Teaching Alternatives to the Standard Inferior Alveolar Nerve Block in Dental Education: Outcomes in Clinical Practice

Abstract

Surveys were sent to Harvard School of Dental Medicine students and graduates from the classes of 2000 through 2006 to determine their current primary means of achieving mandibular anesthesia. Orthodontists and orthodontic residents were excluded. All subjects received clinical training in the conventional inferior alveolar nerve block and two alternative techniques (the Akinosi mandibular block and the Gow-Gates mandibular block) during their predoctoral dental education. This study tests the hypothesis that students and graduates who received training in the conventional inferior alveolar nerve block, the Akinosi mandibular block, and the Gow-Gates mandibular block will report more frequent current utilization of alternatives to the conventional inferior alveolar nerve block than clinicians trained in the conventional technique only. At the 95 percent confidence level, we estimated that between 3.7 percent and 16.1 percent (mean=8.5 percent) of clinicians trained in using the Gow-Gates technique use this injection technique primarily, and between 35.4 percent and 56.3 percent (mean=47.5 percent) of those trained in the Gow-Gates method never use this technique. At the same confidence level, between 0.0 percent and 3.8 percent (mean=0.0 percent) of clinicians trained in using the Akinosi technique use this injection clinical technique primarily, and between 62.2 percent and 81.1 percent (mean=72.3 percent) of those trained in the Akinosi method never use this technique. No control group that was completely untrained in the Gow-Gates or Akinosi techniques was available for comparison. However, we presume that zero percent of clinicians who have not been trained in a given technique will use the technique in clinical practice.

Untitled

“…In the present study, can be noted a higher prevalence of teeth in Class I Position A (35%), in this case, totally erupted and, according to the radiographic classification, with a lower grade of surgical complexity compared to teeth more inserted in the mandibular ramus and inferior to the occlusal plane of the second mandibular molar 21 .…”

Failure rate of inferior alveolar nerve block among dental students and interns

“…Remarkably, Jung et al 10 found that buccal-plus-lingual infiltrations could provide satisfactory anesthesia in 32-67% of patients if lidocaine was used, and in 57-92% of patients if articaine was used, even without the use of standard IANB. Although the mentioned alternative techniques are well-established, Johnson et al 15 found that nearly half (47.5%) of Harvard dental students alumni (classes 2000-2006) not only had never used an alternative technique, but further stated that they felt no need for an alternatives. The aims of this study were 1) to assess IANB failure rate among dental students and interns, and how it was overcome, 2) to report the causes of failure, 3) to investigate the awareness of alternative techniques, and 4) to assess IANB-related complications.…”

Modified Jorgensen and Hayden Approach to Intraoral Mandibular Anesthesia

“…Because the target for the conventional IAN block is very near the neurovascular bundle, this technique also has a high frequency of positive aspiration, and intravascular injection is possible. [5] Achieving excellence in pain control is an intrinsic, yet challenging, goal of dentistry. Traditionally, the inferior alveolar nerve block (IANB), also known as the "standard mandibular nerve block" or the "Halsted block," has been used to provide anesthesia in mandibular teeth.…”

“…This technique, however, has a success rate of only 80 to 85 percent, with reports of even lower rates. Investigators have described other techniques as alternatives to the traditional approach, of which the Gow-Gates mandibular nerve block and Akinosi-Vazirani closed-mouth mandibular nerve block techniques have proven to be reliable but each of which have merits and draw backs [5].…”