Inferior Alveolar Nerve Block 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.

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.

Origami-Based Haptic Syringe for Local Anesthesia Simulator.

Although medical simulators have benefited from the use of haptics and virtual reality (VR) for decades, the former has become the bottleneck in producing a low-cost, compact, and accurate training experience. This is particularly the case for the inferior alveolar nerve block (IANB) procedure in dentistry, which is one of the most difficult motor skills to acquire. As existing works are still oversimplified or overcomplicated for practical deployment, we introduce an origami-based haptic syringe interface for IANB local anesthesia training. By harnessing the versatile mechanical tunability of the Kresling origami pattern, our interface simulated the tactile experience of the plunger while injecting the anesthetic solution. We present the design, development, and characterization process, as well as a preliminary usability study. The force profile generated by the syringe interface is perceptually similar with that of the Carpule syringe. The usability study suggests that the haptic syringe significantly improves the IANB training simulation and its potential to be utilized in several other medical training/simulation applications.

Role of Age, Gender and Vertical Facial Type on Anatomical Location of Mandibular Foramen in Paediatric Population: A Cross-sectional Study

Introduction: Pain management is paramount in paediatric dental care, influencing patient cooperation and future perceptions of dental treatment. The widely used Inferior Alveolar Nerve Block (IANB) anaesthesia faces challenges in children due to anatomical variations. The position of the mandibular foramen, which evolves with age, growth patterns, and facial types, necessitates customised approaches for effective paediatric pain management. Aim: To identify the position of the mandibular foramen amongst children aged 7-14 years with respect to age, gender, and facial types. Materials and Methods: In a cross-sectional study conducted in West Bengal, India, 126 children aged 7-14 were investigated from March 2021 to August 2022. The Orthopantomograms (OPG) and lateral cephalograms were assessed for the location of the mandibular foramen with respect to age, sex, and facial type in clear radiographs with normal growth. Statistical analysis encompassed descriptive statistics, Analysis of Variance (ANOVA), and multiple linear regression analysis. Results: A total of 126 x-rays were analysed across age, gender, and facial types, showing a mean age of 10.78 years. There were 52 (41.3%) males and 74 (58.7%) females. The distribution of subjects according to facial types was as follows: short (n=33, 26.2%), normal (n=19, 15.1%), and long (n=74, 58.7%). The vertical position of the mandibular foramen increased with age. No significant gender difference was observed regarding the vertical position of the mandibular foramen. However, a significant variation across facial types was observed, with individuals with normal faces exhibiting a greater vertical position. Conclusion: This study revealed that the vertical position of the mandibular foramen increases with age. There was no significant difference found between males and females in the location of the mandibular foramen; however, individuals with normal faces exhibited a greater vertical position of the same

Assessing the Impact of Mandibular Molar Root Length on Success in Supplemental Intraligamentary Injection for Irreversible Pulpitis.

This study investigates the influence of root length in mandibular molars with irreversible pulpitis on the success of supplemental intraligamentary injection following an inferior alveolar nerve (IAN) block. Various factors, including anatomical location, tooth type, and anesthetic solution, may affect supplemental anesthesia success. A total of 251 patients diagnosed with irreversible pulpitis in mandibular first or second molars underwent buccal infiltration anesthesia (4% articaine with 1:100,000 epinephrine) after IAN block injection (3% prilocaine and 0.03 IU/mL of felypressin). Fifty patients experiencing pain during access cavity preparation received supplemental intraligamentary injection (0.3 mL of 2% lidocaine with 1:80,000 epinephrine) at each mesial and distal line angle. The root length of treated teeth was recorded using an apex locator. Data analysis involved independent t-tests, Chi-square tests, and logistic regression. Successful supplemental intraligamentary injection was observed in 21 (42%) out of 50 patients. No significant correlation was found between the mean length of mesiobuccal (P=0.61), mesiolingual (P=0.34), or distal (P=0.60) canals of mandibular molars and the injection's success. Logistic regression analysis, however, revealed a significant impact of mesiolingual canal length on the success rate [OR 0.09 (0.01-0.79), P=0.030]. The root length of mandibular first and second molars does not significantly affect the success of supplemental intraligamentary injection.

