Soft Tissue Anesthesia Research Articles

EFFECT OF PHENTOLAMINE MESYLATE ON THE INCIDENCE OF SELF-INFLICTED SOFT TISSUE INJURY FOLLOWING INFERIOR ALVEOLAR NERVE BLOCK ANESTHESIA IN CHILDREN: (RANDOMIZED CONTROLLED CLINICAL TRIAL)

INTRODUCTION:One of the shortcomings of local anesthesia (LA) is that the soft tissue anesthesia (STA) typically lasts for 3 to 5 hours while most routine dental procedures are completed in less than an hour. Pediatric patients particularly may accidently bite on their lips. OBJECTIVES: The study was conducted to evaluate the effectiveness of phentolamine mesylate (PM) on the reduction of the incidence of self-inflicted soft tissue injury (STI) and its effect on the time of return of normal function, after inferior alveolar nerve block anesthesia. MATERIALS AND METHODS: The study is a blinded randomized controlled parallel group clinical trial with a 1:1 allocation ratio. A total of eighty pediatric patients, with an age range of 5-8 years, selected from the Pediatric Dentistry out-patient clinic, Faculty of Dentistry, Alexandria University, after obtaining necessary consents. Inferior alveolar nerve block anesthesia (2 percent lidocaine with 1:100,000 epinephrine) was administered in the recommended dose. After completion of the operative procedure, participants were randomly allocated into 2 groups: study and control group. The experimental group received a PM injection using the same technique employed for administration of LA, in a cartridge ratio of 1:1. The control group did not receive any reversal agent. The incidence of self-inflicted STA and return to normal function were recorded post-operatively and STI was followed up after 24 hours. RESULTS: There were no significant differences in the incidence of self-inflicted STI between the PM and control group except for the occurrence of ulcers after 24 hours (P=0.04). Phentolamine mesylate accelerated the median time of return to normal function (P =0.001). CONCLUSION: Phentolamine mesylate was efficacious in reducing the incidence of self-inflicted soft-tissue ulceration and accelerated the time of return to normal function after LA.

Comparison of clinical efficacy of ropivacaine and lignocaine with adrenaline for implant surgery anesthesia: a split-mouth randomized controlled clinical trial.

BackgroundThe primary indication for using long-acting anesthetics in dentistry is extensive dental procedures that require pulpal anesthesia beyond 90 min and management of postoperative pain. Ropivacaine is an amide local anesthetic that is available at various concentrations with inherent vasoconstrictive properties at low concentrations. Ropivacaine has a 75% greater margin of safety than bupivacaine. Ropivacaine can be a good alternative to bupivacaine as a local anesthetic in dental implant surgery as it provides a longer duration of both pulpal and soft tissue anesthesia after mandibular nerve block and lowers CNS and cardiovascular toxicity. This study aimed to evaluate and compare the clinical efficacy of ropivacaine and lignocaine for implant surgery anesthesia.MethodsFifteen patients with bilateral edentulous sites indicated for implant placement were recruited for this study. Patients aged 20–60 years of both sexes were randomly recruited. Thirty implant placements were performed in the test and control groups using ropivacaine and lignocaine with adrenaline as local anesthetics, respectively.ResultsThe results were analyzed statistically. The duration of anesthesia was significantly higher in the test group than in the control group. Ropivacaine was found to be superior to lignocaine in terms of the quality of anesthesia. The comparison of mean visual analog scale scores showed ropivacaine to have better anesthetic and analgesic effects than the control group.ConclusionRopivacaine 0.75% provides a significantly longer duration of anesthesia than lignocaine 2% with adrenaline. Ropivacaine 0.75% decreased intraoperative and postoperative analgesia compared to lignocaine 2% with adrenaline. Hence, ropivacaine 0.75% can be used as an alternative to lignocaine in implant surgeries and other intraoral surgical procedures that require a longer duration of anesthesia and analgesia.

