Pediyatrik Süt Mandibular Molar Diş Çekimlerinde Ağrı Kontrolü İçin İnferior Alveolar Sinir Bloğu ve İnfiltrasyon Anestezi Tekniklerinin Karşılaştırılması

Year 2024, Volume: 8 Issue: 2, 59 - 65, 29.08.2024

Ezgi Murat , Cansu Şahin , Ferit Bayram

https://doi.org/10.29228/erd.72

Abstract

Amaç: Bu çalışma, pediatrik hastalarda süt mandibular molar diş çekimleri sırasında ağrıyı yönetmede inferior alveolar sinir bloğu (IANB) ve bukkal infiltrasyon anestezisinin etkinliğini karşılaştırmayı amaçladı.
Yöntemler: Bu prospektif gözlemsel çalışma Marmara Üniversitesi Diş Hekimliği Fakültesi'nde, rutin primer molar diş çekimi için sevk edilen çocukları kapsıyordu. Katılımcılar IANB ve infiltrasyon anestezi gruplarına ayrıldı. Çalışmanın birincil sonuç ölçütü, görsel analog skala (VAS) kullanılarak ölçülen ağrı şiddetiydi. Bu çalışmanın kovaryatları anestezi grubu, kalan diş kökü uzunluğu ve rezorpsiyon evresiydi. Betimsel istatistikler demografik ve klinik özellikleri özetledi. Mann-Whitney ve Kruskal-Wallis testleri, gruplar ve rezorpsiyon evreleri arasındaki VAS skorlarını karşılaştırırken, Pearson korelasyon ve çoklu doğrusal regresyon analizleri, ağrı şiddetinin ilişkilerini ve belirleyicilerini değerlendirdi.
Sonuçlar: Katılımcıların ortalama yaşı 8.3 yıl (SD = 1.8) idi. Cinsiyetler, anestezi grupları veya rezorpsiyon evreleri arasında VAS skorlarında anlamlı bir fark bulunmadı. Korelasyon analizi, ağrı şiddeti ile kalan diş köklerinin yüzdesi arasında anlamlı bir ilişki göstermedi. Çoklu doğrusal regresyon analizi, hiçbir belirleyicinin ağrı şiddetini anlamlı şekilde etkilemediğini gösterdi.
Sonuç: İnfiltrasyon anestezisi, çocuklarda primer mandibular molar diş çekimleri sırasında ağrıyı yönetmede en az IANB kadar etkilidir. Bulgular, daha basit uygulanabilirliği ve daha az komplikasyonları göz önüne alındığında, bukkal infiltrasyon anestezisinin IANB'ye geçerli bir alternatif olarak kullanılabileceğini desteklemektedir.

Keywords

İnfiltrasyon anestezisi, rejyonal anestezi, mandibular sinir, süt dişi

Comparison of Inferior Alveolar Nerve Block and Infiltration Anesthesia Techniques for Pain Control in Pediatric Primary Mandibular Molar Extractions

Abstract

Objective: This study aimed to compare the effectiveness of inferior alveolar nerve block (IANB) and infiltration anesthesia in managing pain during primary mandibular molar extractions in pediatric patients.
Methods: This prospective observational study at the Marmara University Faculty of Dentistry included children referred for routine primary molar tooth extraction. Participants were divided into two groups: the IANB group and the infiltration anesthesia group. The primary outcome measure was pain severity, which was measured using the visual analog scale (VAS). The covariates for this study were anesthesia group, remaining tooth root length, and the stage of resorption. Descriptive statistics summarized demographic and clinical characteristics. Mann‒Whitney and Kruskal‒Wallis tests compared VAS scores between groups and resorption stages, while Pearson correlation and multiple linear regression analyses evaluated relationships and predictors of pain severity.
Results: The mean age of participants was 8.3 years (SD = 1.8). No significant differences in VAS scores were found between sexes, anesthesia groups, or resorption stages. Correlation analysis showed no significant relationship between pain severity and the percentage of remaining tooth roots. Multiple linear regression indicated that none of the predictors significantly affected pain severity.
Conclusion: Infiltration anesthesia is at least as effective as IANB for managing pain during primary mandibular molar extraction in children. The findings support the potential use of infiltration anesthesia as a viable alternative to IANB, given its simpler application and fewer complications.

Keywords

Infiltration anesthesia, regional anesthesia, mandibular nerve, primary tooth

Ethical Statement

This study was conducted as part of an undergraduate student's (E.M.) graduation thesis.