Comparing the Efficacy of Local Intraligamentary Injection of Dexamethasone and Piroxicam on Postoperative Pain in Mandibular Molars with Symptomatic Irreversible Pulpitis

Abstract Background: Endodontic therapy may cause the expulsion of inflammatory agents into the nearby periapical tissues, directly stimulating or sensitizing pain fibers. With the help of glucocorticoids pharmacotherapeutic agents and nonsteroidal anti-inflammatory drugs, the majority of pain following an endodontic therapy is typically successfully controlled. The intraligamentary shot is thought to make it possible to apply localized anti-inflammatory medications precisely to the periapical area. Hence, the aim of the study was to evaluate the impact of piroxicam intraligamentary injection, dexamethasone intraligamentary injection, and local anesthetic agent intraligamentary injection on pain following endodontic therapy in teeth having symptomatic irrevocable pulpitis. Materials and Methods: To create the random order, 84 patients were separated into three comparable categories of 28 patients. Dexamethasone, piroxicam, and mepivacaine were the three interventions that received letters A, B, and C, respectively. On the Numeric Pain Rating Scale pain record form, patients who participated were requested to indicate their degree of preoperative pain. For the typical mandibular inferior alveolar nerve block injections, every individual got 1.8 mL of 2% mepivacaine plus 1:20,000 levonordefrin. When the procedure began, the operator blinding was being performed, the support worker loaded a vacant cartridge with 0.4 mL of either dexamethasone pharmaceutical agent (8 mg/2 mL) or 0.4 mL of piroxicam pharmaceutical agent (20 mg/mL) from the drug vial to the cartridges utilizing an insulin syringe. The study’s main finding was the degree of pain following a root canal therapy, which was assessed employing an eleven-point Numeric Rating Score (NRS) with the limits of no pain and severe pain as endpoints. Results: The postoperative pain was maximum in the mepivacaine category, while it was minimum in the piroxicam category at 4 and 12 h follow-up. Similar trends were observed when there was analysis at 24 h follow-up and 48 h follow up where the postoperative pain was maximum in the mepivacaine category while it was minimum in the piroxicam category. Mann–Whitney pairwise comparison at all postoperatively follow-up time intervals revealed no statistically significant variance in pain decrease after the therapy between the dexamethasone category and piroxicam category (P &gt; 0.05). At every postoperative follow-up, the decrease in pain was demonstrated to be statistically vital among the piroxicam subcategory and the mepivacaine category (P &lt; 0.05). Conclusion: Within the constraints of the present investigation, it could be determined that preventative intraligamentary injections of dexamethasone and piroxicam were significantly more effective than mepivacaine at decreasing postendodontic pain, however, there wasn’t statistical variance between the use of either drug.

Evaluation of the onset of pulpal, soft tissue anesthesia, and pain using buffered lidocaine in children: a randomized-controlled trial

The American Academy of Paediatric Dentistry (AAPD) has recently released guidelines that highlight the importance of conducting further research on the effects of buffered local anesthesia in children. Adjusting the pH of local anesthetics may reduce pain and reduce the onset time of anaesthesia. In this study, we evaluated the onset of pulpal, soft tissue anesthesia and pain during inferior alveolar nerve block injection to treat pulpally involved mandibular primary molars with buffered lidocaine in comparison with non-buffered lidocaine. We conducted a prospective, randomized, triple-blind, crossover trial involving 40 children aged 7 to 10 years. The onset time of soft tissue anaesthesia was assessed by probing the gingiva after ensuring numbness of the tongue, the lower lip, and the angle of the mouth, while the onset time for pulpal anaesthesia assessed using Endo-ice. We identified a significant difference between buffered lidocaine and non-buffered lidocaine in the onset time of pulpal and soft tissue anesthesia (p &lt; 0.001). Analysis also identified a showed a significant difference between the two groups for the Wong-Baker Faces pain rating scale (p &lt; 0.006) and the Sound, Eye and Motor scale (p &lt; 0.043). In conclusion, buffered lidocaine reduced the onset time for anaesthesia in pulpal and soft tissue, and reduced pain during the administration of inferior alveolar nerve block injections in children. According to the findings of this study, buffered lidocaine can be utilized as an alternative to non-buffered lidocaine in children.

Effect of Virtual Reality on Dental Pain in Children during Local Anesthesia Administration

ABSTRACT Background: Dental procedures often generate anxiety and fear in children. Virtual reality (VR) is a novel method of distraction for behavior management during dental treatment. Aim: To evaluate the effect of using VR eyeglasses on anxiety/pain during local anesthesia (LA) administration for children. Materials and Methods: Children aged 6–12 years, rated to be Frankl +(positive) or −(negative) without any systemic background were included. Children receiving inferior alveolar nerve block anesthesia were randomized into two groups: Control group (n = 20) exposed to Tell-Show-Do (TSD) alone and study group (n = 20) exposed to TSD with VR through the use of head-mounted immersive type of display powered by a smartphone VR box. Oxygen saturation (SpO2), pulse rate (PR), and anxiety/pain were monitored preoperatively, during LA administration and postoperatively. Results: SpO2 showed no significant difference between the groups, whereas PR and perceived pain levels were significantly different between the groups. Conclusions: PR and pain scores were reduced with the use of VR in children during the administration of LA. VR can be an effective tool in managing behavior of children rated Frankl positive and negative.

