Inferior Alveolar Nerve Block Research Articles

Comparison of the success of inferior alveolar nerve anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine: A randomized controlled clinical trial

Background: This study aimed to compare the success rate of inferior alveolar nerve (IAN) anesthesia in the mandibular first molars with symptomatic irreversible pulpitis using two anesthetic solutions of prilocaine and mepivacaine.Materials and Methods: The current randomized controlled clinical trial was conducted on 100 patients in two groups (n = 50). Standard injection of IAN block (IANB) was performed using two cartridges of 3% mepivacaine plain in the first group and using two cartridges of 3% prilocaine with 0.03 IU felypressin in the second group. Fifteen minutes after injection, the patients were asked about lip anesthesia. In case of a positive answer, the tooth was isolated with a rubber dam. Success was defined as no or mild pain on the basis of the visual analog scale recording upon access cavity preparation, entry into the pulp chamber, and initial instrumentation. Data were analyzed with SPSS 17 using the Chi-square test, and P < 0.05 was set as statistically significant.Results: The patients' pain severities during the three stages were significantly different (P = 0.001, 0.0001, and 0.001, respectively). The success rate of IANB during access cavity preparation was 88% with prilocaine and 68% with mepivacaine. This rate during entry into the pulp chamber was 78% and 24%, respectively, which was 3.25 times higher with prilocaine than mepivacaine. The success rates during instrumentation were 32% and 10%, respectively, which was 3.2 times higher with prilocaine than mepivacaine.Conclusion: The success rate of IANB in the teeth with symptomatic irreversible pulpitis was higher using 3% prilocaine with felypressin than using 3% mepivacaine.

Mylohyoid Bridging of the Mandible and its Clinical Importance in Dry Mandibles: A Cross-sectional Study

Introduction: Mylohyoid Bridging (MB) is a hyperostotic variation in the mandible. On the inner aspect of the ramus of the mandible, the Mylohyoid Groove (MG) is observed. The content of this groove is the mylohyoid nerve and vessels. The mylohyoid bridging can compress these neurovascular structures. Aim: To determine the incidence of mylohyoid bridging and to determine, whether it is complete/incomplete or proximal/distal or unilateral/bilateral. Materials and Methods: The present cross-sectional study was conducted in the Department of Anatomy, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India, in July 2022. The study was conducted on 60 dried human mandibles (120 sides). The mandibles were collected from the Department of Anatomy. The mandibles were observed for the presence of a mylohyoid bridge on the inner aspect of its ramus on both sides. Results were expressed using descriptive statistics and were expressed in terms of frequency and percentage. Results: Mylohyoid bridge was observed in three out of 120 (2.5%) mylohyoid grooves. All the observed mylohyoid bridges were incomplete types (one each of proximal type, intermediate type, and distal type). In one of the mandible, a triangular bony spicule was noted at the proximal end of the mylohyoid groove, in a close approximation of the mandibular foramen on the right-side, whereas in one of the mandible, the mylohyoid groove was very deep, and communication between the mylohyoid groove and mandibular canal was noted. Conclusion: Knowledge regarding mylohyoid bridging will help in the successful administration of inferior alveolar nerve block.

Comparative evaluation of photobiomodulation therapy at 660 and 810 nm wavelengths on the soft tissue local anesthesia reversal in pediatric dentistry: an in-vivo study.

Local anesthesia has been reliably used to control pain during dental procedures and is important in pediatric dentistry. However, children occasionally complain of prolonged numbness after dental treatment, leading to several problems. Studies conducted to reverse the effect of local anesthesia using phentolamine mesylate and photobiomodulation therapy (PBM) are encouraging but limited. PBM is a type of light therapy that utilizes visible and near-infrared non-ionizing electromagnetic spectral light sources. Hence, this study used this modality to compare the reversal of local anesthesia at two different wavelengths. This study compared the effect of PBM at 660 and 810 nm wavelengths on the reversal of soft tissue local anesthesia using a diode LASER in pediatric dentistry. Informed consent and assent were obtained, and the participants were then divided randomly into three groups of 20 children each: control group-without LASER irradiation, LASER irradiation at 660 nm, and LASER irradiation at 810 nm. Sixty children aged 4-8 years with deciduous mandibular molars indicated for pulp therapy were administered an inferior alveolar nerve block. After 45 min of injection, a duration that was similar to the approximate duration of treatment, they were exposed to 660- and 810-nm LASER irradiation according to their groups until reversal of local anesthesia was achieved. The control group did not undergo LASER irradiation. The reversal of the soft tissue local anesthetic effect was evaluated using palpation and pin prick tests every 15 min, and the LASER irradiation cycle continued until reversal of the soft tissue local anesthesia was achieved. A significant reduction of 55.5 min (27.6%) in the mean soft tissue local anesthesia reversal time was observed after the application of 810 nm wavelength PBM and 69 min (34.7%) after 660 nm wavelength LASER irradiation. PBM with a 660 nm wavelength was more effective in reducing the mean soft tissue local anesthesia reversal duration, and thus can be used as a reversal agent for soft tissue local anesthesia in pediatric dentistry.