Pain assessment after application of 4% articaine with epinephrine 1:100000 during mandibular dental procedures

Inferior alveolar nerve block in the mandibular technique is the blockade that presents most failures in the dental practice, so this technique is considered the less effective of those used in Dentistry and the most frustrating to the dentist. This study aimed to determine pain intensity during dental procedures after using 4% articaine with epinephrine 1:100000 in the inferior alveolar nerve block with buccal infiltration in patients who were attended in the dental clinic of the University of Cartagena, Colombia. A clinical randomized trial was performed. The sample was of patients who required dental procedures in the jaw with local anesthesia. After standardization of the anesthetic technique, and use of 4% articaine with epinephrine 1:100000, the inferior alveolar nerve was blocked with 0.9 mL (half cartridge) followed by buccal infiltration with 0.9 mL in the first mandibular molar. Fifty patients (30 men - 60% and 20 women - 40%), with an average age of 25.3 years old (mean ± standard deviation [SD]: 25.3 ± 6.6) were included in the study. When assessing the pain puncture and during the injection, 92% of patients classified it as mild pain according to VAS. When evaluating the latency period, the average time was less than two minutes and the perioral soft tissue anesthesia was 97%. Only a small percentage of patients required complementary anesthesia. The authors recommend the use of 4% of articaine with epinephrine in mandibular procedures that require deep pulp anesthesia, using this with a buccal infiltration.

Buffered 2% articaine versus non-buffered 4% articaine in maxillary infiltration: randomized clinical trial.

This randomized, triple-blind, crossover clinical trial aimed to evaluate the efficacy, onset, length of pulp and soft tissue anesthesia, and pain during injection of 2% buffered articaine and 4% non-buffered articaine solutions. Each volunteer received two maxillary supraperiosteal anesthesia infiltrations in canine area. The infiltrations were performed at two different sessions using a different local anesthetic solution for each session, and the anesthetic injection speed was always 1 mL/min. The assessment of the onset and length of pulpal and soft tissue anesthesia was performed with the pulp electrical test "pulp tester" and the esthesiometer kit, respectively. Volunteers marked pain during injection on a visual analog scale (VAS). The anesthetics solutions pH was evaluated through the pH meter equipment. There was no difference between the two anesthetic solutions (onset of soft tissue anesthesia, p = 0.5386; length of soft tissue anesthesia, p = 0.718; onset of pulpal anesthesia, p = 0.747; length of pulpal anesthesia, p = 0.375), except for pain during the injection which was lower when buffered 2% articaine was used (p = 0.001) and the pH. The pH analysis revealed that the solutions differed from one another (p < 0.01). The 2% buffered articaine solution provided the same anesthetic properties then 4% unbuffered articaine with a great reduction in pain during injection. The possibility of use 2% buffered articaine solution instead of 4% articaine maintaining the same anesthetic properties with a great reduction in pain during injection and half of the anesthetic salt concentration.

Eutectic mixture of Local Anaesthetic (EMLA) an alternative for painful palatal nerve blocks: Randomised controlled trial

The purpose of this study is to compare the efficacy of EMLA to Palatal nerve blocks in providing anaesthesia to the palatal soft tissues during extraction. Seventy patients who reported for extraction of maxillary premolar and maxillary molar tooth were included in this study. These patients were divided into two groups randomly. One group consisted of patients receiving EMLA (Eutectic mixture of Lidocaine and Prilocaine) over the palatal soft tissues adjacent to the tooth with a cotton swab, and the other group consisted of patients receiving 0.4 – 0.6 ml of 2% lignocaine with 1;2,00,000 dilution adrenaline slightly anterior to the greater palatine foramen with a syringe. The mean score VAS while applying EMLA cream in group A was 0.00. In contrast, while giving palatal nerve block in group B, it was 4.09 that was statistically significant using the independent sample t-test. Likewise, the mean VAS score while extraction in the EMLA group was 0.11, whereas in palatal nerve block group was 0.00 that was not statistically significant using independent sample t-test. EMLA may be advantageous in providing palatal soft tissue anaesthesia during prophylactic extraction, thereby avoiding painful palatal nerve blocks.

