Ashkenazi M, Sher I, Rackoz M, Schwartz-Arad D
Pediatric Dentistry Dental Clinic, 7A Haim Gilad St, Petach-Tikva, 49377, Israel,
Eur Arch Paediatr Dent. 2014 Apr;15(2):121-6. doi: 10.1007/s40368-013-0073-0. Epub 2013 Aug 6.
To evaluate possible associations between successful mandibular block injection and location of penetrating the oral mucosa, location of injection on the ramus and the needle insertion length.
The study consisted of 101 dentists, of whom, 33 were oral surgeons, 33 certified paediatric dentists and 35 general dental practitioners. The dentists were asked to estimate their rate of success in mandibular block injections, defined as the proportion of their patients for whom only a single carpule was necessary, and to indicate the needle insertion length and the location of the injection on a photograph of a ramus and on a photograph of the oral mucosa.
Injecting a single carpule for achieving full anaesthesia in 90% or more of their patients was reported by 79.3 and 57.8% of the dentists treating children and adults, respectively. Of practitioners treating children, experienced dentists (>5 years in occupation) reported higher success rates than did inexperienced ones (p = 0.05). A positive correlation was found between failure rate reported in children, shorter length of the inserted needle (R = 0.356, p = 0.001) and injecting at the central (superior inferior dimension) most anterior quarters of the ramus (p = 0.006; odd ratio = 3.9375). Routine waiting period of more than 5 min after the injection and before operative treatment was associated with higher rates of failure (p = 0.042, χ(2) = 6.335). No correlation was found between the success rates of mandibular block injection and the location of penetrating the oral mucosa in children (p = 0.94), adults (p = 0.57), or between success rates and the target location on the ramus in adults (p = 0.42).
χ(2) test was used to determine the significance of differences among proportions and t test for continuous variables. Pearson's correlation analysis was used to analyse the correlation between the length of the needle inserted in children and adults by the same dentist.
Shorter needle insertion lengths and targeting the injecting to the most anterior quarters of the ramus were positively correlated with failure of anaesthesia in children, according to dentists' reports. A routine waiting period of over 5 min did not increase the success rates of mandibular block injection.
评估下颌阻滞注射成功与口腔黏膜穿刺位置、下颌支注射位置及进针长度之间可能存在的关联。
该研究由101名牙医组成，其中33名是口腔外科医生，33名是认证儿科牙医，35名是普通牙科医生。要求牙医估计他们在下颌阻滞注射中的成功率，定义为仅需一支卡波卡因即可麻醉的患者比例，并在一张下颌支照片和一张口腔黏膜照片上指出进针长度和注射位置。
分别有79.3%和57.8%治疗儿童和成人的牙医报告称，在90%或更多患者中仅注射一支卡波卡因就能实现完全麻醉。在治疗儿童的从业者中，经验丰富的牙医（从业超过5年）报告的成功率高于经验不足的牙医（p = 0.05）。发现儿童报告的失败率与进针长度较短（R = 0.356，p = 0.001）以及在下颌支最前侧四分之一处（上下维度）注射（p = 0.006；比值比 = 3.9375）之间存在正相关。注射后及手术治疗前常规等待超过5分钟与较高的失败率相关（p = 0.042，χ(2)= 6.335）。在下颌阻滞注射成功率与儿童（p = 0.94）、成人（p = 0.57）口腔黏膜穿刺位置之间，以及成人成功率与下颌支目标位置之间均未发现相关性（p = 0.42）。
χ(2)检验用于确定比例差异的显著性，t检验用于连续变量。Pearson相关分析用于分析同一牙医在儿童和成人中进针长度之间的相关性。
根据牙医报告，较短的进针长度以及将注射点定在下颌支最前侧四分之一处与儿童麻醉失败呈正相关。超过5分钟的常规等待时间并未提高下颌阻滞注射的成功率。
