The conventional inferior alveolar nerve block: is there a more predictable alternative?

Précis

The intra-osseous technique and buccal infiltration with articaine are effective alternative methods to the conventional inferior alveolar nerve block for achieving mandibular pulpal anaesthesia.

Abstract

Statement of the problem: The conventional inferior alveolar nerve block is considered the gold standard technique for achieving mandibular pulpal anaesthesia. This technique is considered to be technically challenging, with significant failure rates. Other alternative techniques may be more effective, and easier to administer.

Purpose of the study: The aim of this review was to investigate whether or not new local anaesthetic techniques have lessened the need for the conventional inferior alveolar nerve block.

Materials and methods: A review of the literature was conducted by completing an electronic search on PubMed using key words “local anaesthesia”, “mandible” and “success rates”, populating a list of articles for analysis. Key papers and books that were unavailable electronically were also manually searched to ensure a comprehensive overview. The different techniques were then compared under several headings including success rates, anaesthesia onset times and complications.

Results: There are several randomised controlled trials (RCTs) evaluating the primary methods of achieving pulpal anaesthesia in the mandible. The heterogeneity of the literature makes it difficult to conduct a systematic review and meta-analysis on the topic. The RCTs available are of a IIb evidence base, due to small sample sizes, according to the Oxford Centre for Evidence-Based Medicine, and consequentially grade “B” recommendations may be made for clinical practice. The literature describes how the intra-osseous and buccal infiltration techniques have superior success rates and onset times, in combination with less discomfort and fewer complications, than the alternatives available.

Conclusion: Further investigations into local anaesthetic efficacy would benefit from the introduction of standardised testing methods, reducing heterogeneity of the literature. The intra-osseous technique and buccal infiltration with 4% articaine are effective alternative methods to the inferior alveolar nerve block for achieving mandibular pulpal anaesthesia.

Journal of the Irish Dental Association 2018; 64 (1): 35-43.

Dr Brian Dunne
BA BDentSci(Hons) DipPCD(RCSI) MFD(RCSI)
SHO in oral and maxillofacial surgery, Manchester Royal Infirmary, Manchester Foundation Trust, Oxford Road, Manchester M13 9WL

Corresponding author: dunneb3@tcd.ie