Can local anesthesia with ropivacaine provide postoperative analgesia in extraction of impacted mandibular third molars? A randomized clinical trial

The aim of this study was to compare the local anesthesia efficacy of ropivacaine 0.75% compared to lidocaine 2% with 1:100,000 epinephrine for postoperative analgesia following extraction of impacted mandibular third molars. In this randomized, double-blind crossover clinical trial, 30 participants underwent surgical removal of bilateral impacted mandibular third molars under local anesthesia using ropivacaine 0.75% or lidocaine 2% with 1:100,000 epinephrine. The pain was recorded on a visual analog scale at 4, 8, 12, 24, and 48 h postoperatively. The use of analgesics and the presence of adverse effects were recorded. The duration of soft tissue anesthesia in the ropivacaine group was significantly longer than that in the lidocaine group. The lidocaine group recorded significantly higher visual analog scale scores at all postoperative time intervals, except in the final 48-h period. Analgesic use was higher in the lidocaine group. Rescue medication was used by 2 patients in each group (6.7%). Significantly more postoperative bleeding was seen in the ropivacaine group. Ropivacaine 0.75% injection before the surgical procedure may be associated with preventive analgesia for extraction of impacted mandibular third molars.

Effectiveness of Anterior and Middle Superior Alveolar Nerve Block for Anesthesia of Maxillary Teeth Using Conventional Syringe: A Randomized Prospective Study.

To study the effectiveness of anterior and middle superior alveolar nerve block (AMSA) for anesthesia of unilateral maxillary teeth, i.e., from central incisor to second premolar of the same side by using conventional syringe and needle. Two hundred patients who needed extraction of any tooth/teeth in the region of central incisor to second premolar of the same side were randomly chosen for the study. Successful anesthesia was found in 71.5% of cases. However, the highest success rate was seen with first premolar (82.2%) and minimum with lateral incisor (67.5%), and induction time ranged from 6 to 12 min and duration for 30-45 min. Using conventional syringe and needle, AMSA can be administered to achieve adequate soft tissue anesthesia of maxillary central incisors, canine and premolars of that side and pulpal anesthesia to a good extent (more so with first premolar), without affecting the muscles of facial expressions and lip numbness, reducing the requirement of multiple injections for the same.

Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar.

Introduction:A prospective randomized double-blind controlled trial was conducted to evaluate the latency and duration of pterygomandibular nerve block with a mixture of 1.8 ml 2% lignocaine with 1:80,000 epinephrine and 1 ml of 4 mg dexamethasone and its impact on postoperative sequelae after surgical extraction of impacted mandibular third molars.Materials and Methods:This study was conducted in 40 subjects referred to the department of oral and maxillofacial surgery; they were divided into 20 subjects each in group A and B with the age range of 18–72 years planned for elective surgical removal of unilateral impacted mandibular third molar. Each patient was randomly selected to receive anesthesia using 1.8 ml 2% lignocaine with 1:80,000 epinephrine in group A or 2.8 ml twin mix (1.8 ml 2% lignocaine with 1:80,000 epinephrine + 1 ml 4 mg dexamethasone) in group B. After injection of the anesthetic solution, the time to anesthetic effect, duration of anesthesia from initial patient perception of the anesthetic effect to the time when the effect subsides, need to reanesthetize the surgical site were recorded, and 10-point visual analog scale (VAS) was used to subjectively assess the overall pain intensity while injecting the study drug, during surgery, and in the postoperative period.Results:Mean VAS value for pain on local anesthetic injection was less in twin-mix group. The time of onset of the local anesthetic was significantly less for the study group T, 51.35 ± 7.15 s when compared with patients in study group C (P less than 0.0001). The duration of soft tissue anesthesia was longer for all the patients in the study group T. On comparative evaluation between study group C and study group T, patients in the control group had more severe swelling and reduction in mouth opening in the postoperative period.Conclusion:The addition of dexamethasone to lignocaine and its administration as an intraspace injection significantly shortens the latency and prolongs the duration of the soft tissue anesthesia, with improved quality of life in the postoperative period after surgical extraction of mandibular third molars.

