Inferior Alveolar Nerve Block Research Articles

Do NSAIDs used prior to standard inferior alveolar nerve blocks improve the analgesia of mandibular molars with irreversible pulpitis? An umbrella review.

The aim of the present umbrella review was to answer the following question: "Does the use of NSAIDs as premedication increase the efficacy of the standard inferior alveolar nerve block on teeth with symptomatic irreversible pulpitis?" Systematic reviews with and without meta-analyses that evaluated the influence of premedication on anesthetic efficacy of the inferior alveolar nerve in symptomatic irreversible pulpitis of mandibular molars were searched in six electronic databases (MEDLINE/PubMed, Scopus, Web of Science, Cochrane Library, EMBASE, and Grey Literature Reports), without the restriction of language or year of publication. A Measurement Tool to Assess systematic Reviews (AMSTAR 2) was used to evaluate the quality of the included studies. Twelve systematic reviews were included. Only one did not perform a meta-analysis. The AMSTAR 2 overall confidence ranged from very low to high. In general, the main findings of the systematic reviews were that non-steroidal anti-inflammatory drugs (e.g., ibuprofen, oxicam, diclofenac, association of ibuprofen with acetaminophen, and ketorolac) increased the success rate of the inferior alveolar nerve block. From the "very low" to "high"-quality evidence available, this umbrella review concluded that NSAIDs as premedication acts through cyclooxygenase pathways and block the synthesis of specific prostaglandins that complicate the mechanism of action of the anesthesia, improving its success rate. Non-steroidal anti-inflammatory drugs can increase the success rate of the anesthetic technique of inferior alveolar nerve block efficacy in situations of mandibular molars with symptomatic irreversible pulpitis.

Comparative Assessment of Anxiety during Inferior Alveolar Nerve Block under Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation in Children Aged 3-12 Years: A Randomized Clinical Trial.

A comparative evaluation of children's anxiety with the use of nitrous oxide-oxygen (N2O-O2) inhalation sedation during the administration of inferior alveolar nerve block (IANB). A total of 60 children between 3 and 12 years of age, with Frankl's behavior rating of 2-3 requiring IANB for any dental procedure were enrolled in this randomized clinical study. Group I (n = 30) received N2O and oxygen inhalation sedation at a concentration in the range of 25-50%, whereas group II (n = 30) received 100% O2 as a placebo. The physiological parameters like pulse rate, respiration, blood pressure, and O2 saturation were measured at the baseline, intraoperatively [during and after administration of local anesthesia (LA)] and postoperatively after the termination of the gases in both groups. The sedation level was measured intraoperatively (before administration of LA) using the Ramsay Sedation Score (RSS). The discomfort and anxiety were measured at the baseline, intraoperatively, and postoperatively using the Face, Legs, Activity, Cry, Consolability (FLACC) behavior scale. The data were evaluated using the statistical software International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) statistics 20.0. There was a significant difference in the FLACC scores between the two groups, intraoperatively (p-value-0.002), and postoperatively (p-value-0.049). The mean of the RSS for group I was 2.80 + 1.03, and for group II was 1.80 + 0.81. All the physiological parameters recorded were within the normal range. The use of N2O-O2 inhalation improved the anxiety levels in children while receiving the IANB and showed significant anxiolytic and sedative effects as compared to O2 inhalation. Nitrous oxide-oxygen (N2O-O2) inhalation can be used as a nonpharmacological behavior management adjunct for invasive treatments for children with utmost comfort for the child. Thomas PS, Dave BH, Shah DJ, et al. Comparative Assessment of Anxiety during Inferior Alveolar Nerve Block under Nitrous Oxide + Oxygen and Oxygen Inhalation Sedation in Children Aged 3-12 Years: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2023;16(1):30-36.

Does a New Modification of the Two-Step Injection Technique for Inferior Alveolar Nerve Block Reduce Pain Compared to the Conventional Technique? A Randomized Clinical Trial.

