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
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
Introducción: Se comparó la técnica anestésica con el nervio alveolar inferior (NAI) realizada por estudiantes de cuarto y quinto año de la carrera de Odontología de la Universidad Andrés Bello, Santiago. El objetivo: Fue evaluar la ejecución y éxito de la técnica previo a una extracción dental simple. Metodología: Los estudiantes fueron invitados a participar y firmaron un consentimiento. Se realizó una encuesta que contenía un protocolo informativo para el alumno con los pasos por seguir, luego, al finalizar su atención clínica debía responder una serie de preguntas de selección múltiple. Mediante esta encuesta se evaluó cuántos estudiantes pudieron lograr un correcto bloqueo del nervio alveolar inferior con solo 1 tubo de anestesia lidocaína al 2% y cuántos de estos requirieron de anestesia adicional después de haber inyectado el primer tubo de anestesia, antes de iniciar el procedimiento quirúrgico. También se cuantificó la cantidad de tubos de anestesia que usaron los alumnos para realizar la exodoncia de forma indolora y cuántos requirieron de un refuerzo anestésico adicional durante el intraoperatorio. Así se pudo realizar un análisis comparativo entre ambas generaciones de alumnos en relación con el empleo de la técnica anestésica. Resultados: De los 104 encuestados se obtuvo que un 57% de los estudiantes de 4º y un 65% de los de 5º año, lograron una correcta técnica anestésica al NAI con 1 solo tubo de anestesia. Conclusión: No existieron diferencias significativas con respecto al año académico y las variables estudiadas, exceptuando la necesidad de un refuerzo anestésico posterior a la comprobación de una técnica anestésica exitosa, donde los alumnos de 4to año necesitaron efectuar un mayor control del dolor intraoperatorio.
Introduction: The anesthetic technique to the inferior alveolar nerve (NAI) was compared between the performance by fourthand fifth-year students of the Dentistry career at the Andrés Bello University, Santiago. Objective: Was to evaluate the performance and success of the technique before a simple dental extraction. Methods: The students invited to participate signed an informed consent. A survey was conducted that contained an informative protocol for the student with the steps to follow, then, at the end of their clinical care, had to answer a series of multiple-choice questions. Through this survey, it was evaluated how many students could achieve a correct inferior alveolar nerve block with only 1 tube of anesthesia lidocaine 2% and how many required additional anesthesia after having injected the first tube of anesthesia, before starting the surgical procedure. Also, the amount of anesthesia tubes that the students used to perform the extraction in a painless way was quantified and how many required an additional anesthetic reinforcement intraoperatively. Thereby, a comparative analysis between both generations of students was carried out in relation to the use of the anesthetic technique. Results: Of the 104 participants, it was found that 57% of the 4th year students and 65% of the 5th year students achieved a correct anesthetic technique at the NAI with a single tube of anesthesia. Conclusion: There were no significant differences in relation to the academic year completed and the variables studied except for the need for anesthetic reinforcement after a successful anesthetic technique, where 4th year students needed to perform more intraoperative pain control.
Asunto(s)
Humanos , Estudiantes de Odontología , Anestesia Local , Nervio Mandibular/efectos de los fármacos , ChileRESUMEN
BACKGROUND: Inferior Alveolar Nerve Block (IANB) with Buccal Infiltration (BI) anaesthesia is required to completely anesthetize the mandibular molars with symptomatic irreversible pulpitis. 4% Articaine and 2% Lidocaine provide local anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Objective of the study was to compare the effect of Articaine and Lidocaine in the combination of Inferior alveolar nerve block with buccal infiltration anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic Irreversible Pulpitis. METHODS: One hundred and sixty participants with Symptomatic Irreversible Pulpitis of permanent mandibular molars were divided randomly in two groups. Group A was given Articaine 4% IANB along with BI whereas group B was given Lidocaine 2%. Pain was assessed after 15 minutes of administration of local anaesthesia. Anaesthetic success of the agents is defined as, absence of pain or mild pain first during the access cavity preparation then instrumentation of the canals of tooth. Chi-square test was applied to analyse data for statistical significance. RESULTS: Anaesthetic success of Articaine was 96.2% during access cavity preparation compared to Lidocaine (86.2%). Success during instrumentation of canals was also found to be high in Articaine (90.2%) compared to Lidocaine (76.2%). This difference of anaesthetic efficacy between Articaine and Lidocaine was found statistically significant. (p=0.02). CONCLUSIONS: Articaine is found to be better than Lidocaine regarding anaesthetic efficacy and hence, it can be a safer alternative to Lidocaine.
