Inferior Alveolar Nerve Block Technique Research Articles

Dental students, interns, and junior dentists’ awareness and attitude toward the inferior alveolar nerve block technique and related failure

Background/purposeExploration of early practicing dental professionals' awareness and attitude toward inferior alveolar nerve block IANB will directly inform efforts to improve clinical practices and ensure patient safety. The aim was to highlight the students, interns, and junior dentists’ awareness and attitude toward the IANB, failure, and related complications in the Kingdom of Saudi Arabia (KSA). Materials and methodsAn open web-based survey prepared according to the Checklist for reporting results of Internet e-surveys CHERRIES recommendations was designed and carried out across different regions of the KSA. The questionnaire was composed of four main sections including the participant's details, and qualifications; inferior alveolar nerve block delivery; participants' education, and training-related questions; and attitudes toward proposed solutions to overcome the related failure and complications. Results262 participants completed the questionnaire (94 dental students, 79 interns, and 89 junior dentists). There was a significant difference in the following findings: males performed IANBs more frequently than females (P < 0.05); females, students, and private practice/University type showed less attendance to workshops and seminars on IANB with more need for training (P < 0.05); females were more in agreement with ‘‘continuous education courses’’ and ‘‘workshops done by specialists’’ to propose solutions to overcome IANB failure (P < 0.05). The multivariate logistic regression analysis showed that qualification and attendance of a training course were strong predictors of participants' readiness to manage IANB complications (P < 0.05). ConclusionThe findings emphasize how crucial it is for early dental practitioners to participate in continuing professional development programs to enhance their capacity to administer IANB and handle complications.

Efficacy of Different Techniques of the Inferior Alveolar Nerve Block for Mandibular Anesthesia: A Comparative Prospective Study.

Background The inferior alveolar nerve block (IANB) is a commonly employed technique in oral surgery for achieving profound anesthesia in the mandibular teeth and associated structures. Several techniques have been developed to enhance the success rate and patient comfort during the IANB. The aim of this study was to compare and evaluate the efficacy of different IANB techniques for mandibular anesthesia. Materials and methods The participants included in the study were adultsrequiringsurgical extraction of an impacted mandibular third molar teeth. A total of 100 participants were randomly assigned to five different groups representing various techniques of IANB, i.e., conventional Halsted technique, Vazirani-Akinosi technique, Gow-Gates technique, Fischer 1-2-3, and extraoral Kurt-Thoma technique, with 20 participants in each group. The participants were evaluated for the onset of anesthesia using subjective and objective methods, pain perception during the administration of local anesthesia using a 10-point visual analogue scale (VAS), and the incidence of trismus postoperatively. Data were analyzed using IBM SPSS Statistics for windows, version 23.0 (released 2015; IBM Corp Armonk, United States) with p-values less than 0.05 considered as statistically significant. Descriptive statistics, Kruskal-Wallis, and post-hoc tests were included in the data analysis for intergroup comparisons. Results The primary outcomes evaluated were the onset of anesthesia, the patient's perception of pain during the administration of local anesthesia, and the secondary outcome included in the incidence of trismus. In this study, it was found that the Kurt-Thoma technique had the fastest onset of anesthesia (2.25 minutes), higher incidence of trismus (25%), and higher pain perception (6.5 score on VAS). The conventional Halstead technique (3.55 minutes), Fischer 1-2-3 technique (3.5 minutes), and Vazirani-Akinosi technique (3.1 minutes) had an almost similar mean duration of anesthesia. The onset of anesthesia was delayed in the Gow-Gates technique (5.1 minutes). Patient perception of pain during administration of local anesthesia was higher in the Kurt-Thoma (6.5) and Gow-Gates techniques (4.95), and it was least in the Fischer 1-2-3 technique (0.75) in the VAS scores. The incidence of trismus was highest with the Kurt-Thoma technique (25%), then the Gow-Gates technique (20%), followed by the conventional Halstead technique (5%). Conclusion In this study, it was found that the conventional Halsted technique was the best among the different techniques of IANB and remains the gold standard.

