Search Results (30)

The use of local anesthetics in dentistry is crucial for pain control. Their efficacy may be related to multiple factors, including gender, the clinical status of the patient, anatomical factors, the type of anesthetic, premedication treatment, and the experience of the professional. Aim: The objective of this study was to analyze whether premedication or the degree of patient anxiety influences the anesthetic efficacy of 4% articaine with epinephrine 1:100,000 and 0.5% bupivacaine with epinephrine 1:100,000 in patients undergoing root canal treatment for symptomatic irreversible pulpitis in the upper and lower molars. The null hypothesis (H0) of this study was that articaine and bupivacaine would have a similar anesthetic efficacy when used during the treatment of symptomatic irreversible pulpitis of the posterior mandibular and maxillary teeth, independent of non-steroidal anti-inflammatory drugs (NSAIDs) premedication or the patient’s anxiety levels. Methods: A total of 140 patients presenting with pulpitis in the upper and lower molars were randomly assigned to one of two anesthetics: articaine or bupivacaine. Before root canal treatment, patients completed the Modified Corah Dental Anxiety Scale (MDAS) and a Visual Analog Scale (VAS) for pain intensity. Inferior alveolar nerve block was performed for the lower molars and buccal infiltration for the upper molars, and the anesthetic efficacy was verified by the Endo Coldspray^® test. During the procedure, the patients’ heart rate and oxygen saturation were monitored using a pulse oximeter. The patients reported their pain levels using a VAS twenty-four hours postoperatively. Results: High levels of dental anxiety were significantly associated with higher pain scores (p = 0.000) for both groups. The hemodynamic changes during treatment remained within normal limits. The need for anesthetic reinforcement was higher in the bupivacaine group (p = 0.004). The patients in both groups reported low-intensity postoperative pain, although the pain level was slightly lower in the bupivacaine group. Conclusions: The anesthetic efficacy of articaine and bupivacaine in patients with irreversible pulpitis did not appear to be influenced by the degree of anxiety or the intake of AINEs as premedication. The intrinsic anesthetic efficacy was higher for articaine, which required less reinforcement than bupivacaine. Comparing the results obtained when performing buccal infiltration and inferior alveolar nerve block further highlighted the differences between the two anesthetics; these differences were more pronounced in the bupivacaine group, leading to rejection of the null hypothesis proposed at the beginning of the study. Full article

Background/Objectives: One of the most serious complications following implant placement in the atrophic posterior mandible is injury to the inferior alveolar nerve (IAN), which can also happen during occlusal loading of the implants. This study investigates the effects of 4 mm implant stress transmission to the inferior alveolar nerve during occlusal loading in cases of severe posterior mandibular atrophy. Methods: The computer-aided design (CAD) model was created and modified through Direct Modeling techniques. The structure of cortical and trabecular bones was simplified, and it was modeled as a cylinder block. Finite element analysis (FEA) was carried out in 3D to investigate the pressure distribution over the IAN at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm), and stress and strain deformations were simulated in the mandibular model. Results: The results of the pressure analysis on the inferior alveolar nerve indicate that the pressure distribution at different implant-to-nerve distances (1.5 mm, 0.5 mm, and 0.1 mm) is consistently below 0.026 MPa, which corresponds to the maximum pressure range that may block nerve impulses. This occurs even at the theoretical and simulated distance of 0.1 mm, suggesting that cortical bone stiffness plays a crucial role in mitigating stress at reduced implant-to-nerve proximities. Conclusions: Within the limits of this study, ultra-short implants can be placed even less than 0.5 mm (up to 0.1 mm under the 3D-FEA hypothesis) above the inferior alveolar nerve under the 3D-FEA hypothesis, while maintaining pressure below the threshold value. This is due to the rigidity of the cortical bone, which helps to reduce pressure transmission to the nerve. These findings may expand the indications for ultra-short implants, even in mandibles with a residual bone height of just 4 mm. Full article

Background: Irreversible pulpitis is a severe inflammation of the dental pulp. The purpose of this clinical trial was to evaluate the effectiveness of an inferior alveolar nerve block (IANB) injection followed by oral dexamethasone administration in reducing the pain associated with symptomatic irreversible pulpitis (SIP) in mandibular molars, without performing conventional pulpotomy. Methods: A sample of 80 subjects suffering from acute pain due to SIP on a mandibular molar were assigned to the dexamethasone group, who received an IANB injection followed by one oral dose of 4 mg of dexamethasone during the emergency visit followed by one dose of 4 mg after 8 h, or the control group, who received a conventional pulpotomy. Both groups received complete endodontic treatment after five to six days. The intensity of the preoperative pain and pain levels were measured in both groups at different times after each intervention. The Mann–Whitney U test was used to compare the pain scores between the groups at the same time point, while Friedman’s test was used to compare the pain scores between the four time points within the same intervention group, followed by the Bonferroni correction for multiple pairwise comparisons. Success was determined when the pain score on the visual analogue scale (VAS) was 20 or lower. Results: A survival analysis was conducted, where the event was considered as the disappearance of symptoms (or success: pain score ≤ 20). For both groups, the pain significantly decreased 8 h postoperatively (p < 0.05). The success rates at 8 and 12 h were significantly higher in the dexamethasone group compared to the control group (p = 0.05). However, the pain scores at 24 h remained comparable. Conclusions: An IANB injection followed by 8 mg of oral dexamethasone could reduce pain significantly in patients with SIP without performing conventional pulpotomy. The oral administration of dexamethasone could therefore be a valuable strategy to temporarily alleviate SIP symptoms until definitive treatment becomes feasible. Dexamethasone is a temporary pain management strategy rather than a replacement for pulpotomy. Full article

Background/Objectives: Effective pain control in pediatric dentistry combines behavior management, local anesthesia, and follow-up care. This study compared the efficacy of inferior alveolar nerve block (IANB) with 2% lidocaine and epinephrine versus buccal infiltration (BI) with 4% articaine and epinephrine in treating primary molars, permanent premolars, and molars in children. Methods: Sixty children aged 5–18 years were randomly assigned to two groups in a double-blind study. One group received 1.7 mL BI with 4% articaine, and the other 1.8 mL IANB with 2% lidocaine for dental treatment. Pain was assessed using the self-reported Visual Analog Scale (VAS) and Wong–Baker Faces Pain Rating Scale (W-BFRS), while anesthesia effectiveness and behavior were evaluated using the Frankl Behavior Rating Scale (FBRS) and vitality tests. Results: The articaine group reported significantly lower pain scores on all scales (VAS: 1.23 ± 2.01; FBRS: 0.47 ± 0.57; W-BFRS: 1.33 ± 2.04) than the lidocaine group (VAS: 3.17 ± 1.64; FBRS: 1.26 ± 0.45; W-BFRS: 3.17 ± 1.64). Articaine also outperformed lidocaine in secondary measures, with higher positive responses on the questionnaires (articaine: 8.37 ± 1.61 vs. lidocaine: 5.27 ± 1.41, p < 0.001). Conclusions: Buccal infiltration with 4% articaine is more effective than 2% lidocaine administered via IANB for invasive dental procedures in children, providing superior pain control and positive patient responses. Full article

Background/Objectives: The aim of this study is to identify the most accurate and consistent landmarks for determining the precise location of the mandibular foramen (MF) and the mandibular ramus, suggesting appropriate adjustments to anesthesia techniques based on these variations in order to improve the success rate of the inferior alveolar nerve (IAN) block. Methods: CT scans of the mandibles from 100 patients were analyzed to measure the distance between the MF and various landmarks, including the sigmoid notch, gonion, posterior and anterior margins of the ramus, temporal crest, and the mandibular ramus height from the condyle to the gonion. The width of the mandibular ramus was also assessed, with correlations made to age and gender. Results: The MF was found to be closer to the sigmoid notch (mean = 21.2 mm), p = 0.393, than to the gonion (mean = 22.6 mm), p = 0.801, and closer to the posterior margin of the ramus (mean = 13.1 mm), p = 0.753, than to the anterior margin of the ramus. Additionally, the MF was closer to the temporal crest. Age also influenced the position of the MF, with a posterior and superior movement of the foramen, reducing the distance between the MF and the posterior margin of the ramus as well as the MF and the sigmoid notch (p < 0.001). Conclusions: A precise understanding of the MF’s location will help dentists and oral and maxillofacial surgeons improve the success of the IAN block, avoid injury to the inferior alveola neurovascular bundle, and minimize surgical complications such as paresthesia, permanent anesthesia, and hemorrhage. Full article

