Una nueva alternativa para la localización y la recuperación de agujas fracturadas durante la anestesia odontológica. Presentación de técnica y caso clínico / A new alternative for locating and removing a needle fractured during dental anesthesia. Technique and case report

Objetivo: Describir en un caso clínico una nueva técni- ca para la localización y la remoción de agujas fracturadas du- rante la anestesia odontológica mediante planificación virtual. Caso clínico: Una paciente de género femenino de 52 años de edad concurre a la Cátedra de Cirugía y Traumatolo- gía Bucomaxilofacial I de la Facultad de Odontología de la Universidad de Buenos Aires y relata que dos meses atrás, durante la atención odontológica, se produjo la fractura de la aguja durante la anestesia troncular mandibular. Se realiza diagnóstico y planificación virtual para conocer la ubicación exacta de la aguja y se confecciona un modelo estereolito- gráfico y una guía quirúrgica individualizada para removerla. El uso de una guía quirúrgica individualizada y confeccio- nada mediante planificación virtual permitió ubicar la aguja tridimensionalmente y con mayor precisión en espacios pro- fundos y disminuir tiempos operatorios (AU)

Aim: To describe in a clinical case a new virtual plan- ning technique for locating and removing a fractured dental anesthetic needle. Clinical case: A 52-year-old patient visited the De- partment of Oral and Maxillofacial Surgery I (School of Dentistry, University of Buenos Aires) with a retained den- tal needle in the pterygomandibular space. The needle had fractured during inferior alveolar nerve block two months previously. Virtual diagnosis and planning were performed to locate the needle and a stereolithographic model and a customized surgical guide were prepared. The use of cus- tomized surgical guides prepared by virtual planning ena- bled precise location of the dental needle in deep spaces and reduced operating times (AU)

Deflexión de agujas dentales 30G: comparación de cinco marcas comerciales / Deflection of dental needles 30G: comparison of five trademarks

Abstract Introducción: El grado o nivel de deflexión de la aguja dental, en la mayoría de los casos, puede determinar el éxito o fracaso en la técnica de anestesia dental. Objetivo: Medir el grado de deflexión de la aguja dental, comparando 5 diferentes marcas disponibles en la ciudad de Hermosillo, Sonora, México. Métodos: Se realizó un estudio experimental, en el que con ayuda de un modelo creado con un nivel profesional y una jeringa tipo cárpul, se realizaron diversas punciones en un trozo de carne de res, simulando la realización de una técnica lineal de anestesia bucodental. Se tomaron radiografías periapicales de cada una de las punciones, y con ayuda de una malla milimetrada, se realizaron las mediciones. Dentro de cada grupo de agujas, se presentaron diferentes medidas de deflexión, y se obtuvo un promedio de cada marca. El rango abarcó desde los .65 mm hasta 2.1 mm de deflexión, tomando como referencia un plano recto. Conclusiones: Se demostró que la de la marca Septodont®, fue la que presentó menor deflexión a la punción. Es recomendable verificar y examinar el estado de las agujas antes de ser utilizadas para realizar procesos quirúrgicos, y así disminuir riesgos y/o complicaciones postoperatorias.

Resumen Introduction: The degree or level of deflection of the dental needle, in most cases, can determine the success or failure of the dental anesthesia technique. Objective: Measure the degree of deflection of the dental needle, comparing 5 different brands available in the city of Hermosillo, Sonora, Mexico. Method: An experimental study was carried out, with a model created with a professional level and a carpul syringe, various punctures were made in a piece of beef, simulating the performance of a linear technique of oral anesthesia. Periapical radiographs of each of the punctures were taken, and with the help of a millimeter mesh, measurements were made. Within each group of needles, different deflection measures were presented, and an average of each brand was obtained. The range ranged from .65 mm to 2.1 mm of deflection, taking as reference a straight plane. Conclusions: It was shown that the Septodont® brand was the one that presented the lowest puncture deflection. It is advisable to verify and examine the condition of the needles before being used to perform surgical procedures, and thus reduce risks and / or postoperative complications.

From ACE to ACENO: How America's Munson added Harley's British mixture to nitrous oxide.

An Ohio dentist, Corydon Munson, patented a gasometer with an attachment for vaporizing trace amounts of volatile general anesthetics or their mixtures into unoxygenated nitrous oxide. After vaporizing a variant of George Harley's ACE mixture into nitrous oxide, Munson branded his own novel anesthetic combination as ACENO.

Effects of a Training Needle on Dental Hygiene Student Anxiety.

Purpose: The purpose of this pilot study was to assess whether practicing with a cotton-tipped applicator as compared to a new training device had an effect on the anxiety levels of dental hygiene students prior to administering and receiving their first intraoral injection for local anesthesia.Methods: This pilot study used a convenience sample of senior dental hygiene students from an entry-level Bachelor degree dental hygiene program. Participants completed a pre-test survey after watching a video demonstrating the inferior alveolar nerve block (IANB) injection technique to determine anxiety levels regarding administering and receiving an intraoral injection. Test and control groups were randomly assigned; and participants either received a dental syringe with an attached training needle device (test) or a cotton tip applicator (control). Both groups completed a post-test survey following a 15 minute practice session. Descriptive statistics were performed and Chi-square tests were used to determine significance.Results: Pre-test results showed that 91% of the participants (n=23) reported having anxiety regarding administering or receiving an intraoral injection in one or multiple areas. Chi-square tests determined no statistical significance (p =0.125) between the test and control groups in the post-test surveys.Conclusion: Dental hygiene students demonstrated decreased anxiety levels regarding administering and receiving an intraoral injection regardless of the assigned practice device in this pilot study. While use of a training needle was not shown to be superior at reducing anxiety in novice student operators when compared to a cotton tipped applicator, it may be a useful device for teaching local anesthesia administration techniques.

Single tooth anaesthesia: a new approach to the paediatric patient. A clinical experimental study.

AIM: The objective of this study is to assess the efficacy of the STA Wand System with respect to pain and fear reduction in paediatric patients and by using the Single Tooth Anaesthesia (STA) technique. MATERIALS AND METHODS: Patients included children and teenagers between 6 and 17 years of age, who required the administration of local anaesthesia prior to expected treatments. Local anaesthesia was performed by means of the electronic STA Wand System (Milestone scientific., Inc.) adopting the Single Tooth Anaesthesia (STA) technique. Pre- and post-anaesthesia, the patients were asked to complete the Wong-Baker faces image scale and the provider filled in the Frankl Scale. RESULTS: All treatments were completed successfully and no collaboration issues were recorded. Frankl's assessment showed that 91% of patients regarded dental experience positively. The efficacy of the computer-assisted anaesthesia was at 100% when treating primary teeth, and 70% for procedures on permanent teeth. Almost the totality of treated patients (94%) gave a positive evaluation after having tried the device with STA technique. Only 6% of the patients assessed the procedure negatively. CONCLUSIONS: The STA technique allows for absence of anticipatory anxiety, absence of physical pain, no anaesthetic effects in the perioral tissues and a controllable, lower dosage of the anaesthetic liquid.

Single tooth anesthesia versus conventional anesthesia: a cross-over study.

OBJECTIVES: The aim of the present study was to compare an electronic device, the Wand Injection System (Milestone Scientific Livingstone), with conventional anesthesia in terms of the following: pain sensation during anesthetic injection; effectiveness in achieving adequate anesthesia for a complete painless dental treatment; post-operative discomfort; and patient's anxiety toward dental treatment. MATERIALS AND METHODS: Eighty adults from 18 to 70 years were enrolled in this cross-over study. Each patient served as his/her own control being subject to two anesthesia techniques: conventional and Single Tooth Anesthesia (STA) performed with the Wand. A split-mouth design was adopted in which each tooth undergoing conservative restorative or endodontic treatment received anesthesia with both techniques at 1-week interval. Before anesthetic administration, the patients' anxiety levels were determined. Physiological parameteres were measured before, during, and after the two injection procedures, and the Visual Analogue Scale (VAS) was used to assess pain of injection, discomfort, and anesthetic efficacy. Differences in assessment of pain's injection, discomfort, anesthetic efficacy, vital parameters (heart rate, blood pressure, and oxygen saturation), and state anxiety levels were analyzed using Student's t test (p value < 0.001). RESULTS: The mean injection pain and post-operative discomfort ratings with Wand were lower than those with conventional syringe (p = 0.022 and p < 0.001, respectively). No differences were found in the assessment of anesthetic efficacy. Blood pressure and heart rate mean values were lower during the anesthesia performed with the Wand than with the conventional syringe (p < 0.001). The anxiety level was higher during the first appointment, independently from the device used for the injections. CONCLUSION: The STA technique resulted in lower pain, discomfort, and lower intensity of physiological parameters. CLINICAL RELEVANCE: Single Tooth Anesthesia could be an efficacious alternative to conventional procedures.

Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index.

AIM: The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology. METHODS: Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients. RESULTS: A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$. CONCLUSIONS: Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance.

A randomized clinical trial to compare pain levels during three types of oral anesthetic injections and the effect of Dentalvibe® on injection pain in children.

BACKGROUND: Pain control is of great importance particularly in pediatric dentistry. The Dentalvibe® is a device that delivers vibration to the injection site in order to reduce intraoral injections' pain. AIMS: The purpose of this study was to compare pain levels caused by three types of anesthesia injections and the effect of the Dentalvibe® on reducing the injection pain. DESIGN: The study included 40 children, and each one received six injections. The injections were divided randomly into two methods: experimental (DV): buccal and palatal infiltration on the maxilla and inferior alveolar nerve block (IANB) with vibration and traditional (TR): receiving the same previous injections without vibration. Moreover, pain was assessed using the FLACC® and Wong-Baker faces® pain scales. Then after, patients were asked about their favorite method. RESULTS: No statistically significant differences were observed regardless of the injection site in subjective and objective evaluation in the (TR) method. Although the pain scores in (DV) method were less than the traditional in most injections, the differences were not statistically significant. CONCLUSIONS: Children experienced similar levels of pain in all sites of injection using the traditional method. The Dentalvibe® did not decrease discomfort and was not accepted more by children.

The effect of mouth prop on endotracheal tube intracuff pressure in children during dental rehabilitation under general anaesthesia.

Although the endotracheal tube (ETT) cuff may be associated with tracheal morbidity, cuffed tubes may reduce the aspiration risk in oral procedures. Dentists must use a mouth prop to facilitate oral visualization and to protect the oral soft tissues during dental rehabilitation under general anaesthesia (DRGA). The aim of this study was to evaluate the effect of mouth prop on endotracheal tube intracuff pressure in children during DRGA. Two-hundred and three ASA I-II patients, <18 years of age (mean: 5.3 ± 2.4 years) were included in the prospective observational study whose comprehensive dental treatment was performed under general anaesthesia. Following the induction of general anaesthesia, placement of a cuffed endotracheal tube which was an appropriate size for children was fixed. The intracuff pressure was measured intermittently after the intubation (baseline) (T0), immediately after the mouth prop (T1), 30 min after the mouth prop (T2), after taking out the mouth prop (T3) and just before extubation (T4). The mean intracuff pressure was 28.3 ± 2.01 cm H2O at T0. The mean intracuff pressure significantly increased at T1 (30.8 ± 2.7) and T2 (29.6 ± 3.7) compared to T0 (P < 0.001). No significant differences were observed between the duration of the procedure and intracuff pressure or postoperative complications (P > 0.05). Cough, sore throat and nausea were observed in 4, 1 and 5 patients, respectively. Because a mouth prop may increase the intracuff pressure of ETT, strict measurement and readjustment of cuff pressures should be employed when used in children during DRGA.

Prospective clinical study comparing intraligamentary anesthesia and inferior alveolar nerve block for extraction of posterior mandibular teeth.

OBJECTIVES: The aim of the study was to compare the efficacy of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) for extraction of mandibular posterior teeth. MATERIALS AND METHODS: In a prospective clinical trial, a total of 301 mandibular posterior teeth were extracted in 266 patients. Randomization was conducted into those who received ILA (patients n = 98; teeth n = 105) and those who received IANB (patient n = 140; teeth n = 140). Twenty-eight patients were subjected to bilateral mandibular dental extractions and received both ILA und IANB (teeth n = 56 (ILA n = 28; IANB n = 28)). The primary objective was to evaluate the differences in pain during injection, in pain during tooth extraction (numeric rating scale (NRS)), and in anesthetic quality (complete/sufficient vs. insufficient/no effect). Differences in latency time, amount of anesthetic solution, need for second injection, and duration of local numbness as well as in the incidence of dry socket were assessed. RESULTS: ILA had significant lower pain of injection (p < 0.001), shorter latency time (p < 0.001), and shorter duration of local numbness (p < 0.001) and required lesser amount of local anesthetic solution (p < 0.001) together with a similar anesthetic quality (p = 0.082) compared to IANB. Concerning pain during extraction (p = 0.211), frequency of second injection (p = 0.197), and incidence of dry socket (p = 0.178), no significant differences were detected. CONCLUSION: ILA fulfills the requirements of a minimal invasive and patient-friendly local anesthetic technique. In accordance, it represents a safe and reliable alternative to IANB for extraction of mandibular posterior teeth. CLINICAL RELEVANCE: ILA can be recommended for routine dental extractions.

