Apicectomía de Primer Molar Inferior. Revisión de Literatura y Reporte de Caso

La apicectomía consiste en la amputación de la fracción apical de la raíz de un diente lesionado y se considera la última opción terapéutica para mantener el diente afectado en boca. Con el objetivo de dilucidar el potencial terapéutico de la técnica quirúrgica, en el presente estudio presentamos el reporte de caso de un paciente con cuadro de hiperestesia asociada al nervio alveolar inferior debido a sobreobturación de la raíz mesial de un primer molar inferior izquierdo. Para resolver el caso realizamos apicectomía mediante abordaje convencional acompañado de medicación empírica enfocada a resolver cuadros de parestesia asociada al procedimiento. Durante los controles posteriores al procedimiento quirúrgico se pesquisa ausencia de parestesia y sintomatología dolorosa, por lo que consideramos la apicectomía como una buena opción de tratamiento en casos de sobreobturación apical que no pueden solucionarse mediante tratamiento no quirúrgico.

Apicoectomy consists of the amputation of the apical fraction of the root of an injured tooth and is considered the last therapeutic option to keep the affected tooth in the mouth. With the aim of elucidating the therapeutic potential of the surgical technique, in this study we present the case report of a patient with hyperesthesia associated with the inferior alveolar nerve due to overfilling of the mesial root of a left lower first molar. To solve the case we performed apicoectomy by conventional approach accompanied by empirical medication focused on resolving paresthesia associated to the procedure. During the controls after the surgical procedure we found absence of paresthesia and painful symptomatology, so we consider apicoectomy as a good treatment option in cases of apical overfilling that cannot be solved by non-surgical treatment.

Parestesia do nervo alveolar inferior decorrente de procedimentos cirúrgicos e suas formas de tratamentos / Paresthesi of the lower alveolar nerve resulting from surgical procedures and its forms of treatment

Nas cirurgias odontológicas é possível que ocorra alguns acidentes ou complicações que podem interferir no dia a dia do paciente. A lesão do nervo alveolar inferior é uma complicação decorrente de cirurgias orais que podem causar um distúrbio de sensibilidade transitória ou persistente, na região do lábio inferior e na região delimitada do forame mentoniano e hemi-arco da mucosa. O diagnóstico da parestesia pode ser feito através de testes mecanoceptivos e nocioceptivos em que o profissional escolherá para qual melhor se adapte no paciente. O objetivo do presente trabalho foi abordar por meio de uma revisão de literatura as formas de diagnóstico e tratamento da parestesia do nervo alveolar inferior decorrentes de cirurgias orais. As bases de dados utilizadas para confecção desta revisão são encontradas nas bibliotecas virtuais eletrônicas: BVS (Biblioteca Virtual em Saúde), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Pubmed. Como critério de inclusão foram selecionados artigos publicados de 2012 a 2022 em língua inglesa, portuguesa e espanhola. Após a leitura do título e resumo dos resultados da pesquisa e aplicação dos critérios de inclusão e exclusão dentre eles foram excluídos 883, pois não se enquadravam no nosso critério de inclusão. No final, foram selecionados 13 estudos por meio de base de dados, que serviram de base para esta revisão. Concluímos que as formas de tratamento para a parestesia na literatura, são um pouco escassas e conflitantes, mas relata que o uso da laserterapia e acupuntura tem sido uma forma de tratamento com um bom índice de sucesso, e para os casos que não sejam suficientes tais tratamentos, pode-se optar por uma cirurgia(AU)

In dental surgeries it is possible to have some accidents or complications that can interfere with the patient's day. Injury to the inferior alveolar nerve is a complication resulting from oral surgeries that can cause a disturbance of sensitivity that can be transient or persistent in the region of the lower lip and in the delimited region of the mental foramen and hemiarch of the mucosa. The diagnosis of paresthesia can be made through mechanoceptive and nocioceptive tests that the professional will choose, which best suits the patient. The objective of the present work is to approach, through a literature review, the forms of diagnosis and treatment aimed at inferior alveolar nerve paresthesia resulting from oral surgeries. The databases used for this review are found in the virtual electronic libraries: VHL (Virtual Health Library), LILACS (Latin American and Caribbean Literature on Health Sciences) and Pubmed. As inclusion criteria, articles published from 2012 to 2022 in English, Portuguese and Spanish were selected. After reading the title and summary of the research results and applying the inclusion and exclusion criteria, 883 were excluded, as they did not meet our inclusion criteria. In the end, 13 studies were selected from the database, which served as the basis for this review. We conclude that the forms of treatment for paresthesia in the literature are a little scarce and conflicting, but it reports that the use of laser therapy and acupuncture has been a form of treatment with a good success rate, and for cases that are not enough, such treatments, one can opt for surgery(AU)

Radiological measurement and analysis of trans-inferior alveolar nerve implantation / 口腔医学

Objective@#To measure the position of the mandibular nerve canal at the mandibular second molar by CBCT image data, analyze the theoretical implantation range of trans-alveolar implantation, and provide a theoretical solution to insufficiency of posterior mandibular bone volume in clinical practice. @*Methods@#Eighty patients with missing mandibular second molars whose vertical bone height of the edentulous area was less than 9 mm were selected for CBCT image measurement, and the distances from the mandibular nerve canal to the buccal cortex, lingual cortex, and alveolar crest were measured to simulate trans-inferior alveolar nerve implantation. The angular range of the buccolingual inclination of the implant was also measured.@*Results@#The distances from the mandibular nerve canal to the buccal cortex, lingual cortex and alveolar crest at the mandibular second molar were(6.913±1.222)mm, (2.859±0.891)mm and (7.991±0.783)mm, respectively. The distance from the mandibular nerve canal to the buccal cortex was significantly greater than that to the lingual cortex. And, 75% of the patients could be implanted by the inferior alveolar nerve. The minimum angle of buccolingual inclination of the simulated implant was 19.360°±7.086°, and the maximum angle was 39.462°±6.924°. @*Conclusion@#The mandibular nerve canal at the mandibular second molar is inclined toward the lingual side, which ensures sufficient buccal bone volume. Most patients with severe mandibular atrophy can still adopt implants of conventional length by trans-inferior alveolar nerve implantation to keep a safe distance from the nerve canal.

