Evaluation of different mandibular blocks for the removal of lower third molars: a meta-analysis of randomised clinical
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ORIGINAL ARTICLE
Evaluation of different mandibular blocks for the removal of lower third molars: a meta-analysis of randomised clinical trials Carolina-Noemi Cavallini 1 & Jorge Toledano-Serrabona 1,2,3,4
&
Cosme Gay-Escoda 1,2,3,4,5
Received: 27 March 2020 / Accepted: 11 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To describe the efficacy and number of side effects for the Gow-Gates mandibular block (GGMB) and VaziraniAkinosi mandibular block (VAMB) compared to inferior alveolar nerve block (IANB) in patients requiring lower third molar (L3M) extraction. Materials and methods A systematic search was performed in three electronic databases and complemented with a manual search. The inclusion criteria were randomised clinical trials in healthy patients who underwent at least one L3M extraction. Screening and article selection were carried out by two independent reviewers. After data extraction, a meta-analysis was performed for the success rate, number of positive aspirations, and onset time outcomes. Results Six randomised clinical trials were included out of the 367 potentially eligible papers. No significant differences were found in terms of success rate using GGMB (risk ratio [RR] 1.04; 95% confidence interval [CI] 0.92 to 1.18; P = 0.48) nor VAMB (RR 0.96; 95% CI 0.86 to 1.06; P = 0.41). The VAMB group exhibited a lower number of positive aspirations than the IANB group (RR 0.08; 95% CI 0.01 to 0.55; P = 0.01), but there was no statistically significant difference between the GGMB and IANB groups (RR 1.06; 95% CI 0.13 to 8.78; P = 0.96). The delayed onset was even longer in GGMB (mean difference [MD] 3.32 min; 95% CI 1.98 to 4.66; P < 0.001) and VAMB (MD 0.90 min; 95% CI 0.37 to 1.43; P = 0.0001) than IANB. Conclusions GGMB and VAMB seem to be effective and safe anaesthetic techniques for the removal of L3M, but these blocks exhibited a more delayed onset time than IANB. Clinical relevance GGMB and VAMB are safe and effective anaesthetic techniques for the removal of L3M. However, IANB can still be considered the first option since GGMB and VAMB exhibited more delayed onset times and variable buccal nerve anaesthesia. Keywords Vazirani-Akinosi mandibular block . Gow-Gates mandibular block . Inferior alveolar nerve block . Anaesthetic technique . Mandibular block . Lower third molar
Introduction * Jorge Toledano-Serrabona [email protected] 1
EFHRE International University/FUCSO, Belize City, Belize
2
School of Medicine and Health Sciences, Campus de Bellvitge, University of Barcelona, C/Feixa Llarga, s/n; Pavelló Govern, 2ª planta, Despatx 2.9, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
3
IDIBELL (Bellvitge Biomedical Research Institute), Barcelona, Spain
4
Oral and Maxillofacial Surgery Department, University of Barcelona, Barcelona, Spain
5
Oral Surgery, Implantology and Maxillofacial Surgery Department, Teknon Medical Centre, Barcelona, Spain
Lower third molar (L3M) extraction is a routine surgical procedure performed in dentist
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