Nitrous Oxide Inhalation Sedation Through a Nasal High-Flow System: The Possibility of a New Technique in Dental Sedation.

High-flow nasal cannula (HFNC) systems are increasingly used for patients with both acute and chronic respiratory failure because of the clinical effectiveness and patient comfort associated with their use. Recently, HFNC has been used not only as a respiratory support device, but also as a drug delivery system. HFNC is designed to administer heated and humidified inspiratory oxygen flows (100% relative humidity at 37°C). Therefore, HFNC can provide high flows (up to 60 L/min) without discomfort. Moreover, HFNC improves oxygenation by exerting physiologic effects such as (a) dead-space washout and (b) moderate positive airway pressure. These characteristics and physiologic effects of HFNC may permit administration of high-flow nitrous oxide sedation while ensuring patient comfort and adequate sedative effect.

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block.

OBJECTIVES: This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. MATERIAL AND METHODS: To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results' analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). RESULTS: The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues' resistance. The evaluation of visual aspects was influenced by the participants' experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it. CONCLUSION: The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block

Abstract Objectives This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. Material and Methods To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results' analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). Results The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues' resistance. The evaluation of visual aspects was influenced by the participants' experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it. Conclusion The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.

Telescopic Dental Needles versus Conventional Dental Needles: Comparison of Pain and Anxiety in Adult Dental Patients of Kerman University of Medical Sciences-A Randomized Clinical Trial.

INTRODUCTION: Pain felt during dental injections is dependent on dental anxiety. Patients feel increased pain if anxiety in the treatment environment is high, and therefore it is important to reduce anxiety during treatment to reduce pain. The purpose of this study was to compare pain and anxiety levels experienced during injections using a newly invented telescopic-coated dental needle that covers the conventional needle and also has the capability of applying topical anesthesia through its unique design with the conventional dental injection needle. METHODS: Dental injection anxiety questionnaires were completed by 60 adult patients who were randomly assigned to either the telescopic (a newly invented telescopic-coated dental needle that covers the needles) or the conventional group. Patients also completed visual analog scales to rate their pain perception during injection, their overall experience, and their future anticipated anxiety. Wilcoxon, Mann-Whitney, and Student t tests were used for statistical analysis. Statistical significance was defined as P < .05. RESULTS: A total of 25 men and 35 women with an age range of 19-55 years (mean age of 38.7 ± 2.31 years) participated in this study. Pain levels reported during the injection using the telescopic-coated needle (4.13 ± 1.37) were significantly lower than those using the conventional needle (5.63 ± 1.57), with statistically significant differences between the 2 groups (P < .05). Patients experienced significantly lower overall postinjection anxiety (P < .05) and had more positive overall experience ratings with the telescopic-coated needles. CONCLUSIONS: A new telescopic-coated dental needle was superior to a conventional injection system in pain perception and in reducing postinjection dental anxiety.

A Vibration Device to Control Injection Discomfort.

Pain from local anesthesia injections can be reduced by distraction and counter-stimulation techniques. This study investigated the DentalVibe® Injection Comfort System (third-generation, DV3), developed to lessen anesthesia pain through pulsed vibration, a form of counter-stimulation. The aim of the study was to evaluate both the efficacy of DV3 in reducing pain and discomfort from intraoral long buccal (LB) and inferior alveolar nerve (IAN) injections and the time needed to achieve complete anesthesia during an IAN block. The study enrolled 60 subjects, 30 men and 30 women, aged 21 to 32 years, who rated both injection pain on a visual analog scale and discomfort, unpleasantness, and difficulty in enduring the injection on a modified symptom severity index. Each subject received bilateral LB injections and an IAN block. Using block design, the third-generation DV (DV3) was randomly assigned to either the first or second LB injection and to 30 subjects on their third injection, the IAN block. No topical anesthesia was applied. Subjects receiving DV3 reported significantly less pain, discomfort, unpleasantness, and difficulty in enduring LB and IAN injections (P < .05), regardless of whether DV3 was used on the first or second LB injection. Time to complete anesthesia was not significantly different (P > .05) when DV3 was used on IAN block injections. The DV3 significantly (P < .02) reduced pain/discomfort from anesthetic injections in this pilot study, in which many subjects were either dental or medical students familiar with performing and enduring injections. More studies are warranted on layperson populations.