Efficacy of Exclusive Lingual Nerve Block versus Conventional Inferior Alveolar Nerve Block in Achieving Lingual Soft-tissue Anesthesia

Abstract

Objective: The aim of this randomized clinical trial was to assess the efficacy of exclusive lingual nerve block (LNB) in achieving selective lingual soft-tissue anesthesia in comparison with conventional inferior alveolar nerve block (IANB).

Materials and methods: A total of 200 patients indicated for the extraction of lower premolars were recruited for the study. The samples were allocated by randomization into control and study groups. Lingual soft-tissue anesthesia was achieved by IANB and exclusive LNB in the control and study group, respectively. The primary outcome variable studied was anesthesia of ipsilateral lingual mucoperiosteum, floor of mouth and tongue. The secondary variables assessed were (1) taste sensation immediately following administration of local anesthesia and (2) mouth opening and lingual nerve paresthesia on the first postoperative day.

Results: Data analysis for descriptive and inferential statistics was performed using SPSS (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp. Released 2013) and a P < 0.05 was considered statistically significant. In comparison with the control group, the study group (LNB) showed statistically significant anesthesia of the lingual gingiva of incisors, molars, anterior floor of the mouth, and anterior tongue.

Conclusion: Exclusive LNB is superior to IAN nerve block in achieving selective anesthesia of lingual soft tissues. It is technically simple and associated with minimal complications as compared to IAN block.

Keywords: Inferior alveolar nerve block; lingual nerve block; lingual soft-tissue; selective anesthesia.

Figure 1

CONSORT Chart

Figure 2

Lingual nerve block landmark

Figure 3

Anatomic zones to check pain 1- Lingual gingiva of molars 2- Lingual gingiva of canine & premolar 3- Lingual gingiva of incisors aF- anterior part of the floor of the mouth pF- posterior part of the floor of the mouth aT- anterior part of the tongue pT- posterior part of the tongue

Figure 4

Graph demonstrating pain in the lingual gingiva

Figure 5

Graph demonstrating pain in the floor of the mouth

Figure 6

Graph demonstrating pain in the tongue

Figure 7

Graph demonstrating Mean mouth opening on 1st post extraction day

Figure 8

Position of the lingual nerve Ln- Lingual nerve 1- Lingual crest 2- Lingual gingiva a- Horizontal position of the lingual nerve from the lingual plate (0.00-3.20 mm) b- Vertical position of lingual nerve from lingual crest (1.70 to 4.00 mm)