Inferior Alveolar Nerve Block Research Articles

Do Regional Nerve Blocks during Bimaxillary Surgery Decrease Postoperative Pain and Vomiting Compared with Patient- Controlled Analgesia?

Postoperative pain after orthognathic surgery is commonly managed with opioids, which can cause nausea and vomiting. The purpose of this study was to determine whether regional nerve blocks during bimaxillary surgery reduced postoperative pain and vomiting compared with patient-controlled analgesia (PCA). This retrospective cohort study recruited patients who underwent bimaxillary surgery between August 2018 and September 2020 at the Fourth Military Medical University Hospital. Participants whose procedures involved the cheekbone, temporomandibular joint, mandibular angle, or an autogenous iliac bone graft and those who were admitted to the intensive care unit after surgery were excluded. The primary predictor variables were postoperative analgesia management, regional maxillary and inferior alveolar nerve blocks, and PCA. The primary outcome variables were moderate-to-severe postoperative pain and postoperative vomiting (POV) during the first 24hours. Moderate-to-severe pain was defined as pain numerical rating scale ≥4, POV was defined as vomiting of gastrointestinal contents. The study covariates included demographic, surgical, and anesthesia characteristics. Statistical analyses were conducted using an unpaired t-test, χ2 test, or Fisher's exact test for the bivariate analysis. A multivariate logistic regression analysis was performed to assess the associations between the primary predictor variables and outcomes. Statistical significance was set at P<.05. 354 participants were included in the study (262 in the nerve block group, mean age 22.5±4.0years; 92 in the PCA group, mean age 22.6±4.4years; P=.81). There was no significant difference in sex between the groups (63.4 and 55.4% females in nerve block and PCA groups, respectively, P=.18). The multivariate regression analyses demonstrated that nerve blocks did not decrease moderate-to-severe postoperative pain (7.6 vs 10.9%, adjusted odds ratio=0.67, 95% confidence interval: 0.22-2.01, P=.48), although they were associated with decreased POV (38.5 vs 65.2%, adjusted odds ratio=0.34, 95% confidence interval: 0.18-0.65, P=.001). For bimaxillary surgery, regional nerve blocks as opioid-free postoperative analgesia were not significantly associated with decreased postoperative pain but were associated with a low POV risk.

EVALUATION OF THE RELATIVE POSITION OF THE MANDIBULAR FORAMEN IN YEMENI CHILDREN AS A REFERENCE FOR INFERIOR ALVEOLAR NERVE BLOCK USING AN ORTHOPANTAMOGRAPH

Aim and objectives: A crucial component of managing a kid dentistry patient's behavior is pain control. For mandibular teeth, the most used local anesthetic method is inferior alveolar nerve block (IANB). So, an effective IANB anesthetic requires knowledge of the mandibular foramen's location. Using digital panoramic radiography pictures, the mandibular foramen's position in relation to the occlusal plane and the deepest point of the anterior border of the ramus was assessed in a sample of Yemeni children aged 4 to 12. Materials and Methods: This retrospective study consisted of 501 orthodontic charts that were analyzed and divided into three groups: Group 1: 4-6 years, Group 2: 7-9 years and Group 3: 10-12 years. The OPGS were traced directly on radiographic films and measurements were taken from the mandibular foramen to the occlusal level and to the deepest point of the anterior border of the ramus, respectively, on the right and left sides of the mandible. Data were analyzed and the mean and SD were determined and compared for different gender, age groups and side (right/left). Results: Male participants showed slightly higher mean distance values for MF-AB-Right compared to females (16.276±2.03 mm VS 15.952±1.82), but the contrast was not statistically significant. The study found significant differences in the mean MF distances of ABR between the 10-12 year age group and the 4-6 year age group (16.518±1.86 mm VS 15.487±1.95 mm), (p=0.0001). The mean OP-MF distances for the 10-12 year age group were also significant, with significant differences observed in the right side and left side. Conclusion: The results were similar for the total children, regardless of gender. The study suggests that the mandibular foramina position may vary among different age groups. For inferior alveolar nerve block, the needle should be inserted slightly below the OP in 4-6 years old girls and at the same level of OP in 7-9 years old girls, and 4-6 years old boys. Peer Review History: Received 23 March 2024; Revised 6 May 2024; Accepted 29 June; Available online 15 July 2024 Academic Editor: Dr. Asia Selman Abdullah, Pharmacy institute, University of Basrah, Iraq, asia_abdullah65@yahoo.com Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. Masoumeh Divar, Shiraz University, Shiraz, Iran, zhaledivar@gmail.com