The anesthetic efficiency of retromolar infiltrations with two local anesthetic solutions of the same concentration in lower third molar surgery.

BackgroundMandibular third molar removal is the most common surgical procedure encountered in oral and maxillofacial clinics. It also presents the greatest challenges and controversies for surgeons when surgical removal is considered. Furthermore, diverse anesthesia results and success rates are achieved after using the same concentrations of different solutions or the same amounts of local anesthetics. The purpose of this study was to examine the efficiency of using double-cartridge (3.4 ml) 4% lidocaine (high concentration) and 4% articaine with a 1:100000 epinephrine infiltration in the retromolar region for impacted lower third molar surgery.MethodsThis double-blind study included 30 patients with symmetrically impacted lower third molars. The patients were randomly selected to receive 4% articaine on one side and 4% lidocaine on the other, as a local anesthetic for third molar surgery. The onset, duration of soft-tissue numbness, pulpal sensitivity, amount of additional local anesthetic needed, pain score during the surgical procedure, and duration of the operation were recorded.ResultsThe results of this research indicate that 86.7% of the operations in the 4% articaine group and 83.3% of those in the 4% lidocaine group were successful. Furthermore, the outcomes in both groups were not statistically significant (P > 0.05). Numbness onset occurred faster in the articaine group than it did in the lidocaine group. However, the duration of soft-tissue anesthesia and pain scores recorded immediately postoperatively were similar.ConclusionIt is concluded that 4% lidocaine and 4% articaine had a similar infiltration efficacy in the retromolar region and both local anesthetics are adequate for impacted lower third molar surgery. There were no statistically significant differences between the two local anesthetics regarding pain control and the duration of soft-tissue numbness during the procedure.

Effect of Phentolamine as Reversal of Soft-Tissue Anesthesia on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial

Introduction: Phentolamine mesylate (OraVerse) is mostly used to reverse soft tissue anesthesia after dental procedures. The aim of the present study was to evaluate the effect of the injection of OraVerse on postoperative pain after root canal treatment in patients with symptomatic irreversible pulpitis. Methods and Materials: In this randomized single-blind clinical trial study, 100 patients (50 per group) with symptomatic irreversible pulpitis in the first or second mandibular molars, randomly received either OraVerse or sham treatment after a single-visit root canal therapy. Each patient recorded their pain score, using a Heft Parker visual analogue scale, before and after 6, 12, 24, 36, 48, and 72 h of the treatment. They also monitored their soft-tissue anesthesia every 15 min for 5 h. Data were analyzed by t -test and repeated measured ANOVA statistical tests. The level of significance was set at 0.05. Results: Patients who received phentolamine had significantly higher pain scores at 6- and 12-h postoperative intervals compared with those receiving sham treatment ( P =0.01 and P =0.00 respectively). Consumption of analgesics in OraVerse group was significantly higher than that of the sham group ( P =0.48). Conclusion: Although phentolamine accelerated the reversal of normal soft tissue sensation after the dental visit, it increased postoperative pain in patients suffering from symptomatic irreversible pulpitis, which may limit phentolamine administration in this group. Keywords: Anesthesia; Inferior Alveolar Nerve; Lidocaine; Phentolamine Mesylate; Postoperative Pain

Assessment of photobiomodulation therapy by an 8l0-nm diode laser on the reversal of soft tissue local anesthesia in pediatric dentistry: a preliminary randomized clinical trial.

During the injection of local anesthesia in pediatric dental procedures, from the injection time until the elimination of tissue anesthesia, inevitable problems were reported. According to the encouraging results of previous studies addressing the positive effects of laser therapy on increasing the microcirculation, we aimed to investigate the clinical effect of photobiomodulation therapy on the reversal of soft tissue anesthesia in children. Using a split-mouth design, 34 children aged 4 to 8years old, candidate for receiving local infiltration injection at both right and left side in mandible, were enrolled in the study. The mandibular right and left quadrants were randomly assigned to groups of laser or sham laser: in laser side, patients received 810-nm laser irradiation, and in the sham laser group, the patients had the laser in off mode at 45min after injection with an interval of 7-10days between two sessions of each quadrant treatments. The degree of anesthesia was evaluated using the palpation technique alternately every 15min. Data were analyzed using paired sample t test and multiple linear regression test. The mean duration of anesthesia expressed in minutes was equal to 145.15 ± 23.27 and 188.82 ± 12.31 for the laser group and sham laser group, respectively. There was a significant difference in duration of anesthesia between two groups (P < 0.001). Considering the results and limitations of the present study, photobiomodulation therapy by 810-nm diode laser can be proposed as a non-invasive method in order to reduce the duration of anesthesia in pediatric patients.

Comparison of latency and efficacy of twin mix and modified twin mix in impacted mandibular third molar surgery – A Preliminary Randomized Triple Blind Split Mouth Clinical Study

IntroductionIntra-space drug administration have recently gained popularity in the clinical practice posing several advantages over the conventional routes of drug administration. A preliminary prospective randomized triple blind clinical study was conducted to compare the latency and duration of anesthesia with twin mix (1.8ml 2% lignocaine with 1:200,000 epinephrine and 1ml/4mg dexamethasone) and modified twin mix (1.7ml of 4% articaine with 1:100,000 epinephrine and 1ml/4mg dexamethasone) to two conventional local anesthesia solutions along with co-relation of clinical effects in the postoperative phase in patients undergoing extraction of impacted mandibular third molars in terms of patients comfort post-surgery. Materials and MethodsThe study was conducted among 20 patients with bilateral impacted mandibular third molars who were randomly allotted to two groups, Group A and B. Each patients in both the groups was allotted with study and control site. Among Group A, patients were further divided into Sub-group L (Control) and Sub-group TM (Twin Mix). Group B patients were divided as Sub-group A (Control) and sub-group MTM (Modified Twin Mix). Sub-group L patients received 1.8ml of 2% lignocaine with 1:200,000 adrenaline and sub-group TM received twin mix. Sub-group A received 1.7ml of 4% articaine with 1:100,000 adrenaline and sub-group MTM received modified twin mix solution. All the procedure was performed by a single operator with a gap of 1 month between the two interventions among both the groups. Various subjective and objective parameters were measured pre-operatively and postoperatively to assess the latency and efficacy of various anesthesia solutions used in this study for third molar removal. ResultsMean (±SD) VAS scores for sting on injection and pain were found to be less in TM and MTM sub-group with a score of 2.3 (±0.768) and 2.7 (±0.065) respectively. The anesthetic latency was significantly less in sub-group TM, with a mean (±SD) of 52.4 (±28.3) seconds. Sub-groups A and MTM had longer latency of anesthesia when compared with L and TM sub-groups. The duration of soft tissue anesthesia was maximum in sub-group MTM as compared to the other sub-groups. Patients from control sub-groups among both the groups had increased swelling, post-surgical pain and trismus postoperatively. DiscussionIntra-space administration of twin mix and modified twin mix is clinically efficacious in impacted mandibular third molars surgery with better clinical outcomes postoperatively. We observed one significant difference between TM and MTM that the latter solution provided a prolonged duration of anesthesia increasing the patient's comfort postoperatively after surgical removal of mandibular third molars.

