Amaurosis and transient diplopia, a rare complication secondary to mandibular nerve block: A case report.

Ocular complications are one of the rare side effects that can be seen after a mandibular nerve block and have the most dramatic results. Since the mandibular nerve block is mostly performed by dentists, this complication is mostly seen after an intraoral mandibular nerve block. The mandibular nerve is the third division of the trigeminal nerve. It is the most caudal and lateral part of Gasser's ganglion. It arises from the middle cranial fossa through the foramen ovale. In this region, a block method, which is performed by passing through the coronoid process, has been defined. This block, usually made using anatomical markers, is used in the treatment of trigeminal neuralgia. A 42-year-old female patient was admitted to our department for a maxillary and mandibular block with a diagnosis of trigeminal neuralgia. Immediately after the administration of the local anesthetic, the patient described a complete loss of vision. The complaint of vision loss lasted for about 1 minute, after which the patient's complaint of diplopia continued for 2 hours and 10 minutes. This case report presents the ocular complications after a mandibular block applied with the extraoral technique as an unexpected side effect.

Endoscopically-assisted extraction of broken roots or fragments within the mandibular canal: a retrospective case series study.

PURPOSE: To assess the impact of endoscope-assisted fractured roots or fragments extraction within the mandibular canal, along with quantitative sensory testing (QST) alterations in the inferior alveolar nerve (IAN). METHODS: Six patients with lower lip numbness following mandibular third molar extraction were selected. All patients had broken roots or fragments within the mandibular canal that were extracted under real-time endoscopic assistance. Follow-up assessments were conducted on postoperative days 1, 7, and 35, including a standardized QST of the lower lip skin. RESULTS: The average surgical duration was 32.5 min, with the IAN exposed in all cases. Two of the patient exhibited complete recovery of lower lip numbness, three experienced symptom improvement, and one patient remained unaffected 35 days after the surgery. Preoperative QST results showed that the mechanical detection and pain thresholds on the affected side were significantly higher than those on the healthy side, but improved significantly by postoperative day 7 in five patients, and returned to baseline in two patients on day 35. There were no significant differences in the remaining QST parameters. CONCLUSIONS: All endoscopic surgical procedures were successfully completed without any additional postoperative complications. There were no cases of deterioration of IAN injury, and lower lip numbness recovered in the majority of cases. Endoscopy allowed direct visualization and examination of the affected nerve, facilitating a comprehensive analysis of the IAN.

Is 3T MR nerve-bone fusion imaging a viable alternative to MRI-CBCT to identify the relationship between the inferior alveolar nerve and mandibular third molar.

OBJECTIVES: To investigate the feasibility of MRI nerve-bone fusion imaging in assessing the relationship between inferior alveolar nerve (IAN) / mandibular canal (MC) and mandibular third molar (MTM) compared with MRI-CBCT fusion. MATERIALS AND METHODS: The MRI nerve-bone fusion and MRI-CBCT fusion imaging were performed in 20 subjects with 37 MTMs. The Hausdorff distance (HD) value and dice similarity coefficient (DSC) was calculated. The relationship between IAN/MC and MTM roots, inflammatory, and fusion patterns were compared between these two fused images. The reliability was assessed using a weighted κ statistic. RESULTS: The mean HD and DSC ranged from 0.62 ~ 1.35 and 0.83 ~ 0.88 for MRI nerve-bone fusion, 0.98 ~ 1.50 and 0.76 ~ 0.83 for MRI-CBCT fusion. MR nerve-bone fusion had considerable reproducibility compared to MRI-CBCT fusion in relation classification (MR nerve-bone fusion κ = 0.694, MRI-CBCT fusion κ = 0.644), direct contact (MR nerve-bone fusion κ = 0.729, MRI-CBCT fusion κ = 0.720), and moderate to good agreement for inflammation detection (MR nerve-bone fusion κ = 0.603, MRI-CBCT fusion κ = 0.532, average). The MR nerve-bone fusion imaging showed a lower ratio of larger pattern compared to MR-CBCT fusion (16.2% VS 27.3% in the molar region, and 2.7% VS 5.4% in the retromolar region). And the average time spent on MR nerve-bone fusion and MRI-CBCT fusion was 1 min and 3 min, respectively. CONCLUSIONS: Both MR nerve-bone fusion and MRI-CBCT fusion exhibited good consistency in evaluating the spatial relationship between IAN/MC and MTM, fusion effect, and inflammation detection. CLINICAL RELEVANCE: MR nerve-bone fusion imaging can be a preoperative one-stop radiation-free examination for patients at high risk for MTM surgery.

