An advanced inferior alveolar nerve block protocol for patients with mandibular anesthesia difficulties
McKinley, I Blake,Jr
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The success rate of the inferior alveolar nerve block (IANB) is commonly reported to be between 85% and 87%. Several studies have mentioned that there is some variation in the location of the mandibular foramen and that this variation accounts for the mandibular anesthesia failures. However, none have attempted to plot or rank the positional variations of the mandibular foramen. The purpose of this study was to clinically and radiographically evaluate reported cases of mandibular anesthesia difficulties and rank any positional variations of the mandibular foramen. Sixty cases with a history of being difficult to anesthetize were clinically evaluated. Sixteen of these cases were also evaluated by panoramic radiographs. Clinically, pulpal anesthesia and soft tissue anesthesia as well as the patients level of discomfort were evaluated and recorded. From this data, the following conclusions were made: 1)Three types of anesthesia difficulties have been identified; 2) The hierarchy of atypical mandibular foramen positional variations, in descending order, is high, low, and deep; 3) The hierarchy of atypical IANB approaches, in descending order, is high, low, two positions, and deep; 4) Five of the sixteen cases had a bifid mandibular canal or an accessory canal; 5) Radiographically, fifteen out of sixteen cases did not conform to the anatomic norms.
PLEASE NOTE: This work is protected by copyright. Downloading is restricted to the BU community: please click Download and log in with a valid BU account to access. If you are the author of this work and would like to make it publicly available, please contact email@example.com.Thesis (MSD) --Boston University, Goldman School of Dental Medicine, 1999 (Department of Endodontics).Includes bibliography: leaves 262-281.
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