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 Unpublished university data have seen preliminary data that relate the reduction in intraoral NSI when a mirror retraction technique was introduced into the curriculum .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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