Efficacy of articaine anesthesia with needle-free/Comfort-in method and conventional needle injection in dental patients with irreversible pulpitis: a randomized clinical trial.

OBJECTIVE: To assess the anesthetic efficacy of articaine with the needle-free/Comfort-in™ method compared to the conventional needle method. To assess pain during anesthesia application, onset of anesthesia and patient`s self-reported quality of life-related to oral health after the dental emergency appointment. MATERIALS AND METHODS: This parallel, randomized clinical trial was conducted by a single operator/dentist in the state of Maranhao, northeast of Brazil. Included participants were adult dental patients with one molar (maxillary) or premolar (maxillary or mandibular) tooth diagnosed with symptomatic irreversible pulpitis. The primary outcome was the anesthetic efficacy, measured using a combination of electrical and cold pulp tests (cold + EPT) and the Numerical Rating Scale (NRS). Secondary outcomes were pain during anesthesia application, onset of anesthesia, and patient`s quality-of-life (measured with the OHIP-14). RESULTS: 62 patients were randomized in the anesthesia needle-free group and Comfort-in group (34.26 ± 10.786 × 33.29 ± 8.399 years old, respectively). The group of patients in the Comfort-in group had 71.0% success. Patients from the Comfort-in group reported statistically lower pain during the anesthesia application than patients from the conventional group (2.13 ± 2.172 × 6.03 ± 3.146 NRS scores, respectively) as well as immediately after the anesthetic procedure. Patients self-reported negative impact in quality of life was similar between groups before (p > 0.05) and after (p > 0.05) the dental emergency. CONCLUSIONS: Comfort-in™ had similar efficacy to the conventional needle method. CLINICAL RELEVANCE: This trial showed that it is possible to anesthetize patients with tooth pulpits without using needles to provide comfort mainly to anxious patients.

Adjunctive Effect of Photobiomodulation Therapy with Nd:YAG Laser in the Treatment of Inferior Alveolar Nerve Paresthesia.

Background: Disruption of peripheral branches of the trigeminal nerve in the field of maxillofacial surgery is a known risk due to the close connection of these branches with the bony structures of the maxilla and mandible. As a result, injuries of the lingual nerve and inferior alveolar nerve take place within routine maxillofacial surgery procedures, including local anesthetic injection, wisdom tooth surgery, and dental implant placement, resulting in paresthesia and dysesthesia. During the last three decades, low-level lasers (LLL) have been frequently used in various medical fields. Lately, this application has increased in several sectors. Methods and materials: This experiment was designed to explore the effect of low-level laser therapy (LLLT) with Nd:YAG on the paresthesia and dysesthesia of the lower lip. This ethics committee of Tbzmed, Tabriz, Iran, proved the present experiment with ethical code: IR.TBZMED.REC.1401.839. Results: After completing 10 sessions of laser therapy for the case group consisting of 25 patients with lower lip anesthesia, the visual analog scale index results revealed that following six sessions of laser therapy, a significant difference appeared in contrast to the control group. Also, according to the two-point tests, significant difference among the experimental and the control group appeared after ninth session of the laser therapy. Conclusions: Altogether, these data suggested LLLT with Nd:YAG as an effective treatment option for decreasing the anesthesia of the lower lip.

Investigation of the relationship between the mandibular third molar teeth and the inferior alveolar nerve using posteroanterior radiographs: a pilot study.