Superficial skin necrosis as a rare complication of inferior alveolar nerve block in Egyptian child: A case report

AbstractAimThe aim of the presented case report was to report a rare complication of Inferior Alveolar Nerve Block (IANB) in a 5‐year‐and‐4‐month‐old child and to discuss the possible complications.Materials and MethodsFive years and four months old Egyptian male child presented in paediatric dentistry practice complaining of pain in the lower right primary molars that kept him awake all night. Examination revealed decayed lower right primary first and second molars and the treatment plan was designed to include a pulpectomy procedure for tooth 85 and a pulpotomy procedure for tooth 84. Administration of 1 mL of arctician 4% with 1:100,000 epinephrine anaesthetic solution using the inferior alveolar nerve block technique was done uneventfully. Then, the dental procedure was done as usual. The next morning, the child presented to the dental practice with a non‐painful change in colour in the lower part of the child's right cheek, with small scanty blisters.ResultsThe possible causes of such a complication and the proper management are discussed in this article with a confirmation of the superficial skin necrosis as the most possible cause.ConclusionAlthough proper awareness of the anatomical structures of the orofacial region along with meticulous administration technique of local anaesthesia is mandatory for the everyday dental practice, the dentist may face possible, sometimes rare complications of local anaesthesia and he should be able to manage them probably.

A randomized controlled trial to assess parental satisfaction with computerized intraosseous anesthesia versus inferior alveolar nerve block in children

This study aimed to compare parental satisfaction between two pediatric dental anesthesia techniques, computerized intraosseous anesthesia (CIA) and inferior alveolar nerve block (IANB). This study was designed as a split-mouth randomized controlled clinical trial. A total of 52 parents of children undergoing dental treatment were enrolled in the study. Each participant received both CIA and IANB anesthesia, with the order of administration randomized. Parental satisfaction was evaluated using the parental satisfaction of dental local anesthetic techniques scale (PSLAS). Statistical analysis revealed that parental satisfaction regarding CIA was higher than that for IANB with a significant difference (P ˂ 0.05). However, there was no difference regarding the age, gender or the education level of the parents. (P > 0.05). This study provides insights into parental satisfaction with pediatric dental anesthesia techniques and highlights the influence of socioeconomic factors on anesthesia decision-making. Within the limitations of this trial, it was concluded that CIA was significantly superior to IANB in overall parental satisfaction. However, parental satisfaction values were lower in CIA group regarding costs and concern from complications. In addition, it was concluded that there was no difference in satisfaction levels regarding the gender, age and education level of the parents.

Evaluation of lavender and rose aromatherapies on the success of inferior alveolar nerve block in symptomatic irreversible pulpitis: A randomized clinical trial

