Is the Direct Inferior Alveolar Nerve Block Required for Third Lower Molar Extraction?
Condition: Tooth Extraction; Dental Anesthesia
Study type: Interventional

Summary: 
      This study is a Randomized Controlled Trial (RCT) which objective is to compare the
      effectiveness, efficacy and complication associated to an infiltrative anesthetic technique
      for the removal of lower third molars comparing it to the standard inferior alveolar nerve
      block using 4% articaine 1:100.000 epinephrine.
    

Detailed description: 
      The objective is to compare the anesthetic efficacy of an infiltrative anesthetic technique
      placed buccally between the first and second mandibular molars plus infiltration of the third
      molar's lingual mucosa with the direct inferior alveolar nerve block plus buccal nerve block
      for the extraction of lower wisdom teeth. All using 4% articaine 1:100.000 epinephrine. The
      first technique is to be referred as Alternative Technique (A.T.) and the second Standard
      Technique (S.T.) The study is being conducted at the Hospital Odontològic Universitat de
      Barcelona (Campus de Bellvitge) and is being carried out by members of the Oral Surgery and
      Implantology Master's program of the University of Barcelona.

      The sample (110 patients) consists of patients in need of lower third molar extraction. All
      of them are being properly informed about the study according to the Comité Ético (CEIC) del
      Hospital Odontològic Universitat de Barcelona guidelines, and informed consent must be signed
      prior to the interventions. All patients derive from the Institut Català de la Salut-Consorci
      Sanitari.

      The materials used are 1.8cc carpules of 4% articaine and 1:100.000 epinephrine, dental
      anesthetic syringe, dental anesthetic needles of 35 mm 27G and 25 mm 27G as well as all the
      documents necessary for data collection.

      The determinations to be done are the pulpal anesthetic efficacy (in seconds, using a
      pulpometer), chin and tongue numbness (patient reported, measured in seconds), need for
      supplemental anesthesia, comfort (pain experienced during the punctions and during and after
      surgery), morbility (cramp sensation in the tongue or lip when performing the anesthetic
      technique, local and/or systemic complications).
    

Intervention name(s): Nerve block technique; Infiltrative technique; 4% articaine 1:100.000 epinephrine; Third molar extraction
Intervention type(s): Procedure; Procedure; Drug; Procedure
Intervention description(s): Inferior alveolar nerve block with 1.8 cc of 4% articaine 1:100.000 epinephrine and 1.8 cc of the same anesthetic for the buccal nerve for third molar extraction.; Infiltrative anesthesia buccally between first and second mandibular molar with 3.6 cc of 4% articaine 1:100.000 epinephrine and 0.6 cc lingually to the third molar using the same anesthetic solution.; Articaine in a 4% solution with epinephrine 1:100,000 (Artinibsa; Inibsa Dental, Lliçà de Vall, Spain); Third molar extraction under local anesthesia.
Other intervention name(s): Standard intervention; Experimental intervention
Intervention MeSH terms: Epinephrine; Carticaine
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Control group: inferior alveolar nerve block with 1.8 cc of 4% articaine 1:100.000 epinephrine and 1.8 cc of the same anesthetic for the buccal nerve block.
Test group: infiltration anesthesia buccaly between first and second mandibular molar with 3.6 cc of 4% articaine 1:100.000 epinephrine and 0.6 cc ligually to the third molar using the same anesthetic.
Masking: Triple (Participant, Care Provider, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lower third molar extraction; Infiltration anesthesia; Articaine