The ability to control pain is an essential part of dental procedures and the need for optimal pain control and reduction of discomfort is the primary concern of every dentist. This study aims to compare the pain and vital signs during inferior alveolar nerve block between conventional and a new modification of the two-step injection techniques. In this institutional single-blind randomized clinical trial, attendees of dental school at Mazandaran University of Medical Sciences from February to May 2022 were included. Inclusion criteria were 20-60 years old and healthy (ASA1) individuals who were willing to participate in this study. Individuals who were taking medications affecting their understanding of pain and patients with active infections at the injection site were excluded. These individuals were divided into two groups. First, superficial anesthesia was performed and afterward, conventional and two-step injection techniques were performed. For the two-step injection method, 6 mm of the needle was injected into the mucosa and one-third of the local anesthetic solution was released from the computer-controlled injection toolkit. Afterward, a 25 mm 30-gauge needle was reinserted into the previous hole delivering the remaining local anesthetic. The pain during injection was measured by a patient-reported numerical rating scale (NRS). Moreover, vital signs were monitored immediately before and after the injection. Kolmogorov-Smirnov test, Mann-Whitney U test, independent T-test, and Fisher's exact χ 2 test were performed for statistical analysis (α = 0.05). This study involved 32 adults aged between 20 and 50 years old with 1 : 1 female/male sex distribution. The pain score was significantly higher in the conventional injection technique compared to the two-step injection technique in all sex and age groups. There were no significant differences in vital signs between the conventional and two-step injection techniques. There was no significant difference in the mean pain scores of females and males, regardless of their injection techniques. Utilizing the two-step injection technique in patients for inferior alveolar block reduces pain during injection without altering patients' vital signs significantly. This trial is registered with IRCT20220106053646N1.

Analysis of Hemodynamic Changes after Administration of Mepivacaine HCL 3% with Prilocaine 3% Solution + Felypressin

Introduction: With regards to the usage of local anesthetic drugs in hypertensive patients, this study is designed for comparing the effects of mepivacaine 3% and prilocaine 3% + felypressin in hemodynamic changes after inferior alveolar nerve block to help dental practitioner select anesthetic solutions for hypertensive patients considering their hemodynamic effects in order to provide patient safety.Materials & Methods: In this double blind clinical trial 32 patients were referred to oral and maxillofacial surgery department of Shiraz dentistry school in 2021 were divided into 2 groups with 16 patients in each group. In first group, inferior alveolar nerve block was accomplished by mepivacaine 3% and in the other group, prilocaine 3% and felypressin. Then systolic and diastolic blood pressure, heart rate and oxygen saturation were measured at 4 different time points consisting of before injection, immediately after injection, 10 minutes after injection and 30 minutes after tooth extraction. The data were analyzed by ANOVA and T-test (p value < 0.05).Results: There were no statistically significant differences in systolic blood pressure, diastolic blood pressure, heart rate and oxygen saturation changes between mepivacaine and prilocaine groups during all four sampling time points. But in each group, individually there were significant differences in systolic and diastolic blood pressure, heart rate and oxygen saturation in different times. In addition mepivacaine causes a significant increase in systolic blood pressure immediately after injection but in contrast prilocaine + felypressin didn’t do so.Conclusion: We recommend prilocaine + felypressin in comparison with mepivacaine for local anesthesia in hypertensive patients.

Effect of the inferior alveolar nerve block injection versus maxillary infiltration with two local anesthetic agents on cardiovascular parameters: A randomized comparative double-blind clinical trial

Abstract This study aimed to assess the effect of inferior alveolar nerve (IAN) block of the mandible and infiltration anesthesia of the maxilla using lidocaine plus epinephrine or prilocaine with felypressin anesthetic agents on systolic and diastolic blood pressures, heart rate (HR) and peripheral oxygen saturation rate of patients. This randomized double-blind clinical trial evaluated 112 patients in four groups (n=28) based on the jaw (maxilla or mandible) and type of anesthetic agent (lidocaine with epinephrine or prilocaine with felypressin). Groups 1 and 2 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, with 2% lidocaine plus 1:80.000 epinephrine. Groups 3 and 4 received IAN block of the mandible or infiltration anesthesia of the maxilla, respectively, using prilocaine with felypressin. Systolic and diastolic blood pressures and HR were measured by an automatic upper arm blood pressure monitor and the percentage of peripheral oxygen saturation rate was measured by a finger pulse oximeter 10 minutes before the injection, immediately after injection, 10 minutes after injection and 20 minutes after injection. The mean diastolic blood pressure showed a greater reduction following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p<0.001). The mean HR showed a significantly greater increase following the administration of lidocaine with epinephrine, as compared with prilocaine with felypressin (p<0.001). The effect of type of anesthetic agent on diastolic blood pressure depended on the type of injection (p=0.033). Administration of 2% lidocaine with 1:80.000 epinephrine, in comparison to prilocaine with felypressin, can cause changes in cardiovascular parameters such as heart rate and diastolic blood pressure in patients undergoing restoration of a maxillary or mandibular molar tooth. Type of injection has no significant effect on cardiovascular parameters.

Clinical and Antinociceptive Effects of Distal Inferior Alveolar Nerve Block in Ponies With Tramadol 5% or Lidocaine 2.

This study aimed to compare the antinociceptive effects of tramadol 5% and lidocaine 2% on mental nerve block in horses of the Brazilian Pony breed. Eight adult non-pregnant mares were used in this study. The ponies were tranquilized with acepromazine (5 µg kg-1, IV), and the infiltration of the mental foramen was performed in Treatment 1- tramadol 5% (T, 150 mg) or Treatment 2- lidocaine 2% (L, 60 mg), both at a total dose of 3 ml in each foramen. Heart rate (HR), respiratory rate (RR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), rectal temperature (RT), and formation of skin lesions (SL) were evaluated. Evaluation of nociception of the outer lip (OL), inner lip (IL), and gingiva (GG) were performed using an electronic von Frey device with the evaluation of the ponies' reactions to each stimulus. From these reactions, we determined latency time (LT) and duration of antinociception (DAN). Analysis of variance with 16 observations was performed for HR, RR, SAP, DAP, MAP, LT and DAN. Data were expressed as mean ± standard deviation and the means were compared by the SNK and Student's t-test (P< 0.05). Changes in HR, RR, SAP, DAP, and MAP between evaluation times were associated with the effects of acepromazine (P>0.05). No formation of skin lesions was observed. Latency time did not differ between treatments (P>0.05). Both lidocaine 2% and tramadol 5% produced an antinociceptive effect. We conclude that the duration of the antinociceptive effect of tramadol 5% is longer than that of lidocaine 2%.

Comparison of Ibuprofen and Dexamethasone Premedication on Inferior Dental Nerve Block in Irreversible Pulpitis

Aim: To compare premedication with dexamethasone as compared to ibuprofen in the effectiveness of IDNB in lower molars with asymptomatic irreversible pulpal infection. Study design: A Randomized Control Clinical Trial. Place &amp; duration: Department of Operative Dentistry, Akhtar Saeed Medical and Dental College, Lahore, from October 2022 to November 2022 Methodology: A total of 30 cases in each group were taken, using an expected success rate of Dexamethasone group and Ibuprofen group 38.2% and 78% respectively, taking 5% level of significance 80% power of study. Therefore, sixty endodontic subjects were taken and divided into two equal groups of thirty patients each, group 1 was given 0.5 mg dexamethasone and group 2, was given 400 mg ibuprofen as pre-medication prior to endodontic therapy. Results: The results showed mean pain scores 24.38±15.41 in group 1 and 35.63±18.74 in group 2 (P&lt;0.05). According to pain score, 11 patients (36.7%) have pain score between 0.0-20 (successful) and 21 patients (63.3%) has pain score 21.0-100.0 (unsuccessful) in group 1 with mean±standard deviation of 24.38±15.41. While in group 2, 5 patients (16.7%) have pain score 0.0-20 and 25 patients (83.3%) have pain score 21.0-100.0 with mean±standard deviation of 35.63±18.74. Conclusion: The premedication with dexamethasone as compared to ibuprofen, increased the effectiveness of inferior dental nerve block in lower molars with asymptomatic irreversible pulpitis. Keywords: IDNB, Irreversible pulpitis, Nerve block, Endodontics.

Effect of Preoperative Oral Steroids in Comparison to Anti-inflammatory on Anesthetic Success of Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis—A Double-blinded Randomized Clinical Trial

IntroductionThis randomized double-blinded trial aimed to compare the anesthetic success of inferior alveolar nerve blocks (IANBs) with 2% lidocaine in mandibular molars with symptomatic irreversible pulpitis (SIP) after oral premedication of prednisolone, dexamethasone, and ketorolac with placebo. MethodsOne hundred eighty-four patients diagnosed with SIP in mandibular molars randomly received prednisolone, dexamethasone, ketorolac, or placebo (n = 46 each) 60 minutes before the administration of an IANB. The access cavity preparation was initiated after successfully confirming lip numbness and two consecutive negative responses to electric pulp testing. The success of the anesthesia was clinically confirmed when pain was absent during the endodontic access or instrumentation. A one-way analysis of variance test was used to compare quantitative variables among the groups, and chi-square tests were used for comparing categorical variables. Binary logistic regression was performed to analyze the relationship of age, preoperative pain, and preoperative medications. ResultsWhen premedicated with oral dexamethasone, ketorolac, prednisolone, and placebo, the success rate of IANB was determined to be 60.86 %, 65.21 %, 56.52 %, and 21.73 %, respectively. Compared to the placebo, the success rate of IANB was significantly increased when patients were premedicated with prednisolone, dexamethasone, or ketorolac. However, there were no statistically significant differences among prednisolone, dexamethasone, and ketorolac. One individual in the ketorolac group reported gastritis, whereas no adverse effects were reported in the dexamethasone or prednisolone groups. ConclusionsPreoperative use of oral ketorolac, dexamethasone, or prednisolone may increase the anesthetic efficacy of IANB in mandibular molars with SIP.

