J Dent Anesth Pain Med.  2020 Feb;20(1):9-17. 10.17245/jdapm.2020.20.1.9.

Clinical evaluation of efficacy of transcortical anesthesia for the extraction of impacted mandibular third molars: a randomized controlled trial

Affiliations
  • 1Department of Oral and Maxillofacial Surgery, Selçuk University Faculty of Dentistry, Konya, Turkey. esin_demir88@hotmail.com

Abstract

BACKGROUND
This study aimed to compare the pain levels during anesthesia and the efficacy of the QuickSleeper intraosseous (IO) injection system and conventional inferior alveolar nerve block (IANB) in impacted mandibular third molar surgery.
METHODS
This prospective randomized clinical trial included 30 patients (16 women, 14 men) with bilateral symmetrical impacted mandibular third molars. Thirty subjects randomly received either the IO injection or conventional IANB at two successive appointments. A split-mouth design was used in which each patient underwent treatment of a tooth with one of the techniques and treatment of the homologous contralateral tooth with the other technique. The subjects received 1.8 mL of 2% articaine. Subjects' demographic data, pain levels during anesthesia induction, tooth extractions, and mouth opening on postoperative first, third, and seventh days were recorded. Pain assessment ratings were recorded using the 100-mm visual analog scale. The latency and duration of the anesthetic effect, complications, and operation duration were also analyzed in this study. The duration of anesthetic effect was considered using an electric pulp test and by probing the soft tissue with an explorer.
RESULTS
Thirty patients aged between 18 and 47 years (mean age, 25 years) were included in this study. The IO injection was significantly less painful with lesser soft tissue numbness and quicker onset of anesthesia and lingual mucosa anesthesia with single needle penetration than conventional IANB. Moreover, 19 out of 30 patients (63%) preferred transcortical anesthesia. Mouth opening on postoperative first day was significantly better with intraosseous injection than with conventional IANB (P = 0.013).
CONCLUSION
The IO anesthetic system is a good alternative to IANB for extraction of the third molar with less pain during anesthesia induction and sufficient depth of anesthesia for the surgical procedure.

Keyword

Impacted Tooth; Intraosseous; QuickSleeper; Transcortical Anesthesia

MeSH Terms

Anesthesia*
Anesthetics
Appointments and Schedules
Carticaine
Female
Humans
Hypesthesia
Jupiter
Mandibular Nerve
Molar, Third*
Mouth
Mucous Membrane
Needles
Pain Measurement
Prospective Studies
Tooth
Tooth Extraction
Tooth, Impacted
Visual Analog Scale
Anesthetics
Carticaine

Figure

  • Fig. 1 QuickSleeper device has been set up (a) Anesthetic solution is deposited in the distal cancellous bone adjacent to the mandibular third molar tooth to be anesthetized (b)


Reference

1. Hung PC, Chang HH, Yang PJ, Kuo YS, Lan WH, Lin CP. Comparison of the Gow-Gates mandibular block and inferior alveolar nerve block using a standardized protocol. J Formos Med Assoc. 2006; 105:139–146. PMID: 16477334.
Article
2. Goldberg S, Reader A, Drum M, Nusstein J, Beck M. Comparison of the anesthetic efficacy of the conventional inferior alveolar, Gow-Gates, and Vazirani-Akinosi techniques. J Endod. 2008; 34:1306–1311. PMID: 18928837.
Article
3. Verma PK, Srivastava R, Ramesh KM. Anesthetic efficacy of X-tip intraosseous injection using 2% lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: a clinical study. J Conserv Dent. 2013; 16:162–166. PMID: 23716971.
Article
4. Boonsiriseth K, Sirintawat N, Arunakul K, Wongsirichat N. Comparative study of the novel and conventional injection approach for inferior alveolar nerve block. Int J Oral Maxillofac Surg. 2013; 42:852–856. PMID: 23265758.
Article
5. Razavian H, Kazemi S, Khazaei S, Jahromi MZ. X-tip intraosseous injection system as a primary anesthesia for irreversible pulpitis of posterior mandibular teeth: a randomized clinical trail. Dent Res J (Isfahan). 2013; 10:210–213. PMID: 23946738.
6. Cohen HP, Cha BY, Spångberg LS. Endodontic anesthesia in mandibular molars: a clinical study. J Endod. 1993; 19:370–373. PMID: 8245762.
Article
7. Reisman D, Reader A, Nist R, Beck M, Weaver J. Anesthetic efficacy of the supplemental intraosseous injection of 3% mepivacaine in irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012; 114:S132–S139. PMID: 23063389.
Article
8. Bigby J, Reader A, Nusstein J, Beck M, Weaver J. Articaine for supplemental intraosseous anesthesia in patients with irreversible pulpitis. J Endod. 2006; 32:1044–1047. PMID: 17055903.
Article
9. Idris M, Sakkir N, Naik KG, Jayaram NK. Intraosseous injection as an adjunct to conventional local anesthetic techniques: a clinical study. J Conserv Dent. 2014; 17:432–435. PMID: 25298642.
Article
10. NIH consensus development conference for removal of third molars. J Oral Surg. 1980; 38:235–236. PMID: 6101618.
11. Werkmeister R, Fillies T, Joos U, Smolka K. Relationship between lower wisdom tooth position and cyst development, deep abscess formation and mandibular angle fracture. J Craniomaxillofac Surg. 2005; 33:164–168. PMID: 15878516.
Article
12. Chevalier V, Arbab-Chirani R, Tea SH, Roux M. Facial palsy after inferior alveolar nerve block: case report and review of the literature. Int J Oral Maxillofac Surg. 2010; 39:1139–1142. PMID: 20605412.
Article
13. Smail-Faugeron V, Muller-Bolla M, Sixou JL, Courson F. Split-mouth and parallel-arm trials to compare pain with intraosseous anaesthesia delivered by the computerised Quicksleeper system and conventional infiltration anaesthesia in paediatric oral healthcare: protocol for a randomised controlled trial. BMJ open. 2015; 5:e007724.
Article
14. Madan GA, Madan SG, Madan AD. Failure of inferior alveolar nerve block: exploring the alternatives. J Am Dent Assoc. 2002; 133:843–846. PMID: 12148677.
15. Özer 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–S139. PMID: 23063389.
Article
16. Sovatdy S, Vorakulpipat C, Kiattavorncharoen S, Saengsirinavin C, Wongsirichat N. Inferior alveolar nerve block by intraosseous injection with Quicksleeper® at the retromolar area in mandibular third molar surgery. J Dent Anesth Pain Med. 2018; 18:339–347. PMID: 30637344.
Article
17. Horalek AA. A new approach to intraosseous anesthesia: the Intraflow™ HTP Anesthesia System. Dent Trib Russ. 2008; (6):
18. Eshghpour M, Rezaei NM, Nejat A. Effect of menstrual cycle on frequency of alveolar osteitis in women undergoing surgical removal of mandibular third molar: a single-blind randomized clinical trial. J Oral Maxillofac Surg. 2013; 71:1484–1489. PMID: 23866782.
19. Xue P, Wang J, Wu B, Ma Y, Wu F, Hou R. Efficacy of antibiotic prophylaxis on postoperative inflammatory complications in Chinese patients having impacted mandibular third molars removed: a split-mouth, double-blind, self-controlled, clinical trial. Br J Oral Maxillofac Surg. 2015; 53:416–420. PMID: 25794779.
Article
20. Zandi M, Amini P, Keshavarz A. Effectiveness of cold therapy in reducing pain, trismus, and oedema after impacted mandibular third molar surgery: a randomized, self-controlled, observer-blind, split-mouth clinical trial. Int J Oral Maxillofac Surg. 2016; 45:118–123. PMID: 26597577.
Article
21. Smyth J, Marley J. An unusual delayed complication of inferior alveolar nerve block. Br J Oral Maxillofac Surg. 2010; 48:51–52. PMID: 19297060.
Article
22. Pogrel MA. What is the effect of timing of removal on the incidence and severity of complications? J Oral Maxillofac Surg. 2012; 70:S37–S40. PMID: 22705212.
Article
23. Wright EF. Medial pterygoid trismus (myospasm) following inferior alveolar nerve block: case report and literature review. Gen Dent. 2011; 59:64–67. PMID: 21613042.
24. Woodmansey KF, White RK, He J. Osteonecrosis related to intraosseous anesthesia: report of a case. J Endod. 2009; 35:288–291. PMID: 19166792.
Article
25. 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; 81:634–641. PMID: 8784893.
Article
26. Graetz C, Fawzy-El-Sayed KM, Graetz N, Dörfer CE. Root damage induced by intraosseous anesthesia. An in vitro investigation. Med Oral Patol Oral Cir Bucal. 2013; 18:e130–e134. PMID: 23229260.
27. Beneito-Brotons R, Peñarrocha-Oltra D, Ata-Ali J, Peñarrocha 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–e429. PMID: 22143722.
Article
28. Replogle K, Reader A, Nist R, Beck M, Weaver J, Meyers WJ. Anesthetic efficacy 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; 83:30–37. PMID: 9007920.
Article
29. Fernandez C, Reader A, Beck M, Nusstein J. A prospective, randomized, double-blind comparison of bupivacaine and lidocaine for inferior alveolar nerve blocks. J Endod. 2005; 31:499–503. PMID: 15980707.
Article
30. Remmers T, Glickman G, Spears R, He J. The efficacy of IntraFlow intraosseous injection as a primary anesthesia technique. J Endod. 2008; 34:280–283. PMID: 18291275.
Article
31. Sixou JL, Barbosa-Rogier ME. Efficacy of intraosseous injections of anesthetic in children and adolescents. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 106:173–178. PMID: 18424118.
Article
Full Text Links
  • JDAPM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr