Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Programmed-release intraosseus anesthesia as an alternative to lower alveolar nerve block in lower third molar extraction: a randomized clinical trial

  • Pol, Renato (Oral Surgery Unit, Dentistry Section, Department of Surgical Sciences, University of Turin, Dental School) ;
  • Ruggiero, Tiziana (Oral Surgery Unit, Dentistry Section, Department of Surgical Sciences, University of Turin, Dental School) ;
  • Bezzi, Marta (Oral Surgery Unit, Dentistry Section, Department of Surgical Sciences, University of Turin, Dental School) ;
  • Camisassa, Davide (Oral Surgery Unit, Dentistry Section, Department of Surgical Sciences, University of Turin, Dental School) ;
  • Carossa, Stefano (Oral Surgery Unit, Dentistry Section, Department of Surgical Sciences, University of Turin, Dental School)
  • Received : 2021.09.12
  • Accepted : 2022.05.23
  • Published : 2022.06.01
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Abstract

Background: Intraosseous anesthesia is the process by which an anesthetic solution, after penetration of the cortical bone, is directly injected into the spongiosa of the alveolar bone supporting the tooth. This study aimed to compare the effectiveness of the traditional inferior alveolar nerve block (IANB) and computerized intraosseous anesthesia in the surgical extraction of impacted lower third molars, compare their side effects systemically by monitoring heart rate, and assess patients' a posteriori preference of one technique over the other. Methods: Thirty-nine patients with bilaterally impacted third molars participated in this study. Each patient in the sample was both a case and control, where the conventional technique was randomly assigned to one side (group 1) and the alternative method to the contralateral side (group 2). Results: The traditional technique was faster in execution than anesthesia delivered via electronic syringe, which took 3 min to be administered. However, it was necessary to wait for an average of 6 ± 4 min from the execution to achieve the onset of IANB, while the latency of intraosseous anesthesia was zero. Vincent's sign and lingual nerve anesthesia occurred in 100% of cases in group 1. In group 2, Vincent's sign was recorded in 13% of cases and lingual anesthesia in four cases. The average duration of the perceived anesthetic effect was 192 ± 68 min in group 1 and 127 ± 75 min in group 2 (P < 0.001). The difference between the heart rate of group 1 and group 2 was statistically significant. During infiltration in group 1, heartbeat frequency increased by 5 ± 13 beats per minute, while in group 2, it increased by 22 ± 10 beats per minute (P < 0.001). No postoperative complications were reported for either technique. Patients showed a preference of 67% for the alternative technique and 20% for the traditional, and 13% of patients were indifferent. Conclusion: The results identified intraosseous anesthesia as a valid alternative to conventional anesthesia in impacted lower third molar extraction.

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References

  1. The glossary of prosthodontic terms: ninth edition. J Prosthet Dent 2017; 117: e1-105.
  2. 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
  3. 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
  4. Dental Hi Tec - QuickSleeper, l'expert de l'anesthesie. Dental Hi Tec. Available from http://www.dentalhitec.com/2015en/products/quicksleeper/
  5. Deepak V, Challa RR, Kamatham R, Nuvvula S. Comparison of a new auto-controlled injection system with traditional syringe for mandibular infiltrations in children: a randomized clinical trial. Anesth Essays Res 2017; 11: 431-8. https://doi.org/10.4103/0259-1162.194535
  6. Zhao X, Liu H, Qin M. Application of computer-controlled local anesthetic delivery system in children. Hua Xi Kou Qiang Yi Xue Za Zhi 2011; 29: 389-92.
  7. Ozer S, Yaltirik M, Kirli I, Yargic I. A comparative evaluation of pain and anxiety levels in 2 different anesthesia techniques: locoregional anesthesia using conventional syringe versus intraosseous anesthesia using a computer-controlled system (Quicksleeper). Oral Surg Oral Med Oral Pathol Oral Radiol 2012 ;114: S132-9. https://doi.org/10.1016/j.oooo.2011.09.021
  8. Ghaderi F, Ahmadbeigi M. Pain perception due to dental injection by Smartject: split mouth design study. J Dent 2018; 19: 57-62.
  9. Perugia C, Bartolino M, Docimo R. Comparison of single tooth anaesthesia by computer-controlled local anaesthetic delivery system (C-CLADS) with a supraperiosteal traditional syringe injection in paediatric dentistry. Eur J Paediatr Dent 2017; 18: 221-5.
  10. Mozzati M, Pol R. Chirurgia Stomatologica biologicamente guidata. Vol. 2. 2018
  11. Cros J. Transcortical anesthesia: experimental approach and importance in odontology. Available from http://www.dentalhitec.com/web2/upload_fich/bibliographie2007_07_tc_experimental_approach_and_importance_in_odontology.pdf.
  12. Tolas AG, Pflug AE, Halter JB. Arterial plasma epinephrine concentrations and hemodynamic responses after dental injection of local anesthetic with epinephrine. J Am Dent Assoc 1982; 104: 41-3. https://doi.org/10.14219/jada.archive.1982.0114
  13. Kiyomitsu Y, Sugiyama K, Joh S. Effects of catecholamines added to lidocaine on cardiac function. Anesth Prog 1989; 36: 198-200.
  14. Sixou JL, Marie-Cousin A, Huet A, Hingant B, Robert JC. Pain assessment by children and adolescents during intraosseous anaesthesia using a computerized system (QuickSleeper). Int J Paediatr Dent 2009; 19: 360-6. https://doi.org/10.1111/j.1365-263X.2009.00983.x
  15. Beneito-Brotons R, Penarrocha-Oltra D, Ata-Ali J, Penarrocha M. Intraosseous anesthesia with solution injection controlled by a computerized system versus conventional oral anesthesia: a preliminary study. Med Oral Patol Oral Cir Bucal 2012; 17: e426-9.