Asunto(s)
Glándula Parótida , Complicaciones Posoperatorias , Sudoración Gustativa , Femenino , Humanos , Glándula Parótida/inervación , Glándula Parótida/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Sudoración Gustativa/diagnóstico , Sudoración Gustativa/tratamiento farmacológico , Sudoración Gustativa/etiología , Sudoración Gustativa/fisiopatología , Anciano , Adenoma Pleomórfico/cirugía , Neoplasias de las Glándulas Salivales/cirugía , Mejilla/inervación , Nervio Mandibular/efectos de los fármacos , Nervio Mandibular/fisiopatología , Glándulas Sudoríparas/efectos de los fármacos , Glándulas Sudoríparas/inervación , Glándulas Sudoríparas/fisiopatología , Toxinas Botulínicas/administración & dosificación , Neurotoxinas/administración & dosificaciónRESUMEN
BACKGROUND: The analgesia after lower third molar alveolectomy is based on the use of non-steroidal anti-inflammatory drugs (NSAIDs) that have significant risks, and are contraindicated in the third trimester of pregnancy. Aiming to reduce NSAIDs use after this surgery, we quantified analgesic effects of ultrasound (US)-guided extraoral mandibular nerve block. METHODS: Thirty-six patients were equally allocated to the experimental or control group, based on their willingness to receive experimental US-guided extraoral mandibular nerve block for postoperative analgesia. The experimental block applied prior to lower third molar alveolectomy, was followed by standard intraoral inferior alveolar nerve block. In the control group, patients received only intraoral block of inferior alveolar nerve. All patients reported pain level (visual analogue scale, VAS) right after the application of blocks. The next day, patients reported duration of pain-free time and the use of analgesic. RESULTS: The US-guided extraoral mandibular nerve block prolonged the pain-free time to 8 h (vs. 4 in control group, P < 0.001) and reduced NSAIDs use (12 patients needed analgesic in experimental vs. 17 patients in control group, P = 0.038). The application of experimental block was less painful (VAS = 2) than the application of intraoral inferior alveolar nerve block (VAS = 4, P = 0.011). In 8/18 patients in the experimental group US-guided extraoral mandibular nerve block solely achieved adequate surgical anesthesia. CONCLUSION: US-guided extraoral mandibular nerve block prolonged pain-free period and reduced the use of NSAIDs after lower third molar alveolectomy, thus proving to be successful analgesia method for this dental surgery. CLINICAL TRIAL REGISTRATION: https://classic. CLINICALTRIALS: gov/ct2/show/NCT06009302 , identification number: NCT06009302, date of registration: 18/08/2023.
Asunto(s)
Nervio Mandibular , Tercer Molar , Bloqueo Nervioso , Dolor Postoperatorio , Humanos , Bloqueo Nervioso/métodos , Tercer Molar/cirugía , Femenino , Estudios Prospectivos , Adulto , Masculino , Dolor Postoperatorio/prevención & control , Ultrasonografía Intervencional/métodos , Dimensión del Dolor , Antiinflamatorios no Esteroideos/uso terapéutico , Antiinflamatorios no Esteroideos/administración & dosificación , Adulto Joven , Extracción DentalRESUMEN
OBJECTIVE: This study aimed to compare the effectiveness of lidocaine with magnesium sulphate in patients undergoing root canal treatment following irreversible pulpitis. METHODS: A total of 86 patients were randomised to receive 1.8 ml of 2% lidocaine replaced with 0.2 ml of 10% magnesium sulphate with 1: 80,000 epinephrine (n=43) as MGS group and 1.8 ml of 2% lidocaine with 1: 80,000 epinephrine (n=43) as LDC group. Preoperative visual analogue scale (VAS) pain scores were record-ed. Patients were instructed to report any perioperative pain felt during the access cavity preparation and when introducing the first patency file (#10 k) in the root canal and perioperative VAS recorded. RESULTS: The success rate of the inferior alveolar nerve block (IANB) was higher in the MSG group. The mean+-SD of perioperative pain was 0.16+-0.37 in the MSG group and 3.13+-0.77 in the LDC group. The MGS group produced better anaesthetic efficacy with a p-value of 0.01. CONCLUSION: Based on the results, adding 10% magnesium sulphate to 2% lidocaine increased the effective-ness of IANB in patients with symptomatic irreversible pulpitis of mandibular molar teeth.