Effect of premedication on the success of inferior alveolar nerve block in patients diagnosed with irreversible pulpitis: An umbrella review

Effect of premedication on the success of inferior alveolar nerve block in patients diagnosed with irreversible pulpitis: An umbrella review

Comparative evaluation of efficacy of Halstead technique, Clark and Holmes technique, Gow Gates technique, and Sargenti technique for mandibular anesthesia.

This study aimed to evaluate the inferior alveolar nerve block, that is, the Halstead technique, Clark and Holmes technique, Gow Gates technique, and Sargenti technique, for mandibular anesthesia. This prospective, double-blinded, in-vivo study was conducted amongst 100 patients, requiring mandibular anesthesia. These patients were divided into four groups. Parameters assessed were time required for appearance of subjective and objective symptoms and signs, positive aspiration, need for supplementary anesthesia, and ease of administration. The means for subjective symptoms for the four techniques, that is, Halstead technique, Clark and Holmes technique, Gow Gates technique, and Sargenti technique, were 78.44, 120.76, 176.6, and 203.08, respectively. The means for objectives symptoms for the four techniques, that is, Halstead technique, Clark and Holmes technique, Gow Gates technique, and Sargenti technique, were 110.6, 269.8, 287.48, and 154.08, respectively. Halstead technique had statistically significant (P < 0.05) faster objective signs than all the other techniques. Supplementary block if required was noted for all four techniques. The Clark and Holmes technique showed maximum complications, while Gow Gates technique was most difficult to administer. The Angelo Sargenti technique gave good results, same as standard Halstead technique.

Effect of audio distraction with thermomechanical stimulation on pain perception for inferior alveolar nerve block in children: a randomized clinical trial

Effect of audio distraction with thermomechanical stimulation on pain perception for inferior alveolar nerve block in children: a randomized clinical trial

Effectivness of submucosal, oral and intramuscular routs of dexamethasone administration in trismus, swelling, and pain reduction after the third lower molar surgery

Background/Aim. Surgical extraction of impacted lower third molars is inevitably followed by the postoperative occurrence of trismus, swelling, and pain sensations to some degree. Corticosteroids (dexamethasone in particular) are commonly used drugs in the prevention of these complications. The aim of this study was to determine the effectiveness of dexamethasone in the prevention of postoperative complications, edema, trismus, and pain after the surgical extraction of impacted lower third molars, depending on the method of its administration. Methods. This prospective study involved 30 healthy patients, aged 18 years and above, of both sexes, with fully impacted lower third molar ? class I or II and position B or C, according to Pell and Gregory classification system and vertical position according to Winter classification. All patients were divided randomly into three groups de-pending on the way of dexamethasone administration: oral ? dexamethasone administered in the form of oral tablets in a dose of 4 mg one hour before the surgery; submucosal ? dexamethasone solution administered submucosally in a dose of 4 mg in the area of the buccal sulcus, after the inferior alveolar nerve block anesthesia and additional anesthesia for the buccal nerve; intramuscular ? dexamethasone solution administered intramuscularly in a dose of 4mg into the area of the deltoid muscle, right before the intervention. Preoperatively and at every follow-up (on the first, second, and seventh day postoperatively), interincisal distance, the degree of edema, and the level of pain with the use of a visual analog scale (VAS) were measured. On the seventh postoperative day, the total number of analgesics taken by the patients was recorded. Results. In the postoperative period, there was no statistically significant difference be-tween the examined groups in terms of effectiveness in swelling, trismus, and pain reduction (p &gt; 0.05). Conclusion. There is no significant difference in dexamethasone effectiveness in postoperative trismus, swelling, and pain reduction after the third lower molar surgery, regarding the route of administration ? oral, intramuscular, or local submucosal.