Trial designThis is a prospective, block-randomized, blinded, multiple arm and parallel-group superiority clinical trial. MethodsSeventy-eight patients satisfying the recruitment standards, were randomly allocated into three groups as follows: Group I (n = 26) – Inferior alveolar nerve block (IANB) devoid of aromatherapy (AT); Group II (n = 26) - IANB with lavender AT and Group III - IANB with rose AT (n = 26) with the help of the ultrasonic aroma diffuser (with respective oils)for 20 min/2 h in operatories 1,2 and 3 respectively. For AT, 3–4 drops of lavender and rose-conditioned oils were added from a 100 ml solution containing 100 mg of these medicinal plants. The pre-operative (PRO) and access opening (AO) pain as well as the anxiety of patients were recorded using the Visual Analog Scale (VAS) and Modified Dental Anxiety Scale (MDAS) respectively. Data thus obtained was entered into the Excel sheet and subjected to statistical tests (analysis of variance and paired t-test). The p-value less than 0.05 was considered statistically significant. ResultsGroup I showed non-significant disparity between PRO and AO for both VAS as well as MDAS (p = 0.62, p = 0.71). However, group II (p = 0.04, p = 0.02) and group III (p = 0.03, p = 0.01) revealed significant differences between PO - AO VAS and MDAS. MDAS and VAS intergroup comparison revealed a significant difference among groups I and II (p = 0.03, p = 0.04), and groups I and III (p = 0.02, p = 0.03). However non-significant disparity was observed among groups II and III (p = 0.85, 0.34). Moreover, there was a statistically significant reduction in anxiety levels in females compared to males after rose AT (p = 0.02). Nevertheless, groups I and II did not show any gender predilection for anxiety as well as pain. ConclusionAlleviation of dental anxiety as well as reduction in pain during AO of teeth with SIP can be achieved using Lavender and rose AT. In female patients, rose AT can be preferred over lavender AT.

Influence of computerized intraosseous anesthesia compared with traditional mandibular nerve block on children's behavior: A randomized clinical trial.

Effective pain management is crucial for the successful completion of dental procedures in children. Research has examined whether computerized intraosseous anesthesia (CIOA) could serve as a safe and viable substitute for the conventional inferior alveolar nerve block (IANB) technique in pediatric patients. This study investigates the efficacy of CIOA, aiming to determine its effectiveness as an alternative anesthesia method. This study compared the efficacy of local intraosseous anesthesia using a computerized device (QuickSleeper 5) to conventional IANB anesthesia on cooperation and pain perception in children, using a randomized controlled trial design. The study included 88 healthy children, aged between 6 and 9 years, who required pulpotomy for their mandibular second primary molars. The study was approved by the local research ethics committee and registered at clinicaltrials.gov (NCT05193487). The heart rate and Venham behavior rating scale were recorded and analyzed. Categorical data were analyzed using Fisher's exact test. Age and heart rate were compared using an independent t-test for intergroup comparison. The intragroup comparison was carried out using repeated measures ANOVA, followed by the Bonferroni post hoc test. The Mann-Whitney U-test was used to analyze the Venham scale scores. The significance level was set at p < .05 RESULTS: The mean Venham score was slightly higher in the IANB group than in the CIOA group, but was not statistically significant (p = .852). One minute after anesthesia administration, the heart rate (beats per minute [BPM]) was significantly higher in the IANB group (92.30 ± 13.45) than in the CIOA group (83.20 ± 10.40) (p < .001). Additionally, there was a significant difference in heart rate values measured at different intervals within the IANB group. The QuickSleeper 5 device was found to be a feasible alternative for IANB in children over 6 years old.

Comparison of perineural and systemic dexamethasone use in impacted third molar surgeries in terms of anesthesia duration and postoperative complaints: a controlled, randomized observational study

BackgroundSurgical extraction of impacted third molars (ITM) often leads to postoperative discomfort including pain, swelling, and limited function. Steroids like dexamethasone (DXN) are commonly used in oral surgery to manage pain and inflammation. Various administration routes for DXN exist, including intravenous (IV), perineural (PN), and oral applications, each with its advantages. Previous studies have shown that adding DXN to local anesthetics can prolong anesthesia duration and reduce postoperative sequelae. However, comparative studies on IV and PN applications with inferior alveolar nerve block (IANB) of DXN in ITM surgeries are limited.MethodsThis controlled, randomized observational study involved patients undergoing Class II position B ITM extraction. Patients were divided into three groups. IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was performed 1 h after IV-DXN (4 mg/ml DXN) was administered to the IV group. DXN along with IANB (1.8 ml of articaine hydrochloride + 1 ml of 4 mg/ml DXN) was applied to the PN group. Only IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was applied to the control group. Anesthesia duration was assessed as primary outcomes. Anesthesia duration was evaluated using a vitalometer from the molars. Secondary outcomes included postoperative pain and edema measured on the 1st, 3rd, and 7th days after surgery. Pain was evaluated postoperatively by using a visual analog scale. A p-value < 0.05 was considered statistically significant.ResultsThe study included 45 patients with similar demographic characteristics across groups. IV application significantly prolonged anesthesia duration compared to the control group. (p = 0.049) Both IV and PN administration of DXN reduced postoperative edema at 3rd (p = 0.048) and 7th day (p = 0.01). Post-procedure pain reduction was significant in the IV group (p = 0.011). On the other hand, it was observed that the pain did not decrease in the PN group at 3rd and 7th days compared to the control and IV groups.ConclusionsPN and IV DXN administration prolonged anesthesia duration and reduced postoperative edema in ITM surgeries. However, PN DXN administration was associated with increased postoperative pain compared to IV DXN and control groups. Further studies comparing different doses and administration routes of DXN are needed to determine optimal strategies for managing postoperative discomfort in ITM surgeries.Trial registrationThis study was conducted at Ahmet Keleşoğlu Faculty of Dentistry with the permission of Karamanoğlu Mehmetbey University Faculty of Medicine Ethics Committee (#04-2022/101). Trial registration is also available at clinicaltrail.gov. (NCT06318013, 26/05/2024)

Assessment of lingula and foramen mandibulae morphology and their implications for inferior alveolar nerve block: a comparative study of contemporary and medieval individuals.

In this study, we conducted a detailed morphological analysis of the lingula and foramen mandibulae, aiming to examine their anatomical characteristics and relationships within contemporary and medieval individuals. Our primary objective was to provide valuable insights to assist clinicians in minimizing potential intraoperative complications during anesthesia procedures targeting the inferior alveolar nerve. To accomplish this, we examined the mandibular structures of 22 adults, 11 children aged 6-12 from archaeological findings in the Târgu Mureș area, and 14 contemporary adults. Our observations encompassed the size, shape, and spatial relationships of the lingula and foramen mandibulae concerning various points along the ascending branch of the mandible. The study revealed a distinct order of lingula shapes among medieval children and adults, with the triangle, trapezoid, nodular, and assimilated shapes being most prevalent. In modern adults, the order of nodular and assimilated shapes was reversed. Additionally, oval foramina were more common in adults, while round foramina predominated in children. Notably, there was no statistically significant difference between children and adults in the distance from the most prominent point of the lingula to the anterior edge of the ascending branch. Our findings imply that the depth at which the inferior alveolar nerve can be accessed remains relatively consistent between children and adults. Furthermore, we identified a correlation between the relationship of the shape of the lingula and the position of the mandibular foramen, providing valuable insights for clinical practice. Keywords: lingula, foramen mandibulae, morphology, inferior alveolar nerve block

Comparative effectiveness of preemptive administration of ibuprofen and ibuprofen-arginine on the anesthetic success of inferior alveolar nerve block in teeth with symptomatic irreversible pulpitis - A double-blind randomized clinical trial.

This study examined the impact of premedication with ibuprofen and ibuprofen-arginine and the influence of preoperative pain and anxiety on inferior alveolar nerve block (IANB) efficacy in cases of symptomatic irreversible pulpitis. The study involved 150 SIP patients who were randomly assigned to receive ibuprofen (600mg), ibuprofen-arginine (1,155mg), or a placebo 30min before IANB. Preoperative anxiety and pain levels were assessed using the Modified Dental Anxiety Scale and the Heft-Parker visual scale. IANB efficacy was determined by the absence of or mild pain during the procedure. Statistical analysis included chi-square, z-tests, Analysis of Variance, and Student's t tests. The ibuprofen and ibuprofen-arginine groups exhibited significantly higher IANB success rates (62% and 78%, respectively) compared to the placebo group (34%). However, no significant difference was observed between the ibuprofen and ibuprofen-arginine groups. Patients with successful IANB in the ibuprofen and ibuprofen-arginine groups displayed lower median anxiety scores (8) than those with failed blocks (15) and lower mean preoperative pain scores (118.3). In cases of symptomatic irreversible pulpitis the preemptive medication with ibuprofen-arginine effectively increased the efficacy of the inferior alveolar nerve block The inferior alveolar nerve block efficacy was influenced by preoperative anxiety levels and the intensity of pain. This research underscores the potential benefits of oral premedication with ibuprofen and ibuprofen-arginine in improving anesthesia outcomes in cases of symptomatic irreversible pulpitis.

