Rajiv Gandhi University of Health Sciences s59

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

NAME OF THE CANDIDATE DR.B.SARAT RAVI KIRAN 1. POST GRADUATE STUDENT, AND ADDRESS: DEPARTMENT OF ORAL AND MAXILLOFACIAL SURGERY, THE OXFORD DENTAL COLLEGE, HOSPITAL & RESEARCH CENTER, BANGALORE- 560068

2. NAME OF THE INSTITUTION: THE OXFORD DENTAL COLLEGE,

HOSPITAL & RESEARCH CENTER.

BANGALORE - 560068

COURSE OF THE STUDY AND MASTER OF DENTAL SURGERY IN 3. SUBJECT: ORAL AND MAXILLOFACIAL SURGERY

4. DATE OF ADMISSION TO COURSE 03. 06. 2013

5. TITLE OF THE TOPIC

COMPARISON OF THE ANESTHETIC SUCCESS,ONSET OF ANESTHESIA AND ASPIRATION RATE IN CONVENTIONAL INFERIOR ALVEOLAR, VAZIRANI AKINOSI AND GOW GATES TECHNIQUES.

1 6. BRIEF RESUME OF INTENDED WORK

6.1. NEED FOR THE STUDY: -

The inferior alveolar nerve can be anesthetized using several techniques, which include the conventional inferior alveolar , Vazirani-Akinosi and Gow Gates technique. The most common technique used for achieving local anesthesia for mandibular surgical procedures is the conventional inferior alveolar technique.

The Vazirani- Akinosi technique is used in patients with limited mouth opening in conditions like trismus where even the conventional inferior alveolar technique is difficult to use.

Another technique is the Gow Gates technique uses extra oral landmarks and the target site is the neck of the condyle, higher success rates was found to be with this technique.

This study aims to evaluate the onset of anesthesia, anaesthetic success and positive aspiration during administration of local anesthetic solution in the inferior alveolar,Vazirani- Akinosi and Gow Gates techniques.

6.2. REVIEW OF LITERATURE:-

Steven Goldberg et al compared the degree of pulpal anesthesia obtained with the conventional inferior alveolar, the Vazirani-Akinosi and the Gow-Gates techniques. With a crossover design, 40 subjects received all 3 techniques in a random manner by using 3.6 mL of 2% lidocaine with 1:100,000 epinephrine at 3 separate appointments. An electric pulp tester was used to test for anesthesia in 3 minute Cycles for 60 minutes of the first molars, first premolars, and lateral incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes and the 80 reading was continuously sustained through the 60th minute. The ranges of successful

2 Anesthesia were as follows: inferior alveolar technique, 25%-62%; Gow-Gates technique, 16%-44%; and for theVazirani-Akinosi technique, 13%-50%.There was no significant difference (P>.05) in success among the 3 techniques. However, the Gow- Gates and Vazirani-Akinosi techniques resulted in a statistically slower onset of pulpal anesthesia than the inferior alveolar nerve block. They concluded that, for the subjects who achieved lip numbness, the conventional inferior alveolar nerve block was similar to the Vazirani-Akinosi and Gow Gates techniques regarding anesthetic success but conventional inferior alveolar nerve technique has a faster onset of pulpal anesthesia.

. A study evaluated the onset and duration of anaesthesia, pain during injection, aspiration test, pinprick, depth and frequency of anaesthesia using the conventional inferior alveolar technique, Vazirani-Akinosi and Gow Gates techniques. 90 patients undergoing simple tooth extraction were randomly selected into 3 groups. They were given injections of 2 ml of 2% lidocaine with adrenaline (I :80,000). Positive aspirations were most frequently observed with the direct method of inferior dental anaesthesia, but this method gave the best result for the frequency of anaesthesia. After using the Gow-Gatcs method, the external branches of the buccal nerve were usually anaesthetized but the onset of anaesthesia was relatively slow. Mandibular conduction anaesthesia via the tuberosity approach did not show any particular advantage over the other 2 techniques in this investigation.

A randomised double-blind study compared the efficacy of the closed-mouth and the conventional mandibular block injection techniques in 200 patients requiring anaesthesia for tooth extractions. Results showed the success rate of inferior alveolar nerve anaesthesia with a single injection to be 97% in the conventional group, and 79% in the closed-mouth group. The closed-mouth injection technique produced a greater variety of unexpected symptoms than the conventional. It was concluded that the conventional technique was more effective in blocking the inferior alveolar nerve, and was also faster in producing anaesthesia, but yielded more positive aspirations than the closed-mouth technique.

3 A study on 56 patients who were subjected to lower molar extraction, compared the efficacy of theVazirani-Akinosi technique as an alternative to direct or conventional mandibular nerve block in two groups of 28 subjects each. The parameters evaluated were pain in response to puncture, percentage positive aspiration, latency, pain during the intervention and complications. Patient pain in response to puncture was comparatively less intense and frequent with the Vazirani- Akinosi technique. The latency to anesthesia was briefer with conventional mandibular block than with the Vazirani- Akinosi technique . The patients anesthetized with the Vazirani-Akinosi technique required more buccal nerve reinforcement infiltrations to complete the procedure. The anesthetic failure rates were 10.7% and 17.8% for the conventional and Vazirani-Akinosi technique, respectively. It is concluded that while the Vazirani- Akinosi technique can be used to extract lower molars, direct mandibular block offers superior anesthetic performance.

A study compared the Vazirani- Akinosi mandibular block technique for administration of local anesthesia with conventional nerve block technique in patients undergoing the removal of impacted third molars . Success rates were equivalent, and both techniques resulted in acceptable quality of anesthesia. Buccal nerve anesthesia was achieved with the Akinosi technique in 80% of cases. The Akinosi technique appears to be a successful alternative to traditional mandibular block techniques for oral surgery.

4 6.3. OBJECTIVES OF THE STUDY:-

 To evaluate the onset of anaesthesia, Anaesthetic success and Aspiration rate in Inferior Alveolar, Vazirani-Akinosi and Gow Gates techniques.

7. MATERIAL & METHODS:

7.1. SOURCE OF DATA:-

Two hundred and ten Patients reporting to The Department of Oral & Maxillofacial Surgery, Oxford Dental College, Hospital & Research Center requiring minor surgical procedures in the mandibular region

7.2. METHOD OF COLLECTION OF DATA:-

It is an in vivo study to compare all three techniques of anesthesia and the data will be collected with the help of a straight probe,local anesthesia loaded syringe and visual analog scale.

INCLUSION CRITERIA :-

 The subjects with good physical and mental health status.

 Age should be between 18 to 55 years.

EXCLUSION CRITERIA :-

 All patients with systemic diseases that contraindicate 1.8ml injections of 2% lignocaine with 1:80,000 adrenaline.

 Mentally retarded patients.

5 EQUIPMENTS TO BE USED :-

 Local Anesthesia

 Disposable syringe

 Straight probe

 Stop watch

PROCEDURE:

The study will be done on patients reporting to the department of oral and maxillofacial surgery, oxford dental college and hospital. The patients will be divided into three groups. Three different techniques of administration of local anesthesia will be done in three different groups. The inferior alveolar technique in the first group, Vazirani- Akinosi technique in the second group and Gow Gates technique in the third group. The procedure will be done using 1.8ml of 2% lignocaine with 1:80000 adrenaline. The onset of anesthesia, anaesthetic success and aspiration rate will be evaluated.

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR OTHER ANIMALS?

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

6 8. LIST OF REFERNCES:

1. Goldberg S, Reader AL, Drum M, Nusstein J, Beck M. Comparison Of The Anesthetic Efficacy Of Conventional Inferior Alveolar, Gow Gates And Vazirani Akinosi Techniques. J Endod 2008;34:1306-1311

2. Gonzalez M, Pena B, Caliz F, Martin H, Diago P. A Comparative Study Of Direct Mandibular Nerve Block And The Akinosi Technique . MED ORAL 2003;8:143-149

3. Donker P, Wong J, Moorthy P, An Evaluation Of The Closed Mouth Mandibular Block Technique .Int.J. Oral MaxilloFac. Surg. 1990; 19 : 216- 219.

4. Allen l Sisk. Evaluation Of The Akinosi Mandibular Block Technique In Oral Surgery J Oral MaxilloFac Surg 1986; 44 : 113-115

5. Todorovic L, Stajcic Z And Petrovic V, Mandibular Verses Inferior Dental Anaesthesia:Clinical Assessment Of 3 Different Techniques . Int. J.Oral Maxillofac.Surg.1986: 15: 733-738.

7 9. SIGNATURE OF THE CANDIDATE:

10. REMARKS OF THE GUIDE:

11. NAME AND DESIGNATION OF DR.VINAY M KASHYAP

11.1. GUIDE: READER

DEPARTMENT OF ORAL AND

MAXILLOFACIAL SURGERY,

THE OXFORD DENTAL COLLEGE,

HOSPITAL & RESEARCH CENTER

BANGALORE- 560068.

11.2. SIGNATURE:

11.3. CO-GUIDE:

11.4. SIGNATURE:

8 11.5.HEAD OF THE DR. JAYAPRASAD N. SHETTY DEPARTMENT: PROFESSOR & HEAD OF THE DEPARTMENT,

DEPARTMENT OF ORAL AND

MAXILLOFACIAL SURGERY,

THE OXFORD DENTAL COLLEGE,

HOSPITAL & RESEARCH CENTER

BANGALORE- 560068.

11.6. SIGNATURE:

12. 12.1.REMARKS OF THE CHAIRMAN AND PRINCIPAL:

12.2. SIGNATURE: