Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
권호 표지
DOI QR코드

DOI QR Code

Alternative techniques for failure of conventional inferior alveolar nerve block

  • Lee, Choi Ryang (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University) ;
  • Yang, Hoon Joo (Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University)
  • Received : 2019.05.20
  • Accepted : 2019.06.26
  • Published : 2019.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Successful local anesthesia in dental treatment is the most important prerequisite for pain control of patients. However, unlike that in the maxilla, it is difficult to administer local anesthesia in the mandible, and the success rate of conventional inferior alveolar nerve block (IANB) is only 80-85%. It is attributed to various causes such as anatomical variations, extreme anxiety, and technical errors; thus, various alternatives have been devised to improve this. We will analyze the causes of failure in conventional IANB and examine various alternatives that can be applied in these cases.

Keywords

References

  1. Johnson TM, Badovinac R, Shaefer J. Teaching alternatives to the standard inferior alveolar nerve block in dental education: outcomes in clinical practice. J Dental Educ 2007; 71: 1145-52. https://doi.org/10.1002/j.0022-0337.2007.71.9.tb04378.x
  2. Palti DG, Almeida CM, Rodrigues Ade C, Andreo JC, Lima JE. Anesthetic technique for inferior alveolar nerve block: a new approach. J Appl Oral Sci 2011; 19(1): 11-5. https://doi.org/10.1590/S1678-77572011000100004
  3. Malamed SF. Techniques of mandibular anesthesia. In: Handbook of Local Anesthesia. 4th ed. Noida, India, Harcourt Brace. 1997, pp 193-219.
  4. Haas DA. Alternative mandibular nerve block techniques: a review of the Gow-Gates and Akinosi-Vazirani closedmouth mandibular nerve block techniques. J Am Dent Assoc 2011; 142(Suppl 3): 8S-12S. https://doi.org/10.14219/jada.archive.2011.0341
  5. Murphy TR, Grundy EM. The inferior alveolar neurovascular bundle at the mandibular foramen. Dent Pract Dent Rec 1969; 20: 41-8.
  6. Khoury J, Mihailidis S, Ghabriel M, Townsend G. Anatomical relationships within the human pterygomandibular space: Relevance to local anesthesia. Clin Anat 2010; 23: 936-44. https://doi.org/10.1002/ca.21047
  7. Roda RS Blanton PL. The anatomy of local anesthesia. Quintessence Int 1994; 25: 27-38.
  8. Barker BC, Davies PL. The applied anatomy of the pterygomandibular space. Br J Oral Surg 1972; 10: 43-55. https://doi.org/10.1016/S0007-117X(72)80008-8
  9. Sicher H, DuBrul E. Oral Anatomy. 6th ed. St. Louis, MO, C.V. Mosby Company. 1975.
  10. Ashkenazi M, Sher I, Rackoz M, Schwartz-Arad D. Mandibular block success rate in relation to needle insertion and position: a self-report survey. Eur Arch Paediatr Dent 2014; 15: 121-6. https://doi.org/10.1007/s40368-013-0073-0
  11. Thangavelu K, Kannan R, Kumar NS, Rethish E, Sabitha S, Sayeeganesh N. Significance of localization of mandibular foramen in an inferior alveolar nerve block. J Nat Sci Biol Med 2012; 3: 156-60. https://doi.org/10.4103/0976-9668.101896
  12. Fujimura K, Segami N, Kobayashi S. Anatomical study of the complications of intraoral vertico-sagittal ramus osteotomy. J Oral Maxillofac Surg 2006; 64: 384-9. https://doi.org/10.1016/j.joms.2005.11.009
  13. Hayward J, Richardson ER, Malhotra SK. The mandibular foramen: its anteroposterior position. Oral Surg Oral Med Oral Pathol 1977; 44: 837-43. https://doi.org/10.1016/0030-4220(77)90027-5
  14. Hetson G, Share J, Frommer J, Kronman JH. Statistical evaluation of the position of the mandibular foramen. Oral Surg Oral Med Oral Pathol 1988; 65: 32-4. https://doi.org/10.1016/0030-4220(88)90187-9
  15. Ashkenazi M, Taubman L, Gavish A. Age-associated changes of the mandibular foramen position in anteroposterior dimension and of the mandibular angle in dry human mandibles. Anat Rec 2011; 294: 1319-25. https://doi.org/10.1002/ar.21429
  16. da Fontoura RA, Vasconcellos HA, Campos AE. Morphologic basis for the intraoral vertical ramus osteotomy: anatomic and radiographic localization of the mandibular foramen. J Oral Maxillofac Surg 2002; 60: 660-5. https://doi.org/10.1053/joms.2002.33115
  17. Khoury JN, Mihailidis S, Ghabriel M, Townsend G. Applied anatomy of the pterygomandibular space: improving the success of inferior alveolar nerve blocks. Aust Dent J 2011; 56: 112-21. https://doi.org/10.1111/j.1834-7819.2011.01312.x
  18. Takasugi Y, Furuya H, Moriya K, Okamoto Y. Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen. Anesth Prog 2000; 47: 125-9.
  19. Berns JM, Sadove MS. Mandibular block injection: a method of study using an injected radiopaque material. J Am Dent Assoc 1962; 65: 735-45. https://doi.org/10.14219/jada.archive.1962.0337
  20. Garg A, Townsend G. Anatomical variation of the sphenomandibular ligament. Aust Endod J 2001; 27: 22-4. https://doi.org/10.1111/j.1747-4477.2001.tb00446.x
  21. Shiozaki H, Abe S, Tsumori N, Shiozaki K, Kaneko Y, Ichinohe T. Macroscopic anatomy of the sphenomandibular ligament related to the inferior alveolar nerve block. Cranio 2007; 25: 160-5. https://doi.org/10.1179/crn.2007.025
  22. Khalil H. A basic review on the inferior alveolar nerve block techniques. Anesth Essays Res 2014; 8: 3-8. https://doi.org/10.4103/0259-1162.128891
  23. Thotakura B, Rajendran SS, Gnanasundaram V, Subramaniam A. Variations in the posterior division branches of the mandibular nerve in human cadavers. Singapore Med J 2013; 54: 149-51. https://doi.org/10.11622/smedj.2013051
  24. Siessere S, Hallak Regalo SC, Semprini M, Honorato De Oliveira R, Vitti M, Mizusaki Iyomasa M, et al. Anatomical variations of the mandibular nerve and its branches correlated to clinical situations. Minerva Stomatol 2009; 58: 209-15.
  25. Kim SY, Hu KS, Chung IH, Lee EW, Kim HJ. Topographic anatomy of the lingual nerve and variations in communication pattern of the mandibular nerve branches. Surg Radiol Anat 2004; 26: 128-35. https://doi.org/10.1007/s00276-003-0179-x
  26. DeSantis JL, Liebow C. Four common mandibular nerve anomalies that lead to local anesthesia failures. J Am Dent Assoc 1996; 127: 1081-6. https://doi.org/10.14219/jada.archive.1996.0333
  27. Stein P, Brueckner J, Milliner M. Sensory innervation of mandibular teeth by the nerve to the mylohyoid: implications in local anesthesia. Clin Anat 2007; 20: 591-5. https://doi.org/10.1002/ca.20479
  28. Arensburg B, Nathan H. Anatomical observations on the mylohyoid groove, and the course of the mylohyoid nerve and vessels. J Oral Surg 1979; 37: 93-6.
  29. Jidoi K, Nara T, Dodo Y. Bony bridging of the mylohyoid groove of the human mandible. Anthropol Sci 2000; 108: 345-70. https://doi.org/10.1537/ase.108.345
  30. Madeira MC, Percinoto C, das Gracas M, Silva M. Clinical significance of supplementary innervation of the ower incisor teeth: a dissection study of the mylohyoid nerve. Oral Surg Oral Med Oral Pathol 1978; 46: 608-14. https://doi.org/10.1016/0030-4220(78)90455-3
  31. Ossenberg NS. Retromolar foramen of the human mandible. Am J Phys Anthropol 1987; 73: 119-28. https://doi.org/10.1002/ajpa.1330730112
  32. Tong DC. The great auricular nerve: a case report and review of anatomy. N Z Dent J 2000; 96: 57.
  33. Malamed SF. Techniques of mandibular anesthesia. In: Handbook of Local Anesthesia. 5th ed. St. Louis, Mosby; 2004: 227-37.
  34. Lew K, Townsend G. Failure to obtain adequate anaesthesia associated with a bifid mandibular canal: a case report. Aust Dent J 2006; 51: 86-90. https://doi.org/10.1111/j.1834-7819.2006.tb00406.x
  35. Sanchis J, Penarrocha M, Soler F. Bifid mandibular canal. J Oral Maxillofac Surg 2003; 61: 422-4. https://doi.org/10.1053/joms.2003.50004
  36. Langlais RP, Broadus R, Glass BJ. Bifid mandibular canals in panoramic radiographs. J Am Dent Assoc 1985; 110: 923-6. https://doi.org/10.14219/jada.archive.1985.0033
  37. Kaufman E, Weinstein P, Milgrom P. Difficulties in achieving local anesthesia. J Am Dent Assoc 1984; 108: 205-8. https://doi.org/10.14219/jada.archive.1984.0470
  38. Madan GA, Madan SG, Madan AD. Failure of inferior alveolar nerve block: exploring the alternatives. J Am Dent Assoc 2002; 133: 843-6. https://doi.org/10.14219/jada.archive.2002.0298
  39. DuBrul EL. Anatomy of mandibular anesthesia. In: DuBrul EL, Sicher H, eds. Sicher and Dubrul's Oral Anatomy. 8th ed. St. Louis, Ishiyaku EuroAmerica. 1996, pp 273-80.
  40. Shields PW. Further observations on mandibular anaesthesia. Aust Dent J 1977; 22: 334-7. https://doi.org/10.1111/j.1834-7819.1977.tb05118.x
  41. You TM, Kim KD, Huh J, Woo EJ, Park W. The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia. J Dent Anesth Pain Med 2015; 15: 113-9. https://doi.org/10.17245/jdapm.2015.15.3.113
  42. Keros J, Kobler P, Baucic I, Cabov T. Foramen mandibulae as an indicator of successful conduction anesthesia. Coll Antropol 2001; 25: 327-31.
  43. Meechan JG. How to overcome failed anaesthesia. Br Dent J 1999; 186: 15-20. https://doi.org/10.1038/sj.bdj.4800006
  44. Saatchi M, Shafiee M, Khademi A, Memarzadeh B. Anesthetic efficacy of Gow-Gates nerve block, inferior alveolar nerve block, and their combination in mandibular molars with symptomatic irreversible pulpitis: a prospective, randomized clinical trial. J Endod 2018; 44: 384-8. https://doi.org/10.1016/j.joen.2017.10.008
  45. Nusstein J, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis. J Endod 1998; 24: 487-91. https://doi.org/10.1016/S0099-2399(98)80053-8
  46. Saatchi M, Khademi A, Baghaei B, Noormohammadi H. Effect of sodium bicarbonate-buffered lidocaine on the success of inferior alveolar nerve block for teeth with symptomatic irreversible pulpitis: a prospective, randomized double-blind study. J Endod 2015; 41: 33-5. https://doi.org/10.1016/j.joen.2014.09.011
  47. Tortamano IP, Siviero M, Costa CG, Buscariolo IA, Armonia PL. A comparison of the anesthetic efficacy of articaine and lidocaine in patients with irreversible pulpitis. J Endod 2009; 35: 165-8. https://doi.org/10.1016/j.joen.2008.10.020
  48. Chaudhary P, Martenson ME, Baumann TK. Vanilloid receptor expression and capsaicin excitation of rat dental primary afferent neurons. J Dent Res 2001; 80: 1518-23. https://doi.org/10.1177/00220345010800060801
  49. Goodis HE, Poon A, Hargreaves KM. Tissue pH and temperature regulate pulpal nociceptors. J Dent Res 2006; 85: 1046-9. https://doi.org/10.1177/154405910608501114
  50. Hargreaves KM, Keiser K. Local anesthetic failure in endodontics. Endod Topics 2002; 1: 26-39. https://doi.org/10.1034/j.1601-1546.2002.10103.x
  51. Stenholm E, Bongenhielm U, Ahlquist M, Fried K. VRland VRL-l-like immunoreactivity in normal and injured trigeminal dental primary sensory neurons of the rat. Acta Odontol Scand 2002; 60: 72-9. https://doi.org/10.1080/000163502753509455
  52. Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod. 2012; 38: 421-5. https://doi.org/10.1016/j.joen.2011.12.006
  53. Simpson M, Drum M, Nusstein J, Reader A, Beck M. Effect of combination of preoperative ibuprofen/ acetaminophen on the success of the inferior alveolar nerve block in patients with symptomatic irreversible pulpitis. J Endod 2011; 37: 593-7. https://doi.org/10.1016/j.joen.2011.02.015
  54. Haase A, Reader A, Nusstein J, Beck M, Drum M. Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block. J Am Dent Assoc 2008; 139: 1228-35. https://doi.org/10.14219/jada.archive.2008.0338
  55. Malamed SF. Supplemental injection techniques. In: Handbook of Local Anesthesia. 4th ed. Noida, India, Harcourt Brace. 1997, pp 220-31.
  56. Walton RE, Abbot BJ. Periodontal ligament injection: a clinical evaluation. J Am Dent Assoc 1981; 103: 571-5. https://doi.org/10.14219/jada.archive.1981.0307
  57. Smith GN, Walton RE, Abbott BJ. Clinical evaluation of periodontal ligament anesthesia using a pressure syringe. J Am Dent Assoc 1983; 107: 953-6. https://doi.org/10.14219/jada.archive.1983.0357
  58. Moore PA, Cuddy MA, Cooke MR, Sokolowski CJ. Periodontal ligament and intraosseous anesthetic injection techniques: alternatives to mandibular nerve blocks. J Am Dent Assoc 2011; 142 Suppl 3: 13S-8S. https://doi.org/10.14219/jada.archive.2011.0342
  59. Shabazfar N, Daublander M, Al-Nawas B, Kammerer PW. Periodontal intraligament injection as alternative to inferior alveolar nerve block-meta-analysis of the literature from 1979 to 2012. Clin Oral Investig 2014; 18: 351-8. https://doi.org/10.1007/s00784-013-1113-1
  60. Berlin J, Nusstein J, Reader A, Beck M, Weaver J. Efficacy of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005; 99: 361-6. https://doi.org/10.1016/j.tripleo.2004.11.009
  61. Masselink BH. The advent of painless dentistry. Dent Cosmos 1910; 52: 868-72.
  62. Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod 2004; 30: 568-71. https://doi.org/10.1097/01.DON.0000125317.21892.8F
  63. Malamed SF. Supplemental injection techniques. In: Handbook of Local Anesthesia. 5th ed. St. Louis: Mosby. 2004, pp 256-275.
  64. Roberts GJ, Simmons NB, Longhurst P, Hewitt PB. Bacteraemia following local anaesthetic injections in children. Br Dent J 1998; 185: 295-8. https://doi.org/10.1038/sj.bdj.4809795
  65. Brannstrom M, Lindskog S, Nordenvall KJ. Enamel hypoplasia in permanent teeth induced by periodontal ligament anesthesia of primary teeth. J Am Dent Assoc 1984; 109: 735-6. https://doi.org/10.14219/jada.archive.1984.0172
  66. Masselink BH. The advent of painless dentistry. Dent Cosmos 1910; 52: 868-72.
  67. Replogle K, Reader A, Nist R, Beck M, Weaver J, Meyers WJ. Anesthetic efficiency of the intraosseous injection of 2% lidocaine (1:100,000 epinephrine) and 3% mepivacaine in mandibular first molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997; 83: 30-7. https://doi.org/10.1016/S1079-2104(97)90087-1
  68. Replogle K, Reader A, Nist R, Beck M, Weaver J, Meyers WJ. Cardiovascular effects of intraosseous injections of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine. J Am Dent Assoc 1999; 130: 649-57. https://doi.org/10.14219/jada.archive.1999.0274
  69. Coggins R, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the intraosseous injection in maxillary and mandibular teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996; 81: 634-41. https://doi.org/10.1016/S1079-2104(96)80067-9
  70. Sam S, Chakorn V, Sirichai K, Chavengkiat S, Natthamet W. Inferior alveolar nerve block by intraosseous injection with $Quicksleeper^{(R)}$ at the retromolar area in mandibular third molar surgery. J Dent Anesth Pain Med 2018; 18: 339-47. https://doi.org/10.17245/jdapm.2018.18.6.339
  71. Nusstein J, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the supplemental intraosseous injection of 2% lidocaine with 1:100,000 epinephrine in irreversible pulpitis. J Endod 1998; 24: 487-91. https://doi.org/10.1016/S0099-2399(98)80053-8
  72. Parente SA, Anderson RW, Herman WW, Kimbrough WF, Weller RN. Anesthetic efficacy of the supplemental intraosseous injection for teeth with irreversible pulpitis. J Endod 1998; 24: 826-8. https://doi.org/10.1016/S0099-2399(98)80011-3
  73. Gow-Gates GA. Mandibular conduction anesthesia: a new technique using extraoral landmarks. Oral Surg Oral Med Oral Pathol 1973; 36: 321-8. https://doi.org/10.1016/0030-4220(73)90208-9
  74. Thangavelu K, Kannan R, Kumar NS. Inferior alveolar nerve block: alternative technique. Anesth Essays Res 2012; 6: 53-7. https://doi.org/10.4103/0259-1162.103375
  75. Malamed SF. The Gow-Gates mandibular block. Evaluation after 4,275 cases. Oral Surg Oral Med Oral Pathol 1981; 5: 463-7. https://doi.org/10.1016/0030-4220(52)90226-0
  76. Levy TP. An assessment of the Gow-Gates mandibular block for third molar surgery. J Am Dent Assoc 1981; 103: 37-41. https://doi.org/10.14219/jada.archive.1981.0467
  77. Jofre J, Munzenmayer C. Design and preliminary evaluation of an extra oral Gow-Gates guiding device. Oral Surg oral Med Oral Pathol Oral Radiol Endod 1998; 85: 661. https://doi.org/10.1016/S1079-2104(98)90032-4
  78. Vazirani SJ. Closed mouth mandibular nerve block: a new technique. Dent Dig 1960; 66: 10-3.
  79. Akinosi JO. A new approach to the mandibular nerve block. Br J Oral Surg 1977; 15: 83-7. https://doi.org/10.1016/0007-117X(77)90011-7
  80. Dover WS. The mandibular block injections it sometimes fails. J Dent Assoc South Afr 1971; 26: 373-7.
  81. Chakranarayan A, Mukherjee B. Arched needle technique for inferior alveolar mandibular nerve block. J Maxillofac Oral Surg. 2013; 12: 113-6. https://doi.org/10.1007/s12663-011-0310-1
  82. Parsons-Smith G, Roberts JM. Facial paralysis after local dental anaesthesia. Br Med J 1970; 4: 745-6. https://doi.org/10.1136/bmj.4.5737.745-c

Cited by

  1. How Successful is Supplemental Intraseptal and Buccal Infiltration Anaesthesia in the Mandibular Molars of Patients Undergoing Root Canal Treatment or Tooth Extraction? vol.11, pp.1, 2020, https://doi.org/10.5037/jomr.2020.11105
  2. The success of using 2% lidocaine in pain removal during extraction of mandibular premolars: a prospective clinical study vol.20, pp.1, 2019, https://doi.org/10.1186/s12903-020-01228-x
  3. Effectiveness of face-to-face, blended and e-learning in teaching the application of local anaesthesia: a randomised study vol.21, pp.1, 2019, https://doi.org/10.1186/s12909-021-02569-z