Mylohyoid Nerve Injection for Unsuccessful Anesthesia of Posterior Teeth with Successful Inferior Alveolar Nerve Block.

Background and objective: variations in mylohyoid could lead to failure of an inferior alveolar nerve blockade. This study aimed to evaluate the impact of mylohyoid nerve variation on the persistence of pain following a successful inferior alveolar nerve block. Method: This clinical study was performed at the oral and maxillofacial department/college of Dentistry, Hawler Medical University. All patients with pain following a successful inferior alveolar nerve block were enrolled in this study. An additional submucosal injection (infiltration technique) as few drops in the lingual mucosa of the offending tooth is given by the same surgeon Results: A total of fifty patients were enrolled in this study,30 males and 20 females. age range was (16-56). Among the total only 20 patients (60%females,40% males) experienced pain on the lingual side during the attempt of dental extraction. Following lingual infiltration, all the cases were treated successfully in a pain free environment. Descriptive statistics was used to analyze the data. Conclusion: Lingual submucosal injection of 1/3 of 1.8 ml of local anesthesia might be an effective way to block all possible nerve variation on the lingual side. Keywords: Inferior alveolar nerve block (IANB), mylohyoid nerve variation, lingual mucosal infiltration, pain.

Expediting the reversal of inferior alveolar nerve block anesthesia in children with photobiomodulation therapy.

In pediatric dentistry, complications arising from extended soft tissue anesthesia can negatively impact patient comfort and trust in dental care. This study evaluates the clinical efficacy of diode laser-based photobiomodulation therapy (PBMT) in expediting the resolution of anesthesia in children aged 6-9 receiving inferior alveolar nerve block (IANB) injections. In this split-mouth double-blind randomized clinical trial, 36 pediatric subjects aged 6-9, requiring pulpotomy procedures on both sides of the mandible, received IANBs (single cartridge of 2% lidocaine/1:100,000 epinephrine). PBMT and sham laser were alternately applied to each side of the mandible, in two separate sessions, with the envelope method determining treatment allocation and intervention side on the first treatment day. During the laser session, laser (808nm, 250 mW, 23s continuous, 0.5cm², 11.5J/cm², direct contact) irradiated two points at the injection site, five intra-oral and five extra-oral points along the infra-alveolar nerve's pathway. Soft tissue anesthesia reversal was quantified through tactile assessment. Soft tissue trauma was also assessed by the researcher and reported by parents 24h post-dental visit. All data were analyzed using IBM SPSS Statistics v25.0 via Paired T-test, two-way repeated measures ANOVA, and McNemar's test. The laser group exhibited a mean lip anesthesia duration of 122.78 ± 2.26min, while the sham laser group experienced 134.44 ± 21.8min, indicating an 11.66-minute reduction in anesthesia duration for the laser group. (P < 0.001) Soft tissue trauma occurred in two sham laser group patients and one laser group patient, with no significant difference. (P = 1) The findings indicate that employing laser with defined parameters can reduce the length of IANB-induced anesthesia.

Occurrence of neurosensory disturbance after the use of articaine and lidocaine in the inferior alveolar nerve block: a double-blind randomised clinical trial

This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study’s predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18–44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.

A randomized controlled trial to evaluate the efficacy of inferior alveolar nerve block as an adjunct to general anaesthesia in mandibulectomy: a pilot study

A randomized controlled trial to evaluate the efficacy of inferior alveolar nerve block as an adjunct to general anaesthesia in mandibulectomy: a pilot study

The Pterygomandibular Space: A Volumetric Evaluation Using the Novel A-Silicone Injections Method.