BACKGROUND: The most severe complication that can occur after mandibular third molar (MM3) surgery is inferior alveolar nerve (IAN) damage. It is crucial to have a comprehensive radiographic evaluation to reduce the possibility of nerve damage. The objective of this study is to assess the diagnostic accuracy of panoramic radiographs (PR) and posteroanterior (PA) radiographs in identifying the association between impacted MM3 roots and IAN. METHODS: This study included individuals who had PR, PA radiographs, and cone beam computed tomography (CBCT) and who had at least one impacted MM3. A total of 141 impacted MM3s were evaluated on CBCT images, and the findings were considered gold standard. The relationship between impacted MM3 roots and IAN was also evaluated on PR and PA radiographies. The data was analyzed using the McNemar and Chi-squared tests. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of PR and PA radiographies were determined. RESULTS: Considering CBCT the gold standard, the relationship between MM3 roots and IAN was found to be statistically significant between PR and CBCT (p = 0.00). However, there was no statistically significant relationship between PA radiography and CBCT (0.227). The study revealed that the most prevalent limitation of the PR in assessing the relationship between MM3 roots and IAN was the identification of false-positive relationship. CONCLUSIONS: PA radiography may be a good alternative in developing countries to find out if there is a contact between MM3 roots and IAN because it is easier to get to, cheaper, and uses less radiation.

Pulsed Radiofrequency of the Auriculotemporal Nerve to Reduce the Intensity of Tinnitus.

INTRODUCTION: Stimulation of the nonauditory nervous systems via the trigeminal nerve pathways can be a promising intervention for patients with tinnitus refractory to medical, conservative, and other treatment options. Therapy of the mandibular division of the trigeminal nerve through the auriculotemporal nerve has been reported as useful for patients with tinnitus. OBJECTIVES: The objective of our study was to study the long-term effects of pulsed radiofrequency of the auriculotemporal nerve in a large group of tinnitus sufferers and to find predictors for a prosperous result. DESIGN: A monocenter backward-looking group study. RESULTS: In a two-year period, 67 tinnitus patients had pulsed radiofrequency of the auriculotemporal nerve. Twentythree (35%) reported reduced tinnitus loudness at the 7-week post-treatment follow-up. These patients valued the improvements as: 61% good, 22% moderate, and 17% slight. In 3% of patients, tinnitus magnified after the treatment. The odds of permanent tinnitus relief after successful pulsed radiofrequency of the auriculotemporal nerve are 68% at 1 year postoperative. In tinnitus patients without cervical pain 62% had an improvement following pulsed radiofrequency of the auriculotemporal nerve compared to 28% in those not fulfilling this criterion (p=0.024). CONCLUSIONS: Neuromodulation of the auriculotemporal nerve is an uncomplicated remedy for tinnitus. In a select group of tinnitus patients this treatment can a good relief of their tinnitus for a long period. Especially, tinnitus sufferers without cervical pain will benefit of this therapy.

Visuo-Haptic VR and AR Guidance for Dental Nerve Block Education.

The inferior alveolar nerve block (IANB) is a dental anesthetic injection that is critical to the performance of many dental procedures. Dental students typically learn to administer an IANB through videos and practice on silicone molds and, in many dental schools, on other students. This causes significant stress for both the students and their early patients. To reduce discomfort and improve clinical outcomes, we created an anatomically informed virtual reality headset-based educational system for the IANB. It combines a layered 3D anatomical model, dynamic visual guidance for syringe position and orientation, and active force feedback to emulate syringe interaction with tissue. A companion mobile augmented reality application allows students to step through a visualization of the procedure on a phone or tablet. We conducted a user study to determine the advantages of preclinical training with our IANB simulator. We found that in comparison to dental students who were exposed only to traditional supplementary study materials, dental students who used our IANB simulator were more confident administering their first clinical injections, had less need for syringe readjustments, and had greater success in numbing patients.