Asunto(s)
Anestésicos Locales/farmacología , Carticaína/farmacología , Lidocaína/farmacología , Mandíbula , Diente Molar/cirugía , Manejo del Dolor/métodos , Pulpitis/cirugía , Adulto , Método Doble Ciego , Humanos , Masculino , Nervio Mandibular/efectos de los fármacos , Persona de Mediana Edad , Bloqueo NerviosoRESUMEN
OBJECTIVE: To evaluate the efficacy, duration and safety of greater auricular and auriculotemporal nerve blocks in rabbits. STUDY DESIGN: Prospective, randomized, crossover, experimental study. ANIMALS: A total of 11 healthy adult Dutch-belted rabbits. METHODS: The rabbits underwent general anesthesia and injections of the greater auricular and auriculotemporal nerves using either bupivacaine (0.3 mL kg-1, 0.5%) or the same volume of saline. After anesthesia, the efficacy and duration of nerve blocks were assessed using analgesiometry forceps on the pinna and cotton-tipped applicators within the vertical ear canal. Rabbits were monitored for abnormal carriage of the ear and auriculopalpebral nerve block of the ipsilateral eye. Body weight, food intake, fecal output and fecal pellet diameter were measured daily for 6 days after the nerve blocks were performed and compared with baseline to assess short-term effects. RESULTS: The greater auricular nerve was successfully blocked in 12/16 (75%) ears for mean ± standard deviation duration of 88 ± 52 minutes. In successfully blocked ears, altered ear position was noted in five/16 (31%) cases. The auriculotemporal nerve was blocked in one/16 ears for 120 minutes. The auriculopalpebral nerve was inadvertently blocked in three/16 ears. Food intake and fecal output decreased significantly during the treatment day but returned to pretreatment values after 24 hours. There was no change in body weight or fecal pellet diameter for either treatment. CONCLUSIONS AND CLINICAL RELEVANCE: The results suggest that duration of the greater auricular nerve block with 0.5% bupivacaine was short-lived in the live rabbit. Auriculotemporal nerve block was only achieved in one ear; therefore, further studies are warranted to evaluate the contribution of these blocks in the pain management of rabbits undergoing auricular surgery.
Asunto(s)
Nervio Mandibular/efectos de los fármacos , Bloqueo Nervioso/veterinaria , Anestesia de Conducción/veterinaria , Anestésicos Locales , Animales , Bupivacaína , Estudios Cruzados , Bloqueo Nervioso/métodos , Proyectos Piloto , Estudios Prospectivos , Conejos , Factores de TiempoRESUMEN
Introduction: The present study evaluated the anaesthetic efficacy of 2% lidocaine with 1:80,000 epinephrine vs. 2% lidocaine with 1:200,000 given as supplemental intraligamentary injections after a failed inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. The effect of these solutions on the heart rate was also evaluated.Methods: One-hundred-eighteen adult patients with symptomatic irreversible pulpits in a mandibular first or second molar, received an initial IANB with 2% lidocaine with 1:80,000 epinephrine. Pain during the endodontic treatment was assessed using a visual analogue scale (Heft-Parker VAS). Eighty-eight patients with unsuccessful anaesthesia were randomly allocated to one of the two treatment groups: one group received 0.6 mL/root of supplementary intraligamentary injection of 2% lidocaine with 1:80,000 epinephrine; while the second group received 2% lidocaine with 1:200,000 epinephrine. Endodontic treatment was re-initiated. Success after primary injection or supplementary injection was defined as no or mild pain (pain score ≤54 mm on HP VAS) during access preparation and root canal instrumentation. Heart rate was monitored using a finger pulse oximeter. The anaesthetic success rates were analyzed with the Pearson chi-square test at 5% significance levels. The heart rate changes were analyzed using the t-test.Results: The anaesthetic success rate in patients receiving supplementary intraligamentary injections in 1:80,000 epinephrine group was 82%, while the intraligamentary injections with 2% lidocaine with 1:200,000 epinephrine were successful in 57% of cases. The difference was statistically significant (χ2=6.4, p = .011). There was no significant effect of both the anaesthetic agents on the mean heart rate.Conclusions: Both 2% lidocaine with 1:80,000 epinephrine and 2% lidocaine with 1:200,000 epinephrine improved the success rates after a failed primary anaesthetic injection. The 1:80,000 epinephrine group was significantly more successful.