Background: Anesthetic irrigation is an effective treatment for postoperative pain suppression in patients after molar extraction, but exerts a short period of extraction. The study aimed to evaluate the effect of lidocaine with epinephrine irrigation on acute pain relief in healthy volunteers with inferior alveolar nerve block (IANB) injection for the surgical removal of mesioangular (MA)-impacted third molars. Methods: A total of 28 patients (56 samples) with bilateral MA-impacted third molars were recruited. This study was a split-mouth, double-blind, randomized clinical trial. Surgical procedures were conducted over two separate appointments. Each patient randomly received 2% lidocaine with 1:100,000 epinephrine for the irrigation of the extraction site after surgery on one side of the mouth and normal saline solution on the other side. The postoperative visual analog scale (VAS) as a pain indicator was recorded and statistically analyzed for both treatments. Results: The VAS levels at 3 and 4 h after surgery in the lidocaine group were significantly lower than those of the normal saline group. Increases in pain scores were recorded five hours after surgery in both groups. No complications were recorded during this study. Conclusions: Continuous local anesthetic irrigation appears to be effective in reducing acute postoperative pain in patients with IANB for MA-impacted third molar surgery. Clinical Trial Registry: Reference number ISRCTN13866362, Date: 1 October 2024. Full article

Background and Objectives: the mandibular foramen is an essential anatomic landmark in performing various dental and surgical procedures, including inferior alveolar nerve block (IANB). However, its position may vary based on the individual morpho-functional features of the skull and face. This study aims to conduct a personalized assessment of the location of the mandibular foramen in various shapes of skulls, faces, and mandibles. Materials and Methods: this anatomic morphometric cross-sectional study was performed using one hundred and six (n = 106) certified human cadaver heads of both sexes. The cranial index (CI) and Izard’s facial index (FI) were calculated, the linear anatomic parameters of the skull and mandible were measured, the location of the mandibular foramen was identified, and the shapes of the skulls and mandibles were determined. Quantitative statistical data were obtained based on the location of the mandibular foramen, considering different shapes of skulls and faces. Results: there is a significant correlation between the location of the mandibular foramen, the high lengthy index (HLI) of the mandible, and the longitudinal latitude index (LLI) of the mandibular process. Conclusions: personalized assessment of the mandibular foramen based on a comprehensive analysis of craniometric characteristics can contribute to preventing unwanted dental and surgical complications, such as inferior alveolar nerve damage. Full article

Background/Objectives: Locating the mandibular foramen (MF) through imaging is clinically important for inferior alveolar nerve (IAN) anesthesia and mandibular ramus osteotomies. Although cone-beam computed tomography (CBCT) is superior in imaging the mandible, an orthopantomogram (OPG) is preferred for its ease of use and availability. Therefore, the present study aimed to evaluate the accuracy of digital OPG in localizing the MF, in a subset of the Middle Eastern population. Methods: Radiographic images (OPG and CBCT) of selected patients (adults, dentulous and no mandibular abnormalities) were used to locate the MF through digital measurements (mm) of the anteroposterior distance from the anterior border of the ramus (MF-AP) and the superoinferior position from the mandibular occlusal plane (MF-SI). Measurements were statistically compared between OPG and CBCT for accuracy. Differences in measurements between OPG and CBCT were compared against the anatomic location (right/left), age and biological sex, assuming a p-value < 0.05 as significant. Results: A total of 204 radiographic records (males: 100/females: 104/mean age: 34.65 ± 11.55 years) were evaluated. The measurements for the MF were MF-AP-OPG (right: 13.53 ± 2.44/left: 13.19 ± 2.25), MF-AP-CBCT (right: 13.61 ± 2.39/left: 13.36 ± 2.19), MF-SI-OPG (right: 5.25 ± 1.71/left: 5.41 ± 1.65) and MF-SI-CBCT (right: 5.59 ± 1.66/left: 5.52 ± 1.61). Measurements between OPG and CBCT were not significantly different, except for MF-SI (right) (p = 0.042). While the overall difference between OPG and CBCT (MF-AP/MF-SI) measurements showed a significant association (p < 0.01) with the anatomic location (right/left), a significant association (p < 0.05) with biological sex was observed only for MF-AP. Conclusions: Based on this study’s outcomes, digital OPG is an accurate modality to locate the MF based on anteroposterior (MF-AP) and superoinferior (MF-SI) measurements. This would be clinically beneficial for dental and oral surgeons to achieve the optimum IAN block anesthesia based on preoperative panoramic radiographs. Similarly, it would assist maxillofacial surgeons in planning mandibular orthognathic surgeries and ramus osteotomies without complications. Full article