Coronectomy of impacted mandibular third molars: a clinical and radiological retrospective case series study with 2-9 years of follow-up / Coronectomía de terceros molares mandibulares impactados: un estudio de serie de casos retrospectivo clínico y radiológico con 2-9 años de seguimiento

Background: Impacted mandibular third molars occasionally are in intimate relation to the inferior alveolar nerve (IAN). Coronectomy has been proposed as a good alternative to prevent injury of the IAN. The present study evaluates the clinical and radiological outcomes of impacted mandibular third molars presenting radiographic signs associated with a high risk of IAN injury, and which were treated with the coronectomy technique. Material and Methods: A retrospective case series evaluated the outcomes of coronectomies of impacted mandibular third molars. The inclusion criteria were: available preoperative, immediate postoperative and two-year panoramic radiographs, preoperative cone-beam computed tomography (CBCT), and a complete case history. The clinical evaluation comprised intraoperative complications (mobilized fragments of root and damage to adjacent structures), short-term complications (sensory alterations and postoperative infection), and long-term complications (infection or oral exposure). The IAN position with respect to the roots, root shape, eruption status, third molar position, radicular-complex migration and bone above roots were radiographically evaluated as well. Results: Approximately a total of 2000 mandibular third molars were removed from 2011 to 2022. Of these, 39 molars in 34 patients were partially extracted using the coronectomy technique. The mean age was 36 years (range 22-77), and the mean follow-up was 28 months (range 24-84). There were two short-term postoperative infections. One of them was resolved through reintervention to remove the roots after antibiotic treatment, while the other required hospital admission and removal of the roots. One case of short-term transient lingual paresthesia was also recorded. Two long-term oral exposures were detected, and the root fragments had to be extracted. There were no permanent sensory alterations...(AU)

Preservation of the inferior alveolar vasculonervous bundle in mandibular resective therapies: systematic review and report of two cases

Background: Segmental surgical resection is a frequently indicated procedure to treat aggressive mandibular tumors. One of the most important complications derived from this technique is permanent paresthesia of the inferior alveolar nerve (IAN), which significantly affects the quality of life of patients who experience it. This could be avoided through maneuvers that preserve the IAN. The objective of this paper is to review the main techniques for IAN preservation and to present 2 cases with the technique used by the author. Material and Methods: A systematic review was performed according to the PRISMA guidelines, apropos of two clinical cases reported in this study. The MEDLINE/PubMed and Scopus databases were searched. Several variables were considered and are presented in detail in the form of tables and figures. In addition, 2 case reports with NAI preservation techniques are presented. Results: 13 articles were finally obtained for analysis. 127 patients were evaluated, reporting mandibular resections associated with various pathologies. Various surgical techniques were used, all with the same goal of maintaining the IAN. In most of the patients, the maintenance of sensitivity was achieved, which was verified with different methods. Conclusions: Preservation of the IAN in maxillofacial surgical procedures where surgical resection of the mandibular bone has been performed is an alternative that has demonstrated successful results in terms of reducing postoperative sequelae and is currently positioned as a necessary and feasible procedure. (AU)

Lateralization of the Inferior Alveolar Nerve in the Rehabilitation of Mandibular Atrophy: Case Report.

The lateralization of the inferior alveolar nerve, or LIAN procedure, may be a surgical consideration for implant-prosthetic rehabilitation in the edentulous mandibular posterior region. This technique can be advantageous in that it does not require a donor site and allows for the immediate placement of an implant, potentially leading to reduced morbidity, healing time, and costs. Although such risks as altered sensory nerve function and weakening of the mandibular body are associated with the LIAN procedure, it is a viable alternative to various regenerative techniques to rehabilitate a patient with an implant-supported fixed prosthesis.

Performance evaluation of three versions of a convolutional neural network for object detection and segmentation using a multiclass and reduced panoramic radiograph dataset.

OBJECTIVES: To evaluate the diagnostic performance of three versions of a deep-learning convolutional neural network in terms of object detection and segmentation using a multiclass panoramic radiograph dataset. METHODS: A total of 600 orthopantomographies were randomly selected for this study and manually annotated by a single operator using an image annotation tool (COCO Annotator v.11.0.1) to establish ground truth. The annotation classes included teeth, maxilla, mandible, inferior alveolar nerve, dento- and implant-supported crowns/pontics, endodontic treatment, resin-based restorations, metallic restorations, and implants. The dataset was then divided into training, validation, and testing subsets, which were used to train versions 5, 7, and 8 of You Only Look Once (YOLO) Neural Network. Results were stored, and a posterior performance analysis was carried out by calculating the precision (P), recall (R), F1 Score, Intersection over Union (IoU), and mean average precision (mAP) at 0.5 and 0.5-0.95 thresholds. The confusion matrix and recall precision graphs were also sketched. RESULTS: YOLOv5s showed an improvement in object detection results with an average R = 0.634, P = 0.781, mAP0.5 = 0.631, and mAP0.5-0.95 = 0.392. YOLOv7m achieved the best object detection results with average R = 0.793, P = 0.779, mAP0.5 = 0.740, and mAP0.5-0.95 = 0,481. For object segmentation, YOLOv8m obtained the best average results (R = 0.589, P = 0.755, mAP0.5 = 0.591, and mAP0.5-0.95 = 0.272). CONCLUSIONS: YOLOv7m was better suited for object detection, while YOLOv8m demonstrated superior performance in object segmentation. The most frequent error in object detection was related to background classification. Conversely, in object segmentation, there is a tendency to misclassify True Positives across different dental treatment categories. CLINICAL SIGNIFICANCE: General diagnostic and treatment decisions based on panoramic radiographs can be enhanced using new artificial intelligence-based tools. Nevertheless, the reliability of these neural networks should be subjected to training and validation to ensure their generalizability.

Identifying the Anatomical Variations of the Inferior Alveolar Nerve with Magnetic Resonance Imaging.

BACKGROUND: The inferior alveolar nerve (IAN) is located in the mandibular canal (MC). It is critical to evaluate the position of the MC during treatment planning to prevent intra or postoperative complications. AIMS: This retrospective study aimed to identify the anatomy and anatomical variations of the IAN using soft tissue imaging (pulse sequence magnetic resonance imaging [MRI]). MATERIALS AND METHODS: This study was designed as a retrospective Consolidated Standards of Reporting Trials (CONSORT) study. In total, 220 MR images were obtained. Nutrient canals (NCs) were classified as intraosseous and dental NCs, while bifid MCs (BMCs) were classified as forward, retromolar, and buccolingual canals. IBM SPSS Statistics 22 was used. Kolmogorov-Smirnov and Shapiro-Wilk tests, descriptive statistical methods (means, standard deviations, and frequencies), and the Chi-square test were used. Statistical significance was set at P < 0.05. RESULTS: In total, 220 patients (172 females and 48 males) were evaluated. NCs were present in 92.3% of all MCs and were significantly higher in patients aged <25 years. BMCs were observed in 106 patients (24.1%). The most common BMC of MC/IAN was in the forward canal (14.4%), followed by the retromolar canal (7.5%). CONCLUSION: Although previously, the dental canal was considered as an anatomical variation, this study revisited the classification and suggested that dental canals are anatomical structures.

A novel extraoral ultrasound-guided approach for mandibular nerve block in Rahmani sheep.

BACKGROUND: Regional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique. METHODS: The research comprised three phases: Phase 1 involved an anatomical examination of mandibles and sheep heads to locate the mandibular foramen and delineate the mandibular nerve course. Phase 2 included ultrasound-guided injection of methylene blue dye at specific sites along the mandibular nerve in cadaveric sheep heads. In Phase 3, clinical implementation of ultrasound-guided inferior alveolar nerve blocks was conducted in 27 live sheep, assessing efficacy, onset, and duration. RESULTS: Vertical extraoral ultrasound-guided nerve block was achieved successfully in 25 sheep (98%). A preliminary cadaveric study showed good distribution of the injectate at the mandibular nerve site. The mean onset time was 138 ± 18 s, and the mean duration time was 54 ± 4.1 min. Prominent analgesia of the ipsilateral mandible, medial surface of the cheek, and lateral border of the tongue was observed. CONCLUSIONS: Ultrasound-guided mandibular nerve block holds promise as a technique for providing effective and safe anesthesia in sheep undergoing mandibular procedures.

Morphological and quantitative study of the inferior alveolar nerve canal in hemifacial microsomia.

This study aimed to probe into the anatomic course of inferior alveolar nerve canal (IANC) in hemifacial microsomia (HFM) on a large scale, morphological observations and further quantitative study were performed. Patients were classified by Pruzansky-Kaban classification. The anatomic course of IANC was analyzed morphologically with three-dimensional (3D) imaging software among 248 patients. Seven distances between fixed landmarks on both sides were measured for 236 patients. The differences between affected and unaffected sides were compared. Significant differences were found in the entrance (P < 0.001), route (P < 0.001), and exit (P < 0.05) of IANC in type IIb and III HFM. The higher the degree of mandibular deformity was, the higher the incidence of IANC variation was (P < 0.05). The distances in the horizontal aspect of IANC including from mandibular foramen to mental foramen (P < 0.05) and from mental foramen to gonion (P < 0.05) were significantly shorter on the affected side. Abnormalities of the anatomical course of IANC exist in patients with Pruzansky-Kaban type IIb and type III HFM. The reduction of IANC on the affected side in the horizontal distance is more obvious. Three-dimensional imaging assessment is recommended before surgery.

Introducing a novel intraoral mandibular nerve block technique for loco-regional analgesia in camels (Camelus dromedarius): a cadaveric study using computed tomography.

The aim of this study was to introduce a novel intraoral technique for performing mandibular nerve blocks in dromedary camels (Camelus dromedarius). In this study, 18 adult camel skulls of varying ages and breeds were examined to determine the position of the mandibular foramen. Using a Vernier caliper, three dimensions in millimeters were measured: (1) the distance between the mandibular foramen (MF) and the caudal edge of the third molar tooth at the occlusal surface level, (2) the distance between the MF and the rostral edge border of the mandible's ramus (RER) at the occlusal surface level, and (3) the distance between the MF and the ventral margin border of the mandible (VM). The technique was evaluated using five intact camel cadaver heads (n = 5), and a total of ten mandibular nerve blocks were described. An 18-gauge 80-mm Tuohy needle was inserted into the mouth commissure and advanced caudally while injecting a saline-methylene blue solution. The accuracy of the injection was confirmed through the infiltration of the contrast dye into the target area using computed tomography (CT) and post procedural dissection. Anatomical study of the mandibular nerve site was performed to aid the blind insertion of the needle. The findings contribute to the development of veterinary anesthesia techniques and provide anatomical considerations for clinicians performing oral surgeries in sedated camels. The results demonstrated the successful implementation of the intraoral technique, highlighting its efficacy and reliability in achieving local anesthesia for oral surgeries involving the lower jaw and teeth in sedated camels. Further research studies are needed to evaluate the long-term efficacy and safety of the technique and to compare it with existing approaches.

System for automatically assessing the likelihood of inferior alveolar nerve injury.

Inferior alveolar nerve (IAN) injury is a severe complication associated with mandibular third molar (MM3) extraction. Consequently, the likelihood of IAN injury must be assessed before performing such an extraction. However, existing deep learning methods for classifying the likelihood of IAN injury that rely on mask images often suffer from limited accuracy and lack of interpretability. In this paper, we propose an automated system based on panoramic radiographs, featuring a novel segmentation model SS-TransUnet and classification algorithm CD-IAN injury class. Our objective was to enhance the precision of segmentation of MM3 and mandibular canal (MC) and classification accuracy of the likelihood of IAN injury, ultimately reducing the occurrence of IAN injuries and providing a certain degree of interpretable foundation for diagnosis. The proposed segmentation model demonstrated a 0.9 % and 2.6 % enhancement in dice coefficient for MM3 and MC, accompanied by a reduction in 95 % Hausdorff distance, reaching 1.619 and 1.886, respectively. Additionally, our classification algorithm achieved an accuracy of 0.846, surpassing deep learning-based models by 3.8 %, confirming the effectiveness of our system.

Effect of preemptive use of a nonsteroidal anti-inflammatory drug and a corticosteroid on the efficacy of inferior alveolar nerve blockade and postoperative pain control in endodontic treatment of molars with symptomatic pulpitis: A randomized double-blind placebo-controlled clinical trial.

