Aim To compare the anaesthetic effect of combination of inferior alveolar nerve block anaesthesia and local infiltration anaesthesia with nerve block anaesthesia techniques in the extraction of mandibular third molars.
Materials and methods One hundred and fifty healthy adult volunteers were divided into three groups and were administered three different local anaesthetic techniques before tooth extractions: group A (inferior alveolar nerve, lingual nerve and buccal nerve block anaesthesia with lidocaine), group B (inferior alveolar nerve, lingual nerve and buccal nerve block anaesthesia with mepivacaine) and group C (inferior alveolar nerve block anaesthesia with lidocaine and infiltration anaesthesia with mepivacaine). The patients' reported pain on anaesthesia injection and tooth extraction, the surgeon's assessment of anaesthetic effect, the severity of intra-operative bleeding and post-operative complications were evaluated.
Results There was no significant difference in visual analogue scale (VAS)-pain of anaesthesia among the three groups. Compared with groups A and B, group C had reduced VAS-pain of tooth extraction scores. Additionally, the surgeon's assessment of anaesthetic effect improved and intra-operative bleeding decreased.
Conclusions The combination of inferior alveolar nerve block and infiltration anaesthesia provides a stronger anaesthetic effect in the extraction of mandibular third molars.
Improvement of painless dental treatment.
Compared to conventional inferior alveolar nerve block, combined anaesthesia improves the anaesthetic effect in the extraction of the mandibular third molar.
The application of combination of inferior alveolar nerve block anaesthesia and local infiltration anaesthesia in the extraction of mandibular molars is worth promoting in the clinic.
Subscribe to Journal
Get full journal access for 1 year
only $20.79 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
Seltsam J H. Mandibular and maxillary anaesthesia; uses of the conduction technique. Calif Med 1956; 85: 406-412.
Aker F D. Blocking the buccal nerve using two methods of inferior alveolar block injection. Clin Anat 2001; 14: 111-119.
Tsukimoto S, Takasugi Y, Aoki R, Kimura M, Konishi T. Inferior Alveolar Nerve Block Using the Anterior Technique to Anaesthetize Buccal Nerve and Improve Anaesthesia Success Rates for Third Molar Extraction: A Randomized Controlled Trial and Magnetic Resonance Imaging Evaluation. J Oral Maxillofac Surg 2019; 77: 2004-2016.
Ghadimi S, Shahrabi M, Khosravi Z, Behroozi R. Efficacy of articaine infiltration versus lidocaine inferior alveolar nerve block for pulpotomy in mandibular primary second molars: A randomized clinical trial. J Dent Res Dent Clin Dent Prospects 2018; 12: 97-101.
Corbella S, Taschieri S, Mannocci F, Rosen E, Tsesis I, Del F M. Inferior alveolar nerve block for the treatment of teeth presenting with irreversible pulpitis: A systematic review of the literature and meta-analysis. Quintessence Int 2017; 48: 69-82.
Brignardello-Petersen R. 2% mepivacaine seems to do better than 2% lidocaine in achieving successful anaesthesia in posterior teeth with irreversible pulpitis. J Am Dent Assoc 2017; DOI: 10.1016/j.adaj.2016.12.010.
Juodzbalys G, Wang H L. Identification of the mandibular vital structures: practical clinical applications of anatomy and radiological examination methods. J Oral Maxillofac Res 2010; DOI: 10.5037/jomr.2010.1201.
Juodzbalys G, Daugela P. Mandibular third molar impaction: review of literature and a proposal of a classification. J Oral Maxillofac Res 2013; DOI: 10.5037/jomr.2013.4201.
Wong M K, Jacobsen P L. Reasons for local anaesthesia failures. J Am Dent Assoc 1992; 123: 69-73.
El-Kholey K E. Infiltration anaesthesia for extraction of the mandibular molars. J Oral Maxillofac Surg 2013; DOI: 10.1016/j.joms.2013.06.203.
Kanaa M D, Whitworth J M, Corbett I P, Meechan J G. Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endod J 2009; 42: 238-246.
Parirokh M, Ashouri R, Rekabi A R et al. The effect of premedication with ibuprofen and indomethacin on the success of inferior alveolar nerve block for teeth with irreversible pulpitis. J Endod 2010; 36: 1450-1454.
Da S J G, Lm D A S, Groppo F C. Comparison of Articaine and Lidocaine for Buccal Infiltration After Inferior Alveolar Nerve Block For Intraoperative Pain Control During Impacted Mandibular Third Molar Surgery. Anesth Prog 2017; 64: 80-84.
Parirokh M, Satvati S A, Sharifi R et al. Efficacy of combining a buccal infiltration with an inferior alveolar nerve block for mandibular molars with irreversible pulpitis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 468-473.
Parirokh M, Sadr S, Nakhaee N, Abbott P V, Askarifard S. Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: a randomized controlled trial. Int Endod J 2015; 47: 926-933.
Abdulwahab M, Boynes S, Moore P et al. The efficacy of six local anaesthetic formulations used for posterior mandibular buccal infiltration anaesthesia. J Am Dent Assoc 2009; 140: 1018-1024.
Vieira W A, Paranhos L R, Cericato G O, Franco A, Ribeiro M A G. Is mepivacaine as effective as lidocaine during inferior alveolar nerve blocks in patients with symptomatic irreversible pulpitis? A systematic review and meta-analysis. Int Endod J 2018; 51: 1104-1117.
Baik J, Ok S H, Kim E J et al. Mepivacaine attenuates vasodilation induced by ATP-sensitive potassium channels in rat aorta. Can J Physiol Pharmacol 2016; 94: 1211-1219.
The present study was supported by special fund for high-level university construction talents of Guangzhou Medical University (B185006003006). Ethics approval: this study was approved by Stomatology Hospital of Guangzhou Medical University IRB (No. KY2019037) and all participants signed an informed consent agreement. Patients were given the option to opt out of this study online. None of the subjects declined to participate. No individual person's data in any form were involved in this study.
The authors have no potential conflicts of interest to declare.
About this article
Cite this article
Li, Z., Yang, M., Liao, T. et al. Combined inferior alveolar nerve block anaesthesia and local infiltration anaesthesia in extraction of impacted mandibular third molars: a randomised controlled trial. Br Dent J (2020). https://doi.org/10.1038/s41415-020-2002-z