Inferior alveolar nerve block (IANB) is one of the most common procedures in operative dentistry, and a deep understanding of the normal anatomical variation of the pterygomandibular space (PM) is essential for its safe and successful administration. This cadaveric anatomical study aimed to use A-silicone injections to evaluate the volume of the PM. This study was conducted using 46 human cadaver heads (25 males and 21 females). A craniometric analysis was performed using the cadavers’ ages, the number of silicone cartridges (carpules) used to fill the pterygomandibular space, Izard’s Facial Index (FI), and the Cranial Index (CI). A Halstead mandibular block was performed by injecting 1.7 mL A-silicone cartridges (as an equivalent to standard local aesthetic carpules volume) into the PM. The cured silicone was extracted from the dissected mandibles. The volume (length, width, and thickness) of the extracted silicone and the number of silicone cartridges used to fill the space were evaluated. The results showed that there are statistically significant positive correlations between the CI and the width of the right PM, as well as the width and length of the left PM. A statistically significant correlation was found between the width of the left PM and the age of the cadaveric heads; the higher the age, the thicker the space on both sides. The volume of the PM corresponded to 1.5 cartridges on average. Full article

Needle phobia is one of the most common fears, inducing painful and uncomfortable procedures in pediatric dentistry. Managing procedural distress can provide both short- and long-term benefits by increasing compliance and reducing avoidance behavior in dental care. Therefore, an expanded focus on fear-reducing interventions is advised for needle operations in addition to pain management. The purpose of the current study is to examine and assess the efficiency of intraoral vibrations, extraoral vibrations, and cooling in alleviating pain perception during the administration of inferior alveolar nerve blocks. Full article

Background and Objectives: Lidocaine Hydrochloride has been the standard choice for local anesthesia in dentistry and Articaine’s unique structure and growing popularity make it a viable alternative. Due to contradictory results in prior research and a scarcity of trials conducted in the Pakistani population, this study aims to compare the anesthetic efficacy of Lidocaine with Articaine for inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis. Materials and Methods: This double-blinded, randomized controlled trial included 152 patients who were selected by consecutive non-probability sampling. The participants included patients who presented with symptomatic irreversible pulpitis in mandibular posterior teeth (molars and premolars) and depicted normal apical tissue radiographically. The patients were equally and randomly divided into two groups. The control group received 2% Lidocaine Hydrochloride injections, and the experiment group received 4% Articaine Hydrochloride injections. Participants scored their pain on the HP-VAS both before and after the administration of anesthesia. A value of 54 mm or less on the scale indicated effective anesthesia. The data obtained were analyzed using SPSS. Chi-square test was applied to analyze data for statistical significance. Results: There was no statistically significant difference in the efficacy of the two anesthetic agents. During access cavity preparation, Lidocaine demonstrated a success rate of 93%, whereas Articaine exhibited a slightly higher success rate of 97%. During initial instrumentation, the success rates for Lidocaine and Articaine were 72% and 71%, respectively. This suggests that both Lidocaine and Articaine were effective in achieving anesthesia during the dental procedure in patients with symptomatic irreversible pulpitis, with Articaine showing a slightly better success rate, although the difference was not statistically significant. Conclusions: The anesthetic efficacy of Articaine is similar to that of lidocaine in subjects with symptomatic irreversible pulpitis. Hence, Articaine can serve as an alternative to Lidocaine for local anesthesia administration in dentistry. Full article

