• Journal of Dental Anesthesia and Pain Medicine
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• 제20권1호
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• pp.9-17
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• 2020

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.

• Journal of Dental Anesthesia and Pain Medicine
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• 제20권4호
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• pp.213-221
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• 2020

Background: Complications following impacted third molar surgery significantly affect patients' quality of life during the immediate postoperative period. This study aimed to achieve the proper anesthesia method by comparing the effect of the application of lidocaine alone with the application of lidocaine and articaine simultaneously in reducing the complications during and following impacted mandibular third molar surgery. Methods: The study design was a split-mouth double-blind randomized clinical trial. The study was conducted on 13 patients (26 samples) referred for elective surgical removal of bilateral impacted mandibular third molar with similar difficulty on both sides. Each patient underwent similar surgical procedures on two separate appointments. Each patient randomly received 2% lidocaine for conventional inferior alveolar nerve block and 4% articaine for local infiltration before the surgery on one side (group A) and 2% lidocaine alone (for both block anesthesia and infiltration) before the surgery on the other side (group B). Intraoperative and postoperative variables for both groups were established and statistically analyzed. Results: The findings showed that pain on the first day after surgery in group A was significantly lower than that in group B. The patients in group A mentioned experiencing less discomfort following the surgery. The increased horizontal swelling on the first and third days following surgery and oblique swelling on the seventh day in patients in group B were statistically significant. Conclusion: Choosing an appropriate anesthetic drug for oral surgery, specifically impacted third molar surgery, is dependent on the clinician's opinion, however; it seems that the combination of lidocaine and articaine may control the patient's pain significantly better than lidocaine alone.

• 대한치과마취과학회지
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• 제10권1호
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• pp.1-6
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• 2010

Background: Articaine, commercially available in South Korea from 2004, is widely being used for dental treatments. In the surgical extraction of impacted mandibular third molars, one of the most common procedures in oral and maxillofacial surgery, the anesthetic efficacy of 4% articaine and 2% lidocaine, both with 1：100,000 epinephrine, was compared. Methods: A randomized double-blind clinical trial was conducted of 80 patients for bilateral surgical extraction of mandibular third molars with informed consents. One operator carried out the routine surgical procedures using local anesthetic 4% articaine or 2% lidocaine with the same concentration of vasoconstrictor. Latency, duration of anesthesia and the amount of anesthetic solution were recorded. A visual analog scale (VAS) was used to evaluate the intraoperative pain. Results: The pain VAS scores reported similar anesthetic effect with both local anesthetics. Not in the latency of anesthesia and the amount of anesthetic solution, statistically significant difference was found in the mean duration of anesthesia. Conclusions: It was concluded that 4% articaine could offer better or at least the same clinical feasibility compared to 2% lidocaine, particularly in terms of the duration of the local anesthesia for common dental treatments.

• Imaging Science in Dentistry
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• 제44권4호
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• pp.273-278
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• 2014

Purpose: This study was performed to investigate the course of the mandibular canal on panoramic radiography and the visibility of this canal on both panoramic radiography and cone-beam computed tomography (CBCT). Materials and Methods: The study consisted of panoramic radiographs and CBCT images from 262 patients. The course of the mandibular canal, as seen in panoramic radiographs, was classified into four types: linear, elliptical, spoon-shaped, and turning curves. The visibility of this canal from the first to the third molar region was evaluated by visually determining whether the mandibular canal was clearly visible, probably visible, or invisible. The visibihlity of the canal on panoramic radiographs was compared with that on CBCT images. Results: Elliptical curves were most frequently observed along the course of the mandibular canal. The percentage of clearly visible mandibular canals was the highest among the spoon-shaped curves and the lowest among the linear curves. On panoramic radiographs, invisible mandibular canals were found in 22.7% of the examined sites in the first molar region, 11.8% in the second molar region, and 1.3% in the third molar region. On CBCT cross-sectional images, the mandibular canal was invisible in 8.2% of the examined sites in the first molar region, 5.7% in the second molar region, and 0.2% in the third molar region. Conclusion: The visibility of this canal was lower in the first molar region than in the third molar region. The mandibular canal presented better visibility on CBCT images than on panoramic radiographs.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권5호
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• pp.435-441
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• 2001

Orthognathic surgery for the correction of dentofacial deformities is a common elective procedure. That has proven over the years to be a safe operation with minimal long-term morbidity. But, there are many surgical complication including mal-union of the bone, TMJ problem, excessive bleeding, and permanent damage of inferior alveolar nerve. Among them excessive bleeding which focus is not clear is one of the serious complication because that is fatal and so a transfusion is performing for the prevention and management of that. Until the end of the 1980's, homologous blood transfusions were routinely necessary because of the large amounts of blood lost during surgery. Recently several blood-saving measures can be undertaken for orthognathic surgery patients before, during, and after the operation. We made a comparative study of an amount of blood loss, hematologic change and transfusion requirements based on a series of 40 consecutive patients undergoing single-jaw and double-jaw surgery. The purpose of this investigation was to make a comparative analysis of an amount of blood loss, post-operative hematologic change and duration of the procedure under induced hypotensive anesthesia in healthy orthognathic patients.

• Imaging Science in Dentistry
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• 제48권3호
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• pp.185-190
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• 2018

Purpose: The aim of this study was to compare the location and the shape of the mandibular lingula in skeletal class I and III patients using panoramic radiography and cone-beam computed tomography. Materials and Methods: The sample group included 190 skeletal class I patients and 157 class III patients. The location of the lingula in relation to the deepest point of the coronoid notch was classified into 3 types using panoramic radiographs. The shapes of the lingulae were classified into nodular, triangular, truncated, or assimilated types using cone-beam computed tomographic images. The data were analyzed using the chi-square test. Results: The tips of the lingulae were at the same level as the coronoid notch in 75.3% of skeletal class I patients and above the coronoid notch in 66.6% of class III patients. The positions of the lingulae in relation to the deepest point of the coronoid notch showed statistically significant differences between class I and class III patients. The most common shape was nodular, and the least common was the assimilated shape. Although this trend was not statistically significant, the triangular shape was more frequently observed in class III patients than in class I patients. Conclusion: The locations and the shapes of the mandibular lingulae were variable. Most of the lingulae were at the same level as the coronoid notch in skeletal class I patients and above the coronoid notch in skeletal class III patients. The nodular and assimilated-shaped lingulae were the most and the least prevalent, respectively.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제39권
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• pp.30.1-30.7
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• 2017

Background: The positions of the mandibular lingula and foramen have been set as indexes for inferior alveolar nerve (IAN) block and ramus osteotomies in orthognathic surgery. This study aimed to evaluate the anatomical structures of mandibular ramus, especially the mandibular lingula and foramen, by analyzing the cone-beam computed tomography (CBCT) data of young adults. Methods: We evaluated 121 sides of hemi-mandibular CBCT model of 106 patients (51 male and 55 female patients; 18 to 36 years old). All the measurements were performed using the 2- and 3-dimensional rulers of $OnDemand3D^{(R)}$ software. Results: Statistical analysis of the data revealed that there was no significant difference in the mandibular angle between the genders. The mandibular lingula was found to be located at the center of ramus in males, but a little posterior in relation to the center in females. The mandibular lingula was rarely located below the occlusal plane; however, the position of the mandibular foramen was more variable (84.3% below, 12.4% above, and 3.3% at the level of the occlusal plane). Conclusions: The results of this study provide a valuable guideline for IAN block anesthesia and orthognathic surgery. CBCT can be considered effective and accurate in evaluating the fine structures of the mandible.