Comparación en técnica anestésica de bloqueo del nervio alveolar inferior en estudiantes de Odontología de diferente año académico / Comparison in technique to the inferior alveolar nerve in dental students from different academic years

Introducción: Se comparó la técnica anestésica con el nervio alveolar inferior (NAI) realizada por estudiantes de cuarto y quinto año de la carrera de Odontología de la Universidad Andrés Bello, Santiago. El objetivo: Fue evaluar la ejecución y éxito de la técnica previo a una extracción dental simple. Metodología: Los estudiantes fueron invitados a participar y firmaron un consentimiento. Se realizó una encuesta que contenía un protocolo informativo para el alumno con los pasos por seguir, luego, al finalizar su atención clínica debía responder una serie de preguntas de selección múltiple. Mediante esta encuesta se evaluó cuántos estudiantes pudieron lograr un correcto bloqueo del nervio alveolar inferior con solo 1 tubo de anestesia lidocaína al 2% y cuántos de estos requirieron de anestesia adicional después de haber inyectado el primer tubo de anestesia, antes de iniciar el procedimiento quirúrgico. También se cuantificó la cantidad de tubos de anestesia que usaron los alumnos para realizar la exodoncia de forma indolora y cuántos requirieron de un refuerzo anestésico adicional durante el intraoperatorio. Así se pudo realizar un análisis comparativo entre ambas generaciones de alumnos en relación con el empleo de la técnica anestésica. Resultados: De los 104 encuestados se obtuvo que un 57% de los estudiantes de 4º y un 65% de los de 5º año, lograron una correcta técnica anestésica al NAI con 1 solo tubo de anestesia. Conclusión: No existieron diferencias significativas con respecto al año académico y las variables estudiadas, exceptuando la necesidad de un refuerzo anestésico posterior a la comprobación de una técnica anestésica exitosa, donde los alumnos de 4to año necesitaron efectuar un mayor control del dolor intraoperatorio.

Introduction: The anesthetic technique to the inferior alveolar nerve (NAI) was compared between the performance by fourthand fifth-year students of the Dentistry career at the Andrés Bello University, Santiago. Objective: Was to evaluate the performance and success of the technique before a simple dental extraction. Methods: The students invited to participate signed an informed consent. A survey was conducted that contained an informative protocol for the student with the steps to follow, then, at the end of their clinical care, had to answer a series of multiple-choice questions. Through this survey, it was evaluated how many students could achieve a correct inferior alveolar nerve block with only 1 tube of anesthesia lidocaine 2% and how many required additional anesthesia after having injected the first tube of anesthesia, before starting the surgical procedure. Also, the amount of anesthesia tubes that the students used to perform the extraction in a painless way was quantified and how many required an additional anesthetic reinforcement intraoperatively. Thereby, a comparative analysis between both generations of students was carried out in relation to the use of the anesthetic technique. Results: Of the 104 participants, it was found that 57% of the 4th year students and 65% of the 5th year students achieved a correct anesthetic technique at the NAI with a single tube of anesthesia. Conclusion: There were no significant differences in relation to the academic year completed and the variables studied except for the need for anesthetic reinforcement after a successful anesthetic technique, where 4th year students needed to perform more intraoperative pain control.

Incidence of inferior alveolar nerve sensory deficit and intra-operative nerve encounters after advancement of retrognathic mandible – A cross-sectional survey study

Aims and Objectives: The aim of the current cross?sectional study was to conduct a survey among the oral and maxillofacial surgeons of South India regarding their experiences of incidence of inferior alveolar nerve (IAN) neurosensory deficit after bilateral sagittal split osteotomy (BSSO) for correction of mandibular retrognathism and to assess the intra?operative nerve encounters and its effect on the inferior alveolar neurosensory deficit (NSD), 6 months post?operatively. Materials and Methods: A self?administered questionnaire (SAQ) was prepared using Google Forms (Google Inc.) and sent to the prospective participants through various social media outlets such as Facebook, WhatsApp groups etc., of the maxillofacial surgery specialty for a period of 3 months. SAQ from surgeons with more than 5 years of experience in orthognathic surgery were included. Results: The incidence of NSD post?BSSO advancement surgery from 859 cases after 6 months was 15.1% (130). After splitting the mandible, the IAN was seen in the proximal fragment in 472 sites and needed dissection. The nerve was transected and neurorrhaphy was carried out in 26 sites. A Chi?square test was used to analyse the qualitative variables. The IAN was not visible post?osteotomy in 140 sites and in the distal fragment in 1080 sites. These groups had decreased incidence of NSD. The NSD was significantly higher in cases where the nerve was transected and sutured, P value <0.001 as compared with the other nerve status, followed by the nerve in the proximal fragment needing dissection. Conclusion: The IAN status intra?operatively can be assumed to have a significant role in persisting NSD

Comparative evaluation of anesthetic efficacy of 4% articaine infiltration versus 2% lignocaine inferior alveolar nerve block for extraction of primary mandibular molars A prospective, split-mouth, randomized controlled trial

Context: Control of pain during dental treatment is an essential aspect of pediatric dentistry. Aims: This study was conducted to evaluate and compare the anesthetic efficacy of 4% articaine buccal infiltration with 2% lignocaine inferior alveolar nerve block (IANB) for primary mandibular molar extractions. Settings and Design: The study was a prospective, split-mouth, randomized controlled trial. Methods: Bilateral symmetrical carious primary mandibular molar (n = 92) extractions in 46 healthy children aged 5–10 years were included in this randomized controlled trial. Extraction was performed on one side using 4% of articaine buccal infiltration and on the contralateral side using 2% lignocaine IANB in two subsequent appointments. Pain and behavior were assessed at baseline, during injection and extraction using Wong–Baker Faces Pain Rating Scale, Modified Behavior Pain Scale (MBPS), and Frankl Behavior Rating Scale. Statistical Analysis Used: Values thus obtained were statistically analyzed by one-way analysis of variance test and compared using independent samples test. Results: According to MBPS, the mean value of pain experienced in the form of cry during injection was reported to be more for 2% lignocaine IANB (1.76) as compared to 4% articaine buccal infiltration (1.30), which was statistically significant (P = 0.024). Comparison of behavior depicted showed no statistically significant difference between the groups. Conclusion: Buccal infiltration with 4% articaine can be utilized as an effective alternative to 2% lignocaine IANB for primary mandibular molar extractions.

Comparison Of Anaesthetic Efficacy Of Inferior Alveolar, Gow-Gates And Vazirani-Akinosi Technique In Dentoalveolar Surgery

Background:Inferior alveolar nerve block has been widely used to anaesthetise the mandibular teeth. The other alternatives include the Gow-Gates and the Vazirani-Akinosi technique. This study aims to compare these three techniques of anaesthesia for posterior mandibular dentoalveolar surgery.Material & Method:Thirty subjects were equally distributed into three groups receiving the specific injection technique assigned to the group. The injection technique was performed using 3.6ml of 2% lignocaine with 1: 200000 adrenaline and clinical parameters such as onset of anaesthesia, pain in the injection site, extent of soft tissue anaesthesia and success rate of each block was assessed. Visual Analogue Scale was used to assess the pain experienced by the patient during theextraction procedure.Results:It was noted that the time taken for the onset of anaesthesia was the same in all the three groups. Vazirani-Akinosi group patients experienced significantly more pain on injection and during extraction of the tooth. Greaterextent of soft tissue anaesthesia was seen with the Gow-Gates technique when compared to the other two techniques. Conclusion:Gow-Gates technique demonstrated better efficiency when compared to the inferior alveolar or the Vazirani-Akinosi technique.

A morphometric study of the mandibular foramen in dry adult human mandibles in a black Malawian population / Un estudio morfométrico del foramen mandibular en mandíbulas humanas adultas secas en una población malauí negra

SUMMARY: The inferior alveolar nerve block (IANB) technique is a common technique performed on patients in dental surgery, placement of mandibular implants and other procedures involving the mandible. Precise identification of the mandibular foramen (MF) is essential for dental surgeons to accurately administer local anesthetics. Inaccurate localization of the mandibular foramen may result in IANB failure and injury to neurovascular tissues. Therefore, this study aimed at investigating the precise location of the MF from various anatomical land marks in dry adult human mandibles of Malawian population. The study was conducted on 29 dry adult human mandibles of unknown sex of Malawian origin from the Anatomy Division collection of human skeletons housed in the Biomedical Sciences Department, College of Medicine, University of Malawi. To determine the position of the mandibular foramen, distances from mandibular foramen to anterior margin, posterior margin, mandibular notch, gonial angle and mandibular base using a Vernier caliper were measured. The mean distance of the MF from posterior margin of mandibular ramus was 11.26±1.22 mm (right side) and 11.47±1.35 mm (left side), from the anterior margin 20.85±3.12 mm (right side) and 20.85±3.22 mm (left side) mandibles. The mean distance between mandibular notch (MN) and MF was 23.87±2.61 mm (right side) and 23.53 ± 2.65 mm (left side). The mean distance between mandibular base (MB) and MF for the right and left were 28.47 ± 2.90 mm and 27.85 ± 2.99 mm respectively. The inferior limit of the mandibular foramen was located at 24.69 ± 3.65 mm (right side) and 24.25 ± 2.77 mm (left side) to the angle (AG) of the mandible. The findings of this study show that the anterior margin mean distance from the MF for both right and left mandibles seem to be bilateral symmetrical suggesting the interpretation that the needle for IANB could be inserted at about 21 mm from the anterior margin to the MF in an adult of Malawian origin during surgery.

RESUMEN: La técnica de bloqueo del nervio alveolar inferior (IANB) es una técnica común que se realiza en pacientes en cirugía dental, colocación de implantes mandibulares y otros procedimientos que involucran la mandíbula. La identificación precisa del foramen mandibular (MF) es esencial para que los cirujanos dentistas administren con precisión anestésicos locales. La localización inexacta del foramen mandibular puede resultar en una falla de la IANB y lesión de los tejidos neurovasculares. Por lo tanto, este estudio tuvo como objetivo investigar la ubicación precisa de la MF de varias marcas anatómicas en las mandíbulas humanas adultas secas de la población de Malawi. El estudio se llevó a cabo en 29 mandíbulas humanas adultas secas de sexo desconocido de origen malauí de la colección de esqueletos humanos de la División de Anatomía del Departamento de Ciencias Biomédicas de la Facultad de Medicina de la Universidad de Malawi. Para determinar la posición del foramen mandibular, se midieron las distancias desde el foramen mandibular hasta el margen anterior, margen posterior, incisura mandibular, ángulo gonial y base mandibular utilizando un calibre Vernier. La distancia media del MF desde el margen posterior de la rama mandibular fue de 11,26 ± 1,22 mm (lado derecho) y 11,47 ± 1,35 mm (lado izquierdo), desde el margen anterior 20,85 ± 3,12 mm (lado derecho) y 20,85 ± 3,22 mm (lado izquierdo) lado) mandíbulas. La distancia media entre la muesca mandibular (MN) y MF fue de 23,87 ± 2,61 mm (lado derecho) y 23,53 ± 2,65 mm (lado izquierdo). La distancia media entre la base mandibular (MB) y MF para la derecha y la izquierda fue de 28,47 ± 2,90 mm y 27,85 ± 2,99 mm, respectiva- mente. El límite inferior del foramen mandibular se ubicó a 24,69 ± 3,65 mm (lado derecho) y 24,25 ± 2,77 mm (lado izquierdo) del ángulo (AG) de la mandíbula. Los resultados de este estudio mues- tran que la distancia media del margen anterior desde el MF para las mandíbulas derecha e izquierda parece ser simétrica bilateral, lo que sugiere la interpretación de que la aguja para IANB podría insertarse a unos 21 mm del margen anterior al MF en una adulto de origen malauí durante la cirugía.

Trigeminal nerve injuries. Four years' experience at a single Argentine referral center and a literature review / Lesiones del nervio trigémino. Cuatro años de experiencia de un servicio quirúrgico odontológico en Argentina y revisión bibliográfica

ABSTRACT The aim of this retrospective study was to describe the etiology and characteristics of trigeminal nerve injuries referred to a specialized center in Buenos Aires, Argentina. A retrospective analysis was performed of patients referred from February 2016 to January 2020. Age, sex, intervention performed, nerve affected, time elapsed from injury, diagnosis, location, and whether patient had signed informed consent were recorded. A descriptive analysis of the data was made, and 95% confidence intervals were calculated for prevalence. The study sample consisted of 30 subjects (31 nerve injuries), 19 female and 11 male, average age (±SD) 40 ± 17 years. The inferior alveolar nerve was the most frequently injured nerve (74%,) while the lingual nerve accounted for 26%. The most common etiologies were inferior molar extractions (47%), dental implants (20%), and local anesthesia (13%). Other etiologies were autologous mandibular bone grafts for dental implants, removal of cysts associated with the inferior third molar, and endodontic treatment. Dental Institutions at which treatment was provided were found to be significantly associated with patients being warned and asked to sign informed consent (p<0.05), while dentists working at private offices requested fewer consents. The most frequent symptom was paresthesia, and 5 patients suffered spontaneous or evoked pain. Only 2 patients intended to file legal claims. Dentists should be aware of the debilitating effects resulting from trigeminal injuries, the complexity of their resolution and the importance of carefully planning dental procedures to prevent them.

RESUMEN El objetivo de este estudio fue describir la etiología y características de las lesiones del nervio trigémino remitidas a un servicio de referencia especializado en Buenos Aires, Argentina. Se realizó un análisis retrospectivo de los pacientes remitidos desde febrero de 2016 a enero de 2020. Se registraron edad, género, intervención recibida, nervio afectado, tiempo transcurrido desde la lesión, diagnóstico, ubicación y firma del consentimiento informado previo a la intervención Se realizó un análisis descriptivo de los datos y se calcularon intervalos de confianza del 95%. La muestra del estudio consistió en 30 sujetos (31 lesiones nerviosas), 19 mujeres y 11 hombres, con una edad promedio (± DE) de 40 ± 17 años. Aproximadamente 3 de cada 4 lesiones correspondieron al nervio alveolar inferior, representando el resto al nervio lingual. Las etiologías más frecuentes fueron la extracción dentaria (47%), los implantes dentales (20%) y la aplicación anestesia local (13%). Otras etiologías fueron la regeneración ósea para la colocación de implantes mandibulares, la extirpación de quistes asociados al tercer molar inferior y el tratamiento endodóntico. Se encontró que el tipo de establecimiento donde se realizó el procedimiento odontológico que generó la lesión, se asoció significativamente con los pacientes a los que se les advirtió y se les pidió que firmen el consentimiento informado (p<0.05); los odontólogos que trabajan en consultorios privados obtienen una menor proporción de consentimientos que los de las instituciones. El síntoma más frecuente fue la parestesia y 5 pacientes sufrieron dolor espontáneo o evocado. Solo 2 pacientes tenían intención de iniciar acciones legales. Teniendo en cuenta que son lesiones potencialmente permanentes, y de resolución compleja, la comunidad odontológica debe realizar especiales esfuerzos para disminuir esta complicación.

Anatomical Variation of the Auriculotemporal Nerve in Thai Cadavers / Variación Anatómica del Nervio Auriculotemporal en Cadáveres Tailandeses

SUMMARY: The auriculotemporal nerve (ATN) is an important structure lying within a limited area of an infratemporal region (ITR). The ATN is originated from the posterior branch of the mandibular division of the trigeminal nerve (V3). The ATN conveys somatosensory, secretomotor, and parasympathetic fibres of the V3 and gustatory nerve (CN IX). In literature, the most common pattern of the ATN is composed of 2 roots that encloses the middle meningeal artery (MMA). However, in many studies, it has been reported that there are many variations in ATN pattern formation. To study the variation of ATN pattern formation in Thai cadavers, 73 hemifaces from 39 Thai embalmed cadavers were dissected and the relations of the ATN to the MMA were recorded. This study concluded that there were 4 patterns observed in Thai cadavers. The common pattern is 2 roots (67.1 %), 3 roots (15.1 %), 1 root (9.6 %), and 4 roots (8.2 %). Knowledge of this variation in the ATN may be useful in understanding the symptoms of temporo-orofacial pain, paresthesia of temporomandibular joint (TMJ), possible side effects from the TMJ surgery and the efficiency of auriculotemporal nerve block for regional anesthesia of the temporomandibular joint in Thai people.

RESUMEN: El nervio auriculotemporal (NAT) es una estructura importante que se encuentra dentro de la región infratemporal (ITR). El NAT se origina en la rama posterior de la división mandibular del nervio trigémino (V3), y transmite fibras somato sensoriales, secreto motoras y parasimpáticas del V3 y del nervio gustativo (CN IX). En la literatura, se reporta que el patrón más común de NAT está compuesto por 2 raíces que contienen la arteria meníngea media (AMM). Sin embargo, en diversos estudios, se ha informado que existen múltiples variaciones en la for- mación de patrones NAT. Con el objetivo de estudiar la variación de la formación del patrón NAT en cadáveres tailandeses, se disecaron 73 estructuras hemi faciales de 39 cadáveres tailandeses y se registraron las relaciones del NAT con el AMM. En conclusión, se observaron 4 patrones en los cadáveres tailandeses. El patrón común de 2 raíces (67,1 %), 3 raíces (15,1 %), 1 raíz (9,6 %) y 4 raíces (8,2 %). El conocimiento de esta variación en el NAT puede ser útil para comprender los síntomas de dolor temporo-orofacial, parestesia de la articulación temporomandibular (ATM), posibles efectos secundarios de la cirugía de ATM y la eficacia del bloqueo del nervio auriculo-temporal para la anestesia regional de la articulación temporomandibular en Tailandeses.

Phentolamine Mesylate as a Drug for Reversal of Local Anaesthesia - A Questionnaire Based Study

Local anaesthesia being the most commonly administered drug in dentistry has its prolonged action for up to 3 - 5 hours due to the addition of vasoconstrictors. The extended periods of soft tissue anaesthesia due to the addition of these vasoconstrictors can cause other problems while speaking, drinking, and eating during which there is a higher risk of experiencing self-inflicted injuries to the tongue and lips. Phentolamine mesylate is a drug which helps in the reversal of action of local anaesthesia. Hence, the objective of this study was to provide a basic knowledge about this drug to the patient and assess the interest of the patient in taking the drug when given a choice. METHODSA questionnaire-based survey was conducted among 200 patients who required the administration of inferior alveolar nerve block for their dental treatment. This questionnaire contained basic information about Phentolamine Mesylate drug along with six questions where the patient was asked as to whether or not he / she was willing to take this drug for reversal of the effect of local anaesthesia and specific reason for its usage. RESULTSAmong 200 patients, 122 patients wanted to reverse the effect of local anaesthesia by the use of the phentolamine mesylate drug. Amongst these patients, 93 wanted to take the drug orally initially and upon informing that the injection will be given in the previously anaesthetized area, 91 patients preferred to take an injection of the drug. CONCLUSIONSMajority of patients surveyed in this study wanted to reverse the effect of local anaesthesia by taking phentolamine mesylate drug. However, there is a need to increase the awareness of the type of drug used and the importance of administration of the same.

Relação da exodontia de terceiros molares e a ocorrência de parestesia do nervo alveolar inferior: uma revisão narrativa / Relationship of third molar extraction and occurrence of lower alveolar nerve paresthesia: a narrative review

Terceiros molares inferiores podem apresentar uma estreita relação com o nervo alveolar inferior, aumentando as chances de lesão durante o ato cirúrgico. Objetivo: descrever a relação entre a exodontia de terceiros molares e a ocorrência da parestesia do nervo alveolar inferior. Revisão de literatura: cirurgia para exodontia de dentes terceiros molares é o procedimento mais frequentemente realizado entre as cirurgias bucais e, como todo tipo de cirurgia, possui riscos e acidentes e/ou complicações que podem acometer os pacientes tal como a parestesia. Esta é uma condição que altera a sensibilidade de determinada área e pode ocorrer em consequência de traumas diretos ao nervo ou pela compressão deste, devido a hematoma e edema, levando a desconforto e incômodo. Considerações finais: é importante o profissional cirurgião-dentista atentar para o planejamento correto, criterioso e fazer uso de exames complementares, a fim de precaver possíveis complicações durante o ato cirúrgico. Caso a parestesia aconteça, podem ser utilizados tratamentos medicamentosos, a laser ou cirúrgicos, com resultados em longo prazo positivos e reversão do caso.(AU)

Lower third molars may present a close relation with the inferior alveolar nerve increasing the chances of injury during the surgical act. In view of this, this literature review aims to describe the relationship between the extraction of molars third and the occurrence of inferior alveolar nerve paresthesia. Paresthesia is a condition that alters the sensitivity of a certain area and can occur as a result of direct trauma to the nerve or compression of the nerve due to hematoma and edema. It leads to discomfort and discomfort, and it is important for the professional to attend to the correct, judicious planning and to make use of complementary exams. If paraesthesia occurs, medical, laser or surgical treatments are used, with positive long- -term results and reversal of the case. (AU)

Alternativas Microquirúrgicas (Autoinjertos Nerviosos / Aloinjertos Nerviosos / Conductos Nerviosos) para la Recuperación Sensitiva Funcional de Nervio Alveolar Inferior y Nervio Lingual: Revisión de la Literatura / Microsurgical Alternatives (Nerve Autografts / Nerve Allografts/ Nerve Ducts) for Functional Sensory Recovery of the Lower Alveolar Nerve and Lingual Nerve: Review of the Literature

RESUMEN: Objetivo: analizar y comparar las modalidades actuales de reconstrucción microquirúrgica (autoinjertos, aloinjertos y conductos nerviosos) para lograr recuperación sensitiva funcional (RSF) en reparaciones de nervio alveolar inferior (NAI) y nervio lingual (NL). Materiales y Métodos: se realizó una revisión de la literatura para identificar estudios relacionados con reconstrucciones de NAI y NL. Los estudios incluidos proporcionaron un tamaño de muestra definido, modalidad de reconstrucción microquirúrgica y tasas de RSF. Se realizó un test de proporciones para saber si existían diferencias estadísticamente significativas (P <0,05) entre las modalidades de reconstrucción mencionadas. Resultados: se seleccionaron y analizaron 9 estudios que dieron como resultado una muestra de 130 reconstrucciones de NAI y 102 de NL. Entre las reconstrucciones de NAI, se encontró que los autoinjertos y aloinjertos eran superiores para lograr una RSF sobre los conductos nerviosos (P de 0,033 y 0,0397 respectivamente). Entre las reconstrucciones de NL, no se encontraron diferencias estadísticamente significativas. Y al comparar reconstrucciones mediante autoinjertos con aloinjertos, no hubo diferencias estadísticamente significativas para NAI y NL. Conclusiones: Las reconstrucciones mediante aloinjertos y autoinjertos tiene tasas de RSF equivalentes y mejores que los conductos nerviosos. Además, con el uso de aloinjertos, se evitan comorbilidades asociadas al sitio donante.

ABSTRACT: Objective: to analyze and compare the current modalities of microsurgical reconstruction (autografts, allografts, and nerve ducts) to achieve functional sensory recovery (RSF) in repairs of the inferior alveolar nerve (NAI) and lingual nerve (NL). Materials and Methods: a literature review was performed to identify studies related to NAI and NL reconstructions. The studies included provided a defined sample size, microsurgical reconstruction modality, and RSF rates. A test of proportions was performed to find out if there were statistically significant differences (P <0.05) between the mentioned reconstruction modalities. Results: 9 studies were selected and analyzed that resulted in a sample of 130 reconstructions of NAI and 102 of NL. Among the NAI reconstructions, autografts and allografts were found to be better in achieving an RSF than the nerve ducts (P of 0.033 and 0.0397 respectively). Among the NL reconstructions, no statistically significant differences were found. And when comparing reconstructions using autografts with allografts, there were no statistically significant differences for NAI and NL. Conclusions: Reconstructions using allografts and autografts have equivalent and better RSF rates than nerve conduits. Furthermore, with the use of allografts, comorbidities associated with the donor site are avoided.

Reconstrucción del nervio alveolar inferior con aloinjerto de nervio acelular humano en resección mandibular / Reconstruction of the inferior alveolar nerve with human acellular nerve allograft in mandibular resection

La reconstrucción de nervios periféricos con aloinjertos nerviosos acelulares humanos en neurocirugía ha sido bastante estudiada estableciendo su predictibilidad y éxito en intervenciones principalmente en los nervios digitales de las manos. En cirugía maxilofacial existe una creciente investigación para poder restaurar el nervio alveolar inferior en cirugías de resección mandibular en donde la extirpación de esta estructura nerviosa es inevitable. El objetivo de esta publicación es mostrar un reporte de un caso en donde se realizó la reconstrucción del nervio alveolar inferior con aloinjerto de nervio acelular humano (Avance® Nerve Graft, Axogen) con microcirugía para poder proveer de sensibilidad a la región de la cara afectada en un paciente reconstruido con un injerto de fíbula microvascularizada posterior a una hemimandibulectomía por ameloblastoma plexiforme.

The reconstruction of peripheral nerves with allografts of human acellular nerves in neurosurgery is well studied, establishing its predictability and success in interventions mainly in the digital nerves of the hands. In maxillofacial surgery there is a growing investigation to be able to restore the inferior alveolar nerve in mandibular resection surgeries where the removal of this nervous structure is inevitable. The objective of this publication is to show a case report in which the reconstruction of the inferior alveolar nerve was performed with human acellular nerve allograft (Avance® Nerve Graft, Axogen) with microsurgery in order to provide sensitivity to the region of the affected face in a reconstructed patient with a microvascularized bone fibula graft after hemimandibulectomy due to plexiform ameloblastoma.

The Efficacy of Two Different Concentrations of Local Anaesthetic on Pain in Mandibular Third Molar Surgery

@#Mepivacaine is a common local anaesthetic used with claims of a high safety profile. There are two commercial types, 2% mepivacaine with vasoconstrictor and 3% without vasoconstrictor. There are many suggestions regarding the usage of plain 3% without vasoconstrictor for systemic medical problems, however, there have not been any previous studies to confirm this necessity in impacted lower third molar surgery (ILTMS). This study aims to evaluate the anaesthetic efficiency and the effect on the patient of 2% and 3% mepivacaine, adding vasoconstrictor to the 3% mepivacaine. This crossover study comprised of 24 patients with bilateral, symmetrically positioned, impacted lower third molars. Patients received either 2% or 3% mepivacaine for the inferior alveolar nerve block (IANB). Onset and duration of anaesthesia, and haemodynamic considerations were analysed as primary outcomes. Furthermore, pain, duration of postoperative anaesthesia and pulp vitality were analysed as secondary outcomes. Different concentrations of mepivacaine showed similar anaesthetic onset time (p > 0.05). There was no statistically significant difference regarding the duration of anaesthesia, as well as the postoperative analgesia (p > 0.05). The two concentrations did not lead to any haemodynamic changes or complications during ILTMS. Thus, adding the vasoconstrictor to mepivacaine 3% did not cause any adverse effects on the patients intra or postoperatively. Therefore, it is possible for dentists to use only 2% mepivacaine with vasoconstrictor for IANB effectively and safely when the case necessitates the need for a vasoconstrictor, or in other words, longer duration of haemostasis.

