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15-year unique observational study of intraligamentary local anaesthesia for posterior mandibular extractions

Olley, R. C., Renton, T. F. and Frost, P. M. 2021. 15-year unique observational study of intraligamentary local anaesthesia for posterior mandibular extractions. British Dental Journal 10.1038/s41415-020-2350-8

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Introduction Intraligamentary local anaesthesia (ILA) with articaine is described as an effective alternative to inferior alveolar nerve block (IANB) for extraction of posterior teeth in the mandible, with reduced risk of complications. Aim To investigate ILA with 4% articaine and conventional syringe as a unique method for providing tooth extractions in the posterior mandible. Materials and methods All consecutive teeth to be extracted in the posterior mandible were recruited to the study, within exclusion criteria, between 2002 and 2017 in one London NHS and private dental practice. Four percent articaine was given by ILA with a conventional syringe slowly at two points lingual and two points buccal adjacent to each tooth. Extraction procedures were all performed flapless. Heavily broken-down teeth (n = 43) were extracted by sectioning of roots, guttering and elevation with luxators using socket preservation techniques. Demographic, quantitative and qualitative data were collected at initial appointments and up to 15 years at review. Results The median age was 64 years (interquartile range 17). Teeth extracted included 272 mandibular molars and second premolars, due to periodontal disease (34%), irreversible pulpitis (29%) or posterior tooth fracture (27%). The majority of extractions were second molars (44%), followed by first molars (29%), second premolars (17%) and third molars (10%). Sufficient anaesthesia was achieved within five minutes for all extractions. Procedures lasted less than 30 minutes. Patient feedback reported that the extraction using ILA was quicker than expected and painless, with limited anaesthesia of tissues other than the teeth to be extracted. Numeric rating scale (NRS) scores for pain (0-10) were all less than 3. No complications were recorded. Conclusion The ILA anaesthetic technique is effective for the purpose of a broad range of posterior tooth extractions in the mandible and within certain clinical parameters. It mitigates risks, including nerve injury and cardiovascular disturbances, associated with repeated IANB. This is the largest study of its kind and is conducted in primary care. Key points Demonstrates that intraligamentary local anaesthesia (ILA) with 4% articaine is effective for posterior mandibular extractions in many clinical situations. Provides information on the technique for ILA in primary dental care, with patient feedback. Raises awareness of the techniques for anaesthesia to reduce risk associated with nerve injury.

Item Type: Article
Date Type: Published Online
Status: In Press
Schools: Dentistry
Publisher: Nature Publishing Group
ISSN: 0007-0610
Date of First Compliant Deposit: 22 June 2020
Date of Acceptance: 18 June 2020
Last Modified: 06 Oct 2021 20:29

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