Efficacy and Safety of Conventional Halstead versus Modified Infra Alveolar Block Technique for Third Molar Extraction

Authors

  • Saadat Ullah Azmat Department of Dentistry, Armed Forced Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
  • Muhammad Junaid Department of Dentistry, Armed Forced Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
  • Ashfaq Ahmed Department of Dentistry, Armed Forced Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
  • Syed Junaid Hussain Bukhari Department of Dentistry, Armed Forced Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
  • Ashar Waheed Department of Dentistry, Armed Forced Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan
  • Faisal Asif Department of Dentistry, Armed Forced Institute of Dentistry /National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-2.14051

Keywords:

Conventional Halstead technique Extraction, Modified Halstead technique, Third molar extraction

Abstract

Objective: To compare efficacy of block, safety profile and frequency of adverse effects after using conventional Halstead technique versus experimental modified Halstead technique for inferior nerve block in patients planned for third molar extraction

Study Design: Quasi-experimental study

Place and Duration of Study: Orthodontics department of Armed Forced Institute of Dentistry (AFID), Rawalpindi, Pakistan, from Jun 2024 to Jul 2025

Methodology: Participants were placed in Group-A (n=160) to receive conventional Halstead approach for the block and Group B (n=160) to receive modified infra alveolar block technique for a modified Halstead approach. Primary variables studied were frequency of re-anesthesia required due to persistent pain after starting the procedure, electric discharge sensation felt, local complications including swelling and bleed, mean onset of block time at the level of tongue and lower lip. Secondary variables studied were pain during injection and extraction.

Results: Median pains scores on the VAS during injection were 2.00 (2.00) versus 3.00 (2.00) (p<0.001) and median pain scores during extraction were 3.00 (2.00) versus 5.00 (3.00) (p<0.001). Re-anesthesia requirement was seen in 46(28.7%) patients in Group-A versus 72(45.0%) patients in Group-B (p=0.003). Complete block failure was reported in 05(3.1%) patients in Group-A versus 08(5.0%) patients in Group-B (p=0.396).

Conclusion: Conventional Halstead approach still offers the better patient outcomes with respect of onset of block time, frequency of local complications, median pain scores during the procedure, requirement of re-anesthesia and overall block failure.

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References

1. Cachemaille M, Geering S, Broome M. Cryoneurolysis of alveolar nerves for chronic dental pain: A new technique and a case series. Pain Pract 2023; 23(7): 851–854.

https://doi.org/10.1111/papr.13313

2. Sakka S, Alqhtani NR, Alqahtani AS, Nabhan AB, Eid MK, Alagla M, et al. Dental students, interns, and junior dentists’ awareness and attitude toward the inferior alveolar nerve block technique and related failure. J Dent Sci 2024; 19(4): 2315–2322.

https://doi.org/10.1016/j.jds.2024.04.024

3. Krishna S, Selvarasu K, Kumar SP, Krishnan M. Efficacy of different techniques of the inferior alveolar nerve block for mandibular anesthesia: a comparative prospective study. Cureus 2024; 16(1): e53277.

https://doi.org/10.7759/cureus.53277

4. Pinto AC, Francisco H, Marques D, Martins JN, Caramês J. Worldwide prevalence and demographic predictors of impacted third molars—Systematic review with meta-analysis. J Clin Med 2024; 13(24): 7533.

https://doi.org/10.3390/jcm13247533

5. Awate S, Bhate K, Londhe U, Contractor M, Bhosale T, Lokhande S. Comparative evaluation of efficacy of Halstead technique, Clark and Holmes technique, Gow Gates technique, and Sargenti technique for mandibular anesthesia. Natl J Maxillofac Surg 2023; 14(3): 466–470.

https://doi.org/10.4103/njms.njms_76_23

6. Shuja E, Daaniyal S, Mushtaq O, Ahmed N, Afreen A, Shuja ZAE, et al. Comparison of efficacy of Halstead and Vazirani Akinosi block technique in achieving mandibular anesthesia. J Rawalpindi Med Coll 2022; 26(2): 236–240.

