288.01 [287.67, 288.34], P = 0.634, respectively). The network meta-analysis demonstrated that the intraosseous injection of 4% articaine with epinephrine had the most noteworthy success rate. However, the combination of BI and LI of 4% articaine with epinephrine, and IANB of 0.5% bupivacaine were, according to a VAS, the most effective. It should be noted that a rapid onset of action was produced by BI combined with LI of 4% articaine with epinephrine and IANB of 2% mepivacaine with epinephrine, while the most prolonged duration of action was generated by IANB of 0.5% levobupivacaine or 0.5% bupivacaine. For a better understanding of local anaesthesia for the extraction of the third molar, our study was aimed to provide evidence to guide better dental practices in pain management for clinicians.

Comparison of Clinical Efficacy of Classical Inferior Alveolar Nerve Block and Vazirani-Akinosi Technique in Bilateral Mandibular Premolar Teeth Removal: A Split-Mouth Randomized Study.

To compare the clinical efficacy of classical inferior alveolar nerve block (CIANB) and Vazirani-Akinosi (VA) injection technique in patients indicated for bilateral mandibular premolar teeth extraction for orthodontic treatment. This split-mouth comparative study was conducted on 20 patients randomly selected for bilateral extraction of mandibular premolar indicated for orthodontic treatment to receive CIANB and VA injection technique alternatively. The clinical parameters evaluated were pain during injection, onset of anesthesia, duration of anesthesia, quality of anesthesia, nerve anesthetized with single nerve block, need for re-injection and frequency of positive aspiration. No statistically significant differences were observed regarding the onset of anesthesia, duration of anesthesia, quality of anesthesia, nerves anesthetized with single nerve block and need for re-injection. However, pain experienced during injection was statistically significant and was lesser in VA technique than CIANB. Positive aspiration was not found in both the injection techniques. VA technique showed a statistically significant difference in terms of less pain experienced during injection than CIANB. However, though not significant, VA technique was more clinically superior over the CIANB in terms of duration of anesthesia, quality of anesthesia and the need for re-injection. Also in this study, there were no complications associated with any of the injection techniques and the prevalence of positive aspiration was not found in both the techniques.