Asunto(s)
Anestésicos Locales , Lidocaína , Sulfato de Magnesio , Nervio Mandibular , Bloqueo Nervioso , Pulpitis , Humanos , Lidocaína/administración & dosificación , Lidocaína/uso terapéutico , Lidocaína/farmacología , Sulfato de Magnesio/administración & dosificación , Sulfato de Magnesio/uso terapéutico , Bloqueo Nervioso/métodos , Femenino , Masculino , Adulto , Método Doble Ciego , Anestésicos Locales/administración & dosificación , Anestésicos Locales/uso terapéutico , Dimensión del Dolor/métodos , Adulto Joven , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
PURPOSE: Various anatomical variations of the inferior alveolar canal increase the incidence of surgical complications; Therefore, this study aimed to evaluate the frequency and configuration of bifid and trifid mandibular canals using cone beam computed tomography (CBCT) in the Turkish subpopulation. METHODS: The inferior alveolar canal was evaluated on 1014 hemi-mandibles in the CBCT (I-CAT 3D Imaging System) images of 513 patients. The frequency and configuration of the bifid and trifid mandibular canal (MC) were examined. The relationship between bifid MC configuration and dental status and age groups was analyzed. The distance of the accessory canal to the buccal and lingual walls and the alveolar crest was measured. The diameter of the main canal and accessory canal was measured and its relationship with dental status and age groups was evaluated. RESULTS: Bifid MC was found in 266 hemi-mandibles (24.7%) and 212 (41.3%) of 513 patients. The most common type of bifid MC was the retromolar canal (87 sides), followed by the forward canal without confluence (41; 4%) and the dental canal (34; 3.4%). 10 of the dental canals were opening to the 1st molar, 14 of the 2nd molars, and 10 of the 3rd molars. The number of retromolar foramina was 1 on 56 sides, 2 on 15 sides, and 3 on 4 sides. Forward canal without confluence was more common in edentulous patients than in dentulous patients, while the dental canal was more common in dentulous patients. The main canal diameter was 3.53 ± 0.97 mm and the bifid MC diameter was 1.82 ± 0.70 mm. Distance of the bifid MC to the lingual wall was higher in the > 64 years group than in the 18-39 years group (p = 0.022). Distance of the bifid MC to the alveolar crest was lower in the > 64 years group compared to the 18-39 years group and 40-64 years group (p = 0.015). The main canal diameter was higher in the 40-64 years group than in the 18-39 years group (p = 0.012). CONCLUSION: Bifid MC has a high prevalence, occurring in almost one in two patients. Dental and retromolar types, which are close to the teeth, are more common, and this increases the possibility of complications. CBCT is the most accurate imaging technique used to detect and define these variations.
Asunto(s)
Variación Anatómica , Tomografía Computarizada de Haz Cónico , Mandíbula , Humanos , Turquía/epidemiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Mandíbula/diagnóstico por imagen , Mandíbula/anomalías , Mandíbula/anatomía & histología , Adolescente , Prevalencia , Anciano , Adulto Joven , Anciano de 80 o más Años , Nervio Mandibular/diagnóstico por imagen , Nervio Mandibular/anatomía & histología , Nervio Mandibular/anomalías , Imagenología TridimensionalRESUMEN
OBJECTIVE: The aim of the study is reducing the risks of surgical injury to the inferior alveolar nerve, by taking into account individual topographic and anatomical features, improving diagnostic methods, and techniques for removing retinated teeth with a close fit to the mandibular canal. MATERIAL AND METHODS: An examination was conducted in the Department of Surgical Dentistry (CBCT/OPG) and surgical treatment of 223 patients, with a close fit of the roots of the retinated lower third molar to the mandibular canal. Microslips of teeth with roots intact during removal (n=96) of the main group and the control group (n=52) were prepared with a Micromet Remet manual petrographic machine. The sections were carried out along the longitudinal axis of the tooth with the capture of the area of close fitting of the nerve, the teeth from the control group were sawed longitudinally along the axis of the root. The measurement of the macroanatomic features of the roots was carried out with a micrometer (MCC-MP-100 0.001 electronic «CHEESE¼, manufactured in the Russian Federation), measurements of the thickness of dentine and cement tissues on macroglyphs were carried out using a microscope calibration ruler with an accuracy of 0.01 mm. RESULTS: In the main group, three types of attachment of the mandibular canal to the root of the third molars were distinguished: 20 (96) cases of inter-root attachment of the mandibular canal, 42 (96) apical, 34 (96) lateral (buccal and lingual). A number of anomalies in the structure of the roots of the third molars have been revealed, which are a factor in injury to the neurovascular bundle of the mandibular canal during tooth extraction. The surface of the roots, as well as the microscopes of the tooth sections adjacent to the mandibular canal, were studied under a microscope. CONCLUSION: A number of specific anomalies of the roots of retinated third molars formed by root dilaceration, thinning of cement tissues, hypercementosis, which are formed at the site of the mandibular canal.In the presence of a deep indentation on the root of the tooth, as well as in the presence of areas of apical hypercementosis in the form of a «spike¼, the probability of nerve injury during tooth extraction increases many times, which must be taken into account when removing retinated third molars.