Bloqueos locorregionales para la corrección del paladar hendido en un potro: reporte de caso

The present work aims to describe the case of a Quarter Horse foal, 9 months old and weighing 166 kg, which was tended to by the medical and surgical clinic for large animals at the Veterinary Hospital of the Federal University of Paraná for correction of a cleft palate. Xylazine (0.5 mg/kg) was used as preanesthetic medication. Subsequently, induction was performed with propofol (1mg/kg) and ketamine (1 mg/kg). For anesthetic maintenance, isoflurane, lidocaine (3 mg/kg/h), ketamine (0.6 mg/kg/h) and dexmedetomidine (1 ug/kg/h) were used. Intraoperative analgesia was combined with locoregional blocks, with maxillary, mental and inferior alveolar nerve blocks being performed using anatomical references with lidocaine and bupivacaine (3 ml per site). Among the physiological parameters monitored, heart rate, systolic blood pressure, mean blood pressure and diastolic blood pressure stand out, having remained stable throughout the anesthetic period. Finally, the maxillary, mental and inferior alveolar nerve block technique was possibly a viable alternative for the proposed procedure, since there were no parametric alterations of nociception during surgery.

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.

Evaluation of a Nishit-Rama Modification of a Gow-Gates Technique for Giving Mandibular Nerve Block: A Randomized Controlled Trial.

In pursuit of improving currently available anesthetic techniques for dental procedures, present study evaluated a novel mandibular nerve block technique in comparison with control group administered standard inferior alveolar nerve block (IANB) technique. A randomized, comparative, parallel design, double-blind study was conducted at Tata Main Hospital, Jamshedpur, India which enrolled 140 adult patients (70 in experimental group and 70 in control group) requiring minor surgical dental procedures involving normal forceps method extractions of mandibular molars. Tingling or numbness of the lower lip of the same side was considered suggestive of successful IANB blockage. Onset of anesthesia, aspiration of blood and failure of anesthesia were also assessed and compared between study groups. Mean age and gender distribution were statistically comparable between study groups (p > 0.05). Diagnosis of the enrolled cases was either acute or chronic apical periodontitis, which was distributed similarly in study groups (p > 0.05). Mean time to onset of the IANB blockage was found to be significantly longer in experimental group versus control (3.72 ± 0.84 versus 1.93 ± 0.62min, p < 0.05). Both, number of positive aspirations (7.14% versus 25.72%, p < 0.05) and need for additional injection were significantly lower in experimental group (18.58% versus 74.28%, p < 0.05). Incidence of pain while tooth removal was similar between study groups (p > 0.05). The novel technique for mandibular nerve block evaluated in present study has various advantages like avoidance of technical difficulties with absence of extra-oral landmark, lower chances of reinsertion reducing complication risk, and decreased systemic complications, evident by lower rates of aspirations.

Effect of Vocal Anesthesia on Adult Dental Patients during Covid-19 pandemic period

BACKGROUND: Pain is as a major concern with dental patients. The dentist-patient interaction can reveal the presence of anxiety and fear, which may result in rise of pain. This study aimed to assess vocabulary communication as support to dental anesthesia on the adult dental patient.MATERIALS AND METHODS: This is a prospective, randomized clinical study, conducted from February 2020 through March 2021. Two hundred individuals (112 males, 88 females) of the age range (16 to 84 years) were separated into two groups for testing the level of pain during dental local anesthesia, with vocal communication and without vocal communication.RESULTS: While the control group showed no difference between males and females, there was a difference between the sexes in the experimental group with past dental visits, VAS and injection type having less anxiety (p=0.0001) while with education/VAS having (p£0.01) as appear in sex to age (p£0.05). There was no difference when data were compared by age, or type of anesthesia (inferior alveolar nerve block or infiltration technique).CONCLUSION: Dental anxiety can be alleviated by talking to the patients before the procedure, which could reduce the amount of pain.

Effectiveness of thaumaturgic distraction in alleviation of anxiety in 4-6-year-old children during inferior alveolar nerve block administration: a randomized controlled trial.

Dental anxiety is a matter of serious concern to pediatric dentists as it may impede the efficient delivery of dental care. If not adequately resolved, a persistent negative response pattern may emerge. Thaumaturgy, commonly known as magic trick, has become popular recently. It is a tool that distracts and relaxes the child by using magic trick while the dentist performs necessary treatment. Hence, the aim of this study was to evaluate the effectiveness of Thaumaturgic aid in alleviation of anxiety in 4-6 - year-old children during administration of local anesthesia using the inferior alveolar nerve block (IANB) technique. Thirty children aged between 4-6 years with dental anxiety requiring IANB were included in this study. Patients were divided equally into two groups: Group I, thaumaturgic aid group and Group II, conventional non-pharmacological group using randomization. Anxiety was measured before and after using the intervention with Raghavendra Madhuri Sujata-Pictorial scale (RMS-PS), Venham's anxiety rating scale, and pulse rate. All the data were tabulated and compared using statistical analysis. Children in thaumaturgy group (Group- I) exhibited significantly lower anxiety during IANB in comparison with children in the conventional group (Group- II) and the difference was statistically significant. Magic tricks are effective in reducing anxiety among young children during IANB; Moreover, it expands the arsenal of behavior guidance techniques for treatment of children with anxiety and plays an important role in shaping the behavior of a child in pediatric dentistry.

The performance of inferior alveolar nerve block technique among undergraduate students.

This study aimed at evaluating the ability to feel bone touch, positive aspirations, and frequency of the success rate during the direct inferior alveolar nerve block (IANB) among dental students. This prospective cross-sectional study involved 203 cases of IANB injections for patients requiring extraction of mandibular posterior teeth who visited student dental clinics at Ajman University, Fujairah Campus. Students' performance of direct IANB including ability to perceive bone touch, frequency of positive aspirations, and success rate were reported. Students reported feeling bone contact in 148 (72.9%), 43 (21.2%), and 12 (5.9%) of the first, second, and third attempts during the IANB, respectively. Positive aspiration was found in 46 (22.7%) of the injections. The success was in 195 (96.1%) of the total injections. Spearman's correlation coefficient indicated that there was no significant correlation between the success rate and the result of aspiration (rho=.054, p= .440). Additionally, there was no correlation between attempts to touch the bone and the outcome of the aspiration (rho=-.091, p= .198) or success rate (rho=-.083, p= .240). There is a relatively high success rate of direct IANB technique among dental students. This confirms the inclusion of this technique in the curriculum. Furthermore, the high rate of positive aspiration reflects the awareness and competency of dental students with the aspiration technique. In turn, this will reduce the failure of anaesthesia and the subsequent systemic complications.

Distraction With Virtual Reality Goggles in Paediatric Dental Treatment: A Randomised Controlled Trial

AimThe aim of this study was to examine whether screening content through virtual reality (VR) goggles can diminish pain perception during local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in routine paediatric dental treatment. Materials and methodsThis is a crossover study of healthy 4- to 12-year-old children who were scheduled to receive local anaesthesia administered using the inferior alveolar nerve block technique and rubber dam placement in 2 visits. The participants were randomly assigned to undergo 1 treatment performed with Oculus GO VR goggles and the other treatment without. Pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Modified Behavioral Pain Scale (MBPS). ResultsThe study group included 29 children with a mean age of 8.29 years (SD, 1.96). Whilst administering local anaesthesia, no significant difference was observed in the Wong-Baker FACES Pain Rating Scale and in MBPS movements between visits with and without the VR goggles. However, significantly lower pain perception was observed in the other parameters of MBPS when using the VR goggles: Face (P = .007) and Cry (P = .046). During placement of a rubber dam, significantly less pain was reported by the patients (P = .005) and observed by the assessor (Face [P = .005], Cry [P = .029], and Movement [P = 0.028]) when the VR goggles were used. ConclusionsVR can decrease pain perception during rubber dam placement in children, but it has limited benefit during administration of local anaesthesia.

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.

Knowledge Level of Clinical Dental Students in Faculty of Dentistry, Universitas Sumatera Utara Regarding the Anesthetic Technique of Inferior Alveolar Nerve Block

The inferior alveolar nerve block technique (Fischer's method) is a local anesthetic technique that is often used in daily dental and surgical treatment. However, the failure rate reaches 15-20% because many factors affect the technique's success. Therefore, this descriptive study aims to determine the knowledge of clinical dental students regarding the inferior alveolar nerve block technique and the management of the failure associated with its characteristics. A cross-sectional approach was employed by using a validated questionnaire consisting of 2 parts, namely 6 general questions and 12 knowledge questions, which were distributed to 68 clinical dental students in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Universitas Sumatera Utara in 2019. The results showed that 51.5% of the students had good knowledge, 41.2% had fair knowledge and 7.4% had less knowledge. The highest percentage of students based on male gender had fair knowledge (10 people out of 15) and the female had good knowledge (30 people out of 53). The clinical dental students’ level of knowledge based on whether they have ever or never failed to perform an anesthetic block technique is in a good category. In conclusion, most of the clinical dental students at the Department of Oral Surgery in 2019 had a good level of knowledge about the inferior alveolar nerve block technique and its failure management.

