Comparison Between Gow-Gates Mandibular Nerve Block Versus Inferior Alveolar Nerve Block in Extraction of Mandibular Third Molars: Gow-Gates Mandibular Nerve Block Versus Inferior Alveolar Nerve Block

Saif ur Rehman; Kashif Ali Channar; Waqas Memon; Aftab Ahmed Kumbhar; Afreen Bilgrami; Farhan Javed

doi:10.54393/pjhs.v5i07.1621

Authors

Saif ur Rehman Department of Oral Biology, Muhammad Dental College, Mirpurkhas, Pakistan
Kashif Ali Channar Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Waqas Memon Department of Science of Dental Materials, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
Aftab Ahmed Kumbhar Department of Oral and Maxillofacial Surgery, Bhittai Dental and Medical College, Mirpurkhas, Pakistan
Afreen Bilgrami Department of Dental Materials, Fatima Jinnah Dental College, Karachi, Pakistan
Farhan Javed Department of Periodontology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v5i07.1621

Keywords:

Gow-Gates, Inferior Alveolar Nerve Block, Mandible, Third Molar

Abstract

Because of the intricacy of the process and the possibility of severe patient suffering, a successful extraction of mandibular third molars, or wisdom teeth, depends on an effective anesthetic. Objective: To compare the efficacy of Gow-Gates Mandibular Nerve Block (GGNB) versus Inferior Alveolar Nerve Block (IANB) in the extraction of mandibular third molars. Methods: This comparative cross-sectional study involved patients aged 20 to 45 years, of both genders, with impacted mandibular third molars. Using non-probability consecutive sampling, 160 patients were allocated to two groups: Group A (IANB) and Group B (GGNB), each with 80 patients. Outcomes such as pain, onset of anesthesia, and post-operation recovery time were measured. Efficacy between the groups was compared using Chi-square and independent t-tests. Results: The mean age was 30.29 ± 6.96 years. The mean pain in IANB (1.43 ± 1.19) was lower than in Gow-Gate (1.59 ± 2.02) statistically (p = 0.041). For anesthetizing the buccal, inferior alveolar nerve, and lingual nerve shows that only the buccal nerve the GGNB (100%) was more effective than IANB (81.5%) statistically (p<0.001). The onset of anesthesia was quicker in GGNB than in IANB for all three nerves (p<0.001). Post-operative recovery time between IANB and GGNB techniques was not statistically different (p=0.227). Conclusions: The research concluded that IANB resulted in significantly lower pain compared to GGNB. GGNB demonstrated greater effectiveness in anesthetizing the buccal nerve compared to IANB. The onset of anesthesia was statistically quicker in GGNB than in IANB for all three nerves.

References

Haghighat A, Jafari Z, Hasheminia D, Samandari MH, Safarian V, Davoudi A. Comparison of success rate and onset time of two different anesthesia techniques. Medicina Oral Patologia Oral y Cirugia Bucal. 2015 Jul; 20(4): e459. doi: 10.4317/medoral.20526. DOI: https://doi.org/10.4317/medoral.20526

Bhatnagar NB, Mantri SP, Dube KA, Jaiswal NU, Singh VJ. Pulpal-anesthesia of a mandibular first molar with irreversible pulpitis by inferior alveolar nerve block plus buccal infiltration using articaine or lignocaine. Journal of Conservative Dentistry. 2020 Mar; 23(2): 201-5. doi: 10.4103/JCD.JCD_410_19. DOI: https://doi.org/10.4103/JCD.JCD_410_19

Ali A, Shah SJ, Shah AA, Aslam S. Comparison of comma incision with Ward's incision in third molar extraction in terms of postoperative sequel–A clinical study. National Journal of Maxillofacial Surgery. 2019 Jul; 10(2): 200-5. doi: 10.4103/njms.NJMS_39_18. DOI: https://doi.org/10.4103/njms.NJMS_39_18

Esteve-Pardo G, De-Larriva E, Salgado A, Bernabeu-Esclapez A, Bardaji JA, Esteve-Colomina L. Is inferior alveolar nerve block needed to perform implant surgery in the posterior mandible? A randomized controlled trial. Journal of Oral and Maxillofacial Surgery. 2022 Mar; 80(3): 490-500. doi: 10.1016/j.joms.2021.09.028. DOI: https://doi.org/10.1016/j.joms.2021.09.028

Kumar A, Memon A, Panjabi SK, Shams S. Flap design: Comparison of ward’s flap versus modified ward’s flap in surgical extraction of impacted mandibular third molar. The Professional Medical Journal. 2019 Aug; 26(08): 1323-7. doi: 10.29309/TPMJ/2019.26.08.3877. DOI: https://doi.org/10.29309/TPMJ/2019.26.08.3877

Anisuzzaman MM, Alam MK, Afrin A. Comparative study between standard Ward’s Incision and coma shaped incision and its postoperative outcome on impacted mandibular third molars extraction in Bangladeshi population. Pesquisa Brasileira em Odontopediatria e Clínica Integrada. 2019 Oct; 19: e4671. doi: 10.4034/PBOCI.2019.191.66. DOI: https://doi.org/10.4034/PBOCI.2019.191.66