AIM: The anaesthetic success rate of an inferior alveolar nerve block (IANB) in mandibular molars with irreversible symptomatic pulpitis can be low, and postoperative pain control in teeth with this diagnosis can be challenging. This study aimed to evaluate the influence of preemptive use of dexamethasone and oral potassium diclofenac on the success of IANB. The influence of these drugs on the intensity of postoperative pain was assessed as a secondary outcome. METHODOLOGY: Eighty-four patients with mandibular molars diagnosed with irreversible symptomatic pulpitis recorded preoperative pain intensity using a cold thermal test and a modified Numerical Rating Scale (mNRS). Sixty minutes before the anaesthetic procedure, patients were randomly assigned to one of three groups based on the medication they received: dexamethasone (4 mg), diclofenac potassium (50 mg), or placebo. All patients received IANB with 4% articaine (1:200 000 epinephrine), and 15 min later, they were evaluated for pain intensity using the cold thermal test. Anaesthetic success was analysed. The pain intensity was then recorded, and endodontic treatment and provisional restoration of the tooth were executed in a single session. Patients were monitored for 6, 12, 24, 48 and 72 h using the mNRS to assess the intensity of postoperative pain. RESULTS: There was a statistically significant increase in anaesthetic success when 4 mg dexamethasone (39.3%) or 50 mg diclofenac potassium (21.4%) was used compared to the placebo group (3.6%) (p < .001), with no significant difference between the two drugs. Regarding postoperative pain, dexamethasone was superior to placebo at 6 h (p < .001), with diclofenac having an intermediate behaviour, not differing between dexamethasone and placebo (p > .05). There was no significant difference amongst the groups at 12 h (p > .05). At 24, 48 and 72 h, the effectiveness of dexamethasone and diclofenac were comparable, and both were superior to placebo (p < .001). CONCLUSION: The use of dexamethasone or diclofenac potassium was favourable in terms of increasing the success rate of inferior alveolar nerve block in cases of mandibular molars with irreversible symptomatic pulpitis and decreased the occurrence of postoperative pain when compared to the use of a placebo.

Is it possible to predict neurosensory alterations in impacted lower third molar removal based on preoperative imaging procedures? A prospective cohort study / ¿Es posible predecir alteraciones neurosensoriales en la extracción del tercer molar inferior impactado basándose en procedimientos de imagen preoperatorios? Un estudio de cohorte prospectivo

Background: Surgical extraction of the lower third molar (LTM) may trigger neurosensory injury of the inferioralveolar nerve, making extraction a real challenge. This study set out to assess whether is it possible to predictneurosensory alterations from preoperative imaging.Material and Methods: A total of 99 patients underwent 124 impacted lower third molar (ILTM) surgeries. Priorto surgery, panoramic and CBCT images were evaluated in an attempt to predict a neurosensory disturbance.Preoperative data (ILTM position, panoramic radiograph signs, inferior alveolar nerve (IAN) location and its con-tact with the ILTM roots) and intra/postoperative findings (extraction difficulty and sensitivity alterations) wererecorded. Descriptive and bivariate data analysis was performed. Statistical comparison applied the chi-squaretest, Fisher test, and one-way ANOVA test. Statistical significance was established with a confidence interval (CI)of 95%.Results: In 4.03% of cases, patients experienced neurosensory alterations. Of 124 ILTM positions in panoramicradiographs, 76 cases were considered to exhibit a potential neurosensory risk as they presented two or more typesof superimposed relationships between ILTM and mandibular canal. Of these, alterations were reported in onlythree cases (3.95%). Of the 48 remaining ILTM images presenting only one sign, neurosensory alterations wereobserved in two cases (4.17%). No permanent alterations were recorded in any of the five cases observed.Conclusions: Within the limitations of the present study, prediction of neurosensory alterations prior to ILTMextraction by means of preoperative imaging did not show a significant statistical correlation with post-surgicalincidence. Nevertheless, interruption of the canal´s white line (ICWL) or a diversion of the canal (DC) may predictan increased risk of IAN injury.(AU)