Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Posterior superior alveolar nerve block alone in the extraction of upper third molars: a prospective clinical study

  • Received : 2023.03.08
  • Accepted : 2023.06.13
  • Published : 2023.08.01
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Abstract

Background: Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction. Methods: A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used. Results: In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation. Conclusion: The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.

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References

  1. Milgrom P, Coldwell SE, Getz T, Weinstein P, Ramsay DS. Four dimensions of fear of dental injections. J Am Dent Assoc 1997; 128: 756-66. https://doi.org/10.14219/jada.archive.1997.0301
  2. Meechan JG. Effective topical anesthetic agents and techniques. Dent Clin North Am 2002; 46: 759-66. https://doi.org/10.1016/S0011-8532(02)00035-6
  3. Harbert H. Topical ice: A precursor to palatal injections. J Endod 1989; 15: 27-8. https://doi.org/10.1016/S0099-2399(89)80094-9
  4. Friedman MJ, Hochman MN. A 21st century computerized injection system for local pain control. Compend Contin Educ Dent 1997; 18: 995-1000, 2-3; quiz 4.
  5. Meechan JG, Winter RA. A comparison of topical anaesthesia and electronic nerve stimulation for reducing the pain of intra-oral injections. Br Dent J 1996; 181: 333-5. https://doi.org/10.1038/sj.bdj.4809252
  6. Sekhar GR, Nagaraju T, Nandagopal V, Sudheer R. Is palatal injection mandatory prior to extraction of permanent maxillary tooth: A preliminary study. Indian J Dent Res 2011; 22: 100-2. https://doi.org/10.4103/0970-9290.80006
  7. Fan S, Chen WL, Yang ZH, Huang ZQ. Comparison of the efficiencies of permanent maxillary tooth removal performed with single buccal infiltration versus routine buccal and palatal injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 359-63. https://doi.org/10.1016/j.tripleo.2008.08.025
  8. Lima-Junior JL, Dias-Ribeiro E, de Araujo TN, Ferreira-Rocha J, Honfi-Junior ES, Sarmento CF, et al. Evaluation of the buccal vestibule-palatal diffusion of 4% articaine hydrochloride in impacted maxillary third molar extractions. Med Oral Patol Oral Cir Bucal 2009; 14: E129-32.
  9. Uckan S, Dayangac E, Araz K. Is permanent maxillary tooth removal without palatal injection possible? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006; 102: 733-5. https://doi.org/10.1016/j.tripleo.2005.12.005
  10. Ozec I, Tasdemir U, Gumus C, Solak O. Is it possible to anesthetize palatal tissues with buccal 4% articaine injection? J Oral Maxillofac Surg 2010; 68: 1032-7. https://doi.org/10.1016/j.joms.2009.12.023
  11. Malamed SF. Handbook of local anesthesia. 6th ed. St. Louis, Elsevier Inc. 2013.
  12. Phyo HE, Chaiyasamut T, Kiattavorncharoen S, Pairuchvej V, Bhattarai BP, Wongsirichat N. Single buccal infiltration of high concentration lignocaine versus articaine in maxillary third molar surgery. J Dent Anesth Pain Med 2020; 20: 203-12. https://doi.org/10.17245/jdapm.2020.20.4.203
  13. Kanaa MD, Whitworth JM, Meechan JG. A comparison of the efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine in achieving pulpal anesthesia in maxillary teeth with irreversible pulpitis. J Endod 2012; 38: 279-82. https://doi.org/10.1016/j.joen.2011.11.010
  14. Vilchez-Perez MA, Sancho-Puchades M, Valmaseda-Castellon E, Paredes-Garcia J, Berini-Aytes L, Gay-Escoda C. A prospective, randomized, triple-blind comparison of articaine and bupivacaine for maxillary infiltrations. Med Oral Patol Oral Cir Bucal 2012; 17: e325-30. https://doi.org/10.4317/medoral.17476
  15. Evans G, Nusstein J, Drum M, Reader A, Beck M. A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations. J Endod 2008; 34: 389-93. https://doi.org/10.1016/j.joen.2008.01.004
  16. Poorni S, Veniashok B, Senthilkumar AD, Indira R, Ramachandran S. Anesthetic efficacy of four percent articaine for pulpal anesthesia by using inferior alveolar nerve block and buccal infiltration techniques in patients with irreversible pulpitis: A prospective randomized double-blind clinical trial. J Endod 2011; 37: 1603-7. https://doi.org/10.1016/j.joen.2011.09.009
  17. Costa CG, Tortamano IP, Rocha RG, Francischone CE, Tortamano N. Onset and duration periods of articaine and lidocaine on maxillary infiltration. Quintessence Int 2005; 36: 197-201. https://doi.org/10.1016/j.prosdent.2005.05.012
  18. 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
  19. Vahatalo K, Antila H, Lehtinen R. Articaine and lidocaine for maxillary infiltration anesthesia. Anesth Prog 1993; 40: 114-6.
  20. Roberts DH, Sowray JH. Local analgesia in dentistry. 3rd ed. Butterworth-Heinemann Ltd. 1987.
  21. Shields PW. Local anaesthesia and applied anatomy. Aust Dent J 1986; 31: 319-25. https://doi.org/10.1111/j.1834-7819.1986.tb01218.x
  22. Isik K, Kalayci A, Durmus E. Comparison of depth of anesthesia in different parts of maxilla when only buccal anesthesia was done for maxillary teeth extraction. Int J Dent 2011; 2011: 575874.
  23. Khan SR, Qazi SR. Extraction of maxillary teeth by dental students without palatal infiltration of local anaesthesia: a randomised controlled trial. Eur J Dent Educ 2017; 21: e39-e42. https://doi.org/10.1111/eje.12215
  24. Srinivasan N, Kavitha M, Loganathan CS, Padmini G. Comparison of anesthetic efficacy of 4% articaine and 2% lidocaine for maxillary buccal infiltration in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 133-6. https://doi.org/10.1016/j.tripleo.2008.09.002
  25. Kumaresan R, Srinivasan B, Pendayala S. Comparison of the effectiveness of lidocaine in permanent maxillary teeth removal performed with single buccal infiltration versus routine buccal and palatal injection. J Maxillofac Oral Surg 2015; 14: 252-7. https://doi.org/10.1007/s12663-014-0624-x
  26. Kandasamy S, Elangovan R, John RR, Nantha Kumar C. Removal of maxillary teeth with buccal 4% articaine without using palatal anesthesia-a comparative double blind study. J Oral Maxillofac Surg Med Pathol 2015; 27: 154-8. https://doi.org/10.1016/j.ajoms.2013.12.001