The injectable local anaesthetics in the prevention of intraoperative pain in paediatric dentistry – practical remarks on agent choice and methods. Possible complications of local anaesthetic administration in paedodontics

In paedodontics, as in general dentistry, causal treatment plays a fundamental role in the management of pain present before the appointment, but the therapeutic procedures performed are often associated with the occurrence of acute pain. It is currently being accepted, that effective dental treatment of children is possible after obtaining the appropriate level of local anaesthesia. Local anaesthesia is one of the most delicate and difficult procedures in paediatric dentistry. Fear of anaesthesia and the accompanying pain is clearly marked in paediatric patients; therefore, the right attitude of a dentist plays a crucial role, while psychological strategies and pharmacological approach may be a valuable help. In the case of intraoperative pain prevention in paedodontics, injectable aminoamide derivatives-mainly lidocaine, articaine and mepivacaine in Polish conditions – are of fundamental importance. The success of the procedure is the result of the precision of the injection and administration of the solution, dependent on the practitioner, the reaction of the tissues into which the drug is deposited, their anatomical structure and the patient's stress level. The article discusses the clinically significant features distinguishing paediatric patient population and the impact of this specificity on the choice of methods of effective dental local anaesthesia. The agents used have been characterized, taking into account the dosage, the latency period and the resulting anaesthesia time for the dental pulp and soft tissues. Pulp anaesthesia allows for painless intervention within the tooth tissues, while soft tissue anaesthesia is necessary to undertake a therapeutic action requiring soft tissue disruption in dental surgery. Soft tissue anaesthesia, especially in the inferior alveolar nerve block, with long-acting local anaesthetics, is associated with a higher risk of self-injury in children with loss of sensation and proprioception in mucosa of the cheeks, lips and tongue. Local and general complications of dental anaesthesia in children were presented, along with their prevention and management.

Evaluation of Intraligamentous and Intraosseous Computer-Controlled Anesthetic Delivery Systems in Pediatric Dentistry: A Randomized Controlled Trial.

Computer-controlled local anesthetic delivery systems (CDS) represent one of the resources that have progressed the most in recent years, but their efficacy and applicability in pediatric dentistry is still the subject of certain controversies. This randomized, controlled, split-mouth clinical trial assessed two CDS in children (n = 100) with deep caries in the temporary dentition that required invasive therapeutic procedures, using inferior alveolar nerve block as the gold standard. Half of the patients (n = 50) underwent the intraligamentary technique (Wand STA®) on one side of the mouth and conventional inferior alveolar nerve block on the contralateral side, while the other half (n = 50) underwent the intraosseous technique (QuickSleeper®) on one side of the mouth and conventional inferior alveolar nerve block on the contralateral side. The following were considered covariates: age, sex, type of dental procedure and the applied local anesthesia system. The outcome variables were the pain caused by the anesthesia injection, the physical reaction during the anesthesia injection, the need for anesthetic reinforcement, pain during the therapeutic procedure, the overall behavior during the visit, the postoperative morbidity and, lastly, the patient's preference. In conclusion, we confirmed the efficacy of intraligamentary and intraosseous techniques administered using a CDS for conducting invasive dental treatments in children, their advantages compared with inferior alveolar nerve block in terms of less pain generated by the anesthesia injection and less postoperative morbidity, as well as the pediatric patients' preference for CDS versus conventional techniques.

The Effect of Preoperative Naproxen Sodium on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

The Effect of Preoperative Naproxen Sodium on the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis

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

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

Buccal Nerve Trunk Block Anesthetizes the Buccal Mucosa Beyond the Papilla of the Parotid Duct