Asunto(s)
Mandíbula , Nervio Mandibular , Tercer Molar , Raíz del Diente , Humanos , Tercer Molar/cirugía , Mandíbula/cirugía , Mandíbula/inervación , Mandíbula/anomalías , Raíz del Diente/anomalías , Masculino , Femenino , Nervio Mandibular/anatomía & histología , Adulto , Lesiones del Nervio Mandibular/prevención & control , Diente Impactado/cirugía , Extracción DentalRESUMEN
The present study assessed the efficacy of photobiomodulation (PBM) following leukocyte-platelet rich fibrin (L-PRF) application for recovery of mental nerve neurosensory disturbances (NSDs) caused by genioplasty. This randomized triple-blind split-mouth clinical trial was conducted on 20 female patients (40 quadrants) requiring genioplasty. In each patient, one random side of the mandible served as the intervention (laser), and the other side as the control group. After genioplasty and L-PRF application, the intervention side underwent GaAIAs diode laser irradiation (880 nm, 500 mW, 15 J/cm2, 0.5 cm2 spot size, continuous-wave). Each point was laser irradiated for 15 s. Unilateral extraoral PBM was performed at 1, 3, 7, 14, 21, and 28 days, postoperatively. Laser in off mode (sham laser) was used for the control side. A visual analog scale (VAS) was used for general sensitivity, and 2-point discrimination, directional discrimination, pain discrimination, and thermal discrimination tests were used to assess the neurosensory recovery at 2 days, 2 weeks, 4 weeks, and 2 months, postoperatively. Statistical analyses were performed using two-way repeated measures ANOVA, Bonferroni test, and generalized estimating equation (alpha = 0.05). Time had a significant effect on improvement of all sensory variables (P < 0.05). Neurosensory recovery was significantly better in the intervention than the control group at all time points according to the two-point discrimination test (P = 0.0135) and brush test (P = 0.025) results. The interaction effect of time and intervention was not significant on any dependent variable (P > 0.05). Application of L-PRF + PBM resulted in significantly greater sensorineural recovery according to the two-point discrimination and brush test results.
Asunto(s)
Terapia por Luz de Baja Intensidad , Humanos , Femenino , Terapia por Luz de Baja Intensidad/métodos , Adulto , Fibrina Rica en Plaquetas , Adulto Joven , Láseres de Semiconductores/uso terapéutico , Nervio Mandibular/efectos de la radiación , Nervio Mandibular/cirugíaRESUMEN
This study aimed to compare parental satisfaction between two pediatric dental anesthesia techniques, computerized intraosseous anesthesia (CIA) and inferior alveolar nerve block (IANB). This study was designed as a split-mouth randomized controlled clinical trial. A total of 52 parents of children undergoing dental treatment were enrolled in the study. Each participant received both CIA and IANB anesthesia, with the order of administration randomized. Parental satisfaction was evaluated using the parental satisfaction of dental local anesthetic techniques scale (PSLAS). Statistical analysis revealed that parental satisfaction regarding CIA was higher than that for IANB with a significant difference (P Ë 0.05). However, there was no difference regarding the age, gender or the education level of the parents. (P > 0.05). This study provides insights into parental satisfaction with pediatric dental anesthesia techniques and highlights the influence of socioeconomic factors on anesthesia decision-making. Within the limitations of this trial, it was concluded that CIA was significantly superior to IANB in overall parental satisfaction. However, parental satisfaction values were lower in CIA group regarding costs and concern from complications. In addition, it was concluded that there was no difference in satisfaction levels regarding the gender, age and education level of the parents.
Asunto(s)
Anestesia Dental , Nervio Mandibular , Bloqueo Nervioso , Padres , Humanos , Masculino , Femenino , Bloqueo Nervioso/métodos , Padres/psicología , Niño , Anestesia Dental/métodos , Preescolar , Adulto , Satisfacción PersonalRESUMEN
This double-blind, randomised clinical trial aimed to find out whether there is a difference in the prevalence of neurosensory disturbance (NSD) between patients who received 2% lidocaine and those who received 4% articaine during inferior alveolar nerve blocks (IANBs). Patients who underwent third molar extraction were randomised into two groups. IANB was performed using 2% lidocaine in Group 1 and 4% articaine in Group 2. The occurrence of NSD was documented. Patients were visited within 48 hours and one week after the tooth was removed. The type of anaesthetic drug (4% articaine versus 2% lidocaine) was the study's predictive factor. A total of 2400 patients were studied in two groups (1200 in each group). The mean (range) age of the patients was 28.40 (18-44) years. Five patients (0.41%) in the lidocaine group and seven (0.58%) in the articaine group had NSD after injection (p = 0.77). The prevalence of NSD after IANB was no higher in the articaine group than in the lidocaine group.