Clinical observation of inferior alveolar nerve block combined with parecoxib sodium intravenous analgesia after mandible orthognaxillary surgery / 口腔疾病防治

Objective @# To compare the analgesic effect and safety of bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intravenous analgesia pump in analgesia after orthognathic surgery.@*Methods @#Forty patients with simple ascending sagittal split osteotomy and ankle plasty were randomly divided into the experimental group and the control group, with 20 patients in each group. The experimental group received 2 mL 1% ropivacaine by inferior alveolar nerve block anesthesia on both sides. Immediately after surgery, parecoxib sodium 40 mg was intravenously administered. The control group was given an intravenous analgesia pump for analgesia. Pain intensity (VAS pain score) and Ramsay sedation score were recorded at 2 h, 4 h, 8 h, 24 h, 48 h after operation, and the incidence of postoperative adverse reactions was observed.@*Results@#There was no significant difference in pain intensity and Ramsay sedation score between the two groups at each time point (P>0.05). During the analgesic treatment, the incidence of nausea and vomiting in the experimental group was significantly lower than that in the control group (P<0.05).@*Conclusion@# Bilateral inferior alveolar nerve block combined with parecoxib sodium analgesia and simple intravenous analgesia pump are effective for analgesia after mandibular orthognathic surgery, but the former has a lower incidence of adverse reactions, more suitable for analgesia after mandibular orthognathic surgery.

A morphometric study of mandibular foramen in dry adult human mandibles of indian population in telangana state

Background: Mandibular foramen is an irregular foramen located just above the centre of the medial surface ofthe ramus of the mandible. Mandibular foramen is leading to mandibular canal through which inferior nerveand vessels will transmit and supply the teeth of lower jaw.The Mandibular foramen is an important anatomical landmark for the inferior nerve blocks, mandibularosteotomies and implant treatment. The inferior nerve block is the commonest local anaesthetic techniquewhich is used for anaesthetizing lower jaw in various surgical and dental procedures on mandible andmandibular teeth such as removal of impaction, reduction of fractures and tooth extraction. Inferior alveolarnerve block failure is not uncommon and it occurs even with experienced hands due to variations in position ofmandibular foramen.A thorough knowledge of anatomy of mandibular foramen is very essential hence aim of this study was todetermine the exact position of mandibular foramen by studying dry adult human mandibles of telanganapopulation.Material and methods: The present study was conducted using 60 dry adult human mandibles obtained fromanatomy department of Shadan institute of medical sciences,Hyderabad and VRK womens medicalcollege,Hyderabad. The data was tabulated and statistically analysed.Result: The mean distance of mandibular foramen to anterior border of ramus (MF-AB)was16.67±2.73mm(R)and16.56±2.52mm(L),to posterior border of ramus(MF-PB) was 12.67±2.37mm(R) and 13.03±2.43mm(L),to mandibularnotch (MF-MN) 21.04±2.95mm(R) and 20.24±2.94mm(L),to angle of mandible was 23.005±3.92mm(R) and22.36±3.89mm,base of mandible or inferior border (MF-MB) was 24.38±3.86mm(R) and 24.42±4.44mm(L), tip ofcoronoid process (MF-CrT) 35.68±3.25mm(R) and 35.19±3.47mm (L).Conclusion: The present study gives a fair knowledge of the position of mandibular foramen and provides usefulinformation for successful local anaesthesia ( inferior nerve block),to the maxillofacial surgeons,radiologistsand oncologists performing operations on the mandible to prevent complications and misinterpretations

Study Of Pattern Of Distribution Of Mylohyoid Bridging And Their Clinical Implications

Background: The occurrence of mylohyoid bridges in mandible resulting compression of inferior alveolar andmylohyoid nerves, and vessels, is important cause of neuropathy in this region.Aim and objective: The present study was aimed at analyzing influence of sex and laterality in the occurrence ofmylohyoid bridging in Indian population, and establishing a clue to the underlying causes of paraesthesia ofidiopathic origin, in the territory of inferior alveolar and mylohyoid nerves.Methods: We studied 300 human mandibles (141 female and 159 male) for location and degree of mylohyoidbridging.Results: We found mylohyoid bridges in 15.66% mandibles. The proximal bridging was found more frequentlythan the distal bridging. The mylohyoid bridges were found in 7.8% female and 13.2% in male mandibles studied.We found mylohyoid bridges on 5% on right side and 5.66% on the left side, bilateral bridging was found in 5.33%mandibles.Conclusion: The frequency of occurrence of mylohyoid bridging was higher in male; however, laterality was not tobe significant amongst the mandibles studied. The location and degree of mylohyoid bridging are one of theimportant etiological factors of paraesthesia in the region of inferior alveolar and mylohyoid nerves distribution.

Cross-Sectional Study of Mandibular Canal Branching in Regions Affected by Dental Inflammation with Cone Beam Computed Tomography / Estudio Transversal de la Ramificación del Canal Mandibular en Regiones Afectadas por Inflamación Dental con Tomografía Computarizada de Haz Cónico

ABSTRACT: The present study aimed to investigate the occurrence of mandibular canal alterations in regions with dental inflammation by means of cone beam computed tomography (CBCT). A database of 2,484 CBCTs was reviewed for identifying dental inflammation in mandibular alveolar ridges. The final sample consisted of 150 CBCTs, including 91 females and 59 males, with ages ranging from 13 to 89 years (mean age of 47.06; ± SD=18.722). The presence and location of dental inflammation, gender, age, as well as presence and location of mandibular canal branching (MCB) were evaluated. The Kolmogorov-Smirnov, Chi-square, and T-test were applied to verify the statistical relationship of the data. There were 178 images of dental inflammation on 150 CBCTs, mainly located at molars' region (75 %). Apical lesions were the most common type of dental inflammation found (79 or 44.4 % of the sample), followed by pericoronitis (32; 18.0 %). This study identified 135 mandibular canal branches in the exams that presented dental inflammation. The MCB were also most commonly located at molars' region (74.07 %). No statistical difference was identified regarding the distribution of mandibular canal branching in relation to the sites with dental inflammation (p=0.370).The MCB found were mostly single (86 or 63.7 % of the total). Sex had no influence on mandibular canal branching occurrence (p=0.308), not did age (p=0.728). A high prevalence of mandibular canal branching was observed in the regions where dental inflammation were identified, most commonly found in the molar region.

