Mandibular Block Anesthesia Research Articles

Cardiovascular and Vector-Cardiographic Effects of Articaine Anesthesia with Epinephrine.

The aim was to investigate the vector-cardiographic effects in patients submitted to dental extraction under local anesthesia. Twenty-one patients aged 36.6 ± 12.4 years with a clinical and radiographic indication of mandibular or maxillary tooth extraction were enrolled. The intervention was a local or mandibular nerve block anesthesia with 4% articaine hydrochloride containing epinephrine (1 : 100,000; 40 mg/ml + 10 μg/ml). Blood pressure (BP), heart rate (HR), pulse wave transit time, and vector-cardiography data were recorded throughout 3 min before and 5 min after injection. QRS- and T-wave area under the curve (QRS AUC/T AUC) were calculated from the X/Y/Z QRS-vector or T-vector. T-wave amplitude (T AM), T AUC values, and diastolic BP decreased, and HR significantly increased 4 min after injection. A transient moderate HR drop and a corresponding small increase in T AM and T AUC immediately after the injection procedure may be explained by a decreased sympathetic tone due to psychological relief. In dental anesthesia, the systemic epinephrine effects are represented by a decrease in T AUC. These effects are most pronounced in the X- and Y-leads. The 3D determination of vector planes or amplitudes is a simple method to register the sympathetic tone in local anesthesia independently of possible effects on T-wave characteristics in single leads. In conclusion, T-wave determination may help to detect even small increases in systemic adrenaline concentration in case of accidental intravascular injection. At the same time, full rhythm and spatial ischemia control is provided.

Perawatan saluran akar satu kali kunjungan dilanjutkan dengan restorasi endocrown

Introduction: Root canal treatment is a common procedure in dentistry. The main indications for root canal treatment are irreversible pulpitis and pulpal necrosis resulting from a carious process, fracture, or trauma to the tooth. The success of root canal treatment depends on various factors, one of which is post-endodontic restoration. Objective: This case report aims to demonstrate a one-visit root canal treatment followed by endocrown restoration. Case report: A 22-year-old male patient came with complaints of throbbing tooth pain in the lower right side since 1 week ago. Intra oral examination of tooth 46 showed a temporary filling on the occlusal surface. Radiographic findings showed that the crown had a radiopaque appearance reaching the pulp chamber, without periapical abnormalities. Root canal treatment was performed based on the diagnosis of irreversible pulpitis followed by endocrown restoration. Root canal treatment begins with mandibular block anesthesia and then inserts a rubber dam, opens the cavity, explores the root canal, and prepares the root canal. Biomechanical preparation was carried out using a single length technique, combined with 5.25% NaOCl irrigation, 17% EDTA, and 2% chlorhexidine. Root canal closure was performed in single visit, with the warm vertical condensation technique. The next restoration was carried out one week after root canal treatment, with an endocrown. A week later the patient came for control with no complaints. Conclusion: Root canal treatment in single visit followed by endocrown restoration was successfully carried out.

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.

The location of the mandibular foramen as a guide in mandibular block anesthesia in children by age: A radiographic analysis

Knowing the correct location of the mandibular foramen (MF) is a significant factor in the success of inferior alveolar nerve block (IANB). The primary clinical guide for this anesthesia in children with continued growth and development may be the location of MF. The present study was carried out retrospectively on panoramic radiographs of children aged 5-14 years. Three linear measurements were performed on panoramic radiographs to evaluate the distance of the MF to the occlusal plane (OP), anterior border of the ramus (ABR), and mandibular base (MB). The participants’ ages were divided into five groups: (G1) 5-6 years, (G2) 7-8 years, (G3) 9-10 years, (G4) 11-12 years, and (G5) 13-14 years. The results revealed a statistically significant increase in the mean values from G2 to G4 in all measurements. However, it was determined that there were no statistically significant differences between G1 and G2 and between G4 and G5 by the mean measurement values, respectively. Besides, the results of the measurements did not significantly differ by sex. Overall, it was concluded that MF was slightly below OP under 8 years of age and moves in the poster superior direction until the permanent dentition period. This result may guide clinicians in IANB in children.

A Systematic Review on Nerve-Related Adverse Effects following Mandibular Nerve Block Anesthesia.

Inferior alveolar nerve (IAN) block injections are commonly used in clinical practice, but they are not free from complications. The aim of the present systematic review is to assess the nerve-related adverse effects of IAN block anesthesia. A structured and systematic search was performed on the major electronic databases (PubMed, Cochrane Library, Web of Science, Scopus and CINAHL) for studies published in English until 30 September 2021. A total of 131 articles were identified through database searching using combinations of keywords. Fifteen papers were included and assessed for eligibility. Overall, nerve damage following an IAN block anesthesia injection is a rare occurrence, probably due to the direct nerve trauma of the needle, a neurotoxic effect of the used anesthetic solution and/or a combination of them. From a medico-legal point of view, a balanced discussion prior to nerve block anesthesia should be pursued in order to avoid patients’ reluctance to undergo necessary dental treatment due to the remote eventuality of nerve injury.

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.

Efficacy of 4% articaine vs 2% lidocaine in mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis: a systematic review and meta-analysis.

ObjectiveThe goal of this systematic review and meta-analysis is to determine the performance of 4% Articaine vs. 2% Lidocaine for mandibular and maxillary block and infiltration anaesthesia in patients with irreversible pulpitis (IP).MethodsPubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Web of Science, Google Scholar, and Open Gray were used to conduct a thorough literature search. A manual search of the reference lists of the publications found was also carried out. Two reviewers critically evaluated the papers for inclusion and exclusion criteria, and data extraction was done on the selected publications. The Cochrane Collaboration Tool and the Minors checklist were used to assess the quality of the selected studies for randomised controlled trials (RCTs) and non-randomised studies, respectively. The RevMan software was used to perform a meta-analysis of the pooled data and subgroups according to the technique of anaesthetic solution delivery, as well as a sensitivity analysis (P < 0.05).ResultsA total of twenty-six papers were included in the qualitative synthesis, with twenty-two of them being included in the meta-analysis. There were fifteen studies with a low potential for bias, three with a moderate potential for bias, and seven with a high potential for bias. The combined results of the 19 trials in the tooth level unit revealed that 4% articaine had a success rate 1.37 times greater than 2% lidocaine for mandibular teeth (RR, 1.37; 95% CI [1.17–1.62]; P = 0.0002). For the maxillary buccal infiltration method, the combined results from the three trials revealed that 4% articaine resulted in a success rate 1.06 times greater than 2% lidocaine (RR, 1.06; 95% CI [0.95–1.2]; P = 0.3). Excluding subgroups with a single study in sensitivity analysis for mandibular teeth revealed a substantial improvement in the success rate of the articaine group in treating IP when compared to the lidocaine group.ConclusionThe findings of this meta-analysis back up the claim that articaine is more effective than lidocaine in providing anaesthesia in patients with IP. PROSPERO Registration No.: CRD42020204606 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020204606).

Comparison of two behavior management techniques used during mandibular block anesthesia among preschool children: a randomized clinical trial.

To compare the Tell-Show-Do Technique (TSD-T) with Hiding Dental-Needle Technique (HDN-T) based on children's anxiety, pain, and behavior during first-time mandibular block anesthesia. A total of 52 children aged 3-5years who had never received dental anesthesia and had at least one mandibular primary molar requiring extraction or pulpal therapy were included in the study. Children were randomly allocated into two groups: G1: TSD-T (n = 26) and G2: HDN-T (n = 26). This study included two sessions: intervention session (baseline) and control session (7days after intervention). Facial Image Scale and Wong-Baker Pain Scale were used to evaluate anxiety and pain levels, respectively. Frankl Behavior Scale was used to assess children's behavior. Anxiety and pain levels were not statistically significant between G1 and G2 groups (p > 0.05). Similar results were observed for children's behavior rating (p > 0.05). Higher pain level was associated with younger children (rate ratios (RR) = 0.41; p = 0.016) and negative behavior (RR = 1.11; p < 0.001). On the other hand, in within-groups comparisons, there was a statistical difference in anxiety levels between intervention session and control session (p = 0.032) in G2. Even though there are no differences in the efficacy of TSD-T compared to HDN-T during first-time mandibular block anesthesia in preschool children in terms of children's anxiety, pain, and behavior, children from the HDN-T group can show reduced dental anxiety levels in the control sessions.

Comparison of the Efficacy of Jilo Animation Approach versus Conventional Tell-Show-Do (TSD) Technique on Cooperation and Anxiety Levels of Children during Dental Practice: A Randomized Controlled Clinical Trials.

Statement of the Problem: Modeling is one of the non-pharmacological approaches to manage anxiety behavior and encourage children’s cooperation in dentistry. This method is based on social learning theory in which the children learn the skills of overcoming anxiety and adapting their skills and behaviors during dental treatment.Purpose: The aim of this study was to evaluate the effect of an animated-movie modeling approach, named Jilo, on cooperation and anxiety of children in comparison with the conventional Tell-Show-Do (TSD) method in a dental setting.Materials and Method: In this randomized controlled trial, 50 healthy children (aged 4-6) with no history of dental treatment were recruited and randomly allocated to experimental (n= 24) and control (n= 24) groups. During the first visit, the experimental group watched the Jilo animated movie. After a 30-minute break, they received prophylaxis followed by fluoride therapy. The control group received the conventional TSD technique and then underwent prophylaxis and fluoride therapy. One week later, a dental restoration, which required mandibular nerve block anesthesia, was performed for both groups. The cooperation and anxiety levels of patients were evaluated during two visits using Venham Clinical Cooperation Scale (VCCS) and Venham Clinical Anxiety Scale (VCAS).Results: The mean VCAS in the experimental group was significantly lower compared to the control group during the first and second visits (p= 0.008 and p= 0.044, respectively). The mean VCCS was also significantly lower in the experimental group during the first (p= 0.015) and second visits (p= 0.019) compared to the control group.Conclusion: The application of animated-movie modeling (Jilo) can be recommended as an effective method for preparation of children before the dental treatment session.

Cone-beam computed tomography of mandibular foramen and lingula for mandibular anesthesia.

PurposeThe positions of the mandibular foramen (MnF) and the lingula affect the success rate of inferior alveolar nerve block. The objective of this study was to investigate aspects of the MnF and the lingula relevant for mandibular block anesthesia using cone-beam computed tomography (CBCT).Materials and MethodsFifty CBCT scans were collected from a picture archiving and communications system. All scans were taken using an Alphard Vega 3030 (Asahi Roentgen Co. Ltd., Kyoto, Japan). Fifty-eight MnFs of 30 subjects were included in the study. The position of the MnF, the size of the MnF, the position of the lingula, the size of the lingula, and the shape of the lingula were measured and recorded. All data were statistically analyzed at a significance level of P<0.05.ResultsThe position of MnF was 0.1 mm and 0.8 mm below the occlusal plane in males and females, respectively. The horizontal position of the MnF was slightly anterior to the center of the ramus in males and in the center in females (P<0.05). The vertical position of the MnF was lower in females than in males (P<0.05). The MnF was an oval shape with a longer anteroposterior dimension. The height of the lingula was 9.3 mm in males and 8.2 mm in females. The nodular type was the most common shape of the lingula, followed by the triangular, truncated, and assimilated types.ConclusionCBCT provided useful information about the MnF and lingula. This information could improve the success rate of mandibular blocks.

Application of Mandibular Nerve Blocks by Dental Practitioners in Bulgaria with Working Experience of Less Than 5 Years - Anonymous Survey

The employment of mandibular nerve block anesthesia is the basis of successful dental treatment. However mandibular nerve blocks are not easy to master, especially by young practitioners. The goal of this article is to acquire information about the usage of mandibular nerve block anesthesia by young dental practitioners with less than 5 years of experience, in Bulgaria.

Efficacy of articaine vs lignocaine in maxillary and mandibular infiltration and block anesthesia in the dental treatments of adults: A systematic review and meta-analysis.

