Anesthetic efficacy of gow-gates versus inferior alveolar nerve block for irreversible pulpitis

• Autor(a) principal: Sarfaraz, Ifrah
• Data de Publicação: 2020
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10284/9270
• topic: Domínio/Área Científica::Ciências Médicas::Medicina Clínica

Introduction: Local anesthesia is a drug used to induce loss of sensation in a particular part of the body that results in nerve endings or obstruction of the peripheral nerve function. Local anesthetic injection may not only generate pain and fear, but also be a triggering factor related to medical emergencies in dental offices, with vasodepressor syncope and hyperventilation as major psychogenic reactions. Various techniques used for Inferior Alveolar Nerve Block (IANB) Mandibular teeth are: • Conventional IANB • Gow-Gates mandibular nerve block (GGMNB) • Vazirani/Akinosi block (Closed mouth block) Mainly Infiltration technique is used for anaesthetizing maxillary teeth (Maxillary nerve). Various approaches have their advantages and limitations. The failure rate for IANB is quite high as compared to Maxillary nerve infiltration. Clinicians have consistently sought an anesthetic alternative, which can increase success rates well below one hundred percent in the posterior mandible in particular. Therefore, during the treatment of the nerve block, dentists should therefore choose the highly appropriate technique with patient interest. Foregoing in view, the purpose of this review was to assess the anesthetic efficacy of the IANB and GGMNB in patients with symptomatic irreversible pulpitis. Objectives: • To systematically review researches on the anesthetic efficacy of GGMNB versus IANB for irreversible pulpitis. • To compare the outcomes of GGMNB and IANB for irreversible pulpitis. Methodology: It was a descriptive systematic review of quantitative researches wherein the “Preferred Reporting Items for Systematic Reviews (PRISMA)” was adopted, which ensured clarity in selection process of shortlisted paper and facilitated comprehensive approach to compose systematic review. PICO criteria, clearly identifying population (P), Intervention (I), Comparison (C),and Outcome (O), was used to structure the research question: “Is Gow-Gates technique (I) has better anesthetic efficacy (O) as compared to IANB (C) for patients with irreversible pulpitis (P)”? The literature search was done on PubMed/Medline, Cochrane library, Google scholar and Ovid. Selection criteria was applied for population as patients of age more than 9 years of either gender with irreversible pulpitis while including articles published in English from all around the world regarding conventional IANB or IANB & Gow-Gates techniques, and articles published between the duration of 2009-2019 as approved vide final work proposal. The prospective randomized clinical trials or randomized controlled trials were included for the review in which anesthetic efficacy or success was measured. A total of six studies on Cochrane, sixteen studies on PubMed/Medline, two on Ovid and eighty seven studies on Google scholar were primarily identified. After removal of the duplicates (n=111), preliminary screening of titles and abstracts was done, and 103 studies were excluded because they were not meeting the eligibility criteria. A total of 8 articles were selected for full‐text reading. Of these 8 studies, 3 studies were further excluded because focused question was not answered in it. At final stage, five articles were included. Results: The results of the five studies that are reviewed establish that anesthetic efficacy of Gow-Gates nerve block technique is better than IANB technique for irreversible pulpitis. However, the overall quality of the literature assessed is fair to poor. Three studies are randomized clinical trial and two randomized controlled trial. The validity and reliability of the studies included is appropriate. This is due to the appropriate study design and accuracy of the study in measuring the efficacy of the selected anesthetic techniques. Conclusion: Patients who receive either of these two mandibular nerve blocks i.e., there is a difference in the pain experienced i.e. Gow-Gates nerve block or IANB. There is evidence of a higher efficacy of the Gow-Gates technique than the IANB. Each of the two techniques is equally easy to execute with training. The value of knowing how to perform the Gow-Gates nerve block is that the Gow-Gates technique will most likely provide satisfactory anesthesia for a specific patient in situations where the IANB will not. Knowing how to perform only one method to block the inferior alveolar nerve limits the ability of the dentist to provide consistently successful anesthesia and makes it more difficult for all patients to achieve the goal of pain-free dentistry. Knowing how to perform Gow-Gates technique, on the other hand, increases the likelihood that patients may be pain-free when undergoing mandible dental procedures.