Palti DG, Almeida CM, Rodrigues AD, Andreo JC, Lima JE. Anesthetic technique for inferior alveolar nerve block: a new approach. Journal of Applied Oral Science. 2011; 19: 11-5. doi: 10.1590/S1678-77572011000100004. DOI: https://doi.org/10.1590/S1678-77572011000100004

Alsaegh MA, Azzawi AD, Marouf BK. The performance of inferior alveolar nerve block technique among undergraduate students. European Journal of Dental Education. 2023 Nov; 27(4): 985-91. doi: 10.1111/eje.12890. DOI: https://doi.org/10.1111/eje.12890

Goldberg S, Reader A, Drum M, Nusstein J, Beck M. Comparison of the anesthetic efficacy of the conventional inferior alveolar, Gow-Gates, and Vazirani-Akinosi techniques. Journal of Endodontics. 2008 Nov; 34(11): 1306-11. doi: 10.1016/j.joen.2008.07.025. DOI: https://doi.org/10.1016/j.joen.2008.07.025

Zhu J, Yuan X, Yan L, Li T, Guang M, Zhang Y. Comparison of postoperative outcomes between envelope and triangular flaps after mandibular third molar surgery: a systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2020 Apr; 78(4): 515-27. doi: 10.1016/j.joms.2019.11.026. DOI: https://doi.org/10.1016/j.joms.2019.11.026

Patel V, Managutti A, Agrawal A, Menat S, Mahida K, Patel J et al. Comparison of the Effect of Modified Ward’s and Triangular Flap Design on Periodontium of the Second Molar after Surgical Removal of Mandibular Impacted Third Molar. Archives of Clinical and Medical Case Reports. 2020; 4(3): 459-70. doi: 10.26502/acmcr.96550218. DOI: https://doi.org/10.26502/acmcr.96550218

Hassan B, Al-Khanati NM, Bahhah H. Effect of lingual-based flap design on postoperative pain of impacted mandibular third molar surgery: Split-mouth randomized clinical trial. Medicina Oral, Patología Oral y Cirugía Bucal. 2020 Sep; 25(5): e660. doi: 10.4317/medoral.23666. DOI: https://doi.org/10.4317/medoral.23666

Nagargoje GL, Badal S, Mohiuddin SA, Balkunde AS, Jadhav SS, Bholane DR. Evaluation of electrocautery and stainless steel scalpel in oral mucoperiosteal incision for mandibular anterior fracture. Annals of Maxillofacial Surgery. 2019 Jul; 9(2): 230-4. doi: 10.4103/ams.ams_158_18. DOI: https://doi.org/10.4103/ams.ams_158_18

Maqsood A, Asim MA, Aslam F, Khalid R, Khalid O. Comparison of efficacy of Gow-Gates mandibular nerve block and inferior alveolar nerve block for the extraction of mandibular molars. Annals of Abbasi Shaheed Hospital and Karachi Medical and Dental College. 2018 Dec; 23(4): 177-83. doi: 10.58397/ashkmdc.v23i4.82. DOI: https://doi.org/10.58397/ashkmdc.v23i4.82

Usama MM, Ashar A, Zafar KJ, Janjua OS, Khalid MU, Ghauri N. Comparison of Efficacy of Gow-Gates Mandibular Nerve Block Technique with Inferior Alveolar Nerve Block for Pain Management during Extraction of Mandibular Teeth. Foundation University Journal of Dentistry. 2022 Jan; 2(1): 64-70.

Jamalpour MR and Talimkhani I. Efficacy of the Gow-Gates and inferior alveolar nerve block techniques in providing anesthesia during surgical removal of impacted lower third molar: a controlled randomized clinical trial. Avicenna Journal of Dental Research. 2013 Jun; 5(1): 26-9. doi: 10.17795/ajdr-20938. DOI: https://doi.org/10.17795/ajdr-20938

Jieping Y, Wei L, Qinghong G. The anesthetic effects of Gow–Gates technique of inferior alveolar nerve block in impacted mandibular third molar extraction. West China Journal of Stomatology. 2013 Aug; 31(4).

Aggarwal V, Singla M, Kabi D. Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2010 Feb; 109(2): 303-8. doi: 10.1016/j.tripleo.2009.09.016. DOI: https://doi.org/10.1016/j.tripleo.2009.09.016

Ghoddusi J, Zarrabi MH, Daneshvar F, Naghavi N. Efficacy of IANB and Gow-Gates techniques in mandibular molars with symptomatic irreversible pulpitis: a prospective randomized double blind clinical study. Iranian Endodontic Journal. 2018; 13(2): 143.

Sabari H, Kumar S, Andrew A, Anandan H. Comparison of Anesthetic Efficacy of IANB-Classical and Gow-Gates Technique during Surgical Removal of Impacted Mandibular Third Molar. Annals of International Medical and Dental Research. 2018; 4(2): 69-72. doi: 10.21276/aimdr.2018.4.2.DE15. DOI: https://doi.org/10.21276/aimdr.2018.4.2.DE15