The aim of the present systematic review and meta-analysis was to address the following Population, Intervention, Comparison, and Outcome question: Is the efficacy of articaine better than lignocaine in adults requiring dental treatment? Four percent articaine was compared with 2% lignocaine for maxillary and mandibular infiltrations and block anesthesia, and with the principal outcome measures of anesthetic success. Using RevMan software, the weighted anesthesia success rates and 95% confidence intervals (CIs) were estimated and compared using a random-effects model. For combined studies, articaine was more likely to achieve successful anesthesia than lignocaine (N=18, odds ratio [OR]: 1.92, 95% CI: 1.45-2.56, P<0.00001, I2 =32%). Maxillary and mandibular infiltration studies showed obvious superiority of articaine to lignocaine (N=8, OR: 2.50, 95% CI: 1.51-4.15, P=0.0004, I2 =41%). Maxillary infiltration subgroup analysis showed no significant difference between articaine and lignocaine (N=5, OR: 1.69, 95% CI: 0.88-3.23, P=0.11, I2 =19%). For combined mandibular anesthesia studies, articaine was superior to lignocaine (N=14, OR: 1.99, 95% CI: 1.45-2.72, P<0.0001, I2 =32%), with further subgroup analysis showing significant differences in both mandibular block anesthesia (N=11, OR: 1.55, 95% CI: 1.19-2.03, P=0.001), I2 =0%) and mandibular infiltration (N=3, OR: 3.87, 95% CI: 2.62-5.72, P<0.00001, I2 =0%), indicating that articaine is more effective than lignocaine in providing anesthetic success in routine dental procedures.

In Patients With Symptomatic Irreversible Pulpitis, Articaine is 3.6 Times More Efficacious Than Lidocaine in Achieving Anesthetic Success When Used for Supplementary Infiltration After Mandibular Block Anesthesia

Does articaine provide an advantage over lidocaine in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. Kung J, McDonagh M, Sedgley CM. J Endod 2015; 41(11):1784-94. The study was supported by the OHSU Department of Endodontology Les Morgan Endowment Fund and a resident research grant from the American Association of Endodontists Foundation TYPE OF STUDY/DESIGN: Systematic review with meta-analysis of data.

A Randomized Controlled Study Comparing Efficacy of Classical and Gow-Gates Technique for Providing Anesthesia During Surgical Removal of Impacted Mandibular Third Molar: A Split Mouth Design.

Reliable profound mandibular block anesthesia is questionable when depositing the anesthetic solution at the lingula. The Gow-Gates technique is an useful alternative to the classical inferior alveolar nerve block and the incidence of unsuccessful anesthesia may be as high as classical technique. The aim of this study is to compare the clinical efficacy, degree of patient acceptability, advantages, disadvantages and limitations of the classical and Gow-Gates techniques for providing anesthesia in patients undergoing bilateral symmetrical surgical removal of impacted mandibular third molar under local anesthesia. The split mouth design study was conducted on 100 patients aged between 20 to 40 years undergoing surgical removal of bilateral symmetrical impacted mandibular third molar performed by the same maxillofacial surgeon. 2ml of 2% lignocaine hydrochloride with 1:80,000 adrenaline was used as a standard local anesthetic solution in all the cases. By using four-digit numbers from a random number table, either Gow-Gates or classical inferior alveolar nerve block were randomly assigned to either left or right sides in each patient. The injections were administered by another surgeon who was blinded to the experiment. The patient was assessed for Pain experienced during injection, frequency of positive aspirations, Onset and duration of anesthesia and Nerves anesthetized. Results were statistically analyzed by Mann-Whitney and chi square test. A 'P' value of less than 0.05 was considered for statistical significance. Higher mean pain during injection was recorded in classical group, was found to be statistically significant. No significant association was observed between aspiration and the groups. Higher mean onset of anesthesia was recorded in Gow-gates group, was found to be statistically significant. Higher mean duration of anesthesia was recorded in Gow-gates group, was not statistically significant. Higher success rate was recorded in Gow-gates group and was statistically significant. If we ignore delayed onset of anesthesia of Gow gates technique, it is found to be more reliable, beneficial and have higher success rate than classical inferior alveolar nerve block technique.

