Title	Anesthetic Success Rate is Highest Using the Gow-Gates Mandibular Conduction Block in Terms of Alleviating Patient Dental Pain
Clinical Question	For patients experiencing dental pain, is anesthetic success higher with Gow-Gates, Vazirani-Akinosi, or conventional inferior alveolar techniques?
Clinical Bottom Line	Gow-Gates alleviates dental pain more successfully than conventional inferior alveolar nerve block and Vazirani-Akinosi techniques.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 20123413 Aggarwal/2010 97 adult volunteer subjects actively experiencing dental pain. Randomized Controlled Trial Key results Gow-Gates mandibular conduction block success rate was 52% and statistically significant compared to control inferior alveolar nerve block (36%) (P<0.05). With a 41% and 27% success rate respectively, Varizrani-Akinosi technique and infiltrations were statistically insignificant compared to control inferior alveolar nerve block. Success was recorded for patient reporting of "none" to "mild" pain using the Heft-Parker visual analog scale which describes levels of pain. 3865562 Sisk/1985 40 patients ages 16-40 in need of extraction of impacted 3rd mandibular molars. Comparative Study Key results Success rate of anesthesia, defined as altered lip sensation, was significantly greater with the Gow-Gates technique (95%) than the conventional inferior alveolar nerve block (79%). The quality of anesthesia, indicating absence of dental pain during the procedure, was significantly less with Gow-Gates technique than conventional inferior alveolar nerve block. However, the pain that occurred was during the reflection of the buccal mucoperiosteal flap. For the 78% of patients who received successful buccal nerve anesthesia with Gow-Gates, there was no statistical significance in anesthetic quality between the two groups. Two patients required a second Gow-Gates injection before onset of surgery, while eleven patients required a second conventional injection. Intraoperative bleeding was significantly higher in the Gow-Gates group compared to conventional inferior alveolar nerve block group. 3456016 Sisk/1986 20 patients requesting extraction of bilateral mandibular 3rd molars. Comparative Study Key results The success of anesthesia, defined as an altered sensation of the tongue, was not statistically different between the Vazirani-Akinosi technique (90%) and the conventional inferior alveolar nerve block technique (90%). The quality of anesthesia, indicating absence of dental pain during the procedure, was statistically insignificant between the two techniques.
Evidence Search	(Gow[All Fields] AND Gates[All Fields]) AND akinosi[All Fields] AND (inferior[All Fields] AND alveolar[All Fields]) AND success[All Fields] AND anesthesia[All Fields] AND efficacy[All Fields] AND (dental[All Fields] AND pain[All Fields])
Comments on The Evidence	Validity: Aggarwal’s randomized controlled trial provides the best available evidence to date evaluating the success rates in terms of anesthetic efficacy as well as alleviation of patient dental pain. Similar at the start of the randomized, double-blind study, the groups were treated the same. With a total of 8 out of 97 patients excluded from the study, completion rate was over 90%. Complication rates or difficulty of injections was not discussed. Although all three mandibular block techniques were not directly compared in both of Sisk’s papers, an indirect comparison of all three techniques can be done. Both of the Sisk’s articles administered 1.6 ml of 2% lidocaine with 1:100,000 epinephrine for the inferior alveolar nerve block and 1.8ml of 2% lidocaine with 1:100,000 epinephrine for both the Gow-Gates and Vazirani-Akinosi techniques. The groups were treated the same. The sequences of injections were randomized. No direct comparison of all three techniques was done in Sisk’s papers.
Applicability	It is important to deliver the lowest possible amount of local anesthetic but effective enough to minimize dental pain and avoid complications. Gow-Gates alleviates patient’s sense of dental pain more successfully than conventional inferior alveolar and Vazirani-Akinosi blocks. However, clinicians must be aware of higher incidence of intraoperative bleeding as a complication with the Gow-Gates technique.
Specialty	(General Dentistry) (Oral Surgery) (Dental Hygiene)
Keywords	Mandibular conduction block, local anesthesia, dental pain
ID#	2639
Date of submission	02/25/2014
E-mail	horani@livemail.uthscsa.edu
Author	Suzzane Horani
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Gregory K. Spackman, DDS, MBA
Faculty mentor e-mail	spackman@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available