The significance of needle bevel orientation in achieving a successful inferior alveolar nerve block
Section snippets
NEEDLE DEFLECTION
Several authors have theorized7, 8, 9 that needle deflection is a cause of IAN block failure. Some authors,7, 8, 9, 10, 11, 12 using in vitro methods, have reported that beveled needles, when passed through substances of varying densities, will deflect toward the nonbeveled side (that is, the needle will deflect away from the bevel). For the IAN block, Davidson8 recommended that the bevel of the needle be placed away from the mandibular ramus. Therefore, on insertion into the tissue, the needle
SUBJECTS, MATERIALS AND METHODS
Fifty-one adults (23 women, 28 men) aged 20 to 46 years (mean age, 26 years) participated in this study. The subjects were in good health and were not taking any medications that would alter their perception of pain. The Ohio State University, Columbus, Human Subjects Review Committee approved the study, and we obtained written informed consent from each subject.
One of us (G.S.) administered all of the injections. The 51 blinded subjects randomly received an IAN block injection with the needle
RESULTS
A total of 22 IAN blocks, 11 administered with the needle bevel oriented away from the mandibular ramus and 11 administered with the needle bevel oriented toward the mandibular ramus, did not result in profound lip numbness at 15 minutes (and were considered unsuccessful blocks). We scheduled these patients for subsequent appointments. Eventually, all 51 subjects experienced profound lip anesthesia with both needle bevel orientations.
Table 1 shows the rates of anesthetic success. For the needle
DISCUSSION
We based our use of the pulp test reading of 80—signaling maximum output—as a criterion for pulpal anesthesia on the studies of Dreven and colleagues14 and Certosimo and Archer.15 These studies14, 15 showed that when patients did not respond to an 80 reading, this ensured pulpal anesthesia in vital asymptomatic teeth. In addition, Certosimo and Archer15 demonstrated that electric pulp test readings of less than 80 resulted in pain during operative procedures in asymptomatic teeth. Therefore,
CONCLUSION
The results of this study show that using a 27-gauge needle with the bevel oriented away from the mandibular ramus was similar to using a 27-gauge needle with the bevel oriented toward the mandibular ramus with regard to achieving pulpal anesthesia after administration of IAN blocks in adults.
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Local anesthesia in oral and maxillofacial surgery: A review of current opinion
2021, Journal of Dental SciencesCitation Excerpt :However, the success rates of single injection methods are often unable to achieve the desired goals. Actually, the failure rate of IANB is 20–47%.21,22 In recent decades, clinicians have been exploring the possibility of combining two or more injection methods.
Three-dimensional anatomic analysis of mandibular foramen with mandibular anatomic landmarks for inferior alveolar nerve block anesthesia
2013, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :Access to the MnF (through which the inferior alveolar nerve enters) is considered to be the most important factor in the success of IANBA.15-17 However, positioning of the needle bevel toward the mandibular ramus does not improve the success of the anesthetic technique in IANBA,18 and, as noted, a more accurate IANBA injection does not increase the success rate.12,13 Methodologic studies have been conducted to investigate the position of the MnF using measurement points from panoramic radiography, oblique (45°) cephalometric radiography, and CT, as well as from a method using ultrasound-assisted IANBA.9-11,19-21
Local Anesthesia Strategies for the Patient With a "Hot" Tooth
2010, Dental Clinics of North America
- 1
Dr. Steinkruger was a graduate student in endodontics, College of Dentistry, The Ohio State University, Columbus, at the time this study was conducted. He currently has a practice limited to endodontics in Charleston, S.C.
- 2
Dr. Nusstein is an associate professor and chair, Section of Endodontics, College of Dentistry, The Ohio State University, Columbus.
- 3
Dr. Reader is a professor and program director of advanced endodontics, Section of Endodontics, College of Dentistry, The Ohio State University, 305 W. 12th Ave., Columbus, Ohio 43210.
- 4
Dr. Beck is an associate professor, Section of Oral Biology, College of Dentistry, The Ohio State University, Columbus.
- 5
Dr. Weaver is a clinical professor and director of anesthesiology, Section of Oral Surgery, Oral Pathology and Anesthesiology, College of Dentistry, The Ohio State University, Columbus.