Retromolar canal diagnosed by cone-beam computed tomography and its influence in inferior alveolar nerve block / Canal retromolar diagnosticado por tomografía computarizada de haz cónico y su influencia en el bloqueo del nervio alveolar inferior

The aim of this study was to observed the anesthetic efficacy of the alveolar nerve block on nine patients that CBCT diagnosed unilateral retromolar canal on a double-blind, split-mouth approach. The assessments of patient response to thermal (pulp vitality test) and pressure (compression of soft tissue) stimuli were carried out before and 5 minutes after the inferior alveolar nerve block procedure, using both visual analog scale (VAS) and Mc Gill pain questionnaires (McG). The mean percentage of patient response decreased after alveolar nerve block, according to both VAS and McG, and was statistically similar among hemi mandibles with and without retromolar canal (Wilcoxon>0.05); however, those without retromolar canal presented greater reduction in patient response in 6 out of 9 cases. Therefore, the retromolar canal is not a determinant factor of inferior alveolar nerve block failure.

El objetivo de este estudio fue observar la eficacia anestésica del bloqueo del nervio alveolar en nueve pacientes que CBCT diagnosticó canal retromolar unilateral en un abordaje de boca dividida doble ciego. Las evaluaciones de la respuesta del paciente a los estímulos térmicos (prueba de vitalidad pulpar) y de presión (compresión de los tejidos blandos) se realizaron antes y 5 minutos después del procedimiento de bloqueo del nervio alveolar inferior, utilizando tanto la escala analógica visual (VAS) como los cuestionarios de dolor de Mc Gill ( McG). El porcentaje medio de respuesta de los pacientes disminuyó tras el bloqueo del nervio alveolar, según EVA y McG, y fue estadísticamente similar entre hemimandíbulas con y sin canal retromolar (Wilcoxon>0,05); sin embargo, aquellos sin canal retromolar presentaron mayor reducción en la respuesta del paciente en 6 de 9 casos. Por lo tanto, el canal retromolar no es un factor determinante del fracaso del bloqueo del nervio alveolar inferior.

Ruptura de aguja dental con migración al espacio pterigomaxilar. Resolución mediante abordaje intrabucal laterofaríngeo / Rupture of dental needle with migration to the pterygomaxillary space. Resolution by intraoral lateropharyngeal approach

Introducción: La ruptura de una aguja dental es una complicación infrecuente y sucede generalmente por el movimiento repentino y/o cierre bucal inesperado del paciente, por doblar la aguja en forma inadecuada, por insertarla completamente o moverla dentro del tejido blando, por elegir agujas de calibre y longitud inadecuados y al realizar técnicas anestésicas inapropiadas. Cuando la aguja no puede ser recuperada al instante, debe establecerse su ubicación imagenológica tridimensional y decidir el manejo. Ante tal situación, su eliminación quirúrgica es la propuesta más recomendable por la posibilidad de que migre y lesione estructuras anatómicas importantes. Objetivo: Realizar una revisión de la literatura y presentar un caso clínico de ruptura de aguja dental localizada en el espacio pterigomaxilar, resuelto con un abordaje intrabucal laterofaríngeo. Presentación de caso: Paciente masculino de 8 años de edad, que acude a consulta por presentar ruptura de una aguja dental. Para obtener su ubicación se utilizó una tomografía computarizada de haz cónico con reconstrucción tridimensional a boca cerrada y abierta. Esta prueba ofreció mayor precisión y correspondencia anatómica, considerando que la eliminación quirúrgica podría realizarse mediante un abordaje intrabucal. Así fue hecho y durante la intervención quirúrgica se advirtió que la aguja había migrado a una ubicación superior y posterior, al espacio pterigomaxilar. Ante tal situación, resultó de mayor complejidad su recuperación, que ya presentaba riesgos por el procedimiento complejo al que se sometió. Conclusiones: La anestesia local intrabucal no está exenta de complicaciones propias como la ruptura de la aguja dental. Cuando este evento se presenta, el resultado puede ser de muy difícil manejo(AU)

Introduction: The rupture of a dental needle is an uncommon complication and usually happens due to the sudden movement and / or unexpected oral closure of the patient, by bending the needle improperly, by inserting it completely or moving it into the soft tissue, by choosing needles of inadequate caliber and length and by performing inappropriate anesthetic techniques. When the needle cannot be recovered instantly, its three-dimensional imaging location must be established and handling decided. In such a situation, its surgical elimination is the most recommended proposal due to the possibility of migrating and injuring important anatomical structures. Objective: Conduct a literature review and present a clinical case of dental needle rupture located in the pterygomaxillary space, resolved with a lateropharyngeal intraoral approach. Case presentation: An 8-year-old male patient, who comes to the consultation for a ruptured dental needle. To obtain its location, a cone-beam computed tomography with three-dimensional reconstruction was used at closed and open mouth. This test offered greater precision and anatomical correspondence, considering that surgical removal could be performed by an intraoral approach. This was done and during the surgical intervention it was noticed that the needle had migrated to an upper and posterior location, to the pterygomaxillary space. Faced with this situation, his recovery was more complex, in addition to the one that this procedure represents by itself. Conclusions: Intraoral local anesthesia is not exempt from its own complications such as the rupture of the dental needle. When this event occurs, the result can be very difficult to manage(AU)

Una nueva alternativa para la localización y la recuperación de agujas fracturadas durante la anestesia odontológica. Presentación de técnica y caso clínico / A new alternative for locating and removing a needle fractured during dental anesthesia. Technique and case report