Is 0.75% ropivacaine more efficacious than 2% lignocaine with 1:80,000 epinephrine for IANB in surgical extraction of impacted lower third molar?

We aim to compare and evaluate the anesthetic efficacy and safety of inferior alveolar nerve block (IANB) using 0.75% ropivacaine and 2% lignocaine with 1:80,000 epinephrine in lower impacted third molar (LI3M) surgery. We designed a prospective randomized, double-blind, split-mouth study evaluating 60 systemically healthy patients with the presence of bilateral symmetrically oriented LI3M. The sides and sequence of drug administered were randomly allocated. The primary outcome variables analyzed were hemodynamic stability, profoundness of anesthesia, and duration of postoperative analgesia. Time of onset, duration of soft tissue anesthesia, patients requiring analgesics, and their quantity for five postoperative days were recorded. Early onset of anesthesia was seen in Lignocaine (68.6 ± 20.4s) compared with Ropivacaine (104.1 ± 17.7s) with significant differences (p= 0.001). Both the anesthetic solutions were found to be equipotent in providing profound intraoperative anesthesia. No significant difference emerged in perioperative hemodynamic stability. Ropivacaine exhibited statistically significant differences in the duration of soft tissue anesthesia (p= 0.001) and postoperative analgesia (p= 0.001). Patients requiring rescue pain medication and the number of analgesics consumed were greater on first and during five postoperative days in lignocaine when compared with that of ropivacaine with significant differences p< 0.001 and p< 0.001 respectively. The results suggest that 0.75% ropivacaine is effective in providing adequate anesthesia, prolonged postoperative analgesia, and better postoperative pain control with a safer cardiovascular profile in LI3M surgery. It can be an addition to the existing list of long-acting local anesthetics used for LI3M surgery.

Effect of Phentolamine as Reversal of Soft-Tissue Anesthesia on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial.

Phentolamine mesylate (OraVerse) is mostly used to reverse soft tissue anesthesia after dental procedures. The aim of the present study was to evaluate the effect of the injection of OraVerse on postoperative pain after root canal treatment in patients with symptomatic irreversible pulpitis. In this randomized single-blind clinical trial study, 100 patients (50 per group) with symptomatic irreversible pulpitis in the first or second mandibular molars, randomly received either OraVerse or sham treatment after a single-visit root canal therapy. Each patient recorded their pain score, using a Heft Parker visual analogue scale, before and after 6, 12, 24, 36, 48, and 72 h of the treatment. They also monitored their soft-tissue anesthesia every 15 min for 5 h. Data were analyzed by t-test and repeated measured ANOVA statistical tests. The level of significance was set at 0.05. Patients who received phentolamine had significantly higher pain scores at 6- and 12-h postoperative intervals compared with those receiving sham treatment (P=0.01 and P=0.00 respectively). Consumption of analgesics in OraVerse group was significantly higher than that of the sham group (P=0.48). Although phentolamine accelerated the reversal of normal soft tissue sensation after the dental visit, it increased postoperative pain in patients suffering from symptomatic irreversible pulpitis, which may limit phentolamine administration in this group.

Tramadol hydrochloride: An alternative to conventional local anaesthetics for intraoral procedures- a preliminary study

PurposeTo evaluate and compare the soft tissue anaesthesia produced by tramadol hydrochloride on gingival tissues in maxilla. MethodsA total of 50 ASA physical status I subjects between 18 and 35 years of age, both male and female were included in the study. Each individual received 0.5 ml of 50 mg tramadol in the soft tissues over maxillary canine tooth as local infiltration on one and 0.5 ml of 20 mg lignocaine on the contralateral side in a double-blinded fashion. After completing the injection, the author recorded pain on injection, the onset of action, duration of anaesthesia, side effects, and feedback from patient. ResultsThe mean onset of anaesthesia for tramadol was 172.00 s (standard deviation 39.898) while for lignocaine it was 162.60 s (standard deviation 35.098) and there was no statistically significant difference between the two groups (p = 0.214). The mean duration of anaesthesia for tramadol group was 45.70 min with a standard deviation of 8.512 min whereas for lignocaine group it was 44.70 min with a standard deviation of 8.107 min. There was no statistical relevant difference between the two groups in duration of anaesthesia (p = 0.549). None of the subjects reported any side effect in both the groups. There was no significant difference in pain on injection between the two groups. ConclusionsTramadol has a local anaesthetic effect similar to lignocaine when injected as infiltration in oral soft tissues.

