Inferior Alveolar Nerve Block Research Articles

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.

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.

Comparative evaluation of intraligamentary injection and traditional inferior alveolar nerve block in endodontic management of mandibular molar with symptomatic irreversible pulpitis: A randomized double-blinded clinical trial

Background: Intraligamentary anesthesia (ILA) injection using a single-tooth anesthesia (STA) system has been used as a supplementary technique for pulpal anesthesia in cases of irreversible pulpitis. Aims and Objective: The current clinical trial was undertaken to assess and compare the effectiveness of the conventional inferior alveolar nerve block (IANB) and the ILA technique utilizing the STA system for endodontic management of mandibular molars presenting symptomatic irreversible pulpitis. Materials and Methods: Patients diagnosed with symptomatic irreversible pulpitis inmandibular molar were allocated into two groups: Group I IANB (n=30) and Group II- STA system (n=30). The onset of anesthesia was evaluated using the electric pulp test, whereas for pain perception the Heft-Parker Visual Analog Scale score was recorded before, during, and after anesthesia. Post-anesthetic pain was recorded at 3 h, 24 h, and 1 week. The collected data was evaluated for effectiveness pain perception, and acceptability of the anesthetic technique, using appropriate statistical tests. Results: The mean time of onset for the Group II STA system (2.93±1.80) was significantly higher (P=0.0001) than Group I IANB (1.40±0.86). Pain at the site of injection was insignificant (P&gt;0.05) between both groups. The severity of pain during the root canal procedure was significantly different (P&lt;0.0001) in both cohorts. For both groups, the patient’s acceptance of the anesthetic procedure was statistically insignificant (P=0.21). Conclusions: The STA system reported similar effectiveness in terms of effectiveness, pain perception, and acceptability of anesthetic technique when compared to IANB. Hence, the primary anesthetic treatment for conducting endodontic procedures on molars with symptomatic irreversible pulpitis appears to be the utilization of the ILA-employing STA system.

The effect of augmented reality book on the proficiency of local anesthesia administration of the inferior alveolar nerve.

Advancements in augmented reality (AR) technology enable developers to create augmented reality books (AR Books). AR Books can show interactive 3D objects and multimedia content to the user. The purpose of this study was to investigate the effect of a developed AR Book on the theoretical and practical abilities in the administration of local anesthesia of the inferior alveolar nerve block. An exclusive AR Book was developed based on Chapter 14, Handbook of Local Anesthesia, seventh edition, Stanley F. Malamed, which enabled students to use their book (printed or electronic) as an AR Book. Forty dental students were randomly divided into control and study groups. In the control group, students were asked to use regular books, while in the study group, students were instructed to use interactive AR Books. All students took the written exam, scoring 0 to 10. Also, the administration of mandibular local anesthesia was evaluated in students. The level of concentration during the study, the written exam score, the practical score, the success rate of local anesthesia, and the needed time for injection were compared between the two groups. There was a significant difference in the level of concentration during the study (p<0.001), practical skill score (p=0.037), and needed time for injection (p=0.040) between the two groups. Conversely, the success rate of local anesthesia was almost similar (p=0.705). Although the written exam score was higher in the study group than in the control group, the difference was not significant (p=0.414). Using AR Books can engage students and help them to remain focused during the study. AR Books may be beneficial in enhancing the practical abilities of dental students.

Student training in administering inferior alveolar nerve block anesthesia with a simple manufactured simulation model.

To compare the effectiveness of administering inferior alveolar nerve blocks (IANB) for the first time with or without a previous practical lesson using a simple manufactured simulator. This was a study designed to compare students' first administration of IANB anesthesia during 2022, with or without a previous practical lesson. Students were randomized into two groups. The experimental group attended both theoretical lessons and a practical lesson with a simulator device, while the control group attended only theoretical lessons. The theoretical lesson included usual contents such as anatomy, physiology, technical maneuvers for administering anesthesia, tips, and complications, and the practical lesson consisted of the administration of anesthesia using a simple manufactured simulator. After students applied their first IANB, its efficacy, and their answers to a questionnaire on a 5-point Likert scale were recorded. Statistical analysis consisted of the Chi-square test (p<0.05). The study recorded 60 anonymous surveys. The main difference observed was in instrument handing (p<0.05), and there was a tendency in the ease of recognition of the anatomical marks used for the technique-pterygomandibular raphe and coronoid notch of the mandible (p=0.08 and 0.11, respectively). No difference in success was observed (p>0.05). Self-confidence and personal feelings did not differ statistically. All students agreed strongly or partially that training with the simulator model was helpful. Students who used simple manufactured simulators achieved better outcomes for instrument handling, and possibly for identification of anatomical landmarks, than those who received only theoretical lessons.

A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study.

The objective of this research was to conduct a comparison and evaluate the pain perception and time of onset of 2% lignocaine 1:80,000 epinephrine with 4% articaine 1:100,000 epinephrine in the pediatric population. A split-mouth randomized control trial was conducted on 50 children aged 9-14 years who required inferior alveolar nerve block (IANB) anesthesia for bilateral dental treatment in the mandibular arch. The time of onset was recorded when no sensation was reported even when maximum electrical stimulus was applied in an electric pulp testing (EPT). The pain perception was assessed using a visual analog scale (VAS) rated by the patient for subjective symptoms and face, legs, activity, cry, and consolability (FLACC) scale for objective pain rated by the operator. The mean onset of time, pain-VAS, and FLACC score decreased by 1.31, 12.07, and 18.39%, respectively in 4% articaine as compared to 2% lignocaine but the difference did not reach statistical significance (p > 0.05), that is, found to be statistically the same.In conclusion, it can be inferred that the utilization of 4% articaine is as potent as 2% lignocaine solution but showed slightly better onset of anesthesia and pain experience among the children although the findings were not statistically significant. Local anesthesia (LA) is one of the main methods of pain management in pediatric practice which makes it essential to choose an LA agent with a shorter time of onset and less pain on administration. Singh SS, Koul M. A Comparative Evaluation of Pain Experience and Time of Onset of 2% Lignocaine and 4% Articaine in Inferior Alveolar Nerve Block among Pediatric Population: A Clinical Study. Int J Clin Pediatr Dent 2024;17(1):67-71.

Clinical Assessment of Preemptive Analgesia on Success of Pulpal Anesthesia and Postendodontic Pain in Children with Irreversible Pulpitis: A Randomized Comparative Study.

Optimal pain management of symptomatic pulpitis in formative years goes a long way in developing a positive dental attitude. Efforts should be made to increase the success of anesthesia, thus diminishing negative dental experiences. The aim of the study was to assess the efficacy of preemptive analgesia on the success of pulpal anesthesia following inferior alveolar nerve block (IANB) in children with symptomatic irreversible pulpitis and on reducing postendodontic pain. The research design was an in vivo, three-group, parallel, quadruple-blind study. A total of 75 patients were randomly allocated to one of the three groups-group I: ibuprofen, group II: combination of ibuprofen and paracetamol, and group III: multivitamin (placebo). Premedication was given 45 minutes before treatment, and patients received IANB in a standardized manner. Pain during pulpectomy was recorded using the face, legs, activity, cry, consolability (FLACC) scale and postoperatively using Wong-Baker's pain rating scale (WBPRS) at 4, 12, and 24 hours. Success was measured if the pain felt was of no or mild intensity. Success of IANB was 64% for ibuprofen, 72% for the combination group, and 40% for the placebo group, with no statistically significant difference between all groups (p = 0.06) on the FLACC scale. At 4 hours postoperatively, a significant difference (p = 0.02) was found among groups with more children experiencing no or mild pain in groups I and II and the highest number of rescue medications taken by the placebo group. Ibuprofen and a combination of ibuprofen and acetaminophen as preemptive analgesics had no significant effect on the success rate of IANB, although it was effective in reducing pain at 4 hours postoperatively. Gori NA, Patel MC, Bhatt RK, et al. Clinical Assessment of Preemptive Analgesia on Success of Pulpal Anesthesia and Postendodontic Pain in Children with Irreversible Pulpitis: A Randomized Comparative Study. Int J Clin Pediatr Dent 2024;17(1):72-78.

Position of the mandibular foramen in relation to the occlusal plane in children with skeletal class malocclusion

Frequently, practitioners use the inferior alveolar nerve block in the procedures desired on the teeth in the mandible and the surrounding tissues. This study aimed to reveal the position of the mandibular foramen (MF) according to the malocclusion types on panoramic radiographs of children aged 9-18 years living with malocclusion in Turkey. Panoramic and cephalometric radiographs of 330 patients between 9 and 18 years old were analyzed retrospectively. We grouped the skeletal malocclusion types as Class 1, 2, and Class 3 based on lateral cephalometric radiographs and evaluated the location of MF in malocclusion types according to age and gender. We observed that the distances to the occlusal plane, posterior edge, and gonion point increased with age while the distance to the anterior edge decreased. There was a significant difference according to age and gender in all malocclusion types (p&lt;0.05). We determined that the MF was positioned upward parallel to the increase in age and approached the midpoint of the ramus of the mandible from the posterior. The fact that MF is placed higher than the occlusal plane in Class 3 malocclusions compared to other types and differs by gender will guide clinicians in providing effective and safe inferior alveolar nerve block in pediatric malocclusions.

Overcoming local anesthesia failure during routine dental treatments in children.

Local anesthesia (LA) during routine dental treatment in children fails in 5%-35% of first attempts. No data, however, are available on the success rates of subsequent attempts. To evaluate the effectiveness of primary, secondary, and tertiary LA attempts (P-LA, S-LA, and T-LA, respectively) for anesthetizing molars during routine dental treatments in children. We retrospectively analyzed dental records of all children (2-18 years) who had been administered LA for the treatment of primary or permanent molars by a single paediatric dentist, between 2011 and 2022. All LAs were delivered using a computer-controlled local anesthetic delivery (CCLAD) system. The failure rate of P-LA in 1312 molars was 13% and correlated with age (p < .001), type of tooth (p < .001), type of treatment (p < .001), and treated arch (p < .001). The effectiveness of S-LA for buccal infiltration, intrasulcular, inferior alveolar nerve block, greater palatine nerve block (GPNB), posterior superior alveolar nerve block (PSANB), or a combination of the last two was 50%, 87.2%, 66.7%, 63.6%, 33.3%, and 100%, respectively, and was not significantly associated with age or the type of tooth, treatment, or P-LA. The optimal choice of S-LA for anesthetizing maxillary molars was a combination of PSANB and GPNB, whereas for mandibular molars, it was IS-CCLAD system.

A novel extraoral ultrasound-guided approach for mandibular nerve block in Rahmani sheep

BackgroundRegional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique.MethodsThe research comprised three phases: Phase 1 involved an anatomical examination of mandibles and sheep heads to locate the mandibular foramen and delineate the mandibular nerve course. Phase 2 included ultrasound-guided injection of methylene blue dye at specific sites along the mandibular nerve in cadaveric sheep heads. In Phase 3, clinical implementation of ultrasound-guided inferior alveolar nerve blocks was conducted in 27 live sheep, assessing efficacy, onset, and duration.ResultsVertical extraoral ultrasound-guided nerve block was achieved successfully in 25 sheep (98%). A preliminary cadaveric study showed good distribution of the injectate at the mandibular nerve site. The mean onset time was 138 ± 18 s, and the mean duration time was 54 ± 4.1 min. Prominent analgesia of the ipsilateral mandible, medial surface of the cheek, and lateral border of the tongue was observed.ConclusionsUltrasound-guided mandibular nerve block holds promise as a technique for providing effective and safe anesthesia in sheep undergoing mandibular procedures.

Flipped classroom teaching model with video instruction improves skills in local anesthesia training

Local anesthesia (LA) training is an essential clinical skill in dental education. However, the traditional teaching method of student-to-student injection has ethical concerns. This study investigated whether a flipped classroom (FC) teaching model with instructional videos improves students' skills in administering LA. Fourth-year dental students in 2017 (traditional teaching, n=70) and 2018 (FC model, n=79) were assessed for their ability to perform an inferior alveolar nerve block and lingual nerve block. The FC group watched pre-recorded videos prior to a hands-on training session. Skills were evaluated using a 24-item checklist converted to letter grades. Perceptions of the FC approach were also surveyed. The FC group showed statistically significantly higher final grades than the traditional teaching group (P<0.05). Most FC students agreed that the videos improved clarity and learning objectives. The FC teaching model with procedural video instruction improved skills and confidence in administering LA over traditional teaching methods. Videos can be a beneficial supplement in pre-clinical dental training.

