Rajiv gandhi university of health scieneces karnataka, bangalore



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENECES

KARNATAKA, BANGALORE

ANNEXURE II

PROFORMA FOR REGISTERATION OF SUBJECTS FOR DISSERTATION

1.

Name of the candidate and

Address (in Block Letters)

DR. PRAGATI

DEPT. OF ORAL AND MAXILLOFACIAL SURGERY, SRI RAJIV GANDHI COLLEGE OF DENTAL SCIENCE & HOSPITAL , CHOLANAGAR,

R.T.NAGAR POST, BANGALORE – 560 032.


2.

Name of the Institution

Sri Rajiv Gandhi College of Dental

Science & Hospital, cholanagar,

R.T.Nagar Post, Bangalore – 560 032.


3.

Name of study and subject

Master of Dental Surgery in

Department of Oral and Maxillofacial Surgery



4.

Date of Admission

1-072013

5.

Title of the Topic

Comparative analysis between conventional
inferior alveolar nerve block and Vazirani-Akinosi closed mouth techniques - a split mouth randomized study





6.

BRIEF RESUME OF THE INTENDED WORK

    1. Need for the study

In dentistry, predictable anesthesia is an essential requirement for both the patient and the dentist. The patient’s opinion about his dental treatment is closely related to his past local anesthesia experience. The proper use of local anesthesia techniques and pain management are indispensable for successful dental treatment.

Success rates are lower for adult mandibular anesthesia as compared to maxillary anesthesia due to greater density of buccal alveolar bone plate, limited accessibility to inferior alveolar nerve and wide variation in anatomy.

Reliable profound anesthesia is questionable with conventional technique of inferior alveolar nerve block.

This study has been designed to determine if the Vazirani-Akinosi technique of mandibular anesthesia is more reliable in providing successful anesthesia consistently as compared to the conventional inferior alveolar nerve block.



    1. Review of Literature



  1. In a study conducted by Allen L. Sisk, the Akinosi technique for mandibular nerve block has been stated to have an approximately equal success rate to conventional inferior alveolar nerve block. Possible advantages include faster rate of onset, less pain on injection, decreased psychological stress on anxious patients and ease of administration. In addition, the inferior alveolar nerve, lingual nerve, and buccal nerve may all be anesthetized by a single injection.


  1. Stanley F. Malamed mentions the advantages of Akinosi technique as it is relatively atraumatic. It has few post injection complications (eg. Trismus). This technique is quite useful in patients who are not able to open their mouth wide. The aspiration rate is lower in this technique and successful anesthesia is provided where bifid mandibular canals are present.




  1. In a study conducted by Vivek Aggarwal, Mamta Singla and Debipada Kabi it has been stated that conventional inferior alveolar nerve block involves deposition of local anesthesia solution in the pterygomandibular space, bathing the inferior alveolar nerve just before it enters the mandibular foramen. Because of the anatomic location of the mandibular foramen and bony prominence of lingula, the positioning of the needle is limited. Accessory nerve supply to mandibular molars also plays a role in failure of conventional. In this study it was found that conventional inferior alveolar nerve block technique, Gow-Gates technique, Vazirani-Akinosi and infiltrations gave a success rate of 36%, 52%,41% and 27% respectively.




  1. In a study conducted by Dr. Haas, the nerves anesthetized by the Akinosi- Vazirani technique include the inferior alveolar and its branches (incisive and mental), lingual, mylohyoid and buccal (approximately 75 percent of the time). A separate buccal nerve block may not be needed because successful anesthesia of the buccal nerve is common when this technique is used. Anesthesia of the mylohyoid nerve could resolve concerns about accessory innervation. The onset of anesthesia is intermediate (five to seven minutes) compared with that of the IANB and the Gow-Gates technique.




  1. In a study conducted by Mishra Sobhan, Tripathy Ramanupam, it was found that onset of lip anaesthesia was faster in Vazirani-Akinosi technique, patients experienced less pain during the Vazirani-Akinosi technique as compared to the direct conventional technique. Post injection complications were less in the Vazirani-Akinosi Technique. This technique has strong clinical applications as in cases with limited mouth opening and apprehensive patients.



