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Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial.

Montserrat-Bosch M, Figueiredo R, Nogueira-Magalhães P, Arnabat-Dominguez J, Valmaseda-Castellón E, Gay-Escoda C - Med Oral Patol Oral Cir Bucal (2014)

Bottom Line: The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation.Three failures were recorded, 2 of them in the experimental group.No relevant local or systemic complications were registered.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Dentistry - University of Barcelona, Campus de Bellvitge, Facultat d`Odontologia, Cirugía e Implantología Bucal, C/ Feixa Llarga, s/n; Pavelló Govern, 2 planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain, rui@ruibf.com.

ABSTRACT

Objective: To compare the efficacy and complication rates of two different techniques for inferior alveolar nerve blocks (IANB).

Study design: A randomized, triple-blind clinical trial comprising 109 patients who required lower third molar removal was performed. In the control group, all patients received an IANB using the conventional Halsted technique, whereas in the experimental group, a modified technique using a more inferior injection point was performed.

Results: A total of 100 patients were randomized. The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation. Three failures were recorded, 2 of them in the experimental group. No relevant local or systemic complications were registered.

Conclusions: Both IANB techniques used in this trial are suitable for lower third molar removal. However, performing an inferior alveolar nerve block in a more inferior position (modified technique) extends the onset time, does not seem to reduce the risk of intravascular injections and might increase the risk of lingual nerve injuries.

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B) Modified IANB using a lower injection location.
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Figure 2: B) Modified IANB using a lower injection location.

Mentions: A possible way to decrease the incidence of these events is to change the injection site to a more inferior position, since the needle tip would be in a location where the neurovascular bundle would be inside the mandibular canal, therefore avoiding direct contact with the vascular structures. Thus, using a modified Halsted technique with a slightly inferior injection height (at the occlusal plane level) would probably reduce positive aspirations without significantly compromising the efficacy of IANB (Fig. 2). For this reason, the authors decided to perform a clinical trial with the aims of comparing the efficacy and the complication rates of these two IANB techniques.


Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial.

Montserrat-Bosch M, Figueiredo R, Nogueira-Magalhães P, Arnabat-Dominguez J, Valmaseda-Castellón E, Gay-Escoda C - Med Oral Patol Oral Cir Bucal (2014)

B) Modified IANB using a lower injection location.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4119316&req=5

Figure 2: B) Modified IANB using a lower injection location.
Mentions: A possible way to decrease the incidence of these events is to change the injection site to a more inferior position, since the needle tip would be in a location where the neurovascular bundle would be inside the mandibular canal, therefore avoiding direct contact with the vascular structures. Thus, using a modified Halsted technique with a slightly inferior injection height (at the occlusal plane level) would probably reduce positive aspirations without significantly compromising the efficacy of IANB (Fig. 2). For this reason, the authors decided to perform a clinical trial with the aims of comparing the efficacy and the complication rates of these two IANB techniques.

Bottom Line: The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation.Three failures were recorded, 2 of them in the experimental group.No relevant local or systemic complications were registered.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Dentistry - University of Barcelona, Campus de Bellvitge, Facultat d`Odontologia, Cirugía e Implantología Bucal, C/ Feixa Llarga, s/n; Pavelló Govern, 2 planta, Despatx 2.9, 08907 L'Hospitalet de Llobregat, Barcelona, Spain, rui@ruibf.com.

ABSTRACT

Objective: To compare the efficacy and complication rates of two different techniques for inferior alveolar nerve blocks (IANB).

Study design: A randomized, triple-blind clinical trial comprising 109 patients who required lower third molar removal was performed. In the control group, all patients received an IANB using the conventional Halsted technique, whereas in the experimental group, a modified technique using a more inferior injection point was performed.

Results: A total of 100 patients were randomized. The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation. Three failures were recorded, 2 of them in the experimental group. No relevant local or systemic complications were registered.

Conclusions: Both IANB techniques used in this trial are suitable for lower third molar removal. However, performing an inferior alveolar nerve block in a more inferior position (modified technique) extends the onset time, does not seem to reduce the risk of intravascular injections and might increase the risk of lingual nerve injuries.

Show MeSH
Related in: MedlinePlus