Objetivo: Describir en un caso clínico una nueva técni- ca para la localización y la remoción de agujas fracturadas du- rante la anestesia odontológica mediante planificación virtual. Caso clínico: Una paciente de género femenino de 52 años de edad concurre a la Cátedra de Cirugía y Traumatolo- gía Bucomaxilofacial I de la Facultad de Odontología de la Universidad de Buenos Aires y relata que dos meses atrás, durante la atención odontológica, se produjo la fractura de la aguja durante la anestesia troncular mandibular. Se realiza diagnóstico y planificación virtual para conocer la ubicación exacta de la aguja y se confecciona un modelo estereolito- gráfico y una guía quirúrgica individualizada para removerla. El uso de una guía quirúrgica individualizada y confeccio- nada mediante planificación virtual permitió ubicar la aguja tridimensionalmente y con mayor precisión en espacios pro- fundos y disminuir tiempos operatorios (AU)

Aim: To describe in a clinical case a new virtual plan- ning technique for locating and removing a fractured dental anesthetic needle. Clinical case: A 52-year-old patient visited the De- partment of Oral and Maxillofacial Surgery I (School of Dentistry, University of Buenos Aires) with a retained den- tal needle in the pterygomandibular space. The needle had fractured during inferior alveolar nerve block two months previously. Virtual diagnosis and planning were performed to locate the needle and a stereolithographic model and a customized surgical guide were prepared. The use of cus- tomized surgical guides prepared by virtual planning ena- bled precise location of the dental needle in deep spaces and reduced operating times (AU)

Deflexión de agujas dentales 30G: comparación de cinco marcas comerciales / Deflection of dental needles 30G: comparison of five trademarks

Abstract Introducción: El grado o nivel de deflexión de la aguja dental, en la mayoría de los casos, puede determinar el éxito o fracaso en la técnica de anestesia dental. Objetivo: Medir el grado de deflexión de la aguja dental, comparando 5 diferentes marcas disponibles en la ciudad de Hermosillo, Sonora, México. Métodos: Se realizó un estudio experimental, en el que con ayuda de un modelo creado con un nivel profesional y una jeringa tipo cárpul, se realizaron diversas punciones en un trozo de carne de res, simulando la realización de una técnica lineal de anestesia bucodental. Se tomaron radiografías periapicales de cada una de las punciones, y con ayuda de una malla milimetrada, se realizaron las mediciones. Dentro de cada grupo de agujas, se presentaron diferentes medidas de deflexión, y se obtuvo un promedio de cada marca. El rango abarcó desde los .65 mm hasta 2.1 mm de deflexión, tomando como referencia un plano recto. Conclusiones: Se demostró que la de la marca Septodont®, fue la que presentó menor deflexión a la punción. Es recomendable verificar y examinar el estado de las agujas antes de ser utilizadas para realizar procesos quirúrgicos, y así disminuir riesgos y/o complicaciones postoperatorias.

Resumen Introduction: The degree or level of deflection of the dental needle, in most cases, can determine the success or failure of the dental anesthesia technique. Objective: Measure the degree of deflection of the dental needle, comparing 5 different brands available in the city of Hermosillo, Sonora, Mexico. Method: An experimental study was carried out, with a model created with a professional level and a carpul syringe, various punctures were made in a piece of beef, simulating the performance of a linear technique of oral anesthesia. Periapical radiographs of each of the punctures were taken, and with the help of a millimeter mesh, measurements were made. Within each group of needles, different deflection measures were presented, and an average of each brand was obtained. The range ranged from .65 mm to 2.1 mm of deflection, taking as reference a straight plane. Conclusions: It was shown that the Septodont® brand was the one that presented the lowest puncture deflection. It is advisable to verify and examine the condition of the needles before being used to perform surgical procedures, and thus reduce risks and / or postoperative complications.

A propósito de la crioanestesia dental / Apropos dental cryoanesthesia

RESUMEN Introducción: La crioanestesia es una forma de anestesia tópica utilizada en procedimientos médicos menores aprovechando el descenso o inhibición del umbral doloroso causado por el estímulo térmico. Es posible emplearla en procedimientos sobre tejidos dentales para complementar la anestesia con fármacos y combatir el fracaso anestésico. Objetivo: Describir los hallazgos sobre el uso y aplicación de la crioanestesia dental en odontología. Métodos: Revisión exploratoria de la literatura científica y gris, donde se evaluó la disminución de la sensación dolorosa empleando frío sin alcanzar congelación del tejido dental. Fueron consultadas las bases de datos Pubmed, Embase, Scopus, SciELO, Elsevier y Science Direct. La búsqueda en Google Académico se realizó eliminando las entradas repetidas y limitada a los 100 primeros resultados. La investigación cubrió el periodo de 1941 hasta diciembre de 2018 y se utilizó la lista de comprobación PRISMA para ejecutar la revisión. Resultados: Cuatro artículos fueron seleccionados. Todos emplearon diferentes dispositivos, refrigerantes y escalas para valoración del dolor; sin embargo, todos reportaron ausencia de dolor en algunas de sus muestras. Conclusión: Se identificó evidencia escasa y antigua con desigualdad en las escalas de valoración, protocolos clínicos, sustancias refrigerantes y dispositivos utilizados(AU)

ABSTRACT Introduction: Cryoanesthesia is a type of topical anesthesia used in minor medical procedures. It is based on the descent or inhibition of the pain threshold caused by the thermal stimulus. Cryoanesthesia may be used in procedures performed on dental tissues to complement anesthetic drugs and combat anesthetic failure. Objective: Describe the findings about the use and application of cryoanesthesia in dental practice. Methods: An exploratory review was conducted of scientific and grey literature to evaluate pain reduction using cold temperatures without freezing the dental tissue. The databases consulted were Pubmed, Embase, Scopus, SciELO, Elsevier and Science Direct. The search in Google Scholar removed repeated entries and was limited to the first 100 results. The study covered the period extending from 1941 to December 2018, and used the PRISMA checklist to carry out the review. Results: Four papers were selected. All four used different devices, refrigerants and pain assessment scales. However, they all reported an absence of pain in some of their samples. Conclusion: Scant, outdated evidence was identified which contained discrepancies in the assessment scales, clinical protocols, refrigerant substances and devices used(AU)

Impact of Two Distinct Dental Anesthesia Simulation Models on the Perception of Learning by Students / Impacto de dos distintos modelos de simulación para anestesia dental en la percepción del aprendizaje en estudiantes

ABSTRACT We evaluated an infiltration anesthesia simulation model (IAM) and a conduction anesthesia simulation model (CAM) on the perception of learning by Mexican dental students. Our aim was to compare the perception of learning by dental students trained with two distinct dental anesthesia simulation model (DASM) with dental students who were not trained with a DASM. 3 groups participated in the study: G1 (N=12 students) learned to block the mental nerve (BMN) by participating in a theoretical lecture (stage 1) and a clinical demonstration (stage 2); G2 (N=12 students) learned the BMN by participating in the stage 1, stage 2, and training with the CAM; G3 (N=12 students) learned the BMN by participating in the stage 1, stage 2, and training with the IAM. The groups performed the BMN in a clinical exercise. Working-time of all participants was timed. Perception of learning for all participants was evaluated with a 5-point Likert Scale. The results showed that statistically significant differences were found between score of G1 and score of G2 and score of G3 (P<0.05). No statistically significant differences were found between scores of G2 and scores of G3. G1, G2 and G3 showed an average working-time of 12:42 minutes, 9.75 minutes and 8:03 minutes, respectively (P<0.05). We concluded that the IAM and CAM showed a positive impact on the perception of learning, and the students trained with the IAM showed a shorter working time compared with the students trained with the CAM.

RESUMEN En este estudio se evaluó el impacto de un modelo de simulación de anestesia dental por infiltración (IAM) y de un modelo de simulación de anestesia dental por bloqueo (CAM) en la percepción del aprendizaje en estudiantes mexicanos en estomatología. El objetivo fue comparar la percepción en el aprendizaje de estudiantes que entrenaron empleando dos distintos modelos de simulación de anestesia dental con estudiantes que no recibieron entrenamiento empleando algún modelo de simulación de anestesia dental. Participaron 3 grupos en el estudio: G1 (n=12) aprendieron el bloqueo del nervio mentoniano (BNM) al participar en una clase teórica (sesión 1) y en una demostración clínica (sesión 2); G2 (n=12) aprendieron la técnica de anestesia del BNM al participar en la sesión 1, sesión 2 y entrenando con el CAM; G3 (n=12) aprendieron la técnica del BNM al participar en la sesión 1, sesión 2 y entrenando con el IAM. Los grupos aplicaron la técnica del BNM en un ejercicio clínico. Se midió el tiempo de trabajo de los participantes. La percepción del aprendizaje de los participantes se evaluó con una Escala de Likert de 5 ítems. Los resultados mostraron diferencias estadísticamente significativas entre los valores del G2 y del G3 en comparación con el G1. No se encontraron diferencias estadísticas entre los valores del G2 y del G3. El tiempo de trabajo para el G1, G2 y G3 fue respectivamente de: 12:42 minutos, 9.75 minutos y 8:03 minutos, (P<0.05). Se concluyó que el IAM y el CAM mostraron un impacto positivo en la percepción del aprendizaje; los estudiantes entrenados con el IAM mostraron un tiempo de trabajo más corto en comparación con los estudiantes entrenados con el CAM.

Minimizing the risk of perioperative cardiovascular complications in homozygous familial hypercholesterolemia: a case report

Homozygous familial hypercholesterolemia (HoFH) is a rare inherited disorder that presents as abnormally elevated levels of low-density lipoprotein cholesterol and premature heart disease, requiring frequent intervention through lipid apheresis for management. The risk of perioperative cardiac events is higher in patients with HoFH because of its pathophysiological manifestations in the vascular system. Careful cardiac precautions and anesthetic assessments are necessary to ensure patient safety. In the following case report, we discuss the clinical course and anesthetic considerations for a 14-year-old girl with HoFH undergoing sedation for dental extractions and mandibular molar uprighting in an outpatient oral surgery clinic. Considerations included the use of heparin in the patient's weekly plasma lipid apheresis treatment. In order to reduce the risks of peri- and postoperative bleeding and perioperative cardiac events, the operation was scheduled for 4 days after apheresis. This allowed for adequate heparin clearance, while also reducing the likelihood of possible cardiac events. A literature review revealed no results for the outpatient management of patients with HoFH undergoing sedation for noncardiac procedures. Our reported case serves as a clinical example for physicians to be utilized in the future.

Lipid emulsion therapy of local anesthetic systemic toxicity due to dental anesthesia

Local anesthetic systemic toxicity (LAST) refers to the complication affecting the central nervous system (CNS) and cardiovascular system (CVS) due to the overdose of local anesthesia. Its reported prevalence is 0.27/1000, and the representative symptoms range from dizziness to unconsciousness in the CNS and from arrhythmias to cardiac arrest in the CVS. Predisposing factors of LAST include extremes of age, pregnancy, renal disease, cardiac disease, hepatic dysfunction, and drug-associated factors. To prevent the LAST, it is necessary to recognize the risk factors for each patient, choose a safe drug and dose of local anesthesia, use vasoconstrictor , confirm aspiration and use incremental injection techniques. According to the treatment guidelines for LAST, immediate application of lipid emulsion plays an important role. Although lipid emulsion is commonly used for parenteral nutrition, it has recently been widely used as a non-specific antidote for various types of drug toxicity, such as LAST treatment. According to the recently published guidelines, 20% lipid emulsion is to be intravenously injected at 1.5 mL/kg. After bolus injection, 15 mL/kg/h of lipid emulsion is to be continuously injected for LAST. However, caution must be observed for >1000 mL of injection, which is the maximum dose. We reviewed the incidence, mechanism, prevention, and treatment guidelines, and a serious complication of LAST occurring due to dental anesthesia. Furthermore, we introduced lipid emulsion that has recently been in the spotlight as the therapeutic strategy for LAST.

Avaliação da deformação de agulhas gengivais e análise fractal / Evaluation of dental needle deformation and fractal analysis

Introdução: A fratura da agulha na anestesia odontológica é rara, mas sua ocorrência tem sérias complicações e deve ser evitada. Objetivo: O objetivo deste estudo foi avaliar a deformação de agulhas dentárias após a aplicação de forças de compressão. Material e método: Agulhas das marcas Dencojet e Septoject XL nos calibres 27G e 30G (quatro grupos) foram dobradas em dois sentidos opostos em máquina de ensaio mecânico DL200 - EMIC, com base na ISO 7885:2010. A resistência à compressão das agulhas foi medida em cada dobra. Ao final, foi realizada inspeção visual em uma lupa EK3ST em aumento de 40×, para análise da integridade das agulhas. Resultado: As agulhas de calibre 30G não apresentaram diferenças significativas entre elas. As agulhas de maior calibre (27G) apresentaram diferenças no primeiro (p = 0,0001) e no segundo dobramento (p = 0,0016). As agulhas Septoject XL 27G demonstraram ser muito menos flexíveis, fornecendo valores mais altos de resistência à dobra. No grupo Septoject XL 30G, 70% das agulhas fraturaram próximo ao canhão. Todas as amostras do grupo Septoject XL 27G apresentaram fraturas após a segunda dobra. Conclusão: Todas as agulhas gengivais testadas apresentaram comportamento aceitável, mesmo quando submetidas a situações críticas. As agulhas Dencojet 27G demonstraram ser mais flexíveis quando dobradas. Todas as agulhas Septoject XL 27G fraturaram após a segunda dobra. Não é aconselhável dobrar as agulhas dentárias.

Introduction: Needle fracture in dental anesthesia is rare, but its occurrence has serious complications and should be avoided. Objective: The objective of this study was to evaluate the deformation of dental needles after the application of compression forces. Material and method: Needles of the Dencojet and Septoject XL brands in the 27G and 30G gauges (4 groups) were folded in two opposite directions in a mechanical test machine DL200 - EMIC, based on ISO 7885: 2010. The compressive strength of the needles was measured at each fold. At the end, visual inspection was performed on an EK3ST magnifying glass in a magnification of 40× for analysis of needle integrity. Result: 30G needles did not present significant differences between them. The largest gauges (27G) presented differences in the first (p = 0.0001) and in the second folding (p = 0.0016). Septoject XL 27G needles have been shown to be much less flexible, providing higher values ​​of resistance to folding. Seventh percent of the Septoject XL 30G group fractured near the cannon. All samples from the Septoject XL 27G group showed fractures after the second fold. Conclusion: All the gingival needles tested presented acceptable behavior, even when submitted to critical situations. Dencojet 27G needles have been shown to be more flexible when folded. All Septoject XL 27G needles fractured after the second fold. It is not advisable to bend the dental needles.

Alternative practices of achieving anaesthesia for dental procedures: a review

Managing pain and anxiety in patients has always been an essential part of dentistry. To prevent pain, dentists administer local anaesthesia (LA) via a needle injection. Unfortunately, anxiety and fear that arise prior to and/or during injection remains a barrier for many children and adults from receiving dental treatment. There is a constant search for techniques to alleviate the invasive and painful nature of the needle injection. In recent years, researchers have developed alternative methods which enable dental anaesthesia to be less invasive and more patient-friendly. The aim of this review is to highlight the procedures and devices available which may replace the conventional needle-administered local anaesthesia. The most known alternative methods in providing anaesthesia in dentistry are: topical anaesthesia, electronic dental anaesthesia, jet-injectors, iontophoresis, and computerized control local anaesthesia delivery systems. Even though these procedures are well accepted by patients to date, it is the authors' opinion that the effectiveness practicality of such techniques in general dentistry is not without limitations.

Subzygomatic and infraorbital approaches for maxillary nerve blockade in cats' cadaver / Abordagens subzigomática e infraorbitária para o bloqueio do nervo maxilar em cadáver de gatos

ABSTRACT: This study compared the accuracy of dye placement on the maxillary nerve by using the percutaneous subzigomatic (SBZ) and infraorbitary (IO) approaches in cats' cadavers. A second aim was to compare the accuracy of dye placement on the maxillary nerve between different untrained anesthetists. This was a prospective, randomized, blinded study, performed in 40 heads obtained from feline cadavers. Three veterinarians (A, B and C) with no previous experience with the IO approach performed the experiments. The SBZ approach was randomly performed on one side of the head and the IO approach was performed in the contralateral side of the same head. For each approach, 0.2ml of 1% methylene blue dye was injected. Scores for length of nerve staining were as follows: 0 (failure), no staining; 1 (moderate), <6mm of nerve stained; and 2 (ideal), ≥6mm of nerve stained. Median scores (interquartile range) for the SBZ and IO approaches were 2.0 (0.3-2.0) and 1.0 (0.0-2.0), respectively. Scores for length of nerve staining were higher with the SBZ approach than the IO approach (P=0.016). Considering the scores for both the SBZ and IO approaches, there was a significant difference among the three veterinarians (P=0.002). Results of this study do not support the IO approach to perform a maxillary nerve block in cats. A greater accuracy of methylene blue dye placement was observed with the SBZ approach. A variable accuracy may exist between different veterinarians when performing a maxillary nerve block employing the SBZ and IO techniques in cats.