Efficacy of Inferior Mandibular Nerve Block (IANB) with Articaine Infiltration Versus Lidocaine Infiltration Administered inTeeth with Irreversible Pulpitis

OBJECTIVES To compare the efficacy of (Inferior mandibular nerve block) IANB with Lidocaine infiltration versus with articaine infiltration in patients with irreversible pulpitis. METHODOLOGY An observational cross-sectional study was conducted in the Department of Operative Dentistry and Endodontics at Altamash Institute of Dental Medicine, Karachi. The study was initiated in January-April 2022. A total of 150 patients’ positive history of irreversible pulpitis, confirmed with cold pulp testing, were randomly allocated into two groups: 75 cases were treated with standard Inferior mandibular nerve block with Lidocaine buccal infiltration, and 75 were treated with buccal infiltration of 1.8 ml of 4% articaine. Before administering the anaesthetic injection, each subject was shown the visual analogue scale (VAS). After 15 minutes of administration, subjects were asked to rate the pain. The data was recorded on a designed proforma. RESULTSThe average age of the patients was 35.52±10.09 years. Efficacy of the inferior alveolar nerve block with buccal infiltration of 1.8 ml of 4% articaine was significantly high as compared to Inferior mandibular nerve block with Lidocaine buccal infiltration [73.3% vs 50.67% p=0.004]. CONCLUSION Buccal infiltration of 4% Articaine for mandibular teeth during IANB can have a high success rate and is considered a good alternative.

Facial Blanching As An Unusual Complication After The Injection of Local Anesthesia: A Clinical Report

Facial blanching is a complication related to local anesthesia in dentistry. Anatomical variation, intravascular injection, rapid local anesthetic injection, decreased blood flow with the vasopressor effect of epinephrine, ortho-retrograde movement of the solution, incorrect positioning of the needle, and neurological origin may cause this phenomenon, the etiology of which is not fully known. Most of the blanching cases reported in the literature are related to injection of the inferior alveolar nerve block. Also, intra-extraoral clinical photography is limited. Supraperiosteal infiltration anesthesia is a safe and easy technique that is frequently used in daily practice in dental clinics. This unique case report describes partial blanching of the face and gingiva after supraperiosteal infiltration of vasoconstrictor containing local anesthetic into the maxilla. In addition, the clinical-anatomical relationship of facial-mucosal blanching with the injection site, literature information, and clinical management with this complication are explained.

Developmental Disturbance in Premolars After Intraligamental Anesthesia Using Computer-Controlled Local Anesthesia Delivery System: An-Eight-Years Follow-Up Study in Children.

Aim This study aimed to evaluate the prevalence of developmental disturbances in permanent second premolars in which their tooth buds were exposed to mandibular intraligamental anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLAD). Materials and methods This was a longitudinal follow-up study conducted in a previous randomized clinical trial (RCT). In the previous RCT, a total of 91 children were included (61 control and 30 cases). A structured form was created that contained details about the date of birth, age, and sex at which the participants received local anesthesiaand the type of local anesthesia administered (ILA using CCLADS, traditional inferior alveolar nerve block [IANB], and IANB using CCLADS). A history of post-treatment abscess, retreatment, and post-treatmentextraction was documented in both groups.Descriptive statistics, including frequency and percentage, and additionally, the chi-square test and Fisher's exact test were used to compare ILA and IANB. Results Forty of the 91 children attended follow-up visits. Only two children had developmental defects: one child who received traditional IANB had a demarcated white opacity (this patient had a history of dental abscess), and another who received ILA using CCLADS showed hypoplasia on his permanent premolar. No significant association was found between the type of anesthesia and the presence of developmental defects. Conclusion The slow administration of ILA delivered by CCLADS in the primary teeth does not increase the chances of developmental disturbances or damage to the corresponding permanent tooth bud.

Use of Adult Dry Human Mandibles to Study of Mandibular Foramen from Various Bony Landmarks.

Precise knowledge of the mandibular foramen's location is essential for clinical and surgical procedures, especially the inferior alveolar nerve block. Variability in its position concerning different bony landmarks can significantly impact clinical outcomes. This study examined 30 Adult dry human mandibles to determine the mandibular foramen's positions in relation to specific bony landmarks: the occlusal plane, posterior border of the ramus, and lingula. Measurements were obtained using a calibrated digital caliper, and statistical analysis was performed. The study revealed significant variations in the position of the mandibular foramen. In relation to the occlusal plane, the mandibular foramen was found at an average height of approximately 15.2 mm (±2.1 mm). Regarding the posterior border of the ramus, it was situated at an average distance of about 18.5 mm (±3.4 mm). In relation to the lingula, the average distance was approximately 21.8 mm (±4.0 mm). These results underscore the considerable individual differences and anatomical variations in the mandibular foramen's location among the studied specimens. The observed variations in the position of the mandibular foramen emphasize the need for clinicians and surgeons to be cognizant of these differences when performing procedures involving the inferior alveolar nerve block. Understanding these anatomical variations is crucial for enhancing clinical precision, reducing complications, and ensuring optimal outcomes.

Topographical anatomy of the mandibular foramen in the dromedary camels (Camelus dromedarius): an extraoral approach for the inferior alveolar nerve blocks.

Understanding the clinical anatomy of the head is essential for performing proper inferior alveolar nerve (IAN) block anesthesia to facilitate invasive dental procedures in camels. However, osteometric data related to the IAN in camels are lacking. This study was carried out to accurately locate the mandibular foramen (MF) and the course of the IAN in the camel head and to establish an approach for its localization in clinical practice. To achieve these aims, eight osteometric measurements were used to determine the location of the MF in relation to its surrounding structures in six cadaveric skulls of adult camels. Four camel heads were dissected, and the course of the IAN inside the mandibular canal was studied. In addition, four heads were used as a trial for the extraoral approach to the IAN block using contrast radiographs based on established metric indices. Dissection of the four camel heads revealed that the MF was located near the intersection of two lines passing through the occlusal surface of the mandibular cheek teeth and at the midpoint of the zygomatic process of the temporal bone. Significant differences were not observed between the right and left mandibles. Successful deposition of the contrast medium near the MF was observed in all examined specimens. This study reports a new, simple approach to reaching the IAN at the MF. However, further clinical validation of the proposed technique is required.

Investigation of the variability of the pterygomandibular space from the point of view of the target point of the inferior alveolar nerve block

IntroductionA thorough knowledge of the anatomy and variability of the pterygomandibular space (PMS) is essential to the success of local anesthesia. This study is aimed at determining the volume of the PMS depending on the shape of the skull, face and mandible using the computed tomography (CT). Materials and methodsanonymized computed tomograms of 48 adult patients were analyzed, the indicators of the cranial index (CI), facial index (FI) according to Yzard, the high lengthy index of the mandible (HLI), the latitudinal-altitude index of the mandible (LAI), the longitudinal latitude index of the mandible (LLI) were calculated. ResultsDifferences in the volume of the PMS were found depending on the shape of the skull, face and mandible. When determining the CI, the largest volume of space on the right was observed with brachycrania (2.05 ml), on the left - with mesocrania and brachycrania (2.0 ml each). With regard to the FI, the largest volume of space was obtained with medium face on the right side (2.03 ml) and broad and medium types of faces (2.0 ml each) on the left. When calculating the indicators for the shapes of mandible, the largest volume of space was found in the brachygenic (2.05 ml), leptogenic (1.98 ml) and platigenic (1.97 ml) shapes on the right and leptogenic and platigenic shapes on the left (2.0 ml each). There were statistically significant differences in the volume of the right side of the PMS between different shapes according to the cranial index (F = 5.075; p = 0.0095). The most pronounced difference was present between samples with brachycrania and dolichocrania: 0.35 mm³ (95% CI 0.05–0.65); p = 0.0188. There was a statistically significant correlation with sex for parameters on both the right and left sides. The values of indicators in men exceeded those of measurements obtained from women. ConclusionThe data obtained determine the differences in the volume of the PMS in individuals with different shapes of the skull, face and mandible, as well as sex differences. Thus, indicating the need to take into account these features when choosing the required amount of anesthetic in clinical practice. The average volume of the PMS space, according to our data, is 1.8–2.0 ml, which is consistent with the clinical data described in the literature.

Comparison of Pain Perception Between Local Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Patients Undergoing Orthodontic Lower Premolar Extractions

Comparison of Pain Perception Between Local Infiltration and Inferior Alveolar Nerve Block Injection Techniques in Patients Undergoing Orthodontic Lower Premolar Extractions

Effectiveness of Nitrous Oxide Sedation on Child’s Anxiety and Parent Perception During Inferior Alveolar Nerve Block: A Randomized Controlled Trial

Effectiveness of Nitrous Oxide Sedation on Child’s Anxiety and Parent Perception During Inferior Alveolar Nerve Block: A Randomized Controlled Trial