Comparative Evaluation of Classical Inferior Alveolar Nerve Block and Gow-Gates Nerve Block for Surgical Removal of Mandibular Third Molar
IANB vs Gow-Gates for Mandibular Third Molar Surgery
DOI:
https://doi.org/10.54393/pjhs.v7i6.3661Keywords:
Inferior Alveolar Nerve Block, Gow-Gates Nerve Block, Surgical Removal, Mandibular Third MolarAbstract
Effective anesthesia is essential for the surgical removal of mandibular third molars. While the classical inferior alveolar nerve block is widely used, its