Asunto(s)
Anestésicos Locales , Carticaína , Lidocaína , Nervio Mandibular , Tercer Molar , Bloqueo Nervioso , Extracción Dental , Humanos , Carticaína/efectos adversos , Carticaína/administración & dosificación , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Método Doble Ciego , Anestésicos Locales/administración & dosificación , Anestésicos Locales/efectos adversos , Bloqueo Nervioso/efectos adversos , Bloqueo Nervioso/métodos , Adulto , Nervio Mandibular/efectos de los fármacos , Adolescente , Adulto Joven , Extracción Dental/efectos adversos , Masculino , Femenino , Tercer Molar/cirugía , Anestesia Dental/efectos adversos , Anestesia Dental/métodos , Estudios de SeguimientoRESUMEN
BACKGROUND: Both precooling the site and injecting a warm anesthetic solution have proven to be efficient in reducing pain individually. However, there is insufficient data on evaluating the efficiency of precooling the site of injection along with the simultaneous administration of a warm local anesthetic solution on the same site in a single patient. AIM: The aim of this study was to evaluate and compare the efficacy, pain perception, hemodynamic changes, and adverse effects of a warm local anesthetic solution injected on precooled injection sites using 2% lignocaine with the conventional local anesthetic technique during inferior alveolar nerve block in 7-9-year-old children. METHODS: A split-mouth, double-blinded, randomized clinical trial was conducted on 70 children who received 2% lignocaine with either technique A or B during the first or second appointment of the treatment procedure. The pain perception, anesthetic efficacy, pulse rate, oxygen saturation levels, and adverse events were evaluated. RESULTS: Pain during injection and treatment after administration of the warm local anesthesia (LA) technique was less as compared to the conventional block technique. Anesthetic success was observed with a faster onset of action (212.57 ± 32.51 s) and shorter duration of LA (165.16 ± 33.09 min) in the warm local technique as compared to the conventional technique. No significant differences were found with regard to heart rate and oxygen saturation levels between the two techniques. Administrating warm LA solutions at precooled injection sites revealed fewer adverse events. CONCLUSION: Injecting warm LA solution on precooled injection sites causes less discomfort and anxiety in children, which makes it more suitable for the child as well as the pediatric dentist.
Asunto(s)
Anestesia Dental , Anestésicos Locales , Estudios Cruzados , Lidocaína , Humanos , Niño , Anestésicos Locales/administración & dosificación , Método Doble Ciego , Anestesia Dental/métodos , Femenino , Masculino , Lidocaína/administración & dosificación , Anestesia Local/métodos , Inyecciones , Bloqueo Nervioso/métodos , Dimensión del Dolor , Calor , Percepción del Dolor , Nervio Mandibular/efectos de los fármacosRESUMEN
CONTEXT: For successfully managing pediatric dental patients, local anesthesia is essential to eliminate pain during or after the operative period. An early recovery from soft-tissue anesthesia after an inferior alveolar nerve block (IANB) should benefit a young child patient by avoiding the risk of inadvertently biting the soft tissues. AIMS: Hence, the purpose of the study was to (1) evaluate and compare the efficacy of pre- and postoperative ibuprofen on pain perception in children who undergo IANB anesthesia with or without the use of PM and (2) evaluate the average time required for reversal of anesthesia symptoms using phentolamine mesylate. METHODS: The present study was a randomized, clinical trial performed among 60 children between 6 and 8 years of age using a convenient sampling method. The children were randomly assigned into four equal groups of 15 each using the computer-generated randomization sequence. IANB anesthesia was performed using 2% lignocaine with 1:100,000 epinephrine, and a mandibular primary molar pulpotomy was performed on each group. Group 1: the ibuprofen tablet was taken 1 h before the onset of the procedure. Group 2: ibuprofen tablet 30 min after the pulpotomy procedure. Group 3: the ibuprofen tablet was taken 1 h before the onset of the procedure, and the Phentolamine mesylate (PM) injection was administered. Group 4: immediately after the pulpotomy, the PM injection was administered, and an ibuprofen tablet was taken 30 min after the pulpotomy procedure. All children were assessed for the duration of soft-tissue anesthesia, their behavior scores and pain rating, as well as the incidence of postoperative self-inflicted injuries. STATISTICAL ANALYSIS USED: A one-way ANOVA was used to compare the average time needed for the reversal of anesthetic symptoms between groups. The effects of phentolamine, local anesthetics, and ibuprofen on the child's behavior and pain scores were compared using the Student's t-test. For the study, P < 0.05 was accepted as statistically significant. RESULTS: The time needed for the full reversal of anesthetic symptoms to manifest on the tongue and lip was substantially reduced by the injection of phentolamine (P < 0.001). The use of phentolamine for reversal or the intake of ibuprofen pre- or postoperatively did not exhibit any significant variation in the behavior, pain experience, or incidence of self-inflicted injuries in the child. CONCLUSION: It is evident that although phentolamine injections shorten the duration of anesthesia, the adjunctive use of pre- or postoperative ibuprofen did not significantly alter pain scores.
Asunto(s)
Anestesia Dental , Anestésicos Locales , Ibuprofeno , Nervio Mandibular , Bloqueo Nervioso , Fentolamina , Humanos , Fentolamina/farmacología , Niño , Bloqueo Nervioso/métodos , Anestesia Dental/métodos , Femenino , Masculino , Nervio Mandibular/efectos de los fármacos , Anestésicos Locales/administración & dosificación , Anestésicos Locales/farmacología , Percepción del Dolor/efectos de los fármacos , Dolor Postoperatorio/prevención & control , Pulpotomía/métodos , Lidocaína/farmacología , Lidocaína/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Analgésicos no Narcóticos/farmacología , Dimensión del DolorRESUMEN
AIMS: Compare the efficacy of 2% lidocaine with adrenaline (1:200,000) and 4% articaine with adrenaline (1:100,000) in inferior alveolar nerve block prior to extraction of bilateral teeth posterior to canine in interval of one week. METHODS AND MATERIAL: Thirty-five patients were selected for the study. Patients were divided into two different groups: Group 1 - (2% lignocaine with adrenaline (1:200,000)) and Group 2 - (4% articaine with adrenaline (1:100,000)) solution. The study variables for each anaesthetic agent were: onset of action and depth of anaesthesia. A pulp tester was used to demonstrate quantitative values and a visual analogue scale (VAS) was used for qualitative evaluation of the two anaesthetic drugs in 2 min cycle for 10 min with respect to test canine. Anaesthesia was considered successful when pulp tester value 64 was achieved in 10 min for both the anaesthetic agent. STATISTICAL ANALYSIS USED: The difference in the efficacy of lignocaine and articaine was analysed using Student's t test. Within group comparison of the response to the pulp vitality test and VAS over various time periods was analysed using repeated measures Analysis of Variance (ANOVA) with post-hoc Bonferroni test. RESULTS: Data analysis showed statistical differences in onset and depth of anaesthesia between the two groups (P < 0.05). CONCLUSIONS: 4% Articaine with adrenaline (1:100,000) onset of action is faster and depth of anaesthesia is better compared to 2% lignocaine with adrenaline (1:200,000). Many previous studies reported onset of anaesthesia, but this study evaluates onset and depth of both the anaesthetic agent quantitatively and qualitatively.
Asunto(s)
Anestesia Dental , Anestésicos Locales , Carticaína , Epinefrina , Lidocaína , Nervio Mandibular , Bloqueo Nervioso , Humanos , Carticaína/administración & dosificación , Lidocaína/administración & dosificación , Lidocaína/farmacología , Anestésicos Locales/administración & dosificación , Bloqueo Nervioso/métodos , Nervio Mandibular/efectos de los fármacos , Epinefrina/administración & dosificación , Adulto , Anestesia Dental/métodos , Adulto Joven , Masculino , Prueba de la Pulpa Dental , Pulpa Dental/efectos de los fármacos , Dimensión del Dolor , Femenino , Extracción Dental , Vasoconstrictores/administración & dosificación , Adolescente , Diente Canino , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Surgical extraction of impacted third molars (ITM) often leads to postoperative discomfort including pain, swelling, and limited function. Steroids like dexamethasone (DXN) are commonly used in oral surgery to manage pain and inflammation. Various administration routes for DXN exist, including intravenous (IV), perineural (PN), and oral applications, each with its advantages. Previous studies have shown that adding DXN to local anesthetics can prolong anesthesia duration and reduce postoperative sequelae. However, comparative studies on IV and PN applications with inferior alveolar nerve block (IANB) of DXN in ITM surgeries are limited. METHODS: This controlled, randomized observational study involved patients undergoing Class II position B ITM extraction. Patients were divided into three groups. IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was performed 1 h after IV-DXN (4 mg/ml DXN) was administered to the IV group. DXN along with IANB (1.8 ml of articaine hydrochloride + 1 ml of 4 mg/ml DXN) was applied to the PN group. Only IANB (1.8 ml of articaine hydrochloride + 1 ml of saline) was applied to the control group. Anesthesia duration was assessed as primary outcomes. Anesthesia duration was evaluated using a vitalometer from the molars. Secondary outcomes included postoperative pain and edema measured on the 1st, 3rd, and 7th days after surgery. Pain was evaluated postoperatively by using a visual analog scale. A p-value < 0.05 was considered statistically significant. RESULTS: The study included 45 patients with similar demographic characteristics across groups. IV application significantly prolonged anesthesia duration compared to the control group. (p = 0.049) Both IV and PN administration of DXN reduced postoperative edema at 3rd (p = 0.048) and 7th day (p = 0.01). Post-procedure pain reduction was significant in the IV group (p = 0.011). On the other hand, it was observed that the pain did not decrease in the PN group at 3rd and 7th days compared to the control and IV groups. CONCLUSIONS: PN and IV DXN administration prolonged anesthesia duration and reduced postoperative edema in ITM surgeries. However, PN DXN administration was associated with increased postoperative pain compared to IV DXN and control groups. Further studies comparing different doses and administration routes of DXN are needed to determine optimal strategies for managing postoperative discomfort in ITM surgeries. TRIAL REGISTRATION: This study was conducted at Ahmet Kelesoglu Faculty of Dentistry with the permission of Karamanoglu Mehmetbey University Faculty of Medicine Ethics Committee (#04-2022/101). Trial registration is also available at clinicaltrail.gov. (NCT06318013, 26/05/2024).