Reversing soft tissue anesthesia

Reversing soft tissue anesthesia

A Simplified Single-Penetration Technique of IANB (MK Technique) for Mandibular Anesthesia.

Owing to the anatomical basis established on the detailed course, distribution and innervations of buccal nerve in the literature, we believe that an effective and extensive buccal nerve block could be achieved when the nerve is anesthetized proximal to its branching point which relates to anteromedial aspect of ramus (retromolar fossa). Though several techniques of inferior alveolar nerve block (IANB) including few single-penetration approaches were already well reviewed and practiced, pitfalls remained in terms of achieving adequate retromolar soft tissue anesthesia, as well as undermining the very importance of contacting the bone and the orientation of the bevel. We propose a simplified single-penetration technique aligning almost similar to conventional technique and its well-adopted landmarks, but still obviating the need for a separate penetration for long buccal nerve anesthesia. To study the efficacy of a simplified single-penetration technique for mandibular anesthesia. To study the adequacy of the simplified IANB technique in minimizing the number of penetrations required to achieve buccal nerve anesthesia decreasing patient's pain and discomfort when IANB is performed and the ease of adaptability across the operators. A 25-gauge 42-mm needle, local anesthesia with adrenaline-2% lignocaine HCl (1:80,000), 2.5-ml syringe, observation form. Study 1-A sample size of 120 cases, in oral surgery department of our college, with 60 patients in Group I (control) where patients received anesthesia through conventional IANB and 60 patients in Group II (experimental) where patients received anesthesia through simplified IANB. Both the groups are again subdivided into group A (single operator) and group B (multiple operators). Study 2-20 bilateral mandibular impacted third molar in oral surgery department of our college, with right side (control-conventional technique) and left side (experimental-simplified single-penetration technique). VAS data are recorded in the excel sheet. The success rate of the simplified technique is quite comparable to the conventional groups. The mean pain and discomfort score in simplified technique was 3.08 which is relatively lower when compared to mean value in conventional technique which was 6.88. The difference was statistically significant. Simplified technique minimizes the number of penetrations, which substantially decreases patient's pain and discomfort levels not only during injection, but also during surgical procedures on mandibular posterior region because of extensive and profound buccal nerve territorial anesthesia.

Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia.

This study was aimed at evaluating the anesthetic success rates in various regions of soft tissue after inferior alveolar nerve (IAN) block and comparing the success rates of soft tissue anesthesia with those of pulpal anesthesia to find correlations. Fifty-nine dental students received an IAN block injection. A total of four test sites were used for soft tissue anesthesia using a pressure algometer (PA): the corner of the lower lip vermilion border (LL); the buccal-attached gingiva of the lateral incisor (BGI), the molar (BGM), and the lingual gingiva (LG). The lateral incisor (LI) and the first molar (M1) were evaluated for pulpal anesthesia using an electric pulp tester. To evaluate whether soft tissue anesthesia can be an indicator of pulpal anesthesia, the positive predictive value (PPV) and negative predictive value (NPV) were calculated. The highest success rate for soft tissue anesthesia was seen on the LG (93.9%), followed by LL (79.6%), BGI (53.1%), and BGM (14.3%). The PPVs of LL for the M1 and Ll were 74.4 and 59.0%. The NPVs for the M1 and LI were much higher in the LL (90.0 and 100%, respectively) than in the BGI (56.5 and 69.6%, respectively). The highest success rate was found in the LG. Lip numbness was not an indicator of pulpal anesthesia of M1 and LI. However, if the LL was not anesthetized, the probabilities of failed pulpal anesthesia were very high in the LI and M1. The clinicians need to consider not doing an additional lingual nerve block after IAN block.