Asunto(s)
Anestesia Dental/métodos , Anestésicos Locales , Epinefrina/administración & dosificación , Lidocaína/administración & dosificación , Nervio Mandibular/efectos de los fármacos , Bloqueo Nervioso/métodos , Pulpitis , Adulto , Método Doble Ciego , Epinefrina/uso terapéutico , Humanos , Inyecciones , Lidocaína/uso terapéutico , Resultado del TratamientoRESUMEN
PURPOSE: To investigate the relationship between the mandibular foramen (MF) and the inferior occlusal plane (IOP) of anatomic specimens, in order to guide clinicians in the inferior alveolar nerve block (IANB). METHOD: Eighty-two dry mandibles (totally or partially toothed) of Brazilian adults were selected, totalizing 66 left and 66 right antimeres. A flat plate of rigid PVC plastic was placed on the occlusal surfaces of posterior teeth and pressure was then manually applied to simulate the IOP. Following, the perpendicular distance from the IOP to the lowest point of the MF was measured by the use of a digital caliper, adopting negative values inferiorly and positive values superiorly. RESULTS: Regarding the antimeres, the majority of the lowest limits of the MF was below the IOP (right: 86.4%, left: 81.8%) with a mean of -4.2mm (±4.8) in the right and -4.1mm (±4.8) in the left ones, without any statistical significance. Considering both sexes, no statistically significant difference was obtained between them. CONCLUSION: The IOP seems not to be a good anatomical landmark to localize the MF and, its turn, to guide clinicians during the IANB for Brazilian adults, given the marked topographic variations.
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Puntos Anatómicos de Referencia , Mandíbula/inervación , Nervio Mandibular/anatomía & histología , Bloqueo Nervioso/métodos , Adulto , Anestésicos Locales/administración & dosificación , Brasil , Femenino , Humanos , Inyecciones/métodos , Masculino , Nervio Mandibular/efectos de los fármacos , Persona de Mediana Edad , Adulto JovenRESUMEN
Blinded techniques to desensitize the inferior alveolar nerve (IAN) include intraoral, angled, and vertical extraoral approaches with reported success rates of 100%, 73%, and 59%, respectively. It has not been determined whether an ultrasound-guided extraoral approach is feasible. Further, the fascicular nature of the inferior alveolar and lingual nerves of the horse has not been described. The objectives of this study were to describe a low-volume ultrasound-guided vertical extraoral inferior alveolar nerve block technique and to describe the fascicular nature of these nerves. An ultrasound-guided approach to the IAN was conducted with a microconvex transducer and an 18-G, 15-cm spinal needle using a solution containing iodinated-contrast and methylene blue dye. Accuracy was assessed by contrast visualized at the mandibular foramen on computed tomography (CT) and methylene blue dye staining of the nerves on gross dissection. Sections of inferior alveolar and lingual nerves were submitted for histological analysis. Assessment by CT and dissection determined success rates of 81.3% and 68.8%, respectively; 68.8% of injections had inadvertent methylene blue dye staining of the lingual nerve. Nerve histology revealed both the inferior alveolar and lingual nerves to be multifascicular in nature. Mean fascicle counts for the inferior alveolar and lingual nerves were 29 and 30.8, respectively. The technique is challenging and no more accurate than previously published blinded techniques. Any extraoral approach to the IAN is likely to also desensitize the lingual nerve.