Asunto(s)
Dexametasona , Tercer Molar , Bloqueo Nervioso , Dolor Postoperatorio , Extracción Dental , Diente Impactado , Humanos , Tercer Molar/cirugía , Dexametasona/administración & dosificación , Dexametasona/uso terapéutico , Diente Impactado/cirugía , Masculino , Femenino , Dolor Postoperatorio/prevención & control , Extracción Dental/efectos adversos , Bloqueo Nervioso/métodos , Adulto , Anestesia Dental/métodos , Anestésicos Locales/administración & dosificación , Adulto Joven , Dimensión del Dolor , Nervio Mandibular/efectos de los fármacos , Carticaína/administración & dosificación , Factores de Tiempo , Edema/prevención & controlRESUMEN
This study explored the average length of the incisive branch (IB) of the inferior alveolar nerve on cone-beam computerized tomography (CBCT) with regard to patient demographics in patients with edentulous mandibles. CBCT was used in a retrospective study of edentulous mandibles to assess the presence and anatomical variation for the IB. Three independent observers measured bilateral IB lengths. In addition to demographics, IB length and port of exit data were obtained. A 1-way analysis of variance was used to test whether IB length varied by sex or port of exit, and a standard Pearson correlation was used to test for IB length and age significance, with a significance level of P < .05. Intraclass correlation coefficients showed significant agreement in IB length across all observers. No significant difference was noted between the exit port and IB length. An important effect was reported for sex, indicating women have generally shorter IB lengths (9.43 ± 3.99 vs 10.55 ± 3.92). There was a significant correlation with age, but the relationship was weak. Edentulous mandibles have an altered anatomic landscape, and establishing predictive IB dimensions aids practitioners in surgical planning.
Asunto(s)
Tomografía Computarizada de Haz Cónico , Arcada Edéntula , Mandíbula , Nervio Mandibular , Humanos , Nervio Mandibular/diagnóstico por imagen , Nervio Mandibular/anatomía & histología , Femenino , Masculino , Arcada Edéntula/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Mandíbula/inervación , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Adulto , Anciano de 80 o más AñosRESUMEN
OBJECTIVE: To determine the frequency of inferior alveolar nerve injury during third molar extraction and the associated factors. STUDY DESIGN: Descriptive study. Place and Duration of the Study: Department of Oral and Maxillofacial Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan, from July to December 2021. METHODOLOGY: A total of 163 patients with third molar surgery were included. Patients were followed up after one week, one month, and three months of duration. The frequency of inferior alveolar nerve injury was determined as well as its relationship with other surgical variables like age, gender, type of impaction, buccal flap retraction, bone cutting, tooth splitting, and duration of surgery via Chi-square test. RESULTS: The frequency of inferior alveolar nerve injury was found to be 1.2% (n = 02). None of the surgical variables had a statistically significant association with it (p >0.05). CONCLUSION: The frequency of nerve injury of the inferior alveolar nerve during extraction of the third molar was 1.2%. Proper treatment planning, using advanced radiography, experienced surgeon, and proper technique can help in lowering nerve injury risk. KEY WORDS: Inferior alveolar nerve injuries, Molar, Tooth extraction, Paraesthesia.
Asunto(s)
Lesiones del Nervio Mandibular , Tercer Molar , Extracción Dental , Diente Impactado , Humanos , Tercer Molar/cirugía , Extracción Dental/efectos adversos , Femenino , Masculino , Adulto , Pakistán/epidemiología , Diente Impactado/cirugía , Lesiones del Nervio Mandibular/epidemiología , Lesiones del Nervio Mandibular/etiología , Adulto Joven , Adolescente , Persona de Mediana Edad , Nervio MandibularRESUMEN
BACKGROUND: Iatrogenic mandibular nerve damage resulting from oral surgeries and dental procedures is painful and a formidable challenge for patients and oral surgeons alike, mainly because the absence of objective and quantitative methods for diagnosing nerve damage renders treatment and compensation ambiguous while often leading to medico-legal disputes. The aim of this study was to examine discriminating factors of traumatic mandibular nerve within a specific magnetic resonance imaging (MRI) protocol and to suggest tangible diagnostic criteria for peripheral trigeminal nerve injury. METHODS: Twenty-six patients with ipsilateral mandibular nerve trauma underwent T2 Flex water, 3D short tau inversion recovery (STIR), and diffusion-weighted imaging (DWI) acquired by periodically rotating overlapping parallel lines with enhanced reconstruction (PROPELLER) pulse sequences; 26 injured nerves were thus compared with contra-lateral healthy nerves at anatomically corresponding sites. T2 Flex apparent signal to noise ratio (FSNR), T2 Flex apparent nerve-muscle contrast to noise ratio (FNMCNR) 3D STIR apparent signal to noise ratio (SSNR), 3D STIR apparent nerve-muscle contrast to noise ratio (SNMCNR), apparent diffusion coefficient (ADC) and area of cross-sectional nerve (Area) were evaluated. RESULTS: Mixed model analysis revealed FSNR and FNMCNR to be the dual discriminators for traumatized mandibular nerve (p < 0.05). Diagnostic performance of both parameters was also determined with area under the receiver operating characteristic curve (AUC for FSNR = 0.712; 95% confidence interval [CI]: 0.5660, 0.8571 / AUC for FNMCNR = 0.7056; 95% confidence interval [CI]: 1.011, 1.112). CONCLUSIONS: An increase in FSNR and FNMCNR within our MRI sequence seems to be accurate indicators of the presence of traumatic nerve. This prospective study may serve as a foundation for sophisticated model diagnosing trigeminal nerve trauma within large patient cohorts.
