图1有年轻牙医朋友问我，下牙槽阻滞麻醉打不准怎么办。关于怎么打的具体方法不过多赘述可参考教科书，今天就分享一些你没听过的知识点。
图2图3我们来看一下这篇外国文献：既往研究报道，患有不可复性牙髓炎的下颌磨牙很难获得适当的麻醉。不管是文献还是实践中有时都会碰到下牙槽麻醉效果不好的情况，特别是在下颌磨牙患有不可复性牙髓炎时。那么碰到这种情况怎么办？supplemental injections are usually unavoidable补充注射通常是不可避免的
图4图5图6实验方法如下：作者征集96名患者，均诊断为不可复性牙髓炎。
随机分为三组，第1组：常规下牙槽神经阻滞麻醉(IANB:inferior alveolar nerve block)；第 2 组：在 IANB 15 分钟后出现严重的嘴唇麻木后进行颊侧浸润麻醉；第 3 组：在 IANB 15 分钟后出现严重的嘴唇麻木后，进行牙周膜内注射。并在 20 分钟后开始牙髓治疗。
图7结果显示：group3:IANB+牙周膜麻醉成功率为75%，group2:IANB+颊侧浸润65%，group1:单独使用IANB成功率仅为28%。
图8此外，文献还指出没有哪一种注射方法是对所有患者都显示出完全成功的麻醉效果
图9综上所述：对于下颌磨牙区的牙齿操作，单独下牙槽阻滞麻醉通常是效果不佳的，通常选用IANB+颊侧浸润+牙周膜，来提高麻醉成功率。
回到最开始的那个问题：下颌阻滞打不准怎么办？首先要确认IANB的效果，是否嘴唇麻木，如果没有麻则需要调整位置方向重新注射。确认麻木后再做颊侧浸润和牙周膜的补充注射。
延伸阅读：图十此外，有国外学者就RMC磨牙后管浸润作为下牙槽神经阻滞注射的补充，做了相关临床试验。
图十一结果显示：RMC 浸润的施用也可以提高 IANB 技术的成功率。关于什么是磨牙后管可参考这篇微博https://t.cn/A6Ht84Cs
参考文献：[1]Shahi S,Rahimi S,Yavari HR,et al.Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial.[J].J Endod,2018,10:1462-1466.
[2]Dianat O,Mozayeni MA,Layeghnejad MK,et al.The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible pulpitis.[J].Clin Oral Investig,2020,3:1281-1286.
[3]Afkhami F,Pirmoazen S,Ardestani A,et al.Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual infiltration using articaine in mandibular molars with irreversible pulpitis: a preliminary prospective randomized single-blind clinical trial.[J].Quintessence Int,1970,9:820-826.
[4]Karamifar K,Shirali D,Saghiri MA,et al.Retromolar canal infiltration as a supplement to the inferior alveolar nerve block injection: an uncontrolled clinical trial.[J].Clin Oral Investig,2021,9:5473-5478.
[5]肖晗. 4种麻醉方法在下颌后牙不可复性牙髓炎根管治疗中的效果研究[D].吉林大学,2023.DOI:10.27162/d.cnki.gjlin.2023.006863.
#牙医IG翻动派[超话]##健闻登顶计划#
图2图3我们来看一下这篇外国文献：既往研究报道，患有不可复性牙髓炎的下颌磨牙很难获得适当的麻醉。不管是文献还是实践中有时都会碰到下牙槽麻醉效果不好的情况，特别是在下颌磨牙患有不可复性牙髓炎时。那么碰到这种情况怎么办？supplemental injections are usually unavoidable补充注射通常是不可避免的
图4图5图6实验方法如下：作者征集96名患者，均诊断为不可复性牙髓炎。
随机分为三组，第1组：常规下牙槽神经阻滞麻醉(IANB:inferior alveolar nerve block)；第 2 组：在 IANB 15 分钟后出现严重的嘴唇麻木后进行颊侧浸润麻醉；第 3 组：在 IANB 15 分钟后出现严重的嘴唇麻木后，进行牙周膜内注射。并在 20 分钟后开始牙髓治疗。
图7结果显示：group3:IANB+牙周膜麻醉成功率为75%，group2:IANB+颊侧浸润65%，group1:单独使用IANB成功率仅为28%。
图8此外，文献还指出没有哪一种注射方法是对所有患者都显示出完全成功的麻醉效果
图9综上所述：对于下颌磨牙区的牙齿操作，单独下牙槽阻滞麻醉通常是效果不佳的，通常选用IANB+颊侧浸润+牙周膜，来提高麻醉成功率。
回到最开始的那个问题：下颌阻滞打不准怎么办？首先要确认IANB的效果，是否嘴唇麻木，如果没有麻则需要调整位置方向重新注射。确认麻木后再做颊侧浸润和牙周膜的补充注射。
延伸阅读：图十此外，有国外学者就RMC磨牙后管浸润作为下牙槽神经阻滞注射的补充，做了相关临床试验。
图十一结果显示：RMC 浸润的施用也可以提高 IANB 技术的成功率。关于什么是磨牙后管可参考这篇微博https://t.cn/A6Ht84Cs
参考文献：[1]Shahi S,Rahimi S,Yavari HR,et al.Success Rate of 3 Injection Methods with Articaine for Mandibular First Molars with Symptomatic Irreversible Pulpitis: A CONSORT Randomized Double-blind Clinical Trial.[J].J Endod,2018,10:1462-1466.
