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Ku, Kim, Jeon, Kwon, and Lee: Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester
Original Article

J Korean Assoc Oral Maxillofac Surg 2011;37(6):464-469.

Published online: 10 January 2011

DOI: https://doi.org/10.5125/jkaoms.2011.37.6.464

Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester

Myong-Suk Ku, Jin Wook Kim, Young Hoon Jeon, Tae Geon Kwon, Sang Han Lee

Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Korea

Sang Han Lee Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University 2175, Dalgubeoldaero, Jung-gu, Daegu 700-721, Korea TEL: +82-53-600-7561 FAX: +82-53-426-5365 E-mail: shalee@knu.ac.kr

Received 24 July 2011       Revised 27 September 2011       Accepted 12 October 2011

Copyright © 2011 Korean Association of Oral and Maxillofacial Surgeons

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction

As dental implant surgery is becoming increasingly popular, it has become one of the causes for the hypesthesia of the inferior alveolar nerve, along with other surgical procedures, such as a third molar extraction. In addition, it tends to cause legal problems between the operator and patient. Therefore, there must be a proper method that is reliable, objective and economical to assess the nerve impairment. For this reason, an attempt was made to use an Electric Pulp Tester to assess inferior alveolar nerve block anesthesia.

Materials and Methods

Thirty patients were tested. Electric pulp testing of the lower jaw skin was performed at the three different times, before anesthesia, at the onset of sensory changes and after 15 minutes waiting from the onset, and on the 10 points of the chin, which produced 10 sections on the skin area.

Results

Twenty seven patients (90%) could feel the electric stimulus on the chin at all 10 points before local anesthesia and the scores represent the statistical differences between the right and left points except R4 and L4. After anesthesia, the difference between the right and left points (L3-R3, L4-R4, L5-R5) increased significantly with time but two points (L2, R2) showed no significant difference. The scores on the left chin (L3, L4, L5) increased, whereas the other points (R1-R5, L1, L2) showed no significant differences.

Conclusion

This study highlights the potential clinical use of an electric pulp tester for an assessment of inferior alveolar nerve impairment.

Keywords: Pulp test, Hypesthesia, Inferior alveolar nerve

References

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Fig. 1.
Gentle-Pulse Pulp Vitality Tester D624MS (Parkell Inc., Edgewood, NY, USA). Myong-Suk Ku et al. Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-464f1.tif
Fig. 2.
Schematic diagram of the evaluation landmarks for electric pulp tester included inferior alveolar nerves and photo of measuring patient. ① R1: a center of right mandible posterior 1/3, ② R2: a center of right mandible middle 1/3, ③ R3: the point 5 mm beneath right commissure of the lip (angular branch), ④ R4: one third of lower lip vermilion border: right (inferior labial branch), ⑤ R5: a center of perpendicular line from R4 to chin (mental branch), ⑥ L5: a center of perpendicular line from L4 to chin (mental branch), ⑦ L4: one third of lower lip vermilion border: left (inferior labial branch), ⑧ L3: the point 5 mm beneath left commissure of the lip (angular branch), ⑨ L2: a center of left mandible middle 1/3, ⑩ L1: a center of left mandible posterior 1/3. Myong-Suk Ku et al. Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester. J Korean Assoc Oral Maxillofac Surg 2011
jkaoms-37-464f2.tif
Table 1.
Difference between the right and the left value evaluated by EPT
  Control side: right Experimental side: left Difference: (left-right) Significance (P-value)
EPT0 (before anesthesia) R1 7.57±2.07 L1 6.07±2.05 −1.50±2.33 0.001
R2 7.13±2.33 L2 6.13±1.46 −1.00±2.26 0.022
R3 6.43±1.82 L3 5.70±2.22 −0.73±144 0.009
R4 5.20±1.68 L4 5.07±2.07 −0.13±1.48 0.625
R5 5.30±2.03 L5 5.87±1.64 0.57±1.41 0.035
EPT1 (first perception of soft tissue sensory change) R1 7.50±1.90 L1 6.67±1.96 −0.83±1.90 0.023
R2 6.97±2.12 L2 6.83±1.54 −0.13±1.63 0.658
R3 6.67±2.01 L3 8.10±1.49 1.43±1.94 <0.001
EPT2 (after 15 minutes) R4 6.10±2.47 L4 7.43±1.69 1.33±2.07 0.001
R5 5.87±2.64 L5 7.17±1.63 1.30±2.09 0.002
R1 7.80±2.08 L1 6.63±1.77 −1.17±2.49 0.016
R2 6.93±2.50 L2 7.03±1.64 0.10±2.67 0.839
R3 6.93±1.98 L3 10.23±1.41 3.30±2.09 <0.001
R4 5.73±2.24 L4 10.00±1.78 4.27±2.13 <0.001
R5 5.80±2.65 L5 9.43±1.79 3.63±2.37 <0.001

(EPT: electric pulp tester, R1: a center of right mandible posterior 1/3, R2: a center of right mandible middle 1/3, R3: the point 5 mm beneath right commissure of the lip (angular branch), R4: one third of lower lip vermilion border: right (inferior labial branch), R5: a center of perpendicular line from R4 to chin (mental branch), L1: a center of left mandible posterior 1/3, L2: a center of left mandible middle 1/3, L3: the point 5 mm beneath left commissure of the lip (angular branch), L4: one third of lower lip vermilion border: left (inferior labial branch), L5: a center of perpendicular line from L4 to chin (mental branch)) Values are presented as mean±standard deviation. Statistical significance tested by paired t-test. Myong-Suk Ku et al. Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester. J Korean Assoc Oral Maxillofac Surg 2011

Table 2.
Verification of statistical difference among the test periods EPT0- EPT1- EPT2
  Difference between EPT0- EPT1- EPT2 Post-hoc test (difference between each time points)
F Sig   Mean difference Significance (P-value)
L1-R1 0.656 0.521 EPT1- −EPT0 0.667 0.489
  EPT1- −EPT2 0.333 0.835
  EPT2- −EPT0 0.333 0.835
L2-L3 2.029 0.138 EPT1- −EPT0 0.867 0.293
  EPT1- −EPT2 −0.233 0.913
  EPT2- −EPT0 1.100 0.142
L3-R3 35.983 0.000 2 EPT1- 0-EPT0 2.167 <0.001
  EPT1- −EPT2 −1.867 0.001
  EPT2- −EPT0 4.033 <0.001
L4-R4 40.938 0.000 EPT1- −EPT0 1.467 0.011
  EPT1- −EPT2 −2.933 <0.001
  EPT2- −EPT0 4.400 <0.001
L5-R5 19.309 0.000 2 EPT1- 0-EPT0 0.733 0.334
  EPT1- −EPT2 −2.333 <0.001
  EPT2- −EPT0 3.067 <0.001

(EPT: electric pulp tester, R1: a center of right mandible posterior 1/3, R2: a center of right mandible middle 1/3, R3: the point 5 mm beneath right commissure of the lip (angular branch), R4: one third of lower ip vermilion border: right (inferior labial branch), R5: a center of perpendicular line from R4 to chin (mental branch), L1: a center of left mandible posterior 1/3, L2: a center of left mandible middle 1/3, L3: he point 5 mm beneath left commissure of the lip (angular branch), L4: one third of lower lip vermilion border: left (inferior labial branch), L5: a center of perpendicular line from L4 to chin (mental branch)) Statistical significance tested by ANOVA and Post-hoc analysis with Tukey test. Myong-Suk Ku et al. Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester. J Korean Assoc Oral Maxillofac Surg 2011

Table 3.
Comparison of the EPT value of each evaluation points over time (EPT0- EPT1- EPT2) and Post-hoc test of the difference of each evaluation landmarks
  Difference between EPT0- EPT1- EPT2 Post-hoc test (difference between each time points)
F Sig     Mean difference Significance (P-value)
R1 0.200 0.819 EPT1 − EPT0 −0.066 0.990
      EPT1 − EPT2 −0.300 0.819
      EPT2 − EPT0 0.233 0.886
R2 0.144 0.866 EPT1 − EPT0 −0.166 0.909
      EPT1 − EPT2 0.033 0.996
      EPT2 − EPT0 −0.200 0.871
R3 0.614 0.543 2 EPT1 0 – EPT0 0.233 0.863
      EPT1 − EPT2 −0.266 0.825
      EPT2 − EPT0 0.500 0.512
R4 1.786 0.174 EPT1 − EPT0 0.900 0.151
      EPT1 − EPT2 0.366 0.725
      EPT2 − EPT0 0.533 0.508
R5 1.007 0.369 EPT1 − EPT0 0.566 0.400
      EPT1 − EPT2 0.066 0.987
      EPT2 − EPT0 0.500 0.487
L5 16.190 0.000 EPT1 − EPT0 1.300 0.107
      EPT1 − EPT2 −2.266 0.02
      EPT2 − EPT0 3.566 0.000
L4 39.210 0.000 EPT1 − EPT0 2.366 0.000
      EPT1 − EPT2 −2.566 0.000
      EPT2 − EPT0 4.933 0.000
L3 41.130 0.000 2 EPT1 0 – EPT0 2.400 0.000
      EPT1 − EPT2 −2.133 0.000
      EPT2 − EPT0 4.533 0.000
L2 1.244 0.293 2 EPT1 0 – EPT0 0.700 0.475
      EPT1 − EPT2 −0.200 0.940
      EPT2 − EPT0 0.900 0.295
L1 0.840 0.435 EPT1 − EPT0 0.600 0.485
      EPT1 − EPT2 0.033 0.998
      EPT2 − EPT0 0.566 0.524

(EPT: electric pulp tester, R1: a center of right mandible posterior 1/3, R2: a center of right mandible middle 1/3, R3: the point 5 mm beneath right commissure of the lip (angular branch), R4: one third of lower lip vermilion border: right (inferior labial branch), R5: a center of perpendicular line from R4 to chin (mental branch), L1: a center of left mandible posterior 1/3, L2: a center of left mandible middle 1/3, L3: the point 5 mm beneath left commissure of the lip (angular branch), L4: one third of lower lip vermilion border: left (inferior labial branch), L5: a center of perpendicular line from L4 to chin (mental branch)) Myong-Suk Ku et al. Evaluation of the change of lower lip sensation after inferior alveolar nerve block by using the electric pulp tester. J Korean Assoc Oral Maxillofac Surg 2011

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