Asunto(s)
Imagen por Resonancia Magnética , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Imagen por Resonancia Magnética/métodos , Lesiones del Nervio Mandibular/diagnóstico por imagen , Imagenología Tridimensional/métodos , Imagen de Difusión por Resonancia Magnética/métodos , Nervio Mandibular/diagnóstico por imagen , Anciano , Adulto Joven , Traumatismos del Nervio Trigémino/diagnóstico por imagen , Relación Señal-RuidoRESUMEN
Background: Third molar removal is the primary reason for inferior alveolar nerve (IAN) damage, with 2% causing persistent neurosensory deficits. This study aimed to investigate how delayed photobiomodulation therapy affects long-lasting neurosensory disturbances. Methods: This study was conducted on patients with neurosensory disturbances lasting longer than 6 months. Patients were randomly allocated to the study and control groups, with the study group receiving a low-power diode laser (continuous wavelength of 810 nm, power of 200 mW) on 16 points (30 sec at each) for 12 sessions (2 sessions/week), while the control group received a placebo treatment by switched-off laser probe. Visual analog scale (VAS; ranging from 1 to 5), static light touch, two-point discrimination, direction discrimination, pinprick, and thermal discrimination tests were performed on each visit up to 9 months post-therapy to evaluate the recovery status. Results: Each group comprised 18 participants. The mean time since injury was 8.26 ± 2.05 and 8.38 ± 1.98 months for the control and intervention groups, respectively (p = 0.81). There was a significant improvement in the intervention group on the static light touch (p = 0.041), two-point discrimination (p = 0.028), VAS (p = 0.031), and pinprick (p = 0.014) tests on the 11th session and subsequent visits and also on direction discrimination test on the 12th session (p = 0.044) and after that. There was no significant difference in the thermal discrimination tests between the two groups (p > 0.05). Conclusion: Photobiomodulation demonstrated potential benefits in resolving persistent neurosensory deficits of the IAN, with noticeable improvements typically observed after around 35 days of treatment initiation (10 sessions).
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Láseres de Semiconductores , Terapia por Luz de Baja Intensidad , Nervio Mandibular , Tercer Molar , Extracción Dental , Humanos , Terapia por Luz de Baja Intensidad/métodos , Femenino , Masculino , Adulto , Nervio Mandibular/efectos de la radiación , Láseres de Semiconductores/uso terapéutico , Lesiones del Nervio Mandibular/radioterapia , Adulto Joven , Recuperación de la Función , Resultado del TratamientoRESUMEN
In pediatric dentistry, complications arising from extended soft tissue anesthesia can negatively impact patient comfort and trust in dental care. This study evaluates the clinical efficacy of diode laser-based photobiomodulation therapy (PBMT) in expediting the resolution of anesthesia in children aged 6-9 receiving inferior alveolar nerve block (IANB) injections. In this split-mouth double-blind randomized clinical trial, 36 pediatric subjects aged 6-9, requiring pulpotomy procedures on both sides of the mandible, received IANBs (single cartridge of 2% lidocaine/1:100,000 epinephrine). PBMT and sham laser were alternately applied to each side of the mandible, in two separate sessions, with the envelope method determining treatment allocation and intervention side on the first treatment day. During the laser session, laser (808 nm, 250 mW, 23s continuous, 0.5 cm², 11.5 J/cm², direct contact) irradiated two points at the injection site, five intra-oral and five extra-oral points along the infra-alveolar nerve's pathway. Soft tissue anesthesia reversal was quantified through tactile assessment. Soft tissue trauma was also assessed by the researcher and reported by parents 24 h post-dental visit. All data were analyzed using IBM SPSS Statistics v25.0 via Paired T-test, two-way repeated measures ANOVA, and McNemar's test. The laser group exhibited a mean lip anesthesia duration of 122.78 ± 2.26 min, while the sham laser group experienced 134.44 ± 21.8 min, indicating an 11.66-minute reduction in anesthesia duration for the laser group. (P < 0.001) Soft tissue trauma occurred in two sham laser group patients and one laser group patient, with no significant difference. (P = 1) The findings indicate that employing laser with defined parameters can reduce the length of IANB-induced anesthesia.