• Restorative Dentistry and Endodontics
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• 제36권1호
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• pp.12-18
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• 2011

목적: 본 후향적 연구의 목적은 의도적 재식술로 치료한 상하악 대구치의 단기간의 치료 결과를 평가하고자 하는 것이다. 환자 및 방법: 본 연구의 대상은 해부학적인 접근의 어려움 및 두꺼운 피질골 또는 하치조 신경, 상악동등과의 근접으로 인해 통상적인 치근단 수술이 불가능하거나 환자가 거부하는 경우 의도적 재식술을 시행한 35개의 상하악 대구치를 대상으로 하였다. 증례들의 경과 관찰 기간은 1년에서 2년 4개월이었다. 성공률은 임상적 성공과 방사선학적 성공을 기준으로 평가하였다. 결과: 의도적 재식술 과정중 발치 실패가 1증례(3%), 치주 질환 및 염증성 흡수로 발치한 경우가 2증례(6%)였고 구강내에서 기능하고 있으나 약간의 동요도와 치근의 흡수상이 관찰되는 경우가 3증례(9%)였고 특이한 이상없이 잘 유지되고 있는 경우는 29증례(82%)였다. 결론: 의도적 재식술은 접근성 및 해부학적인 구조등으로 인해 치근단 수술이 불가능한 경우 적절한 증례 선택과 숙련된 술자에 의해 시술이 이루어진다면 재현성 있고 예지성있는 치료가 될 수 있다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제19권3호
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• pp.143-149
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• 2019

Background: Uncooperative behavior of children due to dental anxiety may interfere with the effective delivery of dental care and compromise the quality of treatment provided. Injection of local anesthesia is one of the most anxiety-inducing stimuli in pediatric dentistry. This study aimed to compare the efficacy of a child-friendly device, having a combined effect of vibration and distraction, with the conventional method of injection on pain, anxiety, and behavior of pediatric patients aged 6-11 years. Methods: This randomized, crossover, split-mouth study included 30 children requiring a bilateral inferior alveolar nerve block. The children were equally divided into two groups: group 1, aged 6-8 and group 2, aged 9-11 years. All children were injected with anesthesia using the conventional and device method in two separate sessions. They were assessed for anxiety by measuring the pulse rate before and during the administration of local anesthesia. Behavior was assessed using Faces, Legs, Activity, Cry, Consolability (FLACC) scale, and the child's experience while receiving anesthesia was assessed using the Wong Bakers Pain Rating Scale. Results: Results showed that the children who received local anesthesia using the device method had a lower mean pulse rate, FLACC scores, and pain rating scores than those who received local anesthesia using the conventional method. Conclusion: The device method was more effective than the conventional method in managing pain, anxiety, and behavior of patients aged 6-11 years. The device is a cost effective, simple, and child-friendly product for administrating local anesthesia in pediatric patients.

• Journal of Dental Anesthesia and Pain Medicine
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• 제21권1호
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• pp.49-59
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• 2021

Background: To evaluate changes in the effectiveness of phentolamine mesylate in combination with different local anesthetics (LAs) and vasoconstrictors. A prospective randomized double-blind study was conducted with 90 patients divided into three groups, with each group being administered one of three different LAs: lidocaine 2% 1/80,000, articaine 4% 1/200,000, and bupivacaine 0.5% 1/200,000. Methods: We compared treatments administered to the mandible involving a LA blockade of the inferior alveolar nerve. Results were assessed by evaluating reduction in total duration of anesthesia, self-reported patient comfort using the visual analog pain scale, incidence rates of the most common adverse effects, overall patient satisfaction, and patient feedback. Results: The differences among the three groups were highly significant (P < 0.001); time under anesthesia was especially reduced for both the lip and tongue with bupivacaine. The following adverse effects were reported: pain at the site of the anesthetic injection (11.1%), headaches (6.7%), tachycardia (1.1%), and heavy bleeding after treatment (3.3%). The patients' feedback and satisfaction ratings were 100% and 98.9%, respectively. Conclusions: Efficient reversal of LAs is useful in dentistry as it allows patients to return to normal life more readily and avoid common self-injuries sometimes caused by anesthesia. Phentolamine mesylate reduced the duration of anesthesia in the three studied groups, with the highest reduction reported in the bupivacaine group (from 460 min to 230 min for the lip and 270 min for the tongue [P < 0.001]).