Top

Clinical Oral Investigations

Published in:

01-03-2019 | Original Article

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

Authors: Sin-Yeon Cho, Wonwoo Choi, Junyoung Kim, Sung-Taek Kim, Hee-Jin Kim, Il-Young Jung

Published in: Clinical Oral Investigations | Issue 3/2019

Abstract

Objectives

This study was aimed at evaluating the anesthetic success rates in various regions of soft tissue after inferior alveolar nerve (IAN) block and comparing the success rates of soft tissue anesthesia with those of pulpal anesthesia to find correlations.

Materials and methods

Fifty-nine dental students received an IAN block injection. A total of four test sites were used for soft tissue anesthesia using a pressure algometer (PA): the corner of the lower lip vermilion border (LL); the buccal-attached gingiva of the lateral incisor (BGI), the molar (BGM), and the lingual gingiva (LG). The lateral incisor (LI) and the first molar (M1) were evaluated for pulpal anesthesia using an electric pulp tester. To evaluate whether soft tissue anesthesia can be an indicator of pulpal anesthesia, the positive predictive value (PPV) and negative predictive value (NPV) were calculated.

Results

The highest success rate for soft tissue anesthesia was seen on the LG (93.9%), followed by LL (79.6%), BGI (53.1%), and BGM (14.3%). The PPVs of LL for the M1 and Ll were 74.4 and 59.0%. The NPVs for the M1 and LI were much higher in the LL (90.0 and 100%, respectively) than in the BGI (56.5 and 69.6%, respectively).

Conclusions

The highest success rate was found in the LG. Lip numbness was not an indicator of pulpal anesthesia of M1 and LI. However, if the LL was not anesthetized, the probabilities of failed pulpal anesthesia were very high in the LI and M1.

Clinical relevance

The clinicians need to consider not doing an additional lingual nerve block after IAN block.

Hur MS, Kim HC, Won SY, Hu KS, Song WC, Koh KS, Kim HJ (2013) Topography and spatial fascicular arrangement of the human inferior alveolar nerve. Clin Implant Dent Relat Res 15:88–95CrossRefPubMed

Vreeland DL, Reader A, Beck M, Meyers W, Weaver J (1989) An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endod 15:6–12CrossRefPubMed

Hinkley SA, Reader A, Beck M, Meyers WJ (1991) An evaluation of 4% prilocaine with 1:200,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin compared with 2% lidocaine with:100,000 epinephrine for inferior alveolar nerve block. Anesth Prog 38:84–89PubMedPubMedCentral

Lai TN, Lin CP, Kok SH, Yang PJ, Kuo YS, Lan WH, Chang HH (2006) Evaluation of mandibular block using a standardized method. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 102:462–468CrossRefPubMed

Malamed SF (2004) Techniques of mandibular anesthesia. Handbook of local anesthesia. Elsevier/Mosby, St. Louis, pp 227–234

Balasubramanian S, Paneerselvam E, Guruprasad T, Pathumai M, Abraham S, Krishnakumar Raja VB (2017) Efficacy of exclusive lingual nerve block versus conventional inferior alveolar nerve block in achieving lingual soft-tissue anesthesia. Ann Maxillofac Surg 7:250–255CrossRefPubMedPubMedCentral

Khoury J, Mihailidis S, Ghabriel M, Townsend G (2010) Anatomical relationships within the human pterygomandibular space: relevance to local anesthesia. Clin Anat 23:936–944CrossRefPubMed

Venkat Narayanan J, Gurram P, Krishnan R, Muthusubramanian V, Sadesh Kannan V (2017) Infiltrative local anesthesia with articaine is equally as effective as inferior alveolar nerve block with lidocaine for the removal of erupted molars. Oral Maxillofac Surg 21:295–299CrossRefPubMed

McMillan AS (1995) Pain-pressure threshold in human gingivae. J Orofac Pain 9:44–50PubMed

10.

Ogimoto T, Ogawa T, Sumiyoshi K, Matsuka Y, Koyano K (2002) Pressure-pain threshold determination in the oral mucosa: validity and reliability. J Oral Rehabil 29:620–626CrossRefPubMed

11.

Fowler S, Reader A, Beck M (2015) Incidence of missed inferior alveolar nerve blocks in vital asymptomatic subjects and in patients with symptomatic irreversible pulpitis. J Endod 41:637–639CrossRefPubMed

12.

Rodriguez-Wong L, Pozos-Guillen A, Silva-Herzog D, Chavarria-Bolanos D (2016) Efficacy of mepivacaine-tramadol combination on the success of inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis: a randomized clinical trial. Int Endod J 49:325–333CrossRefPubMed

13.

Parirokh M, Sadr S, Nakhaee N, Abbott PV, Askarifard S (2014) Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: a randomized controlled trial. Int Endod J 47:926–933CrossRefPubMed

14.

Mikesell P, Nusstein J, Reader A, Beck M, Weaver J (2005) A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod 31:265–270CrossRefPubMed

15.

Jung IY, Kim JH, Kim ES, Lee CY, Lee SJ (2008) An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod 34:11–13CrossRefPubMed

16.

De Jong RH (1970) Kinetics of nerve block physiology and pharmacology of local anesthesia. Thomas, Springfield, pp 114–136

17.

Lee MH, Kim HJ, Kim DK, Yu SK (2015) Histologic features and fascicular arrangement of the inferior alveolar nerve. Arch Oral Biol 60:1736–1741CrossRefPubMed

18.

Tan VL, Andrawos A, Ghabriel MN, Townsend GC (2014) Applied anatomy of the lingual nerve: relevance to dental anaesthesia. Arch Oral Biol 59:324–335CrossRefPubMed

19.

Wongsirichat N, Pairuchvej V, Arunakul S (2011) Area extent anaesthesia from buccal nerve block. Int J Oral Maxillofac Surg 40:601–604CrossRefPubMed

20.

Drum M, Reader A, Beck M (2011) Long buccal nerve block injection pain in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 112:e51–e54CrossRefPubMed

Title: Anesthetic efficacy of an inferior alveolar nerve block in soft tissue and correlation between soft tissue and pulpal anesthesia
Authors: Sin-Yeon Cho
Wonwoo Choi
Junyoung Kim
Sung-Taek Kim
Hee-Jin Kim
Il-Young Jung
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 3/2019
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-018-2532-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 3/2019

Clinical and diagnostic significance of serum immunoglobulin A rheumatoid factor in primary Sjogren’s syndrome

Three-year clinical evaluation of high-viscosity glass ionomer restorations in non-carious cervical lesions: a randomised controlled split-mouth clinical trial

Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study

Variable impact by ambient temperature on fatigue resistance of heat-treated nickel titanium instruments

Factors influencing the effective dose associated with CBCT: a systematic review

Response to: “Direct oral anticoagulants, vitamin K antagonists and simple single tooth extraction”