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.

TO COMPARE THE EFFECTIVENESS OF INTRALIGAMENTARY INJECTION ANAESTHESIA VERSUS INFERIOR ALVEOLAR NERVE BLOCK TECHNIQUE IN EXTRACTION OF MANDIBULAR POSTERIOR TEETH - A RANDOMIZED CLINICAL STUDY.

BACKGROUND: Profound pulpal anaesthesia using the inferior alveolar nerve block (IANB) technique for extraction of mandibular posterior teeth is difcult to achieve. Several authors emphasised the effects of intraligamentary injection anaesthesia (ILA), also known as periodontal injection; as a primary or supplementary technique. The aim of this study was to compare the efcacy of ILA over IANB technique in providing adequate and superior anaesthesia for extraction of mandibular premolars and molars. MATERIALS AND METHODS: 30 patients requiring bilateral extractions of mandibular posterior teeth were selected. The parameters evaluated were subjective (numbness) and objective (pain on gingival probing) signs of anaesthesia, difference in pain perception during the procedure; and duration of anaesthesia for ILA (Group A) and IANB technique (Group B). RESULTS: The results showed that no difference was found in terms of subjective and objective evaluation of anaesthesia between the groups. A statistically signicant difference was seen in Group A, where intraligamentary injection anaesthesia showed less pain perception than the IANB technique. However, longer duration of anaesthesia was noted in Group B. CONCLUSION: With fewer failures and complications, the intraligamentary injection can be effectively used as a primary technique to alleviate pain and profoundly anaesthetize the mandibular posterior teeth during dento-alveolar extraction procedure.

Articaine improves anesthetic achievement for exodontia performed by undergraduate dental students: A clinical comparative study.

To assess the clinical performance of undergraduate dental students in delivering inferior alveolar nerve block (IANB) with either articaine or lidocaine, and to compare the success rate of their IANBs between articaine and lidocaine for the extraction of mandibular molar teeth. In this clinical trial, patients were randomly distributed into 2 study groups: articaine and lidocaine groups. In each group, dental students performed IANB followed by forceps extraction of 1 mandibular molar under close supervision. The operative parameters measured included: assessment of anesthetic technique (on 10 points visual analogue scale 'VAS-10'), onset and depth of anesthesia, intra-operative pain perceived by patients and their satisfaction level (on VAS-10), and the success rate of IANB (in terms of need to additional anesthesia). Data analyses used were descriptive statistics, t-test, χ2 test, and Pearson's correlation. One-hundred sixty patients were included in the final analysis, 80 in each group. The overall students' IANB technique was assessed as good (mean score 7.3). Articaine group showed significantly higher success rate of IANB (71%) compared to (55%) in lidocaine group, (P=0.03). Patients also reported significantly higher satisfaction scores in the articaine group (P=0.04). There were no significant difference in the onset of action and intra-operative pain level between the 2 groups. Students' IANBs were generally assessed as "good." Articaine IANBs performed by undergraduate students showed significantly higher success rate than lidocaine IANBs. By using articaine, the anesthetic achievement was greater for mandibular molar extraction performed by undergraduate students.

Postanesthetic Cold Sensibility Test as an Indicator for the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis of Mandibular Molars.

Materials and Methods This study was conducted on the mandibular first molars of 54 patients (35 males and 19 females) with signs and symptoms of SIP. To anesthetize the affected molars, all patients received a single carpule of 2% lidocaine with 1 : 100000 epinephrine using a standardized inferior alveolar nerve block (IANB) technique. The cold test was conducted before beginning the endodontic procedures and after gaining lip numbness, and the results were reported as either positive or negative response. The root canal preparation (RCP) was then initiated and the patients' responses were documented (Gold standard test). True pulpal anesthetic failure was described as a pain perception during the access cavity and pulp tissue removal. True pulpal anesthesia was defined as no pain or discomfort during the access cavity and pulp extirpation. The qualitative variables frequencies and percentages of patients with true/false positive and negative responses were determined and then compared using the Chi-square test. The pain perception of male and female patients during the cold test and gold standard was compared using the Fisher exact test. The following diagnostic parameters were calculated using an online statistical calculator: sensitivity, specificity, predictive values, accuracy, and Youden index. In addition, a receiver operating characteristic curve (ROC) was constructed and the area under the curve (AUC) was calculated. Results The overall percentage of actual failure of pupal anesthesia was 57%. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden index for the cold test were 0.87, 0.91, 0.93, 0.84, 0.89, and 0.78, respectively. There was no statistically significant difference between male and female patients regarding their responses to cold testing and the gold standard test (P > 0.05). Besides, the patients' reactions to the cold test were significantly matched with their reactions to the gold standard test (P < 0.05). The area under the ROC was mostly 0.9. Conclusion The cold test could be a valuable and accurate method for predicting the potential pupal anesthesia before beginning the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis, particularly after obtaining postanesthetic soft tissue numbness.