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Caballos/cirugía , Nervio Lingual/cirugía , Nervio Mandibular/cirugía , Bloqueo Nervioso/veterinaria , Ultrasonografía/veterinaria , Animales , Cadáver , Nervio Lingual/efectos de los fármacos , Nervio Lingual/fisiología , Nervio Mandibular/efectos de los fármacos , Nervio Mandibular/fisiología , Bloqueo Nervioso/instrumentación , Bloqueo Nervioso/métodosRESUMEN
BACKGROUND: Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth. METHODS: A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary. RESULTS: Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis. CONCLUSION: Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.
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Nervio Mandibular/efectos de los fármacos , Premedicación , Pulpitis/tratamiento farmacológico , Anestesia de Conducción/métodos , Anestésicos Locales/uso terapéutico , Humanos , Nervio Mandibular/fisiopatología , Pulpitis/fisiopatologíaAsunto(s)
Acil-CoA Deshidrogenasa/deficiencia , Procedimientos Quirúrgicos Ambulatorios/efectos adversos , Anestesia Dental/métodos , Anestesia Intravenosa/métodos , Errores Innatos del Metabolismo Lipídico/complicaciones , Extracción Dental/efectos adversos , Adolescente , Anestésicos Locales/administración & dosificación , Femenino , Fentanilo/administración & dosificación , Humanos , Ketamina/administración & dosificación , Lidocaína/administración & dosificación , Nervio Mandibular/efectos de los fármacos , Bloqueo Nervioso/métodos , Resultado del TratamientoRESUMEN
OBJECTIVES: The aim of this study was to compare the onset, success rate, injection pain, and post-injection pain of mental/incisive nerve block (MINB) with that of inferior alveolar nerve block (IANB) using 4% articaine in mandibular premolars with symptomatic irreversible pulpitis. The accuracy of electrical pulp test (EPT) in determining pulpal anesthesia was also examined. MATERIALS AND METHODS: The study was designed as a randomized clinical trial with two study arms-MINB and IANB. Injections were performed using a standardized technique. Root canal treatment was initiated 10 min after the injection. Success was defined as no pain or mild pain during access cavity preparation and instrumentation. Injection pain and post-injection pain (up to 7 days) were recorded. All pain ratings were done using Heft-Parker Visual Analog Scale (HP VAS). RESULTS: Sixty-four patients were enrolled. The success rate of MINB (93.8%) was higher than IANB (81.2%) but the difference was not significant (p > 0.05). The onset of anesthesia with MINB was significantly quicker, and injection pain was significantly less (p < 0.05), but post-injection pain was significantly higher during the first 4 days (p < 0.001). The accuracy of EPT in determining pulpal anesthesia was 96.88%. CONCLUSIONS: MINB and IANB with 4% articaine had similar efficacy in anesthetizing mandibular premolars with irreversible pulpitis. Post-injection pain with MINB was higher than with IANB. CLINICAL RELEVANCE: MINB and IANB with 4% articaine can be used interchangeably to anesthetize mandibular premolars with irreversible pulpitis.
Asunto(s)
Anestesia Dental/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Bloqueo Nervioso/métodos , Pulpitis/cirugía , Adolescente , Adulto , Anciano , Diente Premolar , Femenino , Humanos , Masculino , Mandíbula , Nervio Mandibular/efectos de los fármacos , Persona de Mediana Edad , Dimensión del DolorRESUMEN
BACKGROUND: One of the rare but serious complications observed with deoxycholic acid administration is damage to the marginal mandibular nerve. In this study, we evaluated if deoxycholic acid directly induces histologic damage to fresh cadaveric marginal mandibular nerve. METHODS: A segment of marginal mandibular nerve was harvested from 12 hemifaces of 6 fresh cadavers. The nerve specimen was exposed to either 0.9% sterile saline for 24 h, deoxycholic acid (10 mg/ml) for 20 min, or deoxycholic acid (10 mg/ml) for 24 h. The nerve specimens were then fixed in glutaraldehyde for a minimum of 24 h. Toluidine blue stained sections were evaluated for stain intensity using light microscopy and color deconvolution image analysis. Supraplatysmal fat was harvested as a positive control and exposed to the same treatments as the marginal mandibular nerve specimens, then evaluated using transmission electron microscopy. RESULTS: Toluidine blue staining was less in the marginal mandibular nerve exposed to deoxycholic acid when compared to saline. The specimen exposed to deoxycholic acid for 24 h showed less toluidine blue staining than that of the nerve exposed to deoxycholic acid for 20 min. Transmission electron microscopy of submental fat exposed to deoxycholic acid revealed disruption of adipocyte cell membrane integrity and loss of cellular organelles when compared to specimens only exposed to saline. CONCLUSIONS: Deoxycholic acid (10 mg/ml) damages the marginal mandibular nerve myelin sheath in fresh human cadaver specimens. Direct deoxycholic acid neurotoxicity may cause marginal mandibular nerve injury clinically. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Asunto(s)
