Mandibular Anesthesia Research Articles

Efficacy of QuickSleeper Intraosseous Injection of 4% Articaine in Mandibular First Molars With Symptomatic Irreversible Pulpitis: A Randomized Controlled Trial

Objective To evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine via primary intraosseous (IO) injection with the QuickSleeper device vs inferior alveolar nerve block (IANB) for mandibular first molars diagnosed with symptomatic irreversible pulpitis (SIP). Methods Sixty-four patients with a first mandibular molar with SIP were randomly divided into 2 groups: IO (n = 32) and IANB (n = 32). Each received either an IO injection with the 5th generation QuickSleeper device or a conventional IANB with 1.7 mL 4% articaine with 1:100,000 epinephrine. Success was defined as no/mild pain upon the access cavity preparation and initial filing. Injection pain, anesthetic onset, heart rate (HR) change, HR recovery time, and duration of anesthesia were also recorded and analyzed. Results The success rates were 40.6% for IANB and 81.2% for IO (P < .001). IO exhibited a significantly lower injection pain (P = .027), a shorter onset of action (P < .001), a greater heart rate increase (P < .001), a faster heart rate recovery time (P < .001), and a shorter duration of action (P < .001) vs IANB. Conclusion Primary IO anesthesia using the fifth generation of the QuickSleeper device was more successful than IANB when using 4% articaine with 1:100,000 epinephrine to anesthetize mandibular first molars with SIP. The QuickSleeper device appeared to be a viable alternative to IANB for mandibular anesthesia.

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.

Evaluation of Anaesthetic Efficacy of Ropivacaine for the Removal of Impacted 3rd Molars- A Randomised Control Study

This study involved 20 healthy patients (ASA 1) with bilaterally impacted mandibular third molar were randomly selected of both Sexes between age group of 20-40 years. Purpose: This study was done to evaluate the efficacy of Ropivacaine in comparison with Lignocaine for mandibular anaesthesia for bilaterally impacted mandibular third molars in aspect of onset, duration of anaesthesia, analgesia and postoperative requirement of analgesics. Method: Patients received 2ml of 2% Lignocaine with adrenaline on one side and 2ml of 0.75 % plain ropivacaine on the other side at two different appointments. Pain experiences were measured by Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). Results: In ropivacaine group, the means of onset of anesthesia, duration of anaesthesia, duration of post-operative analgesia and requirement of post-operative analgesics were 5.8±2.33 min, 533.3±142.2 min, 539.6±114.7 min and 4.2±0.8 no’s respectively and there was a significant difference between these group (<0.001). Conclusion: The efficacy of plain ropivacaine 0.75% is superior to 2% lignocaine with adrenaline 1:1,00,000 in terms of duration of anaesthesia and analgesia, intraoperative and post-operative pain control but the onset of action of plain ropivacaine is slightly higher. We conclude that Plain Ropivacaine 0.75% can be used as an alternative to lignocaine in third molar surgeries and other minor surgical procedures which necessitates longer duration of anaesthesia and analgesia in oral and maxillofacial region.

Anatomical and topographic substantiation of mandibular anesthesia in sheep

This study presents an anatomical and topographic justification for performing mandibular anesthesia in sheep. The study was conducted on the basis of the Department of Anatomy and Histology of Animals named after Professor A. F. Klimov of the Moscow State Academy of Veterinary Medicine and Biotechnology – MBA named after K. I. Scriabin. The object of the study was sheep of the Romanov breed (n=20) aged 1-2 years without pronounced signs of pathology of the dental apparatus. The material for the study was the lower jaws (n=20) and survey radiographs of the head area (n=20). To achieve this goal, a comprehensive methodological approach was used, including: anatomical dissection and macromorphometry with the determination of skeletotopic and linear parameters of the mandible. Mandibular anesthesia is one of the most common manipulations in animal dentistry. For high-quality anesthesia of the mandibular branch of the trigeminal nerve, it is important to take into account the topical landmarks of the structures forming the mandibular canal. Based on the results of macromorphometry and rengenogrammetry, skeletotopic landmarks of the holes forming the mandibular canal are presented, which are important to take into account when performing anesthesia of the lower alveolar nerve. Comparative analysis of morphometric and rengenogrammetric parameters of the upper and lower jaws did not reveal significant differences in their linear parameters, which indicates the high informative value of the X-ray diagnostic method in assessing the morphofunctional state of the jaw bones and the channels located on them. The results obtained can be used in the development of new approaches to the mandibular branch of the trigeminal nerve during local anesthesia in veterinary and experimental dentistry.

Modifikovana milohioidna anestezija sa 4% artikainom I adrenalinom I deksametazonom u hirurgiji mandibularnih molara - pilot studija

Introduction: Mylohyoid mandibular anesthesia is not a standard and independent primary anesthesia for performing surgery on mandibular teeth. Objective: The objective was to examine the success of achieved mylohyoid anesthesia for mandibular molar surgery, by injecting an anesthetic that could penetrate the bone in the lingual region of the mandible, using the technique for modified mylohyoid mandibular anesthesia. Materials and methods: In the pilot study, 10 patients were divided into 2 equal groups (of 5 patients each), of both sexes and aged 18-75, who required mandibular anesthesia owing to mandibular molar surgery. In group I, 3.5 ml of 4% articaine with 1:100000 adrenaline, and the addition of 0.5 ml/4 mg of dexamethasone, was injected into the sublingual region of the corner of the mandible using a modified mylohyoid approach; in group II, 4 ml of 2% lidocaine with 1:100000 adrenaline was injected into the region of the mandibular foramen using the approach for standard mandibular conduction direct anesthesia. A visual analogue scale (VAS) was used for the subjective assessment of the pain during surgery in patients, the recorded duration of the realized mandibular anesthesia, as well as the total effectiveness of the achieved anesthesia, expressed in percentages. Results: A successful intervention was achieved in all patients, with different VAS scores, but within the values indicating successful anesthesia (group I: 17.40±11.10mm; group II: 12.80±4.55mm). A longer duration of anesthesia was achieved in the first group-205.2 min (3h 25 min), compared to the second group-182 min (3h 2 min). Conclusion: Mylohyoid mandibular anesthesia with 4% articaine and with adrenaline and dexamethasone could be applied as primary anesthesia for the purpose of successfully achieving standard mandibular anesthesia.

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.

Unusual Communication between Nerve to Mylohyoid and Lingual Nerve and, its Clinical Significance- A Cadaveric Study

Introduction: The nerve to mylohyoid is a branch of inferior alveolar nerve which arises just above the mandibular foramen. There is occasionally communicating branch between nerve to mylohyoid and lingual nerve. Knowledge of such variations has significance during oral and submandibular surgery. Aim: To detect and describe the existence and occurrence of anatomical variations in the innervation pattern of the nerve to mylohyoid by using the dissection technique. Materials and Methods: An observational study was carried out from January 2022 to April 2022 in a total of 15 embalmed and formalin-fixed cadavers in the Laboratory of Anatomy of SMBT Medical College, Nashik, Maharashtra. The nerve to the mylohyoid and lingual nerve were cleared and observed for any unusual communication between the two, if any. Results: In 13 (86.67%) cadavers, classical (normal) anatomical presentation of the nerve to mylohyoid was observed, whereas, in two male (13.33%) cadavers, the presence of communicating branch between the nerve to mylohyoid and lingual nerve was observed. In both the cadavers, the communicating branch was unilateral, in one cadaver on the right-side, and in the second cadaver same variation was noted on the left-side. Conclusion: The existence of communication between the nerve to mylohyoid and the lingual nerve is thought to be responsible for inadequate mandibular anesthesia. Through this study, surgeons will be aware of this variance, to explain unexpected findings in nerve injury following oral procedures.