The Use of Local Anesthesia in Pediatric Dentistry: A Survey of Specialists' Current Practices in Children and Attitudes in Relation to Articaine.

This study aimed to evaluate the clinical practices of local anesthesia in children. The study also sought to investigate pediatric dentists' views on articaine infiltration anesthesia and their willingness to use it to replace the inferior dental nerve block in primary molars. A cross-sectional survey was emailed to 183 registered specialists. Descriptive statistics along with chi-square and Fisher's exact tests were used for data analysis. A total of 72 responses were received. The sample consisted of 62 (86.1%) females and 10 (13.8%) males with varying levels of experience. The vast majority of respondents (98.6%) used topical anesthesia in their practice with children. The most frequently used anesthetic agent was 2% lidocaine (72.2%) followed by 4% articaine (54.2%). The entire sample indicated that they frequently find difficulties in dose calculation for their child patient. Gender and level of experience did not significantly influence specialists' practice or their knowledge of local anesthesia. More than a third (31.9%) of participants were not happy to replace the block anesthesia with articaine infiltration for the treatment of lower primary molars. The most indicated reasons for this unwillingness were lack of effectiveness (11%) and inadequate scientific evidence (11%). Most pediatric dentists used topical anesthesia with children. Lidocaine was the most commonly used injectable local anesthesia. Specialists' current practices of local anesthesia in children generally conformed well to good standards. However, inadequate knowledge regarding dose calculation was revealed. In addition, specialists' reluctance to use articaine infiltration instead of the block anesthesia was evident in the current population. Further studies, with larger sample size are encouraged.

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.

The Maxillary Artery Loops Dangerously Approaching the Mandible's Lingula and Inferior Orbital Fissure.

The maxillary artery (MA) leaves from the external carotid artery and further courses through the infratemporal fossa to reach the pterygopalatine fossa. It typically has an ascending course either on the lateral or on the medial side of the inferior bundle of the lateral pterygoid muscle. While studying retrospectively, the computed tomography angiogram of an adult male case with peculiar tortuosities of the MA was documented. The left MA described a large inferior sagittal loop applied on the mandible's ramus's inner cortical in the pterygomandibular space's upper part. That loop reached 1.66 cm inferior to the mandible's notch and 0.5 cm superior to the mandibular foramen and was applied on the mandible's lingula (spine of Spix). That MA continued to the pterygomaxillary suture, and a second superior coronal loop was found applied on the posterior wall of the maxillary sinus, reaching the inferior orbital fissure. It is therefore mandatory to take good care in the decortication of the mandibular ramus or during osteotomies of the ramus. When an inferior loop of the MA approaches the spine of Spix, bleeding when an inferior alveolar nerve block is performed seems hardly avoidable.

Comparative evaluation of efficacy of 2% lidocaine containing adrenaline with and without hyaluronidase in inferior alveolar nerve blocks for patients requiring bilateral mandibular extractions

AbstractPurposeTo evaluate and compare the efficacy of 2% lidocaine containing adrenaline with and without hyaluronidase in inferior alveolar nerve blocks for patients requiring bilateral mandibular extractions.Patients and MethodsThis was the split‐mouth study conducted on 26 patients requiring bilateral mandibular teeth extraction. All the patients were assigned randomly to one of the two groups: (i) 2% lignocaine HCl + 1:2,00,000 adrenaline + hyaluronidase (75 IU) solution will be administered on one side which is the experimental side and (ii) 2% lignocaine HCl + 1:2,00,000 adrenaline solution on the other side is control side. In the first session, the patients randomly received the inferior alveolar nerve block with or without hyaluronidase in one side of the oral cavity. One week later, the same patient received the other technique which was not received in the first session. We also evaluated the onset, duration and need of any supplementary anaesthesia in both the groups.ResultsComparison of VAS score in the control group (2.73 ± 0.724) and experimental group (3 ± 0.693) showed statistically insignificant results (p = 0.177). Whereas the onset of local anaesthesia showed a statistically significant difference between the two groups (p &lt; 0.001) mean of control group (2.73 ± 0.47) and experimental group (1.15 ± 0.23). Comparison of duration of anaesthesia showed a statistically significant difference (p &lt; 0.001) with the mean duration of the experimental group being higher (106 ± 7.94) than the control group (86.27 ± 3.90). Comparison for the need for supplementary anaesthesia showed no statistically significant difference between the two groups.ConclusionWe conclude that if hyaluronidase is used, better blocks with smaller volumes are produced. LAs with hyaluronidase have been shown to improve the quality and effectiveness of anaesthetic blocks and shorten the time it takes for anaesthesia to begin, accelerate the onset of akinesia and lessen the need for additional anaesthesia. It also increases the duration of anaesthesia.

