Garcia-Blanco Matias, Gualtieri Ariel-Felix, Puia Sebastian-Ariel
Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Cirugía y Traumatología Bucomaxilofacial I. Buenos Aires, Argentina.
Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Biofísica y Bioestadística. Buenos Aires, Argentina.
J Clin Exp Dent. 2018 Oct 1;10(10):e1003-e1010. doi: 10.4317/jced.54330. eCollection 2018 Oct.
To compare global surgical pain under nerve block and mandibular infiltration anesthesia techniques, and to evaluate pain during drilling and the distance to the mandibular canal in posterior mandible implant surgeries.
A prospective, randomized, controlled, double-blind, clinical trial was conducted to compare nerve block (Group A) to mandibular infiltration (Group B) techniques for dental implant placement. Global surgical pain (VAS = visual analogue scale), pain during drilling or implant placement (MPQ = McGill pain questionnaire) and distance to the mandibular canal (Image J) were statically analyzed. Age, gender, anxiety levels, tooth to be replaced, implant size, adjacent teeth and duration of surgery were also analyzed.
172 patients were included and 283 dental implants were analyzed. VAS values were significantly higher in Group B (<0.05). In Group A, 99% of the surgeries were performed painlessly during drilling and implant placement, but in Group B, 11.6% of implant placements (17 implants) felt pain during these surgical steps. Mean distance to mandibular canal (3.8 mm, range: 0.0 to 7.0) in those 17 implants placed under mandibular infiltration was clinically and statistically similar to the mean distance (3.0 mm, range: 0.0 to 9.0) of 130 implants placed painless (=0.10). Pain during drilling under mandibular infiltration was significantly associated with the duration of surgery (<0.05) and to both adjacent teeth being present (<0.05).
Although both techniques are safe and effective for placing implants in the posterior mandible, nerve block provides a more profound analgesia than mandibular infiltration. When placing implants under mandibular infiltration, as getting closer to the canal does not increase the feeling of pain, it is not recommended to use the presence of pain as a preventive resource to avoid inferior alveolar nerve injuries. Dental implant, mandibular infiltration anesthesia, nerve block, pain, nerve injury.
比较神经阻滞和下颌浸润麻醉技术下的整体手术疼痛情况，并评估下颌后牙种植手术中钻孔时的疼痛以及与下颌管的距离。
进行一项前瞻性、随机、对照、双盲临床试验，比较神经阻滞（A组）和下颌浸润（B组）技术用于牙种植体植入的效果。对整体手术疼痛（视觉模拟评分法，VAS）、钻孔或种植体植入时的疼痛（麦吉尔疼痛问卷，MPQ）以及与下颌管的距离（Image J软件）进行统计学分析。还分析了年龄、性别、焦虑水平、待置换牙齿、种植体尺寸、邻牙以及手术时长。
纳入172例患者，分析了283颗牙种植体。B组的VAS值显著更高（<0.05）。在A组，99%的手术在钻孔和种植体植入过程中无痛进行，但在B组，11.6%的种植体植入（17颗种植体）在这些手术步骤中感到疼痛。在下颌浸润麻醉下植入的这17颗种植体与无痛植入的130颗种植体的平均距离（3.0毫米，范围：0.0至9.0）在临床和统计学上相似（平均距离3.8毫米，范围：0.0至7.0；P = 0.10）。下颌浸润麻醉下钻孔时的疼痛与手术时长（<0.05）以及两颗邻牙均存在（<0.05）显著相关。
尽管两种技术在下颌后牙种植中都是安全有效的，但神经阻滞比下颌浸润提供更有效的镇痛效果。在下颌浸润麻醉下植入种植体时，由于靠近下颌管并不会增加疼痛感，因此不建议将疼痛作为预防下牙槽神经损伤的手段。牙种植体、下颌浸润麻醉、神经阻滞、疼痛、神经损伤。