Direct and imaging morphometry for the localization of the mandibular foramen (MF) in dentate and edentulous human subjects.

Background: The mandibular foramen (MF) is the anatomic landmark where the interior alveolar nerve enters the mandibular ramus, and the area of choice where anesthesia of this nerve is performed. The position of the MF can vary, and accurately establishing its location and topographic variations is of great importance for the successful anesthesia of the inferior alveolar nerve. Materials and Methods: We carried out two morphometric ex vivo studies concerning the topography of the MF, on dry human mandibles coming from dentate and completely edentulous human subjects of known age and gender and an in vivo morphometric study, through cone-beam computed tomography (CBCT) scans, concerning the topography of the MF in human subjects having Kennedy Class I mandibular edentulism. The morphological characteristics we investigated were: the distance between the MF and the anterior margin of the mandibular ramus (MF–AM distance), the distance between the MF and the posterior margin of the mandibular ramus (MF–PM distance), the distance between the MF and the inferior margin of the mandibular ramus (MF–IM distance), the distance between the MF and the temporal crest of the mandibular ramus (MF–TC distance), the distance between the MF and the superior margin of the mandibular ramus (MF–SM distance), and the vertical and transverse diameters of the MF. The results were statistically processed in Stata/MP13 software package using Student’s t-test and two-way analysis of variance (ANOVA). Results: Through direct morphometry on dentate dry human mandibles, the MF–AM and the MF–SM distances showed statistically significant differences for age, gender and for interactions, while the MF–PM and MF–IM distances showed statistically significant differences for age and for interactions. In the case of the MF–TC distance, the only significant difference observed was for the gender. No statistical significance was found for side, age, gender, and interactions in the cases of MF vertical and transverse diameters. Through direct morphometry on completely edentulous dry human mandibles, the MF–PM and MF–SM distances showed statistically significant differences for age, gender and for interactions, while the MF–AM, MF–IM, and MF–TC distances, as well as the MF vertical and transverse diameters showed statistically significant differences for age and for model (interactions). The results showed that MF is 2 mm closer to the anterior margin of the mandibular ramus after having lost teeth. Through imaging morphometry, the MF–PM distance and the vertical diameter of MF showed statistically significant differences for age, gender and for interactions, while the MF–AM, MF–IM, MF–SM and MF–TC distances, as well as the transverse diameter of MF showed statistically significant differences for age and for interactions. Comparing the results obtained by the three studies, we found no statistically significant differences in relation to the gender of the subjects. The MF–IM and MF–TC distances and the transverse diameter of MF showed statistically significant differences for age, study and for interactions, while the MF–AM, MF–PM and MF–SM distances, as well as MF vertical diameter showed statistically significant differences only for age and for interactions. Morphological symmetry was demonstrated through our three studies, no statistically significant differences being determined in relation to side. Conclusions: The results of this research should increase the level of awareness among dentists with respect to MF topography changes with loss of teeth and help dental practitioners in refining the inferior alveolar nerve block techniques.

A Morphometric Study of the Mandibular Foramen in Dry Adult Human Mandibles in a Black Malawian Population