The limited area of anesthesia of the buccal mucosa with concomitant conventional buccal nerve block (conventional BNB) may be involved in failed inferior alveolar nerve block (IANB). The aims of this study were to examine the extent of anesthesia by buccal nerve trunk block (BNTB) and compare the success rates of IANB with BNB. This prospective parallel-group randomized single-blinded clinical trial included patients scheduled for removal of a mandibular third molar at the Nippon Dental University Hospital between September 2021 and March 2022. The primary predictor variable was the approach for BNB (BNTB vs conventional BNB). The primary outcome was the extent of tactile sensory loss and anesthesia of the buccal mucosa. The secondary outcomes included onset time and duration of BNBs and the success rate of the IANB with concomitant BNB for third molar extraction, assessed by the proportions of intraoperative pain perception and supplemental infiltration anesthesia. The other study variables were sex, age, and injection side. Comparisons were analyzed by Fisher's exact test or the Mann-Whitney U test. The P value was set to .05. A total of 38 patients (14 male, 24 female) with a mean age of 28.9years (range, 18 to 67years) were enrolled, with 19 patients each in the BNTB group and conventional BNB group. The effective tactile sensory loss rates at ∼5mm above the height of the papilla of the parotid duct of the premolar and molar regions were greater following BNTB (71 and 95%, respectively) than following conventional BNB (37%; P<.01 and 58%; P<.01, respectively). The proportions of intraoperative pain perception of the BNTB group and the conventional BNB group were 10 and 42% (P=.06), respectively, and those of supplemental infiltration anesthesia were 5 and 26% (P=.18), respectively. BNTB provided a wider extent of anesthesia of the buccal mucosa than conventional BNB and may improve the anesthesia success of IANB for removal of mandibular third molars.

A survey to evaluate and compare patients perception to pain, pressure and discomfort induced by types of injection techniques used for mandibular anaesthesia

Local anaesthesia makes the patient and the dentist comfortable to do treatment with least amount of discomfort, but dental patient’s most frequent fear is of receiving local anaesthetic injections. The present study attempted to evaluate and compare patient’s perception to pain, pressure and discomfort induced by three types of injections (Infiltration, mental nerve block and inferior alveolar nerve block injection) for mandibular anaesthesia. Patients were asked to grade pain, pressure and discomfort associated with injection insertion on visual analog scale. Inferior alveolar nerve block was graded the most painful nerve block, while Infiltration was graded as the least painful. Patient’s perception to pressure and discomfort was highest for inferior alveolar nerve block and lowest to mental nerve block.

A Cross-Sectional Study on the Evidence-Based Dentistry, Perception Basis, and Use of Articaine Among Dental Practitioners.

Background: Many dentists use articaine as their choice of local anesthetic agent. However, theuse of articaine is limited to inferior alveolar nerve blocks (IANBs), andliterature data are scarce concerning its perception and choice among various dental practitioners. Aim:The aim of the present study was to assess the extent of articaine use as a local anesthetic in dentistry, its perception basis, and the consistency of evidence of the efficacy and safety of articaine in recent practice. Methods: The present study utilized a survey tool that was given to all the participating dental practitioners, and the participants were given five minutes to fill out the survey questionnaire. The questionnaire was in English and had 14 questions to be answered. The data gathered were statistically assessed to formulate the results. Results: The results of this cross-sectional survey reported that articaine is used as a choice of local anesthetic by more than half of the participating dental practitioners. Sixty percent (n = 480) participants used articaine in their practice, followed by lidocaine, which was used by 33% (n = 264) dental practitioners, mepivacaine by 2% (n = 16) participants, prilocaine by 1% (n = 8) dental practitioners, and other local anesthetics by 4% (n = 32) participants, respectively. Concerning the safety and efficacy of articaine use, 43% used it for all procedures except for IANBs, whereas 20% used it for all procedures, including IANBs. Conclusion: Despite the reported efficacy and safety of articaine as a local anesthetic for all dental procedures, many dental practitioners refrain from using it, especially for IANBs. These data depicta difference between current research evidence and reported clinical practice.

Assessment of Anatomical Location and Variation of Mandibular Foramen Using Cone-Beam Computed Tomography: A Cross-Sectional Study

Background: Determining the exact location of mandibular foramen is an important factor prior to Inferior Alveolar Nerve (IAN) block injection. The aim of this study is to assess the position of Mandibular Foramen (MF) and its variations using Cone-Beam Computed Tomography (CBCT).&#x0D; Methods: This study was conducted on CBCT images of 80 females and 80 males (18 to 68 years). The distance between the MF and the anterior border of ramus (A), inferior border of mandible (B), superior border of mandible (C), and occlusal plane was measured. Data were analyzed by the student t-test, bivariate correlation analysis, paired sample t-test, and Pearson’s correlation coefficient.&#x0D; Results: The mean amount of A, B and C distances, and the mean distance from the occlusal plane to the center of MF were 13.76, 24.24, 12.32, and 7.59 mm, respectively, with no significant difference between the right and left sides (p&gt;0.05). The mean B and C distances were significantly smaller in females than males (p&lt;0.05). The mean size of the measured angle was 43.2°. Significant correlations were noted between aging and decreased A distance, and reduction in the angle between the contralateral premolars and MF (p&lt;0.05).&#x0D; Conclusion: Knowledge about the position of MF can enhance the surgical procedures in this region. Using a 21-25 mm needle would be associated with lower risk of needle fracture during IAN block injection. Also, needle insertion angle &lt;45-degrees is optimal for the samples assessed in this study.

