Posterior superior alveolar nerve block alone in the extraction of upper third molars: a prospective clinical study.

Background: Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction. Methods: A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used. Results: In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation. Conclusion: The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.

Use of disposable needle hub for decompression of large dentigerous cyst: A case report.

Developmental cysts are commonly seen in children, dentigerous cyst is one among them. Cysts associated with vital structures like erupting permanent teeth have to be treated more conservatively. Marsupialization or decompression is more routinely done procedures; the only hitch is maintaining the patency of the window. Various materials are being tried like customized acrylic stents, plastic tubings, disposable suction tips, etc. We want to present a case of decompression of maxillary dentigerous cyst with the use of readily available disposable syringe hub. Syringe hub is cut and trimmed to adapt to the edges of the window created for decompression and stabilized with sutures. It causes less tissue trauma and the larger outer rim provides retention for the stent. Disposable anesthetic syringe hubs can be additional material for decompression with better handling and usage.