7. Bhat P, Chanu HT, Radhakrishna S, Ashok Kumar K, Marimallappa T, Ravikumar R. Comparison of clinical efficacy of classical inferior alveolar nerve block and Vazirani–Akinosi technique in bilateral mandibular premolar teeth removal: a split-mouth randomized study. J Maxillofac Oral Surg 2022; 21(1): 191–202.

https://doi.org/10.1007/s12663-021-01555-3

8. Alhazmi DM, Jadu FM. Effectiveness of ultrasound-guided peripheral mandibular nerve block: a systematic review. Medicine 2025; 104(20): e42509.

https://doi.org/10.1097/MD.0000000000042509

9. Montserrat-Bosch M, Figueiredo R, Nogueira-Magalhães P, Arnabat-Dominguez J, Valmaseda-Castellón E, Gay-Escoda C. Efficacy and complications associated with a modified inferior alveolar nerve block technique: a randomized, triple-blind clinical trial. Med Oral Patol Oral Cir Bucal. 2014; 19(4): e391–396.

https://doi.org/10.4317/medoral.19560

10. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human participants. JAMA 2025; 333(1): 71–74.

https://doi.org/10.1001/jama.2024.26412

11. Alsaegh MA, Azzawi ADA, Marouf BKA. The performance of inferior alveolar nerve block technique among undergraduate students. Eur J Dent Educ. 2023; 27(4): 985–991. https://doi.org/10.1111/eje.12917

12. Khalifah M. A comparative study for a novel technique for the inferior alveolar nerve block versus the conventional technique. Egypt Dent J 2021; 67(1): 211–218.

13. Brizuela M, Daley JO. Inferior alveolar nerve block. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

14. Abbasi AF, Qureshi R, Mehmood S, Dayyan G, Rashid MA, Sarfaraz S. Comparison of effectiveness of inferior alveolar nerve block and Gow-Gates technique in mandibular molar teeth with irreversible pulpitis. J Ayub Med Coll Abbottabad 2024; 36(2): 326–3230.

https://doi.org/10.55519/jamc-02-13362

15. Ur Rehman S, Channar KA, Memon W, Kumbhar AA, Bilgrami A, Javed F. Comparison between Gow-Gates mandibular nerve block versus inferior alveolar nerve block in extraction of mandibular third molars. Pak J Health Sci 2024; 5(7): 52–56.

16. Bicsák Á, Esser L, Hassfeld S, Bonitz L. An in-silico comparison of success rate of different methods for inferior alveolar nerve blockade. J Oral Maxillofac Surg Med Pathol 2025; 37(1): 25–31. https://doi.org/10.1016/j.ajoms.2024.12.004

17. Oiwa D, Kumita S, Chaki T, Ono S. Analgesic effects of ultrasound-guided inferior alveolar nerve block for extraction of impacted mandibular third molar: a retrospective cohort study. J Oral Maxillofac Anesth 2024; 3(1): e6803.

https://doi.org/10.21037/joma-23-42

18. Ahmed S, Tabassum N, Al Dayel O, Bamusa B, Zakirulla M, Binyahya FA. Stumbling block for inferior alveolar nerve block in predoctoral students: an analytical observational study and review of literature of mandibular nerve block techniques. J Family Med Prim Care 2021; 10(4): 1633–1628.

https://doi.org/10.4103/jfmpc.jfmpc_2280_20

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Published

31-03-2026

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How to Cite

1.
Azmat SU, Muhammad Junaid, Ashfaq Ahmed, Syed Junaid Hussain Bukhari, Ashar Waheed, Faisal Asif. Efficacy and Safety of Conventional Halstead versus Modified Infra Alveolar Block Technique for Third Molar Extraction. Pak Armed Forces Med J [Internet]. 2026 Mar. 31 [cited 2026 Apr. 5];76(SUPPL-2):S430-S435. Available from: https://www.pafmj.org/PAFMJ/article/view/14051