  1. In a study conducted by Goel Mahima, Nagpal Ravi, Bhandari Poonampreet it was concluded that the indications of Akinosi technique are- limited mandibular opening and inability to visualize landmarks for inferior alveolar nerve block because of a large tongue. This technique may be less threatening to a patient because he does not have to open his mouth. It is relatively atraumatic and has fewer postoperative complications like trismus. It provides successful anesthesia where bifid canals are present. It has faster rate of onset, decreased psychological stress for anxious patients and ease of administration. It can be used for patients with a strong gag reflex. There is decrease pain on injection, because tissues are relaxed. It was concluded that Vazirani- Akinosi technique provides effective anesthesia of inferior alveolar, lingual and buccal nerve in single injection in statistically significant number of cases.



6.3 Objectives of the study

  1. To determine the anesthetic efficacy of the Vazirani-Akinosi technique as compared to the conventional technique for inferior alveolar nerve block in terms of onset of anesthesia and quality of anesthesia during the extraction procedure.

  2. To evaluate and compare pain during injection

  3. To determine if the vazirani akinosi technique is effective in anesthetizing the long buccal nerve.





7.


MATERIALS AND METHODS

7.1 SOURCE OF DATA

Patients reporting for bilateral extraction of mandibular teeth, to the Department of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bangalore.


INCLUSION CRITERIA

  • Patients in whom bilateral extraction of mandibular teeth is indicated.

  • Patients not taking any medication that would alter pain perception.

  • Patients who are medically fit to undergo extraction under local anesthesia.


EXCLUSION CRITERIA

  • Patients not willing to be part of the study.

  • Patients unable to give a valid response for pain experienced during the procedure.








7.2 METHOD OF COLLECTION OF DATA

  1. A sample size of 48 patients reporting for removal of bilateral mandibular teeth will be included in the study.

  2. If patient satisfies the inclusion criteria, informed consent will be taken.

  3. The patients will receive anesthesia with two techniques randomly on each side of mouth for extraction of mandibular teeth bilaterally to be done on the same sitting.

  4. Every patient will be given a VAS scale post-injection which they have to make entries into for pain during injection.

  5. Time of onset of anesthesia will be detected by assessment of objective and subjective signs and symptoms.

  6. The incidence of anesthesia of long buccal nerve by vazirani-akinosi technique will be evaluated.

  7. Quality of anesthesia will be assessed on an eight-point rating scale.

Category

du Patient response during extractionring extraction

Successful (1)

No pain throughout.

Successful (2)

Some pain during procedure, but reinjection not necessary after beginning of surgery.

Successful (3)

Pain during procedure beginning after first injection. No pain after second injection.

Limited success (4)

Pain during procedure beginning after first injection. Pain also during procedure

after second injection, but surgery completed without third injection.



Limited success (5)

Pain during procedure beginning after two injections, but surgery

completed without third injection.



Failure (6)

Pain during procedure beginning after first injection. Pain also during procedure

after second injection. Third injection required.



Failure (7)

Pain during procedure beginning after two injections. Third injection required.

Failure (8)

No anesthesia after two injections. Third injection required or treatment suspended.


STATISTICAL DATA
Sample size : sample size of 48

Study design : Randomized study, 48 Classical technique and 48

Vazirani-Akinosi closed mouth technique technique of

inferior nerve block.

Study test : two- sided two- sample t- test

Study duration : 1 year


7.3: Does the study require any investigation or interventions to be conducted on patients or other human or animals? If so, please describe briefly.

This study requires interventions to be conducted on patients who will be administered routine local anesthetic agent with two different techniques randomly for the indicated extraction of mandibular teeth.



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

Yes.


8.

LIST OF REFERENCES

  1. SISK LA. Evaluation of the Akinosi Mandibular Block Technique in Oral Surgery. J Oral Maxlllofac Surg . 1966;44:113-115.