References

• Arrow, P. (2012). A comparison of articaine 4% and lignocaine 2% in block and infiltration analgesia in children. Aust Dent J, 57(3), 325-333. https://doi.org/10.1111/j.1834-7819.2012.01699.x
• Bahrololoomi, Z., & Rezaei, M. (2021). Anesthetic efficacy of single buccal infiltration of 4% articaine compared to routine inferior alveolar nerve block with 2% lidocaine during bilateral extraction of mandibular primary molars: a randomized controlled trial. J Dent Anesth Pain Med, 21(1), 61-69. https://doi.org/10.17245/jdapm.2021.21.1.61
• Bataineh, A. B., & Al-Sabri, G. A. (2017). Extraction of Maxillary Teeth Using Articaine Without a Palatal Injection: A Comparison Between the Anterior and Posterior Regions of the Maxilla. J Oral Maxillofac Surg, 75(1), 87-91. https://doi.org/10.1016/j.joms.2016.06.192
• Bataineh, A. B., & Alwarafi, M. A. (2016). Patient's pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block. Clin Oral Investig, 20(8), 2241-2250. https://doi.org/10.1007/s00784-016-1712-8
• Bijur, P. E., Silver, W., & Gallagher, E. J. (2001). Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med, 8(12), 1153-1157. https://doi.org/10.1111/j.1553-2712.2001.tb01132.x
• Chi, D., Kanellis, M., Himadi, E., & Asselin, M. E. (2008). Lip biting in a pediatric dental patient after dental local anesthesia: a case report. J Pediatr Nurs, 23(6), 490-493. https://doi.org/10.1016/j.pedn.2008.02.035
• Choi, E. H., Seo, J. Y., Jung, B. Y., & Park, W. (2009). Diplopia after inferior alveolar nerve block anesthesia: report of 2 cases and literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 107(6), e21-24. https://doi.org/10.1016/j.tripleo.2009.02.009
• Chopra, R., Marwaha, M., Bansal, K., & Mittal, M. (2016). Evaluation of Buccal Infiltration with Articaine and Inferior Alveolar Nerve Block with Lignocaine for Pulp Therapy in Mandibular Primary Molars. J Clin Pediatr Dent, 40(4), 301-305. https://doi.org/10.17796/1053-4628-40.4.301
• Cohen, L. L., Lemanek, K., Blount, R. L., Dahlquist, L. M., Lim, C. S., Palermo, T. M., McKenna, K. D., & Weiss, K. E. (2008). Evidence-based assessment of pediatric pain. J Pediatr Psychol, 33(9), 939-955; discussion 956-937. https://doi.org/10.1093/jpepsy/jsm103
• Corbett, I. P., Kanaa, M. D., Whitworth, J. M., & Meechan, J. G. (2008). Articaine infiltration for anesthesia of mandibular first molars. J Endod, 34(5), 514-518. https://doi.org/10.1016/j.joen.2008.02.042
• Etoz, O. A., Er, N., & Demirbas, A. E. (2011). Is supraperiosteal infiltration anesthesia safe enough to prevent inferior alveolar nerve during posterior mandibular implant surgery? Med Oral Patol Oral Cir Bucal, 16(3), e386-389. https://doi.org/10.4317/medoral.16.e386
• Ezoddini Ardakani, F., Bahrololoumi, Z., Zangouie Booshehri, M., Navab Azam, A., & Ayatollahi, F. (2010). The position of lingula as an index for inferior alveolar nerve block injection in 7-11-year-old children. J Dent Res Dent Clin Dent Prospects, 4(2), 47-51. https://doi.org/10.5681/joddd.2010.013
• Foster, W., Drum, M., Reader, A., & Beck, M. (2007). Anesthetic efficacy of buccal and lingual infiltrations of lidocaine following an inferior alveolar nerve block in mandibular posterior teeth. Anesth Prog, 54(4), 163-169. https://doi.org/10.2344/0003-3006(2007)54[163:AEOBAL]2.0.CO;2
• Jorgenson, K., Burbridge, L., & Cole, B. (2020). Comparison of the efficacy of a standard inferior alveolar nerve block versus articaine infiltration for invasive dental treatment in permanent mandibular molars in children: a pilot study. Eur Arch Paediatr Dent, 21(1), 171-177. https://doi.org/10.1007/s40368-019-00496-8
• Jung, I. Y., Kim, J. H., Kim, E. S., Lee, C. Y., & Lee, S. J. (2008). An evaluation of buccal infiltrations and inferior alveolar nerve blocks in pulpal anesthesia for mandibular first molars. J Endod, 34(1), 11-13. https://doi.org/10.1016/j.joen.2007.09.006
• Kammerer, P. W., Palarie, V., Daublander, M., Bicer, C., Shabazfar, N., Brullmann, D., & Al-Nawas, B. (2012). Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: double-blind randomized clinical trial of anesthetic efficacy. Oral Surg Oral Med Oral Pathol Oral Radiol, 113(4), 495-499. https://doi.org/10.1016/j.tripleo.2011.04.037
• Kammerer, P. W., Schneider, D., Palarie, V., Schiegnitz, E., & Daublander, M. (2017). Comparison of anesthetic efficacy of 2 and 4 % articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial. Clin Oral Investig, 21(1), 397-403. https://doi.org/10.1007/s00784-016-1804-5