Preoperative Ibuprofen and Success Rate of Inferior Alveolar Block in Irreversible Pulpal Inflammation Cases

Background: The inferior dental nerve block (IDNB) is the best method of pain control prior to endodontic treatment. Conventional IDNB is one of the most common technique to get pain control Aim: To compare effectiveness of premedication with Ibuprofen with placebo to increase the success chances of IDNB in lower molars in subjects with asymptomatic irreversible pulpal infection. Methodology: Sixty patients were selected and divided in to two groups (group 1 ibuprofen and group 2 placebo). Patients were pre-medicated and the treatment was commenced with IDNB 45 minutes after premedication. The failed patients were managed with alternate methods Results: The results showed that premedication with ibuprofen gave 16.6 % success rates vs 13.3% of placebo. The mean ages in group 1 were 27.40±4.17 years and 25.73±4.79 years. The practical implication of this study is that ibuprofen can’t be used to increase the success chances of IDNB in lower molars before endodontic therapy. Conclusion: Thus it was concluded that ibuprofen as compared to placebo did not increased the success chances of IDNB in lower molars in subjects with asymptomatic irreversible pulpal infection. Key words: Ibuprofen, Irreversible pulpitis; Endodontics.

Comparison of The Effectiveness Between Preoperative Ibuprofen Verses Placebo On the Success of the Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis

The inferior alveolar nerve block is the simplest often utilized injection procedure in dentistry, and numerous variations of the traditional nerve block have lately been reported. The dentist or surgeon must consider a variety of aspects before choosing the optimum approach, considering the treatment's effectiveness probability and potential problems. Objective: To compare the effectiveness of preoperative ibuprofen verses placebo in enhancing the success of inferior alveolar nerve block in patients with irreversibly inflamed pulp. Methods: This randomized control trial was performed for a period of 6 months. Data collection was done after taking approval from hospital ethical committee of Altamash Institute of Dental Medicine. 236 patients were included in this study. The participant was told to assess their level of discomfort after the endodontic treatment. Results: From 236 patients, the minimum age was found 18 years and maximum age was 45 years. Males were 123/236 (52.1%) while females were 113/236 (47.9%). Effectiveness of both materials was found in 74/236 (31.4%) patients. Effectiveness of materials was found significant in both groups (Ibuprofen, Placebo) having p-value 0.012. Conclusions: The effectiveness of materials was significant in both groups (Ibuprofen, Placebo). Effect modifier like age, duration of pain and gender has no significant association with effectiveness of materials.

Problems associated with the traditional Inferior Alveolar Nerve Block and alternative approaches

Problems associated with the traditional Inferior Alveolar Nerve Block and alternative approaches

Choosing the optimal mandible position for inferior alveolar nerve block (IANB) using finite element analysis

BackgroundOne of the most popular methods of local anesthesia in dentistry, inferior alveolar nerve block (IANB) involves the blockade of the inferior alveolar nerve (IAN) and lingual nerve (LN) in the pterygomandibular space. Despite the large number of works describing the contents of this space, the spatial displacements of the anatomical structures of this area at different positions of the mandible have not been sufficiently studied. The aim of our study was to study the spatial movements of the IAN and inferior alveolar artery (IAA) at various positions of the mandible using computer simulation and finite element analysis to find the safest way to conduct IANB. Materials and methodsReverse engineering was used to create a model of the cranial base and the mandible based on computed tomography (CT) data obtained from patient N (male, 24 years old), the arteries of the head and neck were designed from the data of multiphase angiography of patient M (female, 61 years old). Masticatory muscles, sphenomandibular ligament, temporomandibular joint and mandibular nerve were modeled in the SolidWorks software package based on an open database of anatomical structures. The finite element grid was generated in the Solidworks software.In the first series of experiments, the displacement of the mandible was modeled along the vertical axis down by 48 mm (maximum opening of the mouth), in the second series, the jaw was displaced vertically by 48 mm with a simultaneous transversal movement of 10 mm, in the third series, the jaw was displaced along the vertical axis down by 34 mm and transversally by 22 mm. ResultsThe largest distance between IAN and IAA was noted in the third series of experiments. The distance between the nerve and the vessel was minimal in the first series, with an open mouth without lateral displacements. ConclusionThe generated computer model opens new possibilities for studying the dynamic anatomy of the pterygomandibular space. The results of this study can be used for further experimental and clinical trials to find the safest approach to the implementation of IANB, as well as applied in the practice of the educational process.

