J Dent Anesth Pain Med.  2015 Sep;15(3):113-119.

The influence of mandibular skeletal characteristics on inferior alveolar nerve block anesthesia

• You TM
• Kim KD
• Huh J
• Woo EJ
• Park W

Abstract

BACKGROUND
The inferior alveolar nerve block (IANB) is the most common anesthetic techniques in dentistry; however, its success rate is low. The purpose of this study was to determine the correlation between IANB failure and mandibular skeletal characteristics
METHODS
In total, 693 cases of lower third molar extraction (n = 575 patients) were examined in this study. The ratio of the condylar and coronoid distances from the mandibular foramen (condyle-coronoid ratio [CC ratio]) was calculated, and the mandibular skeleton was then classified as normal, retrognathic, or prognathic. The correlation between IANB failure and sex, treatment side, and the CC ratio was assessed.
RESULTS
The IANB failure rates for normal, retrognathic, and prognathic mandibles were 7.3%, 14.5%, and 9.5%, respectively, and the failure rate was highest among those with a CC ratio < 0.8 (severe retrognathic mandible). The failure rate was significantly higher in the retrognathic group than in normal group (P = 0.019), and there was no statistically significant difference between the other two groups.
CONCLUSIONS
IANB failure could be attributable, in part, to the skeletal characteristics of the mandible. In addition, the failure rate was found to be significantly higher in the retrognathic group.

Keyword

Condyle-coronoid ratio; Inferior alveolar nerve block; Skeletal characteristics

MeSH Terms

Anesthesia*
Dentistry
Mandible
Mandibular Nerve*
Molar, Third
Skeleton

Figure

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  Fig. 1 (A) The condyle-coronoid ratio (CC ratio) is the ratio of the distance from the mandibular foramen to the condyle head (condylar distance, a) and the distance from the mandibular foramen to the tip of the coronoid process (coronoid distance, b); (B) A panoramic radiograph of a typical retrognathic mandible (short condylar distance); (C) A panoramic radiography of a typical normal mandible; (D) A panoramic radiograph of a typical prognathic mandible (long condylar distance).

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  Fig. 2 Inferior alveolar nerve block failure rates by the condyle-coronoid ratio.

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