Анатомо-топографическое обоснование мандибулярной анестезии у животных различных таксономических групп

This article presents anatomical and topographic substantiation of performing mandibular anesthesia in animals of different taxonomic groups (domestic horse, sheep, dog). Studies were carried out at the Department of Anatomy and Histology of Animals named after Prof. A.F. Klimov of Moscow State Academy of Veterinary Medicine and Biotechnology – MVA by K. I. Skryabin. The object of the study were: domestic horse (Equus caballus) (n=14), sheep (Ovis aries) (n=20), mesocephalic dog (Canis lupus familiaris) (n=20) without pronounced signs of pathology of head organs. The material for the study were mandibles and review radiographs of the head region. We used anatomical dissection, macromorphometry and review radiography with subsequent statistical processing of the obtained digital data. The results of the study revealed species and interspecific regularities and features of anatomical organization of mandibular foramen in different taxonomic groups (domestic horse, sheep, dog). Based on the results of macromorphometry and analysis of anatomical structures and review radiographs, the skeletotopic landmarks of the canal-forming foramen on the mandible were established, which are important to consider when anesthetizing the mandibular branch of the trigeminal nerve. The obtained results are basic in the development of new accesses to the inferior alveolar nerve when performing conduction anesthesia in animal dentistry.

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.

Evaluation of Patient Comfort and Impact of Different Anesthesia Techniques on the Temporomandibular Joint Arthrocentesis Applications by Comparing Gow-Gates Mandibular Block Anesthesia with Auriculotemporal Nerve Block.

Aim Temporomandibular disorders (TMDs) are clinical situations that are characterized by pain, sound, and irregular movements of the temporomandibular joints. The most common method in the treatment of TMDs is arthrocentesis. This study aims to compare the effect of conventional extraoral auriculotemporal nerve block (ANB) and Gow-Gates (GG) mandibular anesthesia techniques on patient comfort in an arthrocentesis procedure. Materials and Methods We performed this study on 40 patients who underwent TMJ arthrocentesis with ANB (n = 20) or GG (n = 20) mandibular anesthesia techniques at the Marmara University Faculty of Dentistry between 2016 and 2019. The predictor variable was the type of an anesthesia technique, and the outcome variables included were pain, maximum mouth opening (MMO), and protrusive movement (PM). They were compared at the preoperative period and 3rd and 6th month periods. Statistical analysis included means with standard deviations, a one-way ANOVA for continuous data, and the results were evaluated at the significance level of p < 0.05. Results No statistically significant difference was observed between the VAS values, MMO, and PM averages of preoperative, 3rd and 6th months of ANB and GG (p=0.142, p=0.209, and p=0.148). Conclusion Both anesthesia techniques have provided effective results in terms of pain and functional jaw movements in the postoperative period in arthrocentesis treatment.

Cross-Sectional Study on the Comparative Assessment of Mandibular Anesthesia (Inferior Alveolar Nerve Blockage) Manual Skills Shaping among Dentists on Plastic and Biomaterial Models.

Background: Providing regional anesthesia skills shaping remains relevant nowadays. A number of studies show that dentists have difficulties with these working independently. The study aim is the comparative analysis of the results of mandibular anesthesia (IANB) manual-skills shaping among dentists on plastic models and cadavers. Methods: In total, 999 participants were training in the skills of mandibular anesthesia from 2017 to 2021. The participants were divided in a random way into two groups: 700 participants were trained on plastic models, and 299 were trained on the cadaver material. After a lecture on the clinical and anatomical guidelines for IANB, a demonstration of the technique was provided, with subsequent testing of the injection technique. Satisfaction with the aspects of the training was assessed using the Likert scale. Results: the analysis of average values showed that participants from the group in which the manual skills were practiced on cadavers were more satisfied with the main aspects of the training, according to the sum of the main criteria of the modified scale. Conclusions: The important advantages of cadaver educational technology are that the sensations of tissue resistance are identical to natural ones, the individuality of each object, and the possibility of the visual study of the anesthesia technique, by dissection of the needle course and the location of the anesthetic depot.

Comparison of Efficacy of Halstead and Vazirani Akinosi Block Technique in Achieving Mandibular Anesthesia

OBJECTIVE: To compare the efficacy of Halstead and Vasirani Akinosi block techniques in achieving mandibular anesthesia during exodontia among subjects reporting to Watim Teaching Hospital.&#x0D; STUDY DESIGN: Randomized controlled trial.&#x0D; PLACE AND DURATION OF STUDY: This study was conducted in the department of Maxillofacial Surgery, Watim Dental Hospital, Rawalpindi from July 2019 to January2020.&#x0D; MATERIALS AND METHODS: This is a randomized control trail of 60 patients. Duration of onset of anesthesia, pain during injection, incidence of aspiration, success and failure of Halstead and Vasirani Akinosi techniques and their mean doses were analyzed and compared by using SPSS version 17.Comparison of categorical variables was done by Chi-square test. Comparison of non-categorical variables was done by independent sample t-test. p value of less than 0.05 was considered significant.&#x0D; RESULTS: 28(93.3%) experienced moderate while 2(6.7%) experienced severe pain in Halstead group, while 30(100%) experienced mild pain in Vasirani Akinosi group. Halstead technique was successful in 22(73.3%) while unsuccessful in 8(26.7%) patients. Vasirani Akinosi technique was successful in 29(96.7%) and unsuccessful in 1(3.3%) patients.&#x0D; CONCLUSION: It may be concluded from analysis in the present study that Vasirani Akinosi technique was statistically superior in all parameters such as duration of onset, pain during injection, aspiration and success rate as compared to the conventional Halstead block technique.&#x0D; KEY WORDS: Extraction tooth, local anesthesia, Vasirani-Akinosi technique, nerve block.

The position of the mental foramen towards the alveolar crest using digital panoramic radiographs

Objectives: The rate of mandibular anesthesia failures is higher than maxilla, where the highest percentage is the inferior alveolar nerve block. One alternative action in case of failure is a mental nerve block, located in the mental foramen. Thus, knowledge of the mental foramen anatomy is required to avoid failure in anesthesia. The study is to determine the vertical and horizontal position of the mental foramen, which refers to the crest of the alveolar bone, using panoramic radiographs.&#x0D; Materials and Methods: The type of research that is used is descriptive with a purposive sampling method. The object of research is panoramic radiographs of patients who are in Dentistry Radiology Installation of Dental Hospital Universitas Padjadjaran, Bandung with a total sample of 352 panoramic radiographs. This research measured the vertical and horizontal distances between the mental foramen to the alveolar bone crest between 1st premolar teeth and 2nd premolar teeth.&#x0D; Results: The average value of the vertical distance mental foramen to the alveolar bone crest is 13,43 mm. The average value of the horizontal distance from mental foramen to 1st premolar teeth is 6,97 mm and the horizontal distance from mental foramen to 2nd premolar teeth is 2,80 mm.&#x0D; Conclusion: Mental foramen is closer to the 2nd premolar teeth based on the horizontal position and located below the apex based on the vertical position.

The Assessment of Prolonged Inferior Alveolar Nerve Blockade for Postoperative Analgesia in Mandibular Third Molar Surgery by a Perineural Addition of Dexamethasone to 0.5% Ropivacaine: A Randomized Comparison Study