RESUMO: O objetivo deste estudo foi comparar o acesso do nervo maxilar pela abordagem subzigomática (SBZ) com a abordagem pelo forame infraorbitário (IO) em peças anatômicas de gatos utilizando o corante azul de metileno. Um segundo objetivo foi comparar a acurácia na coloração do nervo maxilar com o azul de metileno entre diferentes anestesistas que não receberam treinamento prévio. Este estudo foi prospectivo, randomizado, cego, realizado em 40 peças anatômicas de cabeças de gatos. Três veterinários (A, B e C), sem experiência prévia da abordagem IO, realizaram o experimento. A abordagem SBZ foi aleatoriamente realizada em um dos lados da cabeça e a abordagem IO foi realizada no lado contralateral da mesma peça anatômica. Para cada abordagem, utilizou-se 0,2mL do corante azul de metileno 1%. Classificou-se o escore de coloração baseado no comprimento do nervo maxilar corado pelo azul de metileno conforme a escala: 0 (falha da técnica), sem coloração; 1 (moderado), <6mm de coloração do nervo maxilar; 2 (ideal), ≥6mm de coloração do nervo maxilar. As medianas (intervalo interquartil) para as abordagens SBZ e IO (dados de todos os veterinários juntos) foram respectivamente 2,0 (0,3-2,0) e 1,0 (0,0-2,0). A abordagem SBZ foi associada a um escore de coloração, significativamente, maior do que a abordagem IO (P=0,016). Considerando os escores de ambas abordagens (SBZ e IO), houve diferença significativa nos escores de coloração do nervo maxilar entre os três veterinários anestesistas (P=0,002). Os resultados deste estudo não sustentam a utilização da abordagem IO para a realização do bloqueio maxilar em gatos. Uma melhor acurácia na coloração do nervo maxilar com o azul de metileno foi observada com a abordagem SBZ. A acurácia da técnica pode variar quando as abordagens SBZ e IO são realizadas por veterinários diferentes, com o objetivo de se obter o bloqueio do nervo maxilar.

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block

Abstract Objectives This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. Material and Methods To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results' analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). Results The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues' resistance. The evaluation of visual aspects was influenced by the participants' experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it. Conclusion The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.

Facial blanching after inferior alveolar nerve block anesthesia: an unusual complication

The present case report describes a complication involving facial blanching symptoms occurring during inferior alveolar nerve block anesthesia (IANBA). Facial blanching after IANBA can be caused by the injection of an anesthetic into the maxillary artery area, affecting the infraorbital artery.

Is pain during pediatric dental sedation associated with children's pre-operative characteristics? An exploratory study / Dor durante sedação em odontopediatria associa-se a características pré-operatórias da criança? Estudo exploratório

Introduction: Little is known about the factors associated with the pain of children in dental treatment under conscious sedation. Objective: To investigate the association between preoperative characteristics and pain during pediatric dental treatment under sedation. Material and method: This exploratory study was conducted with 27 children in restorative treatment under sedation. Information on age, sex and experience of the children with previous dental treatment was obtained through interviews with parents. Oral health status, determined from the presence of dental caries, was verified using the dmf-t index. Pain was assessed by analyzing videos of the dental treatments by two previously calibrated examiners, using the items legs, activity and crying of the observational scale “face, legs, activity, consolability and crying (FLACC). Data were analyzed using bivariate tests. Result Most of the children (n=14, 51.8%) had no pain during dental treatment under sedation. Among the other children, lower or moderate pain scores (median 1.1; minimum 0 to 3.8) were observed. The FLACC scores did not vary according to sex (P=0.38), previous experience with dental treatment (P=0.32) and history with local anesthesia (P=0.96). The FLACC scores did not correlate significantly with age (Spearman rho= -0.08, P=0.67) and dmf-t (Spearman rho= -0.04, P=0.84). Conclusion In this group of children, pain during dental treatment under sedation was of low frequency and intensity and did not associate with age, sex, oral condition and previous dental experience.

Introdução: Pouco se sabe sobre os fatores associados à dor das crianças no tratamento odontológico sob sedação consciente. Objetivo: Verificar a associação entre as características pré-operatórias e a dor durante o tratamento odontopediátrico sob sedação. Material e método: Este estudo exploratório foi realizado com 27 crianças submetidas a tratamento restaurador sob sedação. As informações sobre idade, sexo e experiência de tratamento odontológico prévio da criança foram obtidas por meio de entrevista aos pais. A condição bucal, determinada a partir da presença de cárie dentária, foi verificada por meio do índice ceo-d. A dor foi avaliada por análise dos vídeos dos tratamentos, por dois examinadores previamente calibrados, utilizando-se os itens: pernas, atividade e choro da escala observacional . Face, pernas, atividade, consolabilidade e choro (FLACC). Os dados foram analisados por meio de testes bivariados. Resultado A maioria das crianças (n=14; 51,8%) não teve dor durante o tratamento odontológico sob sedação. Entre as demais crianças, observaram-se escores de dor baixos ou moderados (mediana 1,1; mínimo 0-3,8). Os escores FLACC não diferiram conforme sexo (P=0,38), experiência prévia de tratamento odontológico (P=0,32) e história de anestesia local (P=0,96). Os escores FLACC não se correlacionaram significativamente com idade (Spearman rho= -0,08; P=0,67) e ceo-d (Spearman rho= -0,04, P=0,84). Conclusão: Neste grupo de crianças, a dor durante tratamento odontológico sob sedação foi pouco observada, de baixa intensidade e não se associou a idade, sexo, condição bucal e experiência odontológica anterior.