Reversing the effects of 2% Lidocaine: A randomized controlled clinical trial

ObjectivesProlonged soft tissue anesthesia following a dental appointment is a complaint that is frequently reported by patients. Soft tissue anesthesia generally exceeds the duration of pulpal anesthesia by a few hours. This can lead to difficulties with smiling, drinking, speaking and lip/cheek biting following dental appointments. Phentolamine Mesylate (PM) is a pharmacological agent capable of reducing the duration of soft tissue anesthesia following dental treatments. Many clinical trials supporting its efficacy have used sham injections compared to injections with PM. The present study aims to evaluate the effect of PM on the duration of soft tissue anesthesia compared to a control injection of saline water. MethodsThis randomized controlled trial recruited 40 participants above 18 years of age. Following an inferior alveolar nerve block using 1.8 ml of Lidocaine 2%, 1:100 000 epinephrine, participants were randomized into one of 2 groups. The test group received an injection of 0.4 mg PM (OraVerse). Participants in the control group received an injection of sterile saline water. Participants were trained in self-assessing their anesthesia, which they did until return to normal sensation. ResultsThirty-six participants completed the study. PM significantly reduced the duration of soft tissue anesthesia in the lower lip (104 vs 170 min, p = .001), and tongue (83 vs 134 min, p = .004) compared to the control injection. No serious adverse events were encountered. The only adverse events observed were post-operative pain and discomfort. ConclusionsPhentolamine Mesylate hastens the return to normal soft tissue sensation and function by approximately one hour compared to a control injection of water. Clinical significancePhentolamine Mesylate can be considered a safe and effective way of reducing the duration of soft tissue anesthesia following a dental appointment.This controlled clinical trial is registered at the National Institutes of Health (ClinicalTrials.gov) #NCT02861378.

Comparing the anterior middle superior alveolar nerve block and infraorbital nerve block for maxillary anterior teeth anesthesia: A randomized clinical trial

ObjectiveTo compare the efficacy of the Anterior Middle Superior Alveolar nerve block with that of the Infra-orbital nerve block in achieving anesthesia in the anterior maxillary teeth. Study designWe recruited 62 patients who underwent vital tooth/teeth extraction under local anesthesia. We divided the patients into two groups: group A received Anterior Middle Superior Alveolar (AMSA) nerve block and group I received Infra-orbital nerve block (IONB). We assessed the Pulpal anesthesia by Pulp Tester with 0–10 digital reading, soft tissue anesthesia by pricking with periosteal elevator and injection pain using10 cm VAS (Visual Analogue Scale) score. We entered collected data in Microsoft excel 2010 and categorical variables analysed using Chi Square test and non-categorical variables analysed using Independent t (parametric) and Mann Whitney U (non-parametric) tests. ResultsWe achieved significantly higher pulpal anesthesia with infra-orbital nerve block for canine (p = .04) and 1st premolar (p = .02) as compared to anterior middle superior alveolar nerve block; but no significant difference was found in pulpal anesthesia for 2nd premolar, central and lateral incisors. The labial gingival anesthesia was significantly higher with infra-orbital nerve block than with anterior middle superior alveolar nerve block (p < 0.001). The VAS score in group I was 5.2 ± 2.1 (mean ± SD) and that in group A was 3.9 ± 1.3 (mean ± SD) which was statistically significant (p = .004). ConclusionAnterior middle superior alveolar nerve block resulted in inadequate pulpal and soft tissue anesthesia but less injection pain. Infra-orbital nerve block produced higher pulpal anesthesia for 1st premolar and canine but more injection pain.