The inferior alveolar nerve block (IANB) technique is a common technique performed on patients in dental surgery, placement of mandibular implants and other procedures involving the mandible. Precise identification of the mandibular foramen (MF) is essential for dental surgeons to accurately administer local anesthetics. Inaccurate localization of the mandibular foramen may result in IANB failure and injury to neurovascular tissues. Therefore, this study aimed at investigating the precise location of the MF from various anatomical land marks in dry adult human mandibles of Malawian population. The study was conducted on 29 dry adult human mandibles of unknown sex of Malawian origin from the Anatomy Division collection of human skeletons housed in the Biomedical Sciences Department, College of Medicine, University of Malawi. To determine the position of the mandibular foramen, distances from mandibular foramen to anterior margin, posterior margin, mandibular notch, gonial angle and mandibular base using a Vernier caliper were measured. The mean distance of the MF from posterior margin of mandibular ramus was 11.26±1.22 mm (right side) and 11.47±1.35 mm (left side), from the anterior margin 20.85±3.12 mm (right side) and 20.85±3.22 mm (left side) mandibles. The mean distance between mandibular notch (MN) and MF was 23.87±2.61 mm (right side) and 23.53 ± 2.65 mm (left side). The mean distance between mandibular base (MB) and MF for the right and left were 28.47 ± 2.90 mm and 27.85 ± 2.99 mm respectively. The inferior limit of the mandibular foramen was located at 24.69 ± 3.65 mm (right side) and 24.25 ± 2.77 mm (left side) to the angle (AG) of the mandible. The findings of this study show that the anterior margin mean distance from the MF for both right and left mandibles seem to be bilateral symmetrical suggesting the interpretation that the needle for IANB could be inserted at about 21 mm from the anterior margin to the MF in an adult of Malawian origin during surgery.

Efficacy of Extra-Oral Inferior Alveolar Nerve Block in Mandibular Teeth Extraction

Objective: To determine the effectiveness of Extra oral inferior alveolar nerve block (IANB) technique in terms of pain during injection, onset of anesthesia and pain during extraction of mandibular teeth.&#x0D; Methodology: This cross sectional study was carried out at the department of Oral &amp; Maxillo-facial Surgery, Institute of Dentistry, Liaquat University of Medical &amp; Health Sciences Jamshoro / Hyderabad, from May 2018 to November 2018. All patients in the age range of 18-45 years regardless of gender and having sub-mucous fibrosis were included. Affected teeth were diagnosed via clinical examination, intra oral periapical radiograph (IOPAR) and Orthopantomogram (OPG). Mandibular teeth were anesthetised by extra oral inferior alveolar nerve block. Visual analog scale was used to record severity of the pain during the injection of anesthesia and during the extraction. Onset of the anesthesia was recorded in minutes. Data was documented via self-made proforma and analyzed by SPSS 20 version 20.&#x0D; Results: Overall 64 cases were studied. Out of which 34 were males and 30 were females. In most of the cases pain was not found, while 8 cases showed mild pain and 4 showed moderate pain. During extraction, there was no pain among 46 patients, while 10 had mild pain and only 8 had moderate pain.&#x0D; Conclusion: It was concluded that extra oral inferior alveolar nerve block technique is the best treatment option with less pain during injection, rapid onset of anesthesia, and less pain during extraction.

Comparative evaluation of ropivacaine and lidocaine as dental pulp anaesthesia.

Root canal therapy linked to pulpal diseases or trauma is common in modern dental care. The 2% Lidocaine which is considered as the gold standard has some drawbacks in pulpal anaesthesia. Ropivacaine has beneficial anaesthetic effects on pulpal anaesthesia. Therefore, it is of interest to compare and evaluate the pulpal aesthetic effect using 0.5% Ropivacaine and 2% Lidocaine in symptomatic irreversible pulpitis. A double blinded randomized controlled clinical trial consisting of 110 lower molar and premolar tooth with irreversible pulpitis cases for root canal therapy were selected and randomly divided into 2 groups. Group A: 2% lidocaine with epinephrine and Group B: 0.5% ropivacaine. The pulp sensibility tests with heat test, cold test and electric pulp test were completed. The preoperative pain score was measured with Visual Analogue Scale (VAS) pain scale. The classical inferior alveolar nerve block (IANB) technique was administered to all patients by a single operator. Subjects were asked for lip numbness and presence or absence of lip numbness. Postoperative pain scores were recorded during access opening and on placing files in the canal. There is no statistical difference between the groups during pre operative conditions. The mean pain scores within group A and group B is recorded. The difference was found to be statistically significant with p value ≤ 0.05. Significant difference between the mean values after and before the treatment is observed. However, there is no statistical significance between the mean pain scores between the access and pulp. The 0.5% Ropivacaine and 2% Lidocaine with epinephrine does not have any significant difference during access opening. However, 0.5% Ropivacaine groups were effective while placing the file in the canal. Thus, 0.5% Ropivacaine showed better results even though it was not statistically significant for further consideration in this context.

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.