Inferior alveolar nerve block (IANB) is one of the most common procedures in operative dentistry, and a deep understanding of the normal anatomical variation of the pterygomandibular space (PM) is essential for its safe and successful administration. This cadaveric anatomical study aimed to use A-silicone injections to evaluate the volume of the PM. This study was conducted using 46 human cadaver heads (25 males and 21 females). A craniometric analysis was performed using the cadavers' ages, the number of silicone cartridges (carpules) used to fill the pterygomandibular space, Izard's Facial Index (FI), and the Cranial Index (CI). A Halstead mandibular block was performed by injecting 1.7 mL A-silicone cartridges (as an equivalent to standard local aesthetic carpules volume) into the PM. The cured silicone was extracted from the dissected mandibles. The volume (length, width, and thickness) of the extracted silicone and the number of silicone cartridges used to fill the space were evaluated. The results showed that there are statistically significant positive correlations between the CI and the width of the right PM, as well as the width and length of the left PM. A statistically significant correlation was found between the width of the left PM and the age of the cadaveric heads; the higher the age, the thicker the space on both sides. The volume of the PM corresponded to 1.5 cartridges on average.

Assessment of photobiomodulation by a 660-nm diode laser on the reversal of soft tissue anesthesia in children: A randomized controlled clinical trial.

Soft tissue anesthesia (STA) following inferior alveolar nerve block (IANB) anesthesia lasts 3-5 h. It is important to reverse STA after treatment to prevent soft tissue injury (STI). This study evaluated photobiomodulation using a 660 nm diode laser on STA reversal and its impact on STI following IANB anesthesia. A randomized controlled clinical trial was conducted on 32 children, aged 5-8 years, allocated into the test and control groups. Anesthesia was administered; the operative procedure was performed followed by exposure to laser. STA reversal was monitored through lip tapping, current perception threshold (CPT) tests, and paediatric Functional Assessment Battery. The test group showed significantly faster recovery to normal sensation following exposure to laser than the control group which did not undergo any reversal (p < .0001), with a median time of 115 and 60 min according to lip tapping and CPT tests, respectively. The test group also showed significantly faster recovery to normal function (p = .016). The incidence of STI in the form of redness was significantly higher in the control group (p = .022). Photobiomodulation using a 660 nm diode laser can be considered as an efficient approach to minimize STA and STI after dental interventions.

Evaluating the difference in perception of the Akinosi technique among dentistry students: A comparison between theoretical and practical learning.

Effective pain control is crucial in dental practice; thus, local anesthetic techniques have been extensively taught. The Halstead technique is the most commonly used inferior alveolar nerve block despite its relatively high failure rate. On the other hand, the Vazirani‒Akinosi technique (VAT) is less commonly taught. This study evaluated changes in final-year students' perceptions of VAT after a period of active learning. This prospective randomized study was performed in 2022 and included fifth-year dental students (n=91). The study group (n=49) received practical VAT training during oral surgery internships, whereas the control group (n=42) did not. A Likert-scale questionnaire assessed students' perceptions, theoretical knowledge, and difficulty levels. An independent sample t-test was used for comparison and the statistical significance level was set at p<0.05. The survey response rate was 100%. Statistical analysis revealed significant differences between the groups for seven of the 12 questionnaire statements (p<0.05). Overall, perception scores favored the study group, indicating a more positive response. The statements related to theoretical knowledge, except for one statement, showed no significant differences (p>0.05). Practical training significantly improved students' perceptions of VAT, demonstrating the importance of active learning in dental education. Faculties should integrate active learning methods to enhance students' clinical skills and prepare them for professional practice.

Location of mandibular foramen in dry mandibles in relation to various anatomical landmarks

To localize the mandibular foramen in dry mandibles of adult and old age groups of South Indian origin by estimating its average distance from different anatomical landmarks and to provide a specific and precise site for inferior alveolar nerve block. : A total of 51 mandibles were taken for the study and the distance between the mandibular foramen and the various anatomical landmarks were measured using a digital vernier caliper. Presence of accessory mandibular foramen was observed and recorded. Difference between the sides and the correlation between the gonial angle and various distances were carried out.:Distance of mandibular foramen from anterior border was 16.41±2.44 mm and 16.85±2.55 mm, from posterior border was 10.28±2.08 mm and 10.13±2.02 mm, from mandibular incisure 22.5±3.13mm and 21.9±3.08mm, from mandibular base 23.72±3.37 mm and 24.5±3.27 mm, from third molar 15.27±11.99 mm and 16.85±11.60 mm, from apex of retro molar trigone 18.28±3.02 mm and 19.79±3.18 mm on right and left side respectively. There was no significant difference between the measurements of right and left sides. The measurements had a negative association with gonial angle. Accessory foramina were found to be present in 21and 23 mandibles on right and left side respectively.:Precise localization of mandibular foramen is clinically very important to achieve effective inferior alveolar nerve block prior to dental surgeries in the lower jaw. The present study establishes the presence of bilateral symmetry in the position of mandibular foramen with respect to various anatomical landmarks and the utility of gonial angle in localizing the mandibular foramen.