Background: Perineurally adding dexamethasone to local anesthetics could enable postoperative analgesia. Our aim was to investigate the efficacy of 4 mg dexamethasone and 0.5% ropivacaine on the prolonged duration of mandibular anesthesia for postoperative analgesia during third molar surgery. Materials and method: The patients of both sexes, and in the age range of 17 to 50 yrs of age, received the Gow-Gates anesthesia. Group I received 4 mL of plain 0.5% ropivacaine, with perineurally added 1 mL/4 mg of dexamethasone; group II received 4 mL of plain 0.5% ropivacaine with perineurally added 1 mL of 0.9% saline; group III received 4 mL of plain 0.5 bupivacaine with perineurally added 1 mL of 0.9% saline. The prime anesthesia outcome was the duration of conduction anesthesia (DCA); the secondary outcome was the duration of analgesia (DAN) and analgesia before analgesic intake. Results: In 45 randomly selected subjects (mean age 27.06 ± 8.20), DCA was statistically longest in group I (n = 15) (592.50 ± 161.75 min, p = 0.001), collated with groups II (n = 15) and III (n = 15) (307.40 ± 84.71 and 367.07 ± 170.52 min, respectively). DAN was significantly the longest in group I (mean: 654.9 ± 198.4 min, p = 0.001), compared with group II (345.4 ± 88.0 min) and group III (413.7 ± 152.3 min), with insignificant adverse reactions. One-third of the operated patients absented from the use of analgesics. Conclusion: A amount 0.5% ropivacaine with dexamethasone usefully served as an analgesic with a success rate of 93.4% of the given anesthesia.

Optimizing Local Anaesthetic Practice: Addressing Misconceptions and Minimizing Anaesthetic Failures

Local anaesthesia is a sine qua non for pain management in dentistry. Optimizing local anaesthesia practice reduces intra-operative pain, and ultimately ameliorates patient comfort. Many patients still report experiencing intra-operative pain despite being anaesthetized. This is commonplace with inferior alveolar nerve blocks, the current routine approach to mandibular anaesthesia. This technique has been shown, in many cases, to fail at first attempt and can be uncomfortable for patients. It has a higher positive-aspiration rate than other techniques, increasing the risk of systemic complications. CPD/Clinical Relevance: Clinicians should be aware of more effective techniques for mandibular anaesthesia for optimal and safe pain management, and ultimately a better patient experience.

Anatomic topographic characteristics of the relationship between the lower jaw branch width and the needle immersion depth during mandibular anesthesia

<h3></h3> В настоящее время, несмотря на широкое изучение местной анестезии, до конца не решены проблемы повышения ее качества и безопасности. В связи с этим исследования, направленные на решение этих проблем, являются актуальными, имеют теоретическое, практическое и научное значение. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> На основании краниометрического, рентгенологического и клинического исследований обосновать взаимосвязь ширины ветви нижней челюсти и глубины погружения иглы при проведении мандибулярной анестезии. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Проводили анатомо-топографическое изучение нижней челюсти в 110 нижнечелюстных костях и 158 результатах компьютерной томографии. При этом для определения глубины погружения иглы проводили изучение толщины мягких тканей в области ветви нижней челюсти с учетом индекса массы тела обследованных. Полученные данные обосновали взаимосвязь ширины ветви нижней челюсти и глубины погружения иглы при проведении мандибулярной анестезии и способствовали разработке специальной таблицы Ушницкого—Чахова для определения глубины погружения иглы. <h3>РЕЗУЛЬТАТЫ</h3> Полученные результаты определяют вариабельность показателей ширины ветви нижней челюсти, которые оказывают непосредственное влияние на глубину погружения иглы при проведении мандибулярной анестезии. С учетом полученных данных разработана специальная таблица определения глубины погружения иглы в зависимости от полученных показателей ширины ветви нижней челюсти, обеспечивающая более точное достижение целевого пункта при мандибулярной анестезии. <h3>ВЫВОД</h3> Полученные параметры глубины погружения иглы с учетом показателей ширины ветви нижней челюсти имеют важное теоретическое, практическое и научное значение и могут быть использованы при амбулаторно-поликлиническом и стационарном стоматологическом приеме.

Personalized approach in determining the depth of needle immersion during mandibular anesthesia

Personalized approach in determining the depth of needle immersion during mandibular anesthesia

Addition of 2 mg dexamethasone to improve the anesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine administered for inferior alveolar nerve block to patients with symptomatic irreversible pulpitis in the mandibular molars: a randomized double-blind clinical trial.