Deflexión de agujas dentales 30G: comparación de cinco marcas comerciales

Introducción: El grado o nivel de deflexión de la aguja dental, en la mayoría de los casos, puede determinar el éxito o fracaso en la técnica de anestesia dental. Objetivo: Medir el grado de deflexión de la aguja dental, comparando 5 diferentes marcas disponibles en la ciudad de Hermosillo, Sonora, México. Métodos: Se realizó un estudio experimental, en el que con ayuda de un modelo creado con un nivel profesional y una jeringa tipo cárpul, se realizaron diversas punciones en un trozo de carne de res, simulando la realización de una técnica lineal de anestesia bucodental. Se tomaron radiografías periapicales de cada una de las punciones, y con ayuda de una malla milimetrada, se realizaron las mediciones. Dentro de cada grupo de agujas, se presentaron diferentes medidas de deflexión, y se obtuvo un promedio de cada marca. El rango abarcó desde los .65 mm hasta 2.1 mm de deflexión, tomando como referencia un plano recto. Conclusiones: Se demostró que la de la marca Septodont®, fue la que presentó menor deflexión a la punción. Es recomendable verificar y examinar el estado de las agujas antes de ser utilizadas para realizar procesos quirúrgicos, y así disminuir riesgos y/o complicaciones postoperatorias.

Introduction: The degree or level of deflection of the dental needle, in most cases, can determine the success or failure of the dental anesthesia technique. Objective: Measure the degree of deflection of the dental needle, comparing 5 different brands available in the city of Hermosillo, Sonora, Mexico. Method: An experimental study was carried out, with a model created with a professional level and a carpul syringe, various punctures were made in a piece of beef, simulating the performance of a linear technique of oral anesthesia. Periapical radiographs of each of the punctures were taken, and with the help of a millimeter mesh, measurements were made. Within each group of needles, different deflection measures were presented, and an average of each brand was obtained. The range ranged from .65 mm to 2.1 mm of deflection, taking as reference a straight plane. Conclusions: It was shown that the Septodont® brand was the one that presented the lowest puncture deflection. It is advisable to verify and examine the condition of the needles before being used to perform surgical procedures, and thus reduce risks and / or postoperative complications.

Perception of discomfort during injection and the need for supplemental anesthesia in the intraosseous technique using 4 per cent articaine / Percepción de incomodidad durante la inyección y necesidad de anestesia suplementaria en anestesia intraósea usando articaína al 4

The authors conducted an experimental study to determine patient perception of discomfort during injection and the need for supplemental anesthesia using the intraosseous technique with 4% articaine with 1:100,000 epinephrine in patients with symptomatic pulpitis in mandibular molars. At different clinical sessions, researchers used 4% articaine with 1:100,000 epinephrine to apply intraosseous injection (Group 1) or inferior alveolar nerve block (Group 2). Each technique was applied in 35 patients. In each group, the need for additional anesthesia was determined and patient discomfort during injection was assessed with a Visual Analogue Scale (VAS) test. In the intraosseous group, no supplemental technique was needed in 22 patients (62.85 %), and results were similar for the inferior alveolar technique (n: 23 65.71%). The intraosseous technique proved to be more comfortable than the mandibular technique (18 patients - 25.7%). This study found that the use of intraosseous technique with 4% articaine shows promising results regarding patient comfort and reducing the need for additional anesthesia.

Los autores condujeron un estudio experimental para deter minar la eficacia de la técnica anestésica intraósea usando articaína al 4% con epinefrina 1:100.000, en pacientes con pulpitis aguda en molares mandibulares. En diferentes sesiones clínicas, los miembros del equipo de investigadores usaron articaína al 4% con epinefrina 1:100.000 para inducir anestesia mandibular con la técnica intraósea (Grupo 1) o con el bloqueo del nervio alveolar inferior (Grupo 2), se aplicó cada técnica en 35 pacientes con diagnóstico de pulpitis aguda en molares inferiores. En cada grupo, se determinó la necesidad de hacer anestesia complementaria y la comodidad del paciente con un test Escala Visual Analoga. Un total de 70 pacientes fueron enrolados en este estudio (35 sujetos por grupo). En el grupo de intraósea no fue necesaria la aplicación de técnicas complementarias en 22 pacientes (31.4%), resultados similares en la técnica alveolar inferior (n: 23 32.8%). La técnica intraósea demostró ser más cómoda al compararla con técnica mandibular (18 pacientes 25.7%). Este estudio demostró que el uso de la técnica intraósea conarticaína al 4%, arrojó resultados prometedores en lo que a comodidad y reducción en la anestesia complementaria hace referencia.