RESUMEN: El presente estudio tuvo como objetivo investigar la ocurrencia de ramificación del canal mandibular (RCM) en regiones con inflamación dental mediante tomografía computarizada de haz cónico (TCHC). Se revisó una base de datos de 2.484 TCHC para identificar la inflamación dental en las crestas alveolares mandibulares. La muestra final consistió en 150 TCHC, incluidas 91 mujeres y 59 hombres, con edades comprendidas entre 13 y 89 años (edad media de 47,06 ± DE = 18,722). Se evaluaron el sexo, la edad, la presencia y la ubicación de la inflamación dental, así como la presencia y ubicación de RCM. KolmogorovSmirnov, Chi-cuadrado y prueba-T se aplicaron para verificar la relación estadística de los datos. Hubo 178 imágenes de inflamación dental en 150 TCHC, ubicados principalmente en la región de los molares (75 %). Las lesiones apicales fueron el tipo más común de inflamación dental encontrada (79 o 44,4 % de la muestra), seguidas por pericoronitis (32; 18,0 %). Este estudio identificó 135 ramas del canal mandibular en las regiones que presentaron inflamación dental. El RCM también se localizó con mayor frecuencia en la región de los molares (74,07 %). No se identificaron diferencias estadísticas con respecto a la distribución de la ramificación del canal mandibular en relación con los sitios con inflamación dental (p = 0,370). Las RCM encontrados fueron en su mayoría solteros (86 o 63,7 % del total). El sexo no tuvo influencia en la ocurrencia de la ramificación del canal mandibular (p = 0,308), no la edad (p = 0,728). Se observó una alta prevalencia de ramificación del canal mandibular en las regiones donde se identificó la inflamación dental, que se encuentra con mayor frecuencia en la región molar.

Achados na Radiografia Panorâmica Indicam Tomografia Computadorizada no Pré-Operatório de Terceiro Molar Inferior: Relato de Caso / Panoramic Radiography Findings Indicate Computed Tomography in Mandibular Third Molar Presurgical Evaluation: Case Report

Os terceiros molares inferiores apresentam-se frequentemente retidos e suas raízes podem estar envolvidas pelo canal da mandíbula, representando risco de injúria nervosa durante a exodontia. Na avaliação pré-cirúrgica desses dentes, comumente utiliza-se a radiografia panorâmica, que muitas vezes evidencia a sobreposição das imagens das raízes dentárias sobre o canal da mandíbula, com possibilidade de proximidade entre estas estruturas. Esses casos geram dúvidas ao profissional quanto à necessidade de indicar uma tomografia computadorizada. Na literatura têm sido pesquisados achados na radiografia panorâmica que indicam maior risco de proximidade entre tais estruturas, justificando a indicação do exame seccional. Entre esses achados, destacam-se: escurecimento radicular, interrupção da linha radiopaca do canal, desvio do canal, deformação da raiz, estreitamento do canal, estreitamento radicular, escurecimento e ápice bífido da raiz. A presença de um ou mais desses sinais em radiografia panorâmica indica provável proximidade entre as raízes do terceiro molar e o canal mandibular. O objetivo desse trabalho foi relatar um caso clínico de avaliação do dente 48 previamente à exodontia, envolvendo uma radiografia panorâmica, que revelou dois desses sinais apontados na literatura. Posteriormente, foi obtida tomografia computadorizada por feixe cônico (TCFC), que evidenciou envolvimento de ambas as raízes do dente 48 pelo canal da mandíbula. Concluiu-se que a TCFC foi bem indicada, devendo ser recomendada quando a radiografia panorâmica evidenciar um ou mais dos sinais indicativos de proximidade entre raízes do siso e o canal da mandíbula, contribuindo para a decisão na rotina clínica e para evitar complicações pós-operatórias.

Mandibular third molars are often intraosseous and their roots may be involved by mandibular canal, a risk situation of nerve injury during exodontia. For presurgical evaluation, panoramic radiography is widely used, so that the image often shows the overlapping of dental root images over the mandibular canal, with possible proximity between them. Then, the professional has doubts about the need to indicate a CT scan. In literature, researchers have investigated findings on panoramic radiography that indicate a greater risk of proximity between such structures, justifying the indication of the sectional examination. These findings include root darkening, interruption of white line of mandibular canal, canal deviation, root deformation, canal narrowing, root narrowing, browning and bifid apex of the root. The presence of one or more of these signs in panoramic radiography indicates probable proximity between lower third molar roots and mandibular canal. The aim of this study was to report a clinical case of a tooth 48 presurgical evaluation, involving a panoramic radiograph, which revealed two of these signs pointed out in the literature. Later, a cone beam computed tomography (CBCT) scan was performed, so that sectional images showed involvement of both roots of the tooth 48 by the mandibular canal. It was concluded that the CBCT was well indicated and should be recommended when the panoramic radiography evidences one or more of the signs indicating proximity between wisdom tooth roots and mandibular canal, contributing to the decision in clinical routine and to avoid postoperative complications.