Comparison of pain perception between computer-controlled local anesthetic delivery and the conventional syringe for inferior alveolar nerve block in children.

Local anesthesia (LA) is commonly used for pain control in clinical dental practice. However, it is often perceived as the most painful part of the treatment and the factor leading to the avoidance of dental care. Hence, research on better means of pain management is being conducted. The aim of the study was to evaluate and compare pain perception using the No Pain III™ computer-controlled local anesthesia delivery (CCLAD) system and the conventional syringe, for inferior alveolar nerve block (IANB) in children. Thirty children aged 6-12 years were included in the study. Children were randomly allocated into 2 groups by the flip of a coin. Group A received LA by conventional syringe and group B received LA by No Pain III™, on the contralateral side. Physiological parameters including blood pressure (BP), heart rate (HR) and respiratory rate (RR) were assessed at baseline, during the deposition and after the deposition of LA. A subjective evaluation of pain perception was assessed using the Wong-Baker FACES Pain Rating Scale (WBS). The measured values were subjected to statistical analysis. A statistically significant difference was observed between group A and group B for pain perception using the WBS, systolic BP and RR. The use of the No Pain III™ CCLAD system resulted in reduced pain perception and better acceptance when compared to the use of the conventional syringe, for IANB in children.

A pilot study of local anesthesia training using a mixed-reality haptic fidelity model.

One of the most difficult local anesthetic blocks to master in dentistry is the inferior alveolar nerve block (IANB). Historically, dental students have practiced local anesthesia on one another. At the University of Colorado, these practice sessions have been limited to one required laboratory session. The predictability and confidence of student IANB success have not been high in the past. Therefore, the objective of this study was to investigate the impact of a novel IANB simulator, built on a three dimensional (3D)-printed mixed-reality haptic model, for second-year dental students to practice on prior to their laboratory session. Thirty-nine student participants volunteered to practice with the IANB simulator. Participants were divided into two groups, Group A and Group B. Self-reported confidence and injection-specific accuracy were measured during IANB simulator practice and the laboratory session. During lab, partner numbness was assessed as a measure of IANB success. Groups A (n = 20) and B (n = 19) practiced with the simulator before and after laboratory, respectively. Injection domains were not assessed during Group B's practice with the IANB simulator. Self-reported confidence increased for both groups (p < 0.001). However, for anesthetic success, Group A exhibited significantly greater success (52.6%) than Group B (17.6%) (p = 0.029). Self-reported confidence in performing an IANB improved and higher anesthetic success was achieved for Group A. Further investigation is necessary to determine the long-term impact of using the IANB simulator in dental education.

Anaesthetic efficacy and influence on cardiovascular parameters change of intraosseous computerised anaesthesia versus inferior alveolar nerve block anaesthesia in acute irreversible pulpitis of mandibular molars: study protocol for a prospective randomised controlled trial