Dental local anesthesia in Family Health Units: use, pain and associated factors / Anestesia local odontológica em Unidades de Saúde da Família: uso, dor e fatores associados

ABSTRACT BACKGROUND AND OBJECTIVES: In spite of the relevance of controlling pain during dental procedures and of the fundamental role of Family Health Units in the Brazilian health system, there are few studies integrating both subjects. So, this study aimed at analyzing some aspects of dental anesthesia in Family Health Units of the city of Caruaru-PE. METHODS: We have interviewed 372 adolescent and adult patients from 12 units, in the waiting room or close to it, after dental treatment, using a form with 14 questions. Pain was investigated with a numerical scale of 21 points (0 to 10 with 0.5 intervals). RESULTS: Anesthesia was used in 16.1% of procedures. There has been pain during most anesthesias (58.3%), with intensity of 1±1.2, being more frequent when procedures were in the anterior oral region. For non-surgical invasive procedures, anesthesia was more used in adolescents, in procedures in the posterior oral region, when there was previous pain in the treated region and when the dentist asked patients about their preference. Also for these procedures, pain during treatment as a whole was more frequent and more severe when anesthesia was used. CONCLUSION: Dental anesthesia is rarely used in these units and pain during anesthesia is frequent, however of low intensity. During non-surgical invasive procedures, its use is associated to some characteristics of patients and treatments, but not to a painless or less painful treatment.

RESUMO JUSTIFICATIVA E OBJETIVOS: Apesar da importância do controle da dor em odontologia e do papel fundamental das Unidades de Saúde da Família no sistema de saúde do Brasil, são raros os estudos que integram esses dois assuntos. Portanto, o presente estudo objetivou analisar alguns aspectos relativos à anestesia odontológica em Unidades de Saúde da Família de Caruaru-PE. MÉTODOS: Entrevistou-se 372 pacientes adolescentes e adultos atendidos em 12 unidades, na sala de espera ou proximidades, após o atendimento odontológico, com um formulário contendo 14 perguntas. A dor foi investigada utilizando uma escala numérica de 21 pontos (0 a 10, intervalos de 0,5). RESULTADOS: A anestesia foi utilizada em 16,1% dos atendimentos. Ocorreu dor na maioria das anestesias (58,3%), com intensidade de 1±1,2, sendo mais frequente quando o procedimento foi na região bucal anterior. Para os procedimentos invasivos não cirúrgicos, a anestesia foi mais usada em adolescentes, procedimentos na região bucal posterior, quando havia dor prévia na região tratada e quando o dentista perguntava ao paciente sua preferência. Também para esses procedimentos, a dor do tratamento como um todo foi mais frequente e de maior intensidade quando anestesia foi usada. CONCLUSÃO: Anestesia odontológica é pouco utilizada nessas unidades e a dor durante a mesma é frequente, porém, de baixa intensidade. Em procedimentos invasivos não cirúrgicos seu uso está associado a algumas características do paciente e do atendimento, mas não a um tratamento sem dor ou com dor de menor intensidade.

Efectividad de la benzocaina en gel al 20% y la lidocaina en solución al 10% en pacientes que requieren punción en la mucosa oral: un ensayo clínico controlado aleatorizado cruzado a triple ciego / Effectiveness of benzocaine gel at 20% and lidocaine solution at 10% in patients requiring puncture in the oral mucosa: a randomized controlled crossover triple blind clinical trial

El objetivo del presente estudio fue determinar y comparar la efectividad de la Benzocaína en gel al 20% y la Lidocaína en solución al 10% en pacientes que requerían punción en la mucosa oral. El presente es un ensayo clínico controlado aleatorizado a triple ciego y de diseño cross-over. Se llevó a cabo en la clínica dental de la Unidad de Segunda Especialización en Estomatología (USEE) de la Universidad Nacional de Trujillo, durante los meses de Noviembre y Diciembre del 2010 y de Enero a Marzo del 2011. La muestra estuvo conformada por 60 pacientes, cada paciente firmó un consentimiento informado y se le realizó un análisis de su estado de ansiedad mediante la escala de ansiedad estado-rasgo (IDARE). Antes de realizar la punción en la mucosa oral se aplicó 4 preparados (2 anestésicos tópicos y 2 placebos) para después determinar y comparar la efectividad de los preparados en la reducción del dolor usando la escala visual análoga (EVA). Para la recolección de los datos se usó una ficha especial para tal fin. Para la comparación de la efectividad de los preparados se empleó el Análisis de Varianza (ANOVA). La efectividad de los anestésicos en gel y en solución fue evaluada empleando el test de Tuckey para comparaciones múltiples y el T de students. La significación estadística fue del 5%. Se encontró que la Benzocaína en gel al 20% y la Lidocaína en solución al 10% son efectivos para reducir el dolor a la punción y que no existe una relación estadísticamente significativa (p= 0,0575) entre la efectividad de cada uno de ellos. La administración de Benzocaína en gel al 20% o de la Lidocaína en solución al 10% reduce el dolor a la punción en igual magnitud y pueden ser usados indistintamente en la práctica odontológica diaria.

The objective of this study was to determine the effectiveness of benzocaine 20% gel and lidocaine in 10% solution in patients requiring puncture in the oral mucosa. This is a randomized controlled clinical trial to triple-blind, cross-over design. It was held at the dental clinic of the Unit of Second Specialization in Dentistry (usee) of the National University of Trujillo, in the months of November and December 2010 and January to March 2011. The sample consisted of 60 patients, each patient signed an informed consent and underwent a review of their status by anxiety scale state-trait anxiety (STAI). Before the puncture in the oral mucosa four preparations (2 topical anesthetics and 2 placebo) and then determine and compare the effectiveness of preparations in reducing pain using a visual analogue scale (VAS) was applied. For data collection a special token was used for that purpose. For comparison of the effectiveness of preparations Analysis of Variance (ANOVA). The effectiveness of the gel and anesthetic solution was evaluated using Tukey's test for multiple comparisons and students T. Statistical significance was 5%. We found that benzocaine 20% gel and lidocaine in 10% solution are effective at reducing pain at the puncture and that there is no statistically significant relationship (p= 0.0575) between the effectiveness of each. The administration of benzocaine 20% gel or lidocaine in 10% solution to reduce pain puncture equal and can be used interchangeably in everyday dental practice.

