Post-graduate student department of oral, maxillofacial and reconstructive surgery, bapuji dental college and hospital,davangere



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION



1.



NAME OF THE CANDIDATE

AND ADDRESS

(In Block Letters)



Dr.DEEPA.B.V

POST-GRADUATE STUDENT

DEPARTMENT OF ORAL, MAXILLOFACIAL AND RECONSTRUCTIVE SURGERY,

BAPUJI DENTAL COLLEGE AND HOSPITAL,DAVANGERE-577004 KARNATAKA.




2.

NAME OF THE INSTITUTION

BAPUJI DENTAL COLLEGE AND HOSPITAL, DAVANGERE – 577004.

3.


COURSE OF THE STUDY AND THE SUBJECT.

MASTER OF DENTAL SURGERY IN ORAL AND MAXILLOFACIAL SURGERY

4.

DATE OF ADMISSION TO COURSE


7th MAY 2009

5.

TITLE OF THE TOPIC

COMPARISON AND CLINICAL ASSESSMENT OF THREE DIFFERENT TECHNIQUES OF MANDIBULAR NERVE BLOCK”






6.

BRIEF RESUME OF THE INTENDED WORK:

6.1 NEED FOR STUDY:

Pain relief and prevention is one of the main objective of dentistry. A commonly used method to prevent pain is to inject a local anaesthetic solution adjacent to a nerve. Anesthesia for mandibular procedures may be achieved using standard Inferior alveolar nerve block , or the Gow-Gates or Vazirani Akinosi technique.

Inferior alveolar nerve block is most frequently used injection technique for achieving local anesthesia for mandibular surgical procedures. Anatomical variation in shape and size of mandible may make the accurate localisation of mandibular foramen difficult there by increasing the failure rates with the conventional inferior alveolar nerve block.

To overcome these failures, modification of conventional Inferior alveolar nerve block was introduced by Akinosi and Gow-Gates in which anesthesia of all the three branches of mandibular nerve can be obtained.

Vazirani Akinosi is the nerve block which is given in closed mouth position with intra-oral landmarks for needle insertion to reduce failure rates. In this technique the needle is inserted to its pre-determined depth without contacting a hard tissue landmark.

As another technique, the Gow-Gates uses extra oral landmarks and targets the neck of the condyle which gives higher success rates.

So the present study is planned to compare and assess clinically the 3 different techniques of mandibular nerve block.





6.2. REVIEW OF LITERATURE:

In this study, Todorovic.L has compared the efficacy of Inferior dental nerve block with the mandibular nerve block. (Akinosi & Gow-Gates). For this comparison authors randomly evaluated 90 patients undergoing simple tooth extraction randomly and divided them into 3 groups according to the different anesthesia techniques. For the clinical assessment they followed various signs and symptoms.At the end of study it concluded that the mandibular anesthesia has not shown any advantage over the regular inferior alveolar technique and further study is needed.1

A prospective study was conducted to compare the pain on injection of the 3 mandibular block techniques and to determine the effect of the delivery of nitrous oxide:oxygen [N2O: O2] on the pain. They randomly assigned 60 subjects to receive either local anesthetic alone or local anesthetic with N2O:O2 titrated to effect.They found no difference in pain on injection from the standard nerve block, Gow-Gates or Vazirani Akinosi mandibular block techniques. A dentist’s decision to select one of these techniques should be based on factors other than pain on injection. These factors may include the ability to determine the technique’s respective anatomical landmarks, the presence of accessory innervations, the need to anesthetize the buccal nerve, trismus or a marked gag reflex.2

A prospective study was conducted to compare the degree of pulpal anesthesia obtained with conventional inferior alveolar nerve block, Gow-Gates and Vazirani Akinosi technique. 40 subjects received 3 techniques of mandibular injection randomly by using 3.6 ml of 2% lidocaine with 1:1,00,000 epinephrine. An electric pulp tester was used to test for anesthesis effect in 3 min cycle for 60 min. Thus they concluded that for the subject who achieved lip numbness and the conventional inferior alveolar nerve block is similar to the Gow-Gates and Vazirani Akinosi techniques regarding anesthetic success but has a faster onset of pulpal anesthesia.3