BackgroundIrreversible pulpitis is a highly painful inflammatory condition of the dental pulp. The recommended care is the removal of the coronal pulp (pulpotomy) for emergency treatment in multi-rooted teeth. However, achieving adequate analgesia in the case of mandibular molars presents many difficulties according to the dental literature. Intraosseous computerised anaesthesia (ICA), in particular, the QuickSleeper™ system, has already been demonstrated to be clinically efficient, but ICA is known to increase the heart rate reversibly in a manner that depends on the speed of injection. Therefore, accelerated heart rate was examined as a potential adverse effect of this injection. This trial aims to compare the cardiovascular effects and the anaesthetic efficacy of ICA versus inferior alveolar nerve block anaesthesia (IANB) in acute irreversible pulpitis of mandibular molars.MethodsThis study is a non-inferiority prospective, randomised, controlled, single-blind, two-group trial conducted at the Nantes University Hospital. The study design included two parallel arms at a ratio of 1:1 that will allocate seventy-two patients into two groups: the first group will receive QuickSleeper™ intraosseous anaesthesia; the second will receive an inferior alveolar nerve block before emergency treatment (pulpotomy). This study will include patients requiring emergency dental care under local anaesthesia with confirmed irreversible pulpitis in mandibular molars. The primary outcome is the time taken for the fluctuations in the cardiovascular parameters to return to baseline values during endodontic treatment in two different anaesthetic techniques. The secondary outcomes include efficacy of the technique, patient’s pain perception before and after care, any post-operative effects, and factors associated with the delay of recovery of cardiovascular parameters between the 2 anaesthetic techniques.DiscussionThis trial will evaluate the factors associated with heart rate increase during local anaesthesia administration. The use of blood pressure and cardiovascular measurements can be considered an asset and additional safety in managing local anaesthesia. Detecting early signs of potential adverse events (AEs), particularly patients with certain medical conditions (cardiac rhythm disorders), would suggest caution in administering anaesthesia.Trial registrationClinicalTrials.gov ID: NCT03802305 registered January 14, 2019. (version no. 1.2; 5 November 2021)

A Comparative Study to Evaluate the Anesthetic Efficacy of Buffered Versus Non-buffered 2% Lidocaine During Inferior Alveolar Nerve Block.

The study aimed to compare the clinical efficacy, safety, and acceptability ofbuffered lidocaine (8.4% sodium bicarbonate and 2% lidocaine with 1:80,000 adrenaline) versus non-buffered lidocaine (2% lidocaine with 1:80,000 adrenaline) during inferior alveolar nerve block. Fifty patients who required bilateral extractions in a single arch were included in this study. One hundred extractions were carried out, and all of the patients had nerve blocks during the procedure. We also took note of the patient's pain level as measured on a visual analog scale, as well as the start of the action, duration of postoperative analgesia, and occurrence of any problems. The duration of anesthesia was assessed by the feeling of numbness and the first sign of pain. All the patients in both study groups reported subjective numbness of the lips and tongue. The depth of anesthesia was evaluated by pain and comfort during the procedure with a visual analog scale and showed no significant difference between the two groups. The onset of action for the pterygomandibular nerve block was 1.240.31 minutes (buffered)and 1.710.51 minutes (non-buffered). When compared, the duration of anesthesia was 327.18102.98 minutes (buffered) and 129.0826.85 minutes (non-buffered). This study concludes that the buffered solution has a faster onset of action than the non-buffered solution. Both solutions exhibit similar intraoperative efficacy. The duration of postoperative anesthesia was prolonged with buffering. Buffering also reduced pain scores during the early postoperative period.

Effectiveness of the "pain-free dental injection" (PaFein) teaching model in reducing children's pain: A randomized, controlled study.

This study explores the effectiveness of a comprehensive structured teaching model - the "PaFein" - for instructing postgraduate pediatric dental residents in the provision of pain-free local anesthesia to children. Ten postgraduate pediatric dental residents and 172 children between the ages 5 and 13 participated in the study following ethical approval. The previously measured baselines guided the randomization of study and control groups. The study group (five residents) attended the PaFein course (9hours). Based on power calculations, residents performed dental injections (8 mandibular block, 8 palatal/lingual and 14 buccal infiltrations) in randomly assigned child patients. Demographic data of residents/children, parental and self-report anxiety scores and Visual Analogue Scale (VAS) pain scores were noted to examine children's anxiety and pain during dental injections. Children's mean anxiety score did not differ significantly between groups; however, VAS pain reports during dental injections (a, b, c, d) were found lower in the PaFein study group than the control group (p<0.05). VAS pain reports for (a) buccal injections were 1.08 and 1.9 (p=0.02); (b) inferior alveolar nerve blocks were 1.58 and 3.37 (p=0.0002); (c) palatal/lingual injections were 1.34 and 3.02 (p<0.0001); (d) total means were 1.28 and 2.59, respectively (p=0.0001). VAS pain reports of anxious and non-anxious children in the PaFein study group (1.63 and 1.17) were also lower than the control group (3.33 and 2.39) (p<0.0001 and p=0.005). The "PaFein" teaching model was found to be effective in training dental residents to reduce dental injection pain in children, including the anxious ones.