Traumatismos del Nervio Craneal/inducido químicamente , Ácido Desoxicólico/efectos adversos , Ácido Desoxicólico/farmacología , Nervio Mandibular/anatomía & histología , Vaina de Mielina/efectos de los fármacos , Biopsia con Aguja , Cadáver , Colorantes , Traumatismos del Nervio Craneal/patología , Disección/métodos , Humanos , Inmunohistoquímica , Nervio Mandibular/efectos de los fármacos , Microscopía , Vaina de Mielina/patología , Sensibilidad y Especificidad , Cloruro de TolonioRESUMEN
PURPOSE: To determine the shape, position, vertical height, surrounding bone characteristics, and opening angle of mental foramen (MF) using dental cone beam computed tomography (CBCT). METHODS: A retrospective study was performed on 663 patients. CBCT records analyzed for the shape, position, and surrounding bone measurements of the MF using Simplant 3D software (Hasselt, Belgium). Opening angle of MF was also assessed. Kruskal-Wallis and Mann-Whitney U tests were employed to test significant differences between parameters, genders and ages. RESULTS: All mental foramina were visualized. Regarding location, 49.2% of the MFs were located between first and second premolars, 7.7 distal and 39.7% coincident to the apex of the mandibular second premolar. The mean MF opening angle was 45.4° on the right side, and 45.9° on the left. There were no statistically differences between gender groups with regard to the opening angle degrees. CONCLUSIONS: This study may provide useful information about variations in the position, shape and size, angle of mental foramen, which may help the practitioners to perform safer mental nerve blocks and surgical procedures.
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Puntos Anatómicos de Referencia/anatomía & histología , Mandíbula/anatomía & histología , Bloqueo Nervioso/efectos adversos , Procedimientos Quirúrgicos Orales/efectos adversos , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Puntos Anatómicos de Referencia/diagnóstico por imagen , Puntos Anatómicos de Referencia/inervación , Variación Anatómica , Diente Premolar/anatomía & histología , Diente Premolar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico/métodos , Femenino , Humanos , Imagenología Tridimensional/métodos , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/inervación , Nervio Mandibular/efectos de los fármacos , Persona de Mediana Edad , Bloqueo Nervioso/métodos , Procedimientos Quirúrgicos Orales/métodos , Estudios Retrospectivos , Factores Sexuales , Programas Informáticos , Adulto JovenRESUMEN
PURPOSE: The purpose of this study is to compare the success rates of inferior alveolar nerve block (IANB) and buccal infiltration anesthesia of mandibular second premolar with irreversible pulpitis and to evaluate the level of patient discomfort with these methods. MATHERIALS AND METHODS: Forty patients, who had irreversible pulpitis in the mandibular 2nd premolar teeth, were included in the study. Patients were randomly distributed in two groups. In one group IANB, in the other group buccal infiltration anesthesia were performed. The efficacy of these two different anesthesia techniques on the related teeth was investigated with the Heft-Parker visual analog scale. In addition, with a pulse oximetry device, the changes in the patients' heart rates were compared between the groups. The obtained data were evaluated statistically. RESULTS: Both anesthesia techniques reduced the pain significantly in patients before the administration (P < 0.05), but there was no significant difference among the groups regarding the pain control and success rates of anesthesia (P > 0.05). Both of the anesthesia techniques increased the heart rate (P < 0.05). The increase in the heart rate of the patients was significantly higher in the buccal infiltration anesthesia group than the other anesthesia group (P < 0.05). CONCLUSION: Within the limitation of this in vivo study, there was no difference between the efficacies of the buccal infiltration anesthesia and IANB anesthesia in the mandibular 2nd premolar teeth with irreversible pulpitis. Buccal infiltration anesthesia caused more discomfort in the patients compared with the IANB during the administration.