Effect of the Case for Carpule as a Visual Passive Distraction Tool on Dental Fear and Anxiety: A Pilot Study.

The present cross-over study aimed to evaluate the effect of a visual passive distraction tool, a case for carpule, in the management of fear and anxiety during invasive dental treatment. Children between the ages of 4 and 8 years that need at least two treatments with inferior alveolar nerve block were selected. All the included children received two treatments at different moments: in one treatment, local anesthesia was performed with a visual passive distraction tool, the crocodile case, for carpule (experimental); in the other treatment, local anesthesia was performed without the device (control). An evaluation of the anxiety levels was performed by measuring the heart rate and salivary cortisol levels. Wilcoxon's nonparametric test was used for a data analysis (p < 0.05). The mean heart rate with the visual passive distraction device fell from 81.8 to 78.1, while the control rose from 91.4 to 100 (p < 0.05). The mean salivary cortisol levels with the visual passive distraction device fell from 2.0 to 1.6, while in the control, they rose from 2.1 to 2.4 (p < 0.05). In conclusion, the crocodile case for carpule as a visual passive distraction device contributed positively to the management of fear and anxiety during inferior alveolar nerve block in children.

Sucrose solution for alleviating needle pain during inferior alveolar nerve block in children aged 7-10 years: a randomized clinical trial.

Intraoral local anesthesia is essential for delivering dental care; however, injection of this local anesthetic is perceived as the most painful and distressing agent for children, parents, and healthcare providers. Reducing pain as much as possible is essential to ensure smooth subsequent treatment procedures, especially in pediatric dentistry. In clinical practice, oral sucrose administration has been reported to decrease the pain during heel lance and cold pressor tests in neonates and children. This study aimed to determine whether the prior administration of a 30% sucrose solution reduced the pain related to inferior alveolar nerve block in children. A total of 42 healthy children aged 7-10 years requiring dental treatment of mandibular molars involving inferior alveolar nerve block were recruited. The participants' demographic details were recorded, height and weight were measured, and the anesthetic injection was delivered after receiving the respective intraoral sucrose solution and distilled water by the intervention (group 1) and control (group 2) group participants for 2 min. The subjective pain perceived during injection was measured using an animated emoji scale. The pain scores between the groups were compared using the Mann-Whitney U test. The median pain score and range for the intervention and control groups were 4 (2 - 6) and 6 (4 - 8), respectively, and statistically significant differences (P < 0.001) were observed in the intervention group. Age, sex, height, and weight did not influence the analgesic effect of the sucrose solution. Oral administration of sucrose may relieve pain associated with inferior alveolar nerve block in children.

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

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

Anesthetic efficacy of articaine versus lignocaine as supplementary buccal infiltration after failed inferior alveolar nerve block – A systematic review of randomized clinical trials

ABSTRACT Aim: The aim of this study was to compare the anesthetic efficacy of 4% articaine and 2% lidocaine as supplementary buccal infiltration after failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Methods: MESH terms and specific keywords were used to search Scopus, EBSCOhost, Cochrane Library, and PubMed. Randomized clinical trials were among the included articles that compared the anesthetic efficacy of 4% articaine or 2% lignocaine as supplementary buccal infiltration following a failed IANB in patients with chronic irreversible pulpitis. Results: Five of the 871 studies that were reviewed were given full-text reading considerations, and three studies were subjected to qualitative analysis after meeting the inclusion and exclusion criteria. In 234 patients altogether, patients anesthetized with 4% articaine buccal infiltration had a success rate of 61%–83.3% in the 118 patients in the 4% articaine BI group and 116 patients in the 2% lidocaine BI group. Conclusion: Supplemental buccal infiltration with 4% articaine in permanent mandibular molars was associated with greater anesthetic efficacy than the 2% lignocaine in patients with symptomatic irreversible pulpitis after unsuccessful IANB.