• Kammerer, P. W., Seeling, J., Alshihri, A., & Daublander, M. (2014). Comparative clinical evaluation of different epinephrine concentrations in 4% articaine for dental local infiltration anesthesia. Clin Oral Investig, 18(2), 415-421. https://doi.org/10.1007/s00784-013-1010-7
• Kaufman, E., Weinstein, P., & Milgrom, P. (1984). Difficulties in achieving local anesthesia. J Am Dent Assoc, 108(2), 205-208. https://doi.org/10.14219/jada.archive.1984.0470
• Klingberg, G., Ridell, K., Brogardh-Roth, S., Vall, M., & Berlin, H. (2017). Local analgesia in paediatric dentistry: a systematic review of techniques and pharmacologic agents. Eur Arch Paediatr Dent, 18(5), 323-329. https://doi.org/10.1007/s40368-017-0302-z
• Kuhnisch, J., Daublander, M., Klingberg, G., Dougall, A., Spyridonos Loizides, M., Stratigaki, E., Amar, J. L., Anttonen, V., Duggal, M., & Gizani, S. (2017). Best clinical practice guidance for local analgesia in paediatric dentistry: an EAPD policy document. Eur Arch Paediatr Dent, 18(5), 313-321. https://doi.org/10.1007/s40368-017-0311-y
• Lima-Junior, J. L., Dias-Ribeiro, E., de Araujo, T. N., Ferreira-Rocha, J., Honfi-Junior, E. S., Sarmento, C. F., Seabra, F. R., & de Sousa Mdo, S. (2009). Evaluation of the buccal vestibule-palatal diffusion of 4% articaine hydrochloride in impacted maxillary third molar extractions. Med Oral Patol Oral Cir Bucal, 14(3), E129-132. https://www.ncbi.nlm.nih.gov/pubmed/19242392
• Madeira, M. C., Percinoto, C., & das Gracas, M. S. M. (1978). Clinical significance of supplementary innervation of the lower incisor teeth: a dissection study of the mylohyoid nerve. Oral Surg Oral Med Oral Pathol, 46(5), 608-614. https://doi.org/10.1016/0030-4220(78)90455-3
• Moaddabi, A., Valletta, A., Koochek Dezfuli, M., Soltani, P., Ebrahimikiyasari, S., Hosseinnataj, A., Tafti, K. T., & Spagnuolo, G. (2023). Does a New Modification of the Two-Step Injection Technique for Inferior Alveolar Nerve Block Reduce Pain Compared to the Conventional Technique? A Randomized Clinical Trial. Int J Dent, 2023, 5922663. https://doi.org/10.1155/2023/5922663
• Peedikayil, F. C., & Vijayan, A. (2013). An update on local anesthesia for pediatric dental patients. Anesth Essays Res, 7(1), 4-9. https://doi.org/10.4103/0259-1162.113977
• Pogrel, M. A. (2007). Permanent nerve damage from inferior alveolar nerve blocks--an update to include articaine. J Calif Dent Assoc, 35(4), 271-273. https://www.ncbi.nlm.nih.gov/pubmed/17612365
• Poorni, S., Veniashok, B., Senthilkumar, A. D., Indira, R., & Ramachandran, S. (2011). 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, 37(12), 1603-1607. https://doi.org/10.1016/j.joen.2011.09.009
• Santos, C. F., Modena, K. C., Giglio, F. P., Sakai, V. T., Calvo, A. M., Colombini, B. L., Sipert, C. R., Dionisio, T. J., Faria, F. A., Trindade, A. S., Jr., & Lauris, J. R. (2007). Epinephrine concentration (1:100,000 or 1:200,000) does not affect the clinical efficacy of 4% articaine for lower third molar removal: a double-blind, randomized, crossover study. J Oral Maxillofac Surg, 65(12), 2445-2452. https://doi.org/10.1016/j.joms.2007.04.020
• Shabazfar, N., Daublander, M., Al-Nawas, B., & Kammerer, P. W. (2014). Periodontal intraligament injection as alternative to inferior alveolar nerve block--meta-analysis of the literature from 1979 to 2012. Clin Oral Investig, 18(2), 351-358. https://doi.org/10.1007/s00784-013-1113-1
• Stein, P., Brueckner, J., & Milliner, M. (2007). Sensory innervation of mandibular teeth by the nerve to the mylohyoid: implications in local anesthesia. Clin Anat, 20(6), 591-595. https://doi.org/10.1002/ca.20479
• Takasugi, Y., Furuya, H., Moriya, K., & Okamoto, Y. (2000). Clinical evaluation of inferior alveolar nerve block by injection into the pterygomandibular space anterior to the mandibular foramen. Anesth Prog, 47(4), 125-129. https://www.ncbi.nlm.nih.gov/pubmed/11432177
• Tirupathi, S. P., & Rajasekhar, S. (2020). Can single buccal infiltration with 4% articaine induce sufficient analgesia for the extraction of primary molars in children: a systematic literature review. J Dent Anesth Pain Med, 20(4), 179-186. https://doi.org/10.17245/jdapm.2020.20.4.179
• Uckan, S., Dayangac, E., & Araz, K. (2006). Is permanent maxillary tooth removal without palatal injection possible? Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102(6), 733-735. https://doi.org/10.1016/j.tripleo.2005.12.005 Wright, E. F. (2011). Medial pterygoid trismus (myospasm) following inferior alveolar nerve block: case report and literature review. Gen Dent, 59(1), 64-67. https://www.ncbi.nlm.nih.gov/pubmed/21613042