Visuo-Haptic VR and AR Guidance for Dental Nerve Block Education.

The inferior alveolar nerve block (IANB) is a dental anesthetic injection that is critical to the performance of many dental procedures. Dental students typically learn to administer an IANB through videos and practice on silicone molds and, in many dental schools, on other students. This causes significant stress for both the students and their early patients. To reduce discomfort and improve clinical outcomes, we created an anatomically informed virtual reality headset-based educational system for the IANB. It combines a layered 3D anatomical model, dynamic visual guidance for syringe position and orientation, and active force feedback to emulate syringe interaction with tissue. A companion mobile augmented reality application allows students to step through a visualization of the procedure on a phone or tablet. We conducted a user study to determine the advantages of preclinical training with our IANB simulator. We found that in comparison to dental students who were exposed only to traditional supplementary study materials, dental students who used our IANB simulator were more confident administering their first clinical injections, had less need for syringe readjustments, and had greater success in numbing patients.

Comparison of Anesthetic Efficacy between 2% Lignocaine and 2% Mepivacaine in Inferior Alveolar Nerve Blocks during Extractions and Pulpotomies of Primary Molars in Children

ABSTRACT Context: There are few studies reported in children comparing local anesthetic agents for their efficacy during extraction and pulpotomy procedures, as well as how they affect the patient’s comfort, pain management, and postoperative outcomes. The current study was planned to assess the local anesthetic effectiveness of 2% lignocaine and 2% mepivacaine in inferior alveolar nerve blocks (IANBs) during pediatric primary molar extractions and pulpotomies. Subjects and Methods: A randomized, double-blind clinical trial was carried out among 60 healthy children between the ages of 6 and 12 years who needed pulpotomies or tooth extractions of their mandibular primary molars. Traditional IANBs were performed either using 2% lignocaine or 2% mepivacaine, both with 1:100,000 epinephrine. The efficacy of local anesthesia was determined by an independent, trained operator after the procedures of local anesthesia, pulpotomy, and extraction. The pain experienced and the behavior of the child were recorded. The parameters, such as the onset and duration of anesthesia, between the groups were compared using an unpaired t-test. The pain rating by the child and the behavior rating by the operator were analyzed by an independent t-test and a Mann–Whitney U-test, respectively. The associated discomfort due to local anesthesia among groups was analyzed by the Fisher’s exact test and the Spearman’s correlation coefficient test. A value of P &lt; 0.05 was considered to be statistically significant. Results: The onset of anesthesia was significantly earlier for the lignocaine group (104.93 s) than the mepivacaine group (138.13 s) while performing pulpotomy (P &lt; 0.001) and extraction (P &lt; 0.001) procedures. The duration of action of lignocaine (173.06 min) was longer than that of mepivacaine (139.96 min). However, this comparison was statistically significant only for the extraction group (P = 0.015) but not for the pulpotomy group (P = 0.057). There was no statistically significant difference in the pain rating, their behavior, or the incidence of self-inflicted injury or discomfort between the anesthetic groups. Conclusions: The time taken for the onset of soft-tissue anesthesia was significantly shorter, and its duration was longer for 2% lignocaine when compared to 2% mepivacaine, when both the agents were given along with 1:100,000 adrenaline. Both agents were similarly effective for pulpotomy and extraction of primary molar teeth with respect to pain control and the behavior displayed by the child, which resulted in similar minor postoperative complications.