[2]Dianat O,Mozayeni MA,Layeghnejad MK,et al.The efficacy of supplemental intraseptal and buccal infiltration anesthesia in mandibular molars of patients with symptomatic irreversible pulpitis.[J].Clin Oral Investig,2020,3:1281-1286.
[3]Afkhami F,Pirmoazen S,Ardestani A,et al.Comparative evaluation of anesthetic efficacy of inferior alveolar nerve block and inferior alveolar nerve block plus buccal or lingual infiltration using articaine in mandibular molars with irreversible pulpitis: a preliminary prospective randomized single-blind clinical trial.[J].Quintessence Int,1970,9:820-826.
[4]Karamifar K,Shirali D,Saghiri MA,et al.Retromolar canal infiltration as a supplement to the inferior alveolar nerve block injection: an uncontrolled clinical trial.[J].Clin Oral Investig,2021,9:5473-5478.
[5]肖晗. 4种麻醉方法在下颌后牙不可复性牙髓炎根管治疗中的效果研究[D].吉林大学,2023.DOI:10.27162/d.cnki.gjlin.2023.006863.
#牙医IG翻动派[超话]##健闻登顶计划#
#叶童[超话]#
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Ended up with 10 performances in London and we got several of ⭐️⭐️⭐️⭐️ reviews for a non-verbal Shakespeare play in London and I was very happy to be recognized by the audience in London.
☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎
“ “
: ?
If language were to be removed from Shakespeare’s plays, would there be nothing left? No, because there remains visuals and the underlying imagery. -Shu-wing Tang
Awarded “Director of the Year” by IATC Hong Kong (Shu-wing Tang)
Awarded “Performer of the Year” by IATC Hong Kong (Cecilia Yip)
Nominated “Best Sounds Design” by Hong Kong Drama Award (Anthony Yeung)
European premier (UK, Romania, Germany)
Director: Shu-wing Tang
Set and Costume Designer: Hon-Wai Yuen
Costume Designer: Jade Leung
Music Composer: Billy Ng
Sound Designer: Anthony Yeung
Lighting Designer: Tsz-yan Yeung
Lighting Operator: Vanessa Lee
Cast: Cecilia Yip, Lindzay Chan, Amanda Leung, Cassandra Tang, Peggy Chow, Ting-Kwan Lau, Ki-yan Ko, Corina Druc, Costinela Ungureanu
｜ @riversidestudioslondon
｜ @tsw_theatre
｜ @tsw_theatre
#kinglear #李爾王 #20240502_12 #hongkong #europetrip #london #drama #theatre #nonverbal #gesture #Shakespeare #riversidestudio #hemmersmith #performingarts #dancers
#performer #performance #perform #tsw #actor
cr：chowpy ig
-
Ended up with 10 performances in London and we got several of ⭐️⭐️⭐️⭐️ reviews for a non-verbal Shakespeare play in London and I was very happy to be recognized by the audience in London.
☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎☁︎︎
“ “
: ?
If language were to be removed from Shakespeare’s plays, would there be nothing left? No, because there remains visuals and the underlying imagery. -Shu-wing Tang
Awarded “Director of the Year” by IATC Hong Kong (Shu-wing Tang)
Awarded “Performer of the Year” by IATC Hong Kong (Cecilia Yip)
Nominated “Best Sounds Design” by Hong Kong Drama Award (Anthony Yeung)
European premier (UK, Romania, Germany)
Director: Shu-wing Tang
Set and Costume Designer: Hon-Wai Yuen
Costume Designer: Jade Leung
Music Composer: Billy Ng
Sound Designer: Anthony Yeung
Lighting Designer: Tsz-yan Yeung
Lighting Operator: Vanessa Lee
Cast: Cecilia Yip, Lindzay Chan, Amanda Leung, Cassandra Tang, Peggy Chow, Ting-Kwan Lau, Ki-yan Ko, Corina Druc, Costinela Ungureanu
｜ @riversidestudioslondon
｜ @tsw_theatre
｜ @tsw_theatre
#kinglear #李爾王 #20240502_12 #hongkong #europetrip #london #drama #theatre #nonverbal #gesture #Shakespeare #riversidestudio #hemmersmith #performingarts #dancers
#performer #performance #perform #tsw #actor
cr：chowpy ig
240510
yumeki 为ni-ki宣传～
配文【GO NI-KI】
他是 jam republic 经纪公司的舞者，曾是 smf 1million 舞蹈工作室的团队成员，他在 ig 上发布了一个故事来支持 ni-ki 的 AOTM！他还为 itzy&nct 编舞！
除此之外，还有很多舞者提到过ni-ki..
//宝宝真的很厉害，专业舞者支持专业舞者
cr allforcheolsoo
yumeki 为ni-ki宣传～
配文【GO NI-KI】
他是 jam republic 经纪公司的舞者，曾是 smf 1million 舞蹈工作室的团队成员，他在 ig 上发布了一个故事来支持 ni-ki 的 AOTM！他还为 itzy&nct 编舞！
除此之外，还有很多舞者提到过ni-ki..
//宝宝真的很厉害，专业舞者支持专业舞者
cr allforcheolsoo
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