Mandibular foramen location and its implication to the inferior alveolar nerve block: A retrospective study

Aim: This study was carried out to identify differences in the parameters for locating mandibular foramen (MF) in the central Indian population and the recommended guidelines for the administration of inferior alveolar nerve block (IAN) as mentioned in the dental literature. Methods: Eighty high-resolution full volumes cone-beam computed tomography (CBCT) scans were randomly selected from the radiology database and the scans were rendered, viewed, and measured using the on-demand volumetric imaging software (Anatomage, San Jose, CA). The parameters used in locating the MF/IAN complex were the horizontal distance from the mandibular notch to the midpoint of MF (H); vertical distance from the level of the mandibular occlusal plane to the center of MF (V) and the angle from the contralateral premolar contact area to the MF. Results: Paired t-test was applied. The mean horizontal distance from the mandibular notch to MF was 22.36 ± 2.60 mm in males and 21.05 ± 3.57 mm in females. The mean vertical distance to the occlusal plane was 10.23 ± 4.57 mm in males and 7.42 ± 4.96 mm in females, with a significant difference between the genders (P < 0.05). The mean value for the angulation for the occlusal plane was 39.28° ±5.23° and 37.35° ±3.72° in males and females, respectively. Conclusion: Ethnicity and gender influence the location of the MF/IAN complex. The utilization of long needles, orienting the syringe barrel at an angulation slightly <45° and approximately 10 mm above the mandibular occlusal plane can aid in successfully administering the IAN block.

A stroke mimicker following inferior alveolar nerve block: a case report

Introduction: Local anesthesia administration albeit being the most common dental procedure is associated with complications that usually arise as a result of wrongly placed injections into local or distant sites. Here we present a case of an unexpected complication affecting the upper limb after dental anesthesia administration. Observation: A 26-year-old Malay female presented with the left upper extremity paralysis and paraesthesia following the administration of a local anesthesia block to the left inferior alveolar nerve, at a dental teaching center. The onset of the dental nerve block and left upper extremity weakness occurred and eventually subsided. As the provisional diagnosis was either a transient ischaemic attack or stroke, she was immediately referred to the Emergency Department. She was thoroughly assessed and monitored with the neurology team being consulted. Her vital signs remained stable and she showed no neurological deterioration throughout the observation period. She was discharged without further investigations after regaining full strength and sensation of her left upper extremity. The report tries to hypothesize the possible cause of this incident. Conclusion: This case highlights the importance of dentists being alert to possible effects of local anesthesia to regions beyond the head and neck area.

Articaine versus lidocaine inferior alveolar nerve block in posterior mandible implant surgeries: a randomized controlled trial.

The aim of this study is to compare the effects of %4 articaine and %2 lidocaine on inferior alveolar nerve block (IANB) for implant surgery in the posterior mandible. The patients who have inserted implants in the posterior mandible were divided into 2 groups for IANB: lidocaine and articaine. VAS = visual analog scale, pain during surgery and injection, lip numbness time, mandibular canal-implant apex distance, age, gender, bone density, implant number, release incision, adjacent teeth, and duration of surgery were analyzed using t-test, Mann-Whitney U test, Spearman's coefficient, and, Pearson's chi-squared test. This trial followed the recommendations of the Consort Statement for reporting randomized controlled trials. 577 patients were included and 1185 dental implants were analyzed. There was no significant difference between the two groups in terms of injection and surgery VAS values (p>0.05). The lip numbness time of lidocaine was 3.06±3.22min while articaine was found to be 2.96±3.09min (p>0.05). Mandibular canal-implant apex distance was found to be 2.28±0.75mm in the articaine and 2.45±0.86mm in the lidocaine group (p<0.05). Release incision was made more in the articaine group (51/252) than in the lidocaine group (40/325) (p<0.05). There was no difference between the %4 articaine and %2 lidocaine in terms of pain perception in posterior mandible implant applications. Both anesthetics provided adequate anesthesia for implant application.

A Comparison between Inferior Alveolar Nerve Block and Crestal Anesthesia in Children Undergoing Dental Extraction Procedure

A Comparison between Inferior Alveolar Nerve Block and Crestal Anesthesia in Children Undergoing Dental Extraction Procedure