NEEDLE DEFLECTION
ABSTRACT
Background. The authors conducted a prospective, randomized, singleblinded, crossover study comparing the degree of pulpal anesthesia
achieved with the use of a conventional inferior alveolar nerve (IAN) block
administered with the needle bevel oriented away from the mandibular
ramus or toward the mandibular ramus.
Methods. Fifty-one blinded subjects randomly received an IAN block
injection administered with a 27-gauge needle; the needle bevel was oriented away from the mandibular ramus or oriented toward the mandibular
ramus at appointments spaced at least one week apart, in a crossover
design. The authors used a pulp tester to test molars, premolars and central
and lateral incisors for anesthesia in four-minute cycles for 60 minutes.
They considered anesthesia to be successful when two consecutive 80 readings (the maximum output on the pulp tester) were obtained within 15 minutes, and the 80 reading was sustained continuously for 60 minutes.
Results. When the needle bevel was oriented away from the mandibular
ramus, successful pulpal anesthesia from the central incisor to the second
molar was achieved in 24 to 90 percent of patients. When the needle bevel
was oriented toward the mandibular ramus, successful pulpal anesthesia
was achieved in 14 to 92 percent of patients. The results showed no significant difference between the two needle bevel orientations.
Conclusion. The authors concluded that using a 27-gauge needle with
the bevel oriented away from the mandibular ramus was similar to using
the same needle with the bevel oriented toward the mandibular ramus to
administer successful IAN blocks in adults.
Clinical Implications. For IAN blocks administered with a 27-gauge
needle, positioning the needle bevel away or toward the mandibular ramus
does not affect anesthetic success.
Key Words. Needle bevel; inferior alveolar nerve block; local anesthesia.
JADA 2006;137(12):1685-91.
Dr. Steinkruger was a graduate student in endodontics, College of Dentistry, The Ohio State University, Columbus, at the time this study was conducted. He currently has a practice limited to endodontics in Charleston, S.C.
Dr. Nusstein is an associate professor and chair, Section of Endodontics, College of Dentistry, The Ohio State University, Columbus.
Dr. Reader is a professor and program director of advanced endodontics, Section of Endodontics, College of Dentistry, The Ohio State University,
305 W. 12th Ave., Columbus, Ohio 43210, e-mail reader.2@osu.edu. Address reprint requests to Dr. Reader.
Dr. Beck is an associate professor, Section of Oral Biology, College of Dentistry, The Ohio State University, Columbus.
Dr. Weaver is a clinical professor and director of anesthesiology, Section of Oral Surgery, Oral Pathology and Anesthesiology, College of Dentistry, The Ohio State
University, Columbus.
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1685
R E S E A R C H
R E S E A R C H
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R E S E A R C H
TABLE 1
80
60
40
20
PERCENTAGE OF 80 READINGS
PERCENTAGE OF 80 READINGS
100
80
60
40
20
0
1
17
25
33
41
49
57
17
1688
25
33
41
49
57
TIME (MINUTES)
TIME (MINUTES)
R E S E A R C H
100
80
60
40
20
PERCENTAGE OF 80 READINGS
PERCENTAGE OF 80 READINGS
100
17
25
33
41
49
80
60
40
20
0
1
17
25
33
41
49
57
57
TIME (MINUTES)
TIME (MINUTES)
DISCUSSION
that anesthetic success was not significantly different when needle bevels were oriented away or
toward the mandibular ramus when using a 27gauge needle. Therefore, we do not think it is necessary to use commercial 27-gauge needles with
markers indicating the needle bevel. For the most
part, the results of our study were similar to the
rates of anesthetic success and incidence of pulpal
anesthesia reported in other studies of the IAN
block.1 Neither of the needle bevel orientations
provided complete pulpal anesthesia for
mandibular teeth (Table 1) (Figures 1 through 4),
which could present meaningful clinical problems
because the teeth might not be numb enough for
procedures requiring complete pulpal anesthesia.
P VALUE
December 2006
.135
.526
.403
.898
.681
.930
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R E S E A R C H
The results of this study show that using a 27gauge needle with the bevel oriented away from
the mandibular ramus was similar to using a 27gauge needle with the bevel oriented toward the
mandibular ramus with regard to achieving
pulpal anesthesia after administration of IAN
blocks in adults. I
1. Nusstein J, Reader A, Beck M. Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks.
Gen Dent 2002;50(4):372-5.
R E S E A R C H
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