OPERATOR PREFERENCE OF RETRACTION METHOD DURING ANESTHESIA DELIVERY
Figure 1. Generation 2 model of Dental Vibe System( device) provided by Bing Innovations, LLC
Figure 2. Extraoral palpation of Infraorbital foramen may impact the practitioner’ s risk of experiencing an NSI. Unpublished university data have seen preliminary data that relate the reduction in intraoral NSI when a mirror retraction technique was introduced into the curriculum. 18 Although this paper focusses on the perception of DCPs and their preferred method of retraction, the authors are working on publishing a paper regarding the perception of patients involved in this study.
2. Materials and Methods
The IRB approved study( clinical trials ID: NCT02414620) was performed within a university clinical setting, informed consents were obtained from all participants, and occupational safety health administration( OSHA) guidelines were followed. The inclusion criteria for DCPs covered students enrolled in dental and international dental programs, who successfully completed the basic techniques course in their respective local anesthesia curriculum. These novice DCPs initially learned how to provide anesthesia using a dental mouth mirror during their training. Some DCPs also had prior exposure to using their finger as a retraction method to provide dental anesthesia, and none had previous experience using the device. Exclusions from the study covered DCP’ s who did not complete their basic training in the dental anesthesia curriculum. The armamentarium used to compare the retraction methods consisted of the mirror and the device( Fig. 1). In addition, a standard dental syringe, 27 gauge short needle, and 1.8 ml 2 % Lidocaine HCl 1:100,000 epinephrine were provided. The study protocol compared the comfort of the retraction method used while delivering an anterior superior alveolar( ASA) injection. The participants were required to watch a two minute video describing the proper use of the device. The DCP’ s were encouraged to ask questions prior to the clinical
segment of the study for clarification. The delivery of dental anesthesia was performed under the supervision of the principal investigators. Prior to the injection, the DCPs palpated for the infraorbital foramen extraorally( Fig. 2). Once the injection sites were identified, a piece of gauze was used to dry a single injection site and then a small amount of topical was placed for about a minute at the insertion site. The insertion site for the ASA is the muccobuccal fold above the maxillary first premolar. 1 The range of insertion depth was from 5-10 millimeters for each individual patient. The DCPs were required to pull tissue taut with either retraction method applied. The right side of the mouth used a mirror( control side), while the left side applied the device( device side) as retraction method. After initial penetration into tissue, the needle was slowly advanced apically towards the infraorbital foramen. Once at the deposition site, a supervising investigator verified the depth of insertion and delivery of ASA injection using 0.9 ml of the anesthetic( Fig. 3). Upon reaching the insertion depth, the DCP aspirated during the delivery of the anesthetic to confirm that they were not within a blood vessel, and was verified by the supervising investigator. If aspiration tests were negative, the same syringe and remaining 0.9 ml of anesthetic were administered on the device side, but a new 27 gauge needle was assembled. If aspiration tests were positive, indicated by the entrance of blood into the anesthetic cartridge, then the cartridge and needle were replaced. Per the manufacturer’ s training video, the DCPs were instructed to install the disposable tip onto the device in the view of the patient. The DCPs then placed the device over the back part of the patient’ s hand and communicated to the patient an initial perception of what the device would feel and sound like. The tissue on the device side was
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