IntroductionThis clinical trial aimed to evaluate the anesthetic effect of the addition of 2 mg (4 mg/ml) of dexamethasone to 2% lidocaine (plain or with 1:80,000 epinephrine). The solutions were injected for a primary inferior alveolar nerve block (IANB) to provide mandibular anesthesia for the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis.MethodsIn a double-blinded setup, 124 patients randomly received either of the following injections: 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, or plain 2% lidocaine mixed with 2 mg dexamethasone, which were injected as a primary IANB. Ten minutes after injection, patients with profound lip numbness underwent electric and thermal pulp sensibility tests. Patients who responded positively to the tests were categorized as “failed” anesthesia and received supplemental anesthesia. The remaining patients underwent endodontic treatment using a rubber dam. Anesthetic success was defined as “no pain or faint/weak/mild pain” during endodontic access preparation and instrumentation (HP visual analog scale score < 55 mm). The effect of the anesthetic solutions on the maximum change in heart rate was also evaluated. The Pearson chi-square test at 5% and 1% significance was used to analyze anesthetic success rates.ResultsThe 2% lidocaine with 1:80,000 epinephrine, 2% lidocaine with 1:80,000 epinephrine mixed with 2 mg dexamethasone, and plain 2% lidocaine mixed with 2 mg dexamethasone groups had anesthetic success rates of 34%, 59%, and 29%, respectively. The addition of dexamethasone resulted in significantly better results (P < 0.001, χ2 = 9.07, df = 2).ConclusionsThe addition of dexamethasone to 2% lidocaine with epinephrine, administered as an IANB, can improve the anesthetic success rates during the endodontic management of symptomatic mandibular molars with irreversible pulpitis.

A comparison between articaine mandibular infiltration and lidocaine mandibular block anesthesia in second primary molar: A randomized clinical trial

One of the most important objectives of pediatric dentistry during dental practice is pain control and effective anesthesia. Because of the limitations of inferior alveolar nerve block (IANB), other techniques such as infiltration injection are suggested. Infiltration technique by using some other solutions such as articaine is an appropriate alteration for mandibular anesthesia. The aim of this study is to compare the efficacy of IANB using lidocaine with infiltration injection by articaine in mandibular second primary molar anesthesia in 8-11-year-old children.This is a randomized, cross-over, clinical trial that was performed on 42 children aged 8-11 years, who needed extraction of both mandibular second primary molars. After clinical and radiographic investigations, block or infiltration injection was chosen randomly and treatment was performed in one side in each session. Patient's behavior was registered in two steps of injection and extraction by SEM scores. For comparison of the two sides, Wilcoxon-signed rank test was used (P < 0.05).We concluded that infiltration technique resulted in decrease of all the three SEM scores in comparison to block injection (P < 0.05). The effectiveness of two techniques during tooth extraction, although grade of lidocaine block was more than infiltrate, was not statistically significant.It seems that infiltration technique with articaine is a better substitute for block technique in the extraction of mandibular primary molars.

Comparison of Vazirani-Akinosi and Kurt-Thoma technique for mandibular anesthesia: An observational clinical study.

Introduction:Different techniques have been developed over the years for achieving mandibular nerve anesthesia. Many methods have been proposed back and forth in order to perform effective anaesthesia.Aims and Objective:The main aim of our study was to carry out comparison of clinical efficacy of mandibular nerve anaesthesia by Kurt Thoma technique with that of Vazirani-Akinosi nerve block technique.Materials and Methods:10 adult patients requiring bilateral mandibular teeth extraction were selected randomly to receive Kurt Thoma technique and Vazirani-Akinosi technique for nerve block randomly.Results:There is no statistically difference between two techniques in terms of need of additional injection, pain, complications, onset of action.Conclusions:By this study we conclude that both the techniques are equally effective and all the oral and maxillofacial surgeons should learn these techniques so that they can use in various patients where conventional mandibular nerve block techniques are not feasible.