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Anestesia Dental/métodos , Anestesia Local/métodos , Anestésicos Locales/administración & dosificación , Carticaína/administración & dosificación , Nervio Mandibular/efectos de los fármacos , Diente Molar/inervación , Bloqueo Nervioso/métodos , Pulpitis/tratamiento farmacológico , Adulto , Diente Premolar , Método Doble Ciego , Femenino , Humanos , Inyecciones , Masculino , Persona de Mediana Edad , Dimensión del Dolor/efectos de los fármacos , Estudios Prospectivos , Pulpitis/fisiopatologíaRESUMEN
BACKGROUND AND OBJECTIVES: We aimed to describe a novel technique of ultrasound-guided selective mandibular nerve block with a lateral pterygoid plate (LPP) approach and to assess its feasibility and accuracy in a soft cadaver model. METHODS: Ten soft cadavers were studied. A curved array ultrasound transducer was applied over 1 side of the face of the cadaver, in an open-mouth position. The transducer was placed transversely below the zygomatic arch and tilted in the caudal-to-cranial direction to identify the boundary of the LPP. The needle was inserted in-plane, in an anterior-to-posterior direction, into the posterior border of the uppermost part of the LPP, and 3 mL of methylene blue was injected. RESULTS: Mandibular nerve block was successfully performed in all 10 cadavers using an LPP approach under ultrasound guidance. The mandibular nerve and its branches were seen to be stained with methylene blue in all cadaveric specimens. No accidental injection into the facial nerve or maxillary artery was observed. CONCLUSIONS: This cadaveric study suggests that this novel technique, using an LPP approach under ultrasound guidance, is helpful for selective mandibular nerve block, with high accuracy and feasibility. Further studies are required to establish its safety and efficacy for clinical application. CLINICAL TRIAL REGISTRATION: This study was registered at the Thai Clinical Trials Registry (ClinicalTrials.in.th), identifier TCTR20160601004.
Asunto(s)
Bloqueo Nervioso Autónomo/métodos , Nervio Mandibular/diagnóstico por imagen , Músculos Pterigoideos/diagnóstico por imagen , Ultrasonografía Intervencional/métodos , Cadáver , Femenino , Humanos , Masculino , Nervio Mandibular/efectos de los fármacos , Azul de Metileno/administración & dosificación , Músculos Pterigoideos/efectos de los fármacos , Músculos Pterigoideos/inervaciónRESUMEN
INTRODUCTION: Intact neural supply is necessary for tooth eruption. Sympathetic denervation accelerates or decelerates the eruption rate depending on the tooth condition (intact or injured). The aim of this study is to reexamine the role of the sympathetic innervation, through the observation of the effects of pre or post ganglionic chemical sympathectomy on the eruption of intact rat incisors. MATERIALS AND METHODS: Different groups of rats were subjected to either ganglionic or peripheral chemical sympathectomy and the observed effects on incisor eruption were compared to those made on intact/sham groups or on rats subjected to inferior alveolar nerve (IAN) lesion. RESULTS: The total amount of eruption in control/naïve rats, measured over a total period of 144â¯h, was 3⯱â¯0.15â¯mm and decreased to 2.57⯱â¯0.06â¯mm (nâ¯=â¯8; pâ¯<â¯0.01) or 2.8⯱â¯0.10â¯mm (nâ¯=â¯8; pâ¯<â¯0.05) following treatment with guanethidine and hexamethonium, respectively. This amount decreased to 1.8⯱â¯0.14â¯mm (pâ¯<â¯0.001 vs. control, nâ¯=â¯7; or pâ¯<â¯0.01 vs. sham, nâ¯=â¯5) in rats subjected to IAN lesion. CONCLUSION: Sympathectomy delayed tooth eruption. Blocking the sympathetic effectors with guanethidine exerted more potent effects than ganglionic block with hexamethonium. Intact sympathetic supply is required for tooth growth under normal conditions.