Comparison of the Efficacy of Local Infiltration and Mandibular Block Anesthesia With Articaine for Harvesting Ramus Grafts

We compared the efficacy of local infiltrative anesthesia and regional mandibular block anesthesia using articaine to harvest ramus grafts and the postoperative sequelae. A total of 20 patients with alveolar bone deficiency participated in the present comparative, prospective, randomized study. The first group received regional anesthesia with the mandibular block technique (group A; n= 10), and those in the second group received local infiltration anesthesia (group B; n= 10). Intraoperative pain and bleeding were evaluated as the primary outcome variables. The visual analog scale (VAS) scores were compared at 0.5, 1, 2, and 4hours postoperatively. The maximal interincisal mouth opening (MIO) (on days 3 and 7) and VAS scores (at 6, 12, 24, and 48hours and on days 3 and 7) were compared as secondary outcome variables. The correlation between pain (VASscores) and trismus (MIO) were also compared. A painless procedure was performed in both groups. The VAS score, MIO, and intraoperative bleeding were not significantly different between the 2 groups. Paresthesia was not observed in either group postoperatively. No statistically significant correlations were found between the VAS scores andMIO. Local infiltrative anesthesia preserves almost the same depth of anesthesia as mandibular block anesthesia. No differences were found between these techniques in terms of efficacy and postoperative sequelae during and after ramus graft harvest. Thus, using articaine with a local infiltration technique is an alternative to mandibular block anesthesia during ramus graft harvesting and results in a reduced risk of inferior alveolar nerve damage.

The effectiveness of articaine in mandibular facial infiltrations.

Four percent articaine local anesthetic has been successfully used to attain local anesthesia for dental procedures. Mandibular block anesthesia may consume longer time to attain and have a higher failure of local anesthesia compared to infiltration. Mandibular facial infiltration has been reported to successfully attain effective local anesthesia for dental procedures. This study involved only several tooth sites and found that 1.8 cc of 4% articaine facial infiltration in the mandible may be effective when the facial mandibular cortex is <2.0–3.0 mm. A waiting time of 5–10 minutes may be required for effective anesthesia. An additional 1.8 cc of dose may be required to attain anesthesia if an initial 1.8 cc of dose fails. The need for additional anesthetic may be predicted by a measurement of the facial cortex using cone beam computerized tomography. A study of mandibular sites is needed to delineate the anatomical dimensions, density of cortical bone, and apical neural location for ensuring successful local anesthetic infiltration.

The Pulpal Anesthetic Efficacy of Articaine Versus Lidocaine in Dentistry : A Meta - Analysis

ABSTRACT Background The authors evaluated published evidence from controlled clinical trials regarding the efficacy of two local anesthetic solutions in providing successful pulpal anesthesia. Methods The authors searched MEDLINE and Embase databases to identify peer-reviewed randomized controlled trials in which researchers directly compared articaine and lidocaine local anesthetic solutions in adult participants. They extracted study characteristics and outcomes data as a basis for meta-analysis. They completed subgroup analyses for both infiltration and mandibular inferior alveolar block anesthetic techniques. Results Articaine solutions had a probability of achieving anesthetic success superior to that of lidocaine, with an odds ratio of 2.44 (95 percent confidence interval [CI], 1.59–3.76; P P P = .009), and no difference when the authors considered only symptomatic teeth. Clinical Implications Research evidence supports using articaine versus lidocaine for achieving pulpal anesthesia when the infiltration mode of administration is used. It is premature to recommend articaine for mandibular block anesthesia in cases involving irreversible pulpitis.

Double mandibular foramen leading to the accessory canal on the mandibular ramus.

The knowledge of the variation in the mandibular foramen and canal is clinically significant in surgical procedures of the mandible. This study aims to evaluate the anatomical characteristics of double mandibular foramen leading to the accessory canal on the mandibular ramus using cone beam CT. The sagittal, cross-sectional, and three-dimensional images of cone beam CT data from 446 patients were evaluated in the presence of double mandibular foramen and the accessory canal passing through the foramen. The accessory canals were classified into two types according to the configuration (forward and retromolar type), and the location of double mandibular foramen was recorded. The eight double mandibular foramina leading to the accessory canals were observed in six patients out of 446 patients (1.35 % of population). Regarding the configuration of the accessory canal, there were two forward types and six retromolar types. All double mandibular foramina were located above the mandibular foramina on the medial aspect of the mandibular ramus. Three-dimensional images of cone beam CT data are useful in confirming the presence of double mandibular foramen leading to the accessory canal. The variation may cause failure in the routine mandibular nerve block anesthesia and it is often vulnerable during surgical procedures involving the mandibular ramus. Also, double mandibular foramen is considered as an easy route for tumor cell to spread following the radiotherapy. Therefore, the variation should be carefully investigated using reconstructed cone beam CT images in planning of dental surgery or radiotherapy in the mandible.