The purpose of this study was to compare the effectiveness of the Gow-Gates technique with the Standard inferior alveolar nerve block . 40 subjects were received both injections separately and various tests were performed 10 min after injection . The results demonstrated no significant differences between the two injection techniques except in response to the question concerning subjective tongue numbness. Both techniques achieved a high rate of subjective numbness in the subject’s perception of overall numbness and lip numbness.4

In this study the Akinosi mandibular nerve block technique for administration of local anesthesia was compared with conventional nerve block technique in 20 patients undergoing the removal of impacted 3rd molars . A subject design was used to compare onset of anesthesia, quality of anesthesia & intraoperative hemostasis. Success rates were equivalent and both techniques resulted in acceptable quality of anesthesia. The Akinosi technique appears to be a successful alternative to traditional mandibular block techniques for oral surgery.5



6.3 OBJECTIVES OF THE STUDY:

  1. To compare and assess the 3 mandibular nerve block techniques clinically.

  2. The criteria for assessment are as follows:

  1. Onset and duration of anesthesia .

  2. Pain during injection.

  3. Aspiration test.

  4. Patient comfort.

7.

MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

The study will be conducted in the Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere.



INCLUSION CRITERIA:

      • Patients between the age group of 18 to 50 yrs.

      • Patients in good health (ASA class I & relatively healthy ASA class II)

EXCLUSION CRITERIA:

      • Patients allergic to local anesthetics/ sulphites.

      • Pregnancy.

      • Patients were on any medication 48 hours before testing, which may influence

the result which includes any analgesics, opioids, NSAIDS or Acetaminophen.


      • Patients with active sites of pathosis in area of injection.

7.2 METHOD OF COLLECTION OF DATA:

Prospective Randomised Study.

45 consecutive patients requiring minor oral surgical procedure (Extraction or surgical removal) will be included in the study during the period of 2009-2012 and equally grouped into 3 groups . Each group will be given injection of 2ml of 2% lidocaine with adrenaline [1:80,000] in 3 different techniques which are Inferior alveolar nerve block via intra oral direct approach, Gow - Gates via extraoral landmarks and Vazirani Akinosi via tuberosity approach. The patients will be evaluated using parameters like [onset and duration of anesthesia, pain during injection, aspiration test and depth of anesthesia]. Results of the 3 groups will be compared.

Patients will be informed about the study. A questionnaire with multiple responses will be given to patients in order to evaluate the various parameters under the study. Materials used are:


  1. Minor oral surgical kit

  2. 5ml, 11/2- inch disposable syringe with 26 guage needle.

  3. Lignocaine solution with 1:80,000 adrenaline.

STATISTICAL ANALYSIS:

Statistical analysis will be carried out by using ONE WAY ANOVA, POST HOC Test and CHI SQUARE Test.



7.3 Does the study require any investigation or interventions to be Conducted on patients or other humans or animals? If so please describe briefly.

Yes


  1. Radiographs( OPG/ IOPA)

  2. Routine blood investigation.

7.4 Has ethical clearance been obtained from your institution in case Of 7.3?

Yes


Ethical clearance has been obtained and a copy of the same is attached here with.





8.


LIST OF REFERENCES:

  1. Todorovic L, Stajcic Z, Petrovic V. Mandibular versus Inferior dental anaesthesia: clinical assessment of 3 different techniques. Int J Oral Maxillofac Surg 1986; 15:733-8.

  2. Jacobs S, Haas DA, Meechan JG, May S. Injection pain: Comparison of three mandibular block techniques and modulation by nitrous oxide/oxygen.

J Am Dent Assoc 2003;134:869-76.

  1. Steven G, Reader Al, Melissa D, John N, Mike B. Comparison of the anesthetic efficacy of the Conventional inferior alveolar, Gow-Gates, and Vazirani- Akinosi techniques. JOE 2008 Nov; 34(1):1306-11.

  2. Montagnese TA, Reader A, Melfi R. A comparative study Of the Gow-Gates technique and a standard technique for mandibular anesthesia . J Endod 1984;10:158-63.

  3. Sisk AL. Evaluation of the Akinosi mandibular block technique in oral surgery. J Oral Maxillofac Surg 1986; 44:113-5.




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