  1. Malamed FS. Handbook of local anesthesia. Techniques of mandibular anesthesia 5th ed. New Delhi:Elsevier; 2004




  1. Aggarwal V, Singla M, Kabi D. Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:303-308




  1. Haas AD. Alternative mandibular nerve block techniques : A review of the Gow-Gates and Akinosi-Vazirani closed-mouth mandibular nerve block technique. The journal of the American dental association. 2011;142(suppl 3):8S-12s




  1. Mishra S, Tripathy R, Sabhlok S, Panda PK, Patnaik S. Comparative analysis between direct Conventional Mandibular nerve block and Vazirani-Akinosi closed mouth Mandibular nerve

Block technique. International Journal of Advancements in Research & Technology. 2012;1(6):1-6


  1. Goel M, Nagpal R, Bhandari P. Efficacy Of Anesthesia Of Long Buccal Nerve In Akinosi Closed Mouth Technique – A Prospective Study. Indian jouranal of dental sciences. 2013;5(2): 13-15




9

SIGNATURE OF THE CANDIDATE




10

REMARKS OF THE GUIDE




11

11.1 NAME & DESIGNATION OF GUIDE(in block letters)

Prof .Dr. DEEPIKA KENKERE,M.D.S,

PROFESSOR AND HEAD OF THE DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY,

SRI RAJIV GANDHI COLLEGE OF DENTAL SCIENCES,

BANGALORE.




11.2 SIGNATURE OF GUIDE








11.3 CO-GUIDE(If any)








11.4 SIGNATURE








11.5 HEAD OF THE DEPARTMENT


Prof .Dr. DEEPIKA KENKERE,M.D.S,

PROFESSOR AND HEAD OF THE DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY,

SRI RAJIV GANDHI COLLEGE OF DENTAL SCIENCES,

BANGALORE..




11.6 SIGNATURE





12

12.1 REMARKS OF THE CHAIRMAN &PRINCIPAL







12.2 SIGNATURE






sri Rajiv Gandhi College of Dental Sciences, Bangalore

Department of Oral and Maxillofacial Surgery
CONSENT FORM

I ___________________________________ Son / Daughter of ________________________ Aged ________________ resident of ____________________________________________,

 being under the treatment of Dr. Pragati (PG Student in Department Of Oral and Maxillofacial Surgery, Sri Rajiv Gandhi College of Dental Sciences, Bangalore), do here by give consent to include myself in the study being conducted.The procedure has been explained to me in my own language and also the likely adverse effects of the treatment being used has been explained. I agree that no responsibility will be attached to the surgeon or the hospital staff.

 

 Place : 



Date : Signature of the patient

DR .PRAGATI Signature of Staff

Place:-

Date:-


Department of Oral and Maxillofacial Surgery

Sri Rajiv Gandhi College of Dental Sciences and Hospital

Cholanagar, Hebbal, Bengaluru.

Date -
Patient’s name - OPNo.-


Age / sex -
Diagnosis -
Treatment done –




Technique used



Side

Successful anesthesia

(time in mintues)

Quality of anesthesia

Long buccal nerve anesthesia

3

5

7

10

Present

Absent

Closed mouth technique

























Conventional technique



















N/A

Pain experienced on injection-


  • Closed mouth technique (------- side )


Conventional technique (--------side )


Category

du Patient response during extractionring extraction

Successful (1)

No pain throughout.

Successful (2)

Some pain during procedure, but reinjection not necessary after beginning of surgery.

Successful (3)

Pain during procedure beginning after first injection. No pain after second

injection.



Limited success (4)

Pain during procedure beginning after first injection. Pain also during

procedure after second injection, but surgery completed without third

injection.


Limited success (5)

Pain during procedure beginning after two injections, but surgery

completed without third injection.



Failure (6)

Pain during procedure beginning after first injection. Pain also during

procedure after second injection. Third injection required.



Failure (7)

Pain during procedure beginning after two injections. Third injection

required.



Failure (8)

No anesthesia after two injections. Third injection required or treatment

suspended.



Signature of patient



Place

Date signature of doctor





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