Many ocular complications are described in the literature after dental injections. Facial nerve palsy is a rare complication. We report a case of a 60-year-old woman in the American Society of Anesthesiologists (ASA) I classification under orthodontic treatment with aligners that required an inferior alveolar block for endodontic treatment. Optocaine with epinephrine 1:200,000 and a disposable needle 25 G × 36 mm mounted on a dental syringe were used, and the effect of the anesthesia arose after 10 min. Facial nerve palsy on the side of the injection arose after 1 h and 40 min from the injection, and the patient was immediately visited by an ophthalmologist who reported the examination reported in the present case report. The authors report this unusual case with a subsequent onset and short duration of facial nerve palsy and discuss possible anesthetic solution pathways. Full article

Needle fracture during dental local anesthetic injections is a rare but significant, potentially serious complication. Various approaches for the location and removal of broken needles have been described; however, there are several difficulties and concerns related to the potential complications and critical anatomic challenges peculiar to the head and neck region. In this case, we describe the diagnostic approaches utilized in locating a broken needle that migrated in the pterygomandibular space following gag reflex, and sudden head movement of a middle-aged male patient. A meticulous diagnostic approach was employed to locate the needle utilizing CBCT scan, CT scan with contrast, and C-arm X-ray machine. The needle was successfully retrieved using an angled hemostat inserted through an oral incision, guided by a C-arm X-ray machine and ENT endoscopic instruments. While careful planning could prevent many complications that may arise during oral surgical procedures, inadvertent events leading to serious complications should be addressed using the appropriate and timely diagnostic techniques pre-and intra-operatively. Full article

Anesthetic techniques play an important role in the outcome of the therapeutic procedures in dentistry. Although inferior alveolar nerve block (IANB) anesthesia is currently the most often used, there are situations that imply the need of an alternative anesthesia technique to overcome the potential risks and complications. The aim of the study was to evaluate the efficacy of the retromolar triangle anesthesia technique in achieving the desired nerve block, while evaluating the duration of the anesthesia for the included cases. Methods: The present prospective study included 50 subjects that had indication of inferior molar extraction. The performed anesthesia technique for these cases was the retromolar triangle approach, and the analyzed parameters for evaluating the efficacy of this anesthesia technique were the positive nerve block of the branches involved in the area (inferior alveolar, buccal, and lingual nerves) and the duration of the anesthesia. Results: The efficiency of the retromolar triangle anesthesia technique was positive in 64% of the cases for the inferior alveolar nerve, 46% of the cases for the lingual nerve, and 22% of the cases for the buccal nerve. The duration of the anesthesia revealed a mean value of 72.4 min, suggesting that the duration is an essential factor in its effectiveness. Conclusions: Retromolar triangle anesthesia can be a viable option for clinicians, offering a simple and easy approach for the management of clinical cases. Full article

Background: Dentists administer hundreds of thousands of injections every day without particular concern, but the administration of local anesthetics can cause problems. One event, fortunately uncommon, that is discussed accurately but can cause significant concern is needle breakage. The purpose of this article is to review what has been reported in the literature on this topic to learn about patient symptomatology, management and possible complications. In addition, the case of a 34-year-old patient with needle persistence in the pterygoid space due to accidental rupture during inferior alveolar nerve block (IAN) was reported, for whom non-removal and monitoring over time was chosen. Materials and Methods: A literature search of the PubMed, Scopus, Web of Science and ScienceDirect databases was conducted analyzing anesthetic needle rupture during dental surgery. Results: At the end of the selection process, 17 articles resulted. Asymptomatic subjects were found, as well as those who had several symptoms. No issues were recorded by any of the authors, whether they withdrew the needle or simply monitored the patient. Conclusions: The literature on needle rupture during dental local anesthesia is scarce, and studies report conflicting results on treatment options. Most authors reported removing the fragment; however, others preferred conservative management limited to patient monitoring. No complications were reported in any study. Full article