Enhancing Pediatric Dental Care: The Influence of Virtual Reality.

The purpose of this study was to assess the effects of virtual reality (VR) in reducing pain and anxiety levels in children. The study also compared active and passive distraction methods using VR during the delivery of inferior alveolar nerve blocks (IANBs) in dental procedures in children. The study comprised 45 preschool patients, aged between 4 and 6 years, with no prior dental anesthetic experience. The participants were randomly assigned to three groups based on the sort of management style: Group A used the tell-show-do technique, Group B engaged in passive distraction by watching cartoons using a VR headset, and Group C participated in active distraction by playing games using a controller with the VR headset. Pain and anxiety were evaluated using physiological measurements, namely by analyzing the variations in blood pressure, heart rate, and oxygen saturation before and after the administration of IANB. Psychological assessments were conducted using the Wong-Baker faces scale, Modified Dental Anxiety scale questionnaires, and Revised Face, Legs, Activity, Cry and Consolability scale after administering IANB. The physiological outcomes revealed no statistically significant differences in blood pressure and oxygen saturation. However, there was a statistically significant increase in the heart rate in group A compared with groups B and C. In terms of psychological measurements, groups B and C exhibited a significant improvement in pain experience and a decrease in anxiety. This study concluded that VR reduced pain and anxiety levels in its passive and active forms.

Effect of Back-Pressure Anesthesia on Postoperative Pain after the Endodontic Treatment in Patients with Symptomatic Irreversible Pulpitis: Randomized Double-Blind Clinical Trial

IntroductionThe present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis. MethodsOne-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance. ResultsThe initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them. ConclusionsPatients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.

Determining the position of the lingula and the mandibular foramen using the antilingula in orthognathic surgery

BackgroundThe antilingula located on the lateral surface of the mandibular ramus has been served as a surgical landmark for the mandibular foramen on the medial surface for decades. However, whether the antilingula truly represents the lingula which is the bony prominence overlapping the mandibular foramen, or the foramen itself, is still unclear. This study thus aimed to examine the position of the antilingula in relation to three reference points: the lingula, the anterior and the posterior borders of the mandibular foramen, as well as to the reference plane used in the inferior alveolar nerve block, and to the posterior border of the mandible.MethodsThis observational study was performed in 113 Thai dry mandibles. The antilingula were identified followed by transferring the reference points to the lateral surface. The distances from the antilingula to the reference points, the reference plane and the posterior border of the ramus were then measured. Chi-square test was calculated for side-dependency of the antilingula. Paired t-test was calculated for difference in measurements in left and right sides.ResultsThe antilingula could be identified in 92.48% of the mandibles with 86.67 – 90.00% accuracy and 86.67% reliability. There was no significant difference in the presence of the antilingula on left and right sides (p = 0.801). Only 2.5% and 0.83% of the antilingula correspond to the lingula and the anterior border of the mandibular foramen, respectively. However, 85% of the reference points were located within 11 mm radius. The antilingula was found located 2.80 mm inferior to the reference plane and 16.84 mm from the posterior border of the ramus.ConclusionsThe antilingula does not concur with the reference points on the medial surface. Our study also suggests that the safe area for vertical osteotomy is 11 mm posterior to the antilingula or at 30% of the length from the posterior border parallel to the occlusal plane. The use of more accurate techniques in localizing the mandibular foramen combined with the antilingula is more recommended than using the antilingula as a sole surgical guide.