Anestesia local odontológica y su influencia en anomalías del desarrollo dental: revisión sistemática de la literatura / Dental local anesthesia and its influence on dental developmental abnormalities: systematic review of the literature

La anestesia local odontológica es un procedimiento de rutina en la práctica odontológica pediátrica que, tal como otros sucesos, podría generar anomalías en el desarrollo dental, considerando la susceptibilidad de los gérmenes dentales en desarrollo; por lo anterior consideramos necesario determinar la existencia de asociación entre anomalías del desarrollo dental y el uso de técnicas anestésicas. Para esto se diseñó un estudio descriptivo basado en búsqueda sistemática de literatura en las bases de datos: Scopus, MEDLINE, Web of Science Core Collection, ProQuest Central, Korean Journal Database y SciELO, utilizando combinación de términos MeSH: ("odontoblasts" OR "ameloblasts" OR "odontogenesis" OR "amelogenesis" OR "dentinogenesis" OR "odontodysplasia" OR "dental enamel hypoplasia" OR "dental sac" OR "dental papilla" OR "enamel organ") AND ("anesthesia" OR "local anesthesia" OR "nerve block" OR "dental anesthesia"). De un total de 96 artículos, se incluyeron para revisión 5 artículos relacionados con los objetivos de esta revisión, excluyéndose las coincidencias. La evidencia presente en la literatura es contradictoria. Existen múltiples diferencias entre los estudios analizados, las que podrían deberse a las técnicas anestésicas involucradas, tipo de anestésico, la no consideración de otros posibles agentes causales (síndromes) o la terapia odontológica. No puede ser determinado una relación entre estos dos aspectos.

The dental local anesthesia is a routine procedure in pediatric dental practice that, as other events could generate abnormalities in dental development, considering the susceptibility of developing tooth germs. From the foregoing it necessary to determine the existence of association between disorders of tooth development and use of anesthetic techniques. A descriptive study based on systematic literature review in databases: Scopus, MEDLINE, Web of Science Core Collection, ProQuest Central, Korean Journal Database and SciELO data was designed, using the following combination of MeSH terms ("odontoblasts" OR "ameloblasts" OR "odontogenesis" OR "amelogenesis" OR "dentinogenesis" OR "odontodysplasia" OR "dental enamel hypoplasia" OR "dental sac" OR "dental papilla" OR "enamel organ") AND ("anesthesia" OR "local anesthesia "OR" nerve block "OR" dental anesthesia"). A total of 96 articles, were included for review a total of 5 articles related to the objectives of this review, excluding the matches. The present evidence in the literature is contradictory. There are many differences between the studies analyzed, which could be due to the anesthetic techniques involved, type of anesthetic, other possible causative agents (syndromes) or dental treatment are not included. It can not be determined a relationship between these two aspects.

Vertiginous syndrome associated with incorrect anesthesia technique to block the maxillary nerve via the greater palatine canal: case report and anatomic correlation with cadaveric parts / Síndrome vertiginoso asociado a técnica anestésica incorrecta para bloquear el nervio maxilar vía canal palatino mayor: reporte de caso y correlación anatómica en piezas cadavéricas

The anesthetic technique through the greater palatine canal seeks to block the maxillary nerve in the pterygopalatine fossa and anesthetize a large area, including the pulp and periodontium of the arch in question. After applying this technique in a patient, it failed to obtain the expected result. The patient began to experience dizziness, nausea, vomiting and the sensation of fluid in the ear. She was evaluated in both the emergency room of the Hospital Parroquial de San Bernardo and at a private clinic without accurate diagnosis. Only symptomatic treatment was provided. The next day she was discharged with reduced symptoms, which disappeared completely during the day. We propose the hypothesis of a diffusion of the anesthetic solution into the middle and inner ear through the auditory tube. This diffusion would explain the vestibular symptoms and the absence of anesthesia in the expected areas. We carried out an anatomic correlation in cadavers, following the path of a needle from the palatal mucosa to the pharyngeal opening of auditory tube. We conclude that the vertiginous syndrome could be due to an incorrect application of the technique, with the needle entering the auditory tube and spreading the anesthetic solution into the middle ear.

La técnica anestésica vía canal palatino mayor tiene como objetivo abordar al nervio maxilar en la fosa pterigopalatina, anestesiando un gran territorio, incluyendo la pulpa y periodonto de la hemiarcada correspondiente. Después de haber aplicado esta técnica en una paciente y no obteniendo el resultado esperado, esta comenzó a experimentar vértigo, náuseas, sensación de líquido en el oído y vómitos. Fue evaluada en el servicio de urgencias del Hospital Parroquial de San Bernardo y en una Clínica Privada, sin lograr un diagnóstico preciso y realizando solo un tratamiento sintomático. Al día siguiente fue dada de alta con baja sintomatología, la cual desapareció totalmente durante el día. Se propone la hipótesis de una difusión del anestésico hacia el oído medio e interno mediante el tubo auditivo. Esto explicaría por un lado la sintomatología vestibular y por otro la ausencia de anestesia en los dientes y territorios esperados. Además se realizó una correlación anatómica en cadáveres, utilizando 8 hemicabezas conservadas y siguiendo el posible trayecto de la aguja desde la mucosa palatina hasta el orificio faríngeo de la tuba auditiva. Se concluyó que el síndrome vertiginoso experimentado por la paciente se pudo deber a una técnica fallida al nervio maxilar vía canal palatino mayor con ingreso de la aguja al tubo auditivo, difundiendo el anestésico hacia el oído medio.