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Terapia por Luz de Baja Intensidad , Nervio Mandibular , Bloqueo Nervioso , Humanos , Niño , Nervio Mandibular/efectos de la radiación , Terapia por Luz de Baja Intensidad/métodos , Bloqueo Nervioso/métodos , Femenino , Método Doble Ciego , Masculino , Láseres de Semiconductores/uso terapéutico , Anestesia Dental/métodos , Anestésicos Locales/administración & dosificación , Pulpotomía/métodosRESUMEN
OBJECTIVES: This study examined the impact of premedication with ibuprofen and ibuprofen-arginine and the influence of preoperative pain and anxiety on inferior alveolar nerve block (IANB) efficacy in cases of symptomatic irreversible pulpitis. MATERIALS AND METHODS: The study involved 150 SIP patients who were randomly assigned to receive ibuprofen (600 mg), ibuprofen-arginine (1,155 mg), or a placebo 30 min before IANB. Preoperative anxiety and pain levels were assessed using the Modified Dental Anxiety Scale and the Heft-Parker visual scale. IANB efficacy was determined by the absence of or mild pain during the procedure. Statistical analysis included chi-square, z-tests, Analysis of Variance, and Student's t tests. RESULTS: The ibuprofen and ibuprofen-arginine groups exhibited significantly higher IANB success rates (62% and 78%, respectively) compared to the placebo group (34%). However, no significant difference was observed between the ibuprofen and ibuprofen-arginine groups. Patients with successful IANB in the ibuprofen and ibuprofen-arginine groups displayed lower median anxiety scores (8) than those with failed blocks (15) and lower mean preoperative pain scores (118.3). CONCLUSION: In cases of symptomatic irreversible pulpitis the preemptive medication with ibuprofen-arginine effectively increased the efficacy of the inferior alveolar nerve block The inferior alveolar nerve block efficacy was influenced by preoperative anxiety levels and the intensity of pain. CLINICAL RELEVANCE: This research underscores the potential benefits of oral premedication with ibuprofen and ibuprofen-arginine in improving anesthesia outcomes in cases of symptomatic irreversible pulpitis.
Asunto(s)
Arginina , Ibuprofeno , Nervio Mandibular , Bloqueo Nervioso , Dimensión del Dolor , Pulpitis , Humanos , Pulpitis/cirugía , Ibuprofeno/uso terapéutico , Ibuprofeno/administración & dosificación , Método Doble Ciego , Masculino , Bloqueo Nervioso/métodos , Femenino , Arginina/uso terapéutico , Arginina/administración & dosificación , Adulto , Anestesia Dental/métodos , Resultado del Tratamiento , Persona de Mediana Edad , Combinación de MedicamentosRESUMEN
PURPOSE: The aim of this study is to delineate the safety zone concerning the anteriorization of the AL and correlate it with the behavior of the AL, analyzing its feasibility. METHODS: Adhering to the Joanna Briggs Institute (JBI) manual guidelines, both the protocol and this review were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. MeSH terms, combined with free terms, were utilized to search for articles in the following databases: Embase, LILACS, LIVIVO, PubMed/MEDLINE, Scopus, Web of Science, and grey literature. RESULTS: Fifteen articles were select following the eligibility criteria. An average safe zone of 4.75 mm in humans was observed, with a prevalence 60.8% and average anterior length of the AL of 2.09 mm in humans. CONCLUSION: The AL has varied patterns across different populations, then, it could not be asserted a 100% safe zone. Preoperative analysis of the AL with CBCT is always necessary. While it could be stated that a safe zone should be employed as an inviolable region, stipulated measures of a safe zone should be regarded as an area of greater attention in preoperative planning.
Asunto(s)
Nervio Mandibular , Humanos , Nervio Mandibular/anatomía & histología , Nervio Mandibular/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Variación AnatómicaRESUMEN
INTRODUCTION: The present study evaluated the effect of 2 different back pressure-based supplemental anesthesia on postoperative pain in patients receiving endodontic treatment for a mandibular molar with symptomatic irreversible pulpitis. METHODS: One-hundred-thirty-five adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial inferior alveolar nerve block (IANB) injection with 2% lidocaine with 1:80,000 epinephrine. Ten minutes following the injection, access to cavity preparation began. Lip numbness was a must for all patients. The Heft-Parker visual analogue scale (HP-VAS) was used to measure pain during endodontic therapy. Success of primary injections was defined as no or mild pain (less than 55 mm on HP-VAS) during access preparation. The patients with initial successful anesthesia served as control and received endodontic treatment. Ninety-five patients with unsuccessful primary anesthesia randomly received either intraligamentary injections of 2% lidocaine with 1:80,000 epinephrine or intrapulpal injections with similar anesthetic solution. Endodontic treatment was re-initiated and canals were instrumented till working length under copious irrigation. Intracanal medicament of calcium hydroxide was placed and teeth received a temporary restoration. Postoperative pain was measured at 2 hours, 4 hours, 6 hours, 24 hours, and 3 days. Data were analyzed using the Pearson chi-square test, one-way analysis of variance, and one-way repeated measures analysis of variance. RESULTS: The initial initial inferior alveolar nerve block was successful in 40 cases (out of 135). The intraligamentary injections were successful in 33 out of 47 cases (70%), and intrapulpal injections were successful in all cases (45/45). The patients receiving intraligamentary injections reported significantly higher pain scores at all intervals till 24 hours. After 3 days, the pain significantly reduced in all the groups with no significant difference between them. CONCLUSIONS: Patients receiving supplementary intraligamentary injections can experience increased postoperative pain till 24 hours after the endodontic treatment. The pain scores reduced to the level of the control group after 3 days.