Accessory foramen in the human mandible: anatomical and clinical considerations

We read with interest the published article ‘Anatomical classification of accessory foramina in human mandibles of adults, infants, and fetuses’ by Przystanska and Bruska (2012). The authors performed a meticulous study of the accessory foramen in the mandible. We wish to share few scientific facts related to the published topic. It is always better to visualize an accessory foramen in a radiograph. The best possible means is to insert a wire and visualize the continuity of the canal. An accessory foramen is meant for passage of the neurovascular structures. It would be better to interpret the concerned neurovascular structures according to the position of the accessory foramen. A past study cut the mandible in the midline and measured the dimensions of the canal under dissecting microscope (Liang et al. 2007). Even though the accessory foramina were discussed, no speculation was made about the blood vessels or nerves traversing it. The authors mentioned in their discussion that the accessory foramen was connected to the mandibular foramen. Radiographic investigations may provide exact evidence continuity of the accessory foramina with the mandibular canal but it is quite difficult to believe such in the absence of radiographic studies. The accessory foramen has also been reported to have continuity with the incisive canal (von Arx et al. 2011). If there is continuity of the accessory foramen with the mandibular canal, one wonders if the mental nerve emerges out through this foramen. This raises serious issues for successful nerve blocks. Previous studies have described consideration of additional locoregional anaesthesia in the case of failed mandibular block anesthesia (von Arx et al. 2011). In the second paragraph of the results section, under the subheading Adult mandibles, it was mentioned that four different types of foramina were found but only three were mentioned in pointwise form. We wonder if this really refers to types of foramina or do the authors mean different positions of the foramina. Contrary to the present findings, past research studies depict the accessory foramen varying according to age and race (Kaufman et al. 2000). Interestingly, an earlier study speculated that eruption of wisdom teeth may require additional neurovascular nourishment (von Arx et al. 2011). The present study should have discussed the eventualities of eruption of wisdom teeth or even additional dental spurs. Calculation of the mean distance of this canal with respect to a bony point may have been more beneficial to maxillofacial surgeons. These may be needed for planning graft implants. We congratulate the authors for their valiant effort, and thank the editors for publishing an interesting topic.

Relationship between Mandibular Nerve Block Anesthesia and Body Mass Index in Children

El objetivo de este trabajo fue observar la relacion entre el bloqueo anestesico efectivo (BAE) del nervio mandibular, inyectando 1,8 ml de lidocaina al 2% con epinefrina 1:100.000, en ninos y su indice de masa corporal (IMC). Fue disenado un estudio de cohorte prospectivo. Se selecciono una muestra de 93 ninos que se atienden en el Modulo Dental de JUNAEB de Frutillar entre abril y julio de 2011. Se registro edad, sexo, motivo de la exodoncia y tipo de diente (permanente o deciduo). Se calculo el IMC para cada nino, que fue categorizado en 2 cohortes de acuerdo al criterio de la OMS: “bajo peso - normal” (BPN) para aquellos con un IMC p85. Despues de aplicar la tecnica anestesica, a los 10 minutos se evaluo su efectividad registrando el BAE. Se analizo la relacion estadistica entre IMC y BAE mediante Test exacto de Fisher (p<0,05). Se logro el BAE en 84 ninos (90,3%), con un 89,36% en el grupo BPN y 91,30% en el grupo SPO. No se hallo una asociacion estadisticamente significativa entre BAE e IMC (p=1,00). No existe relacion entre la efectividad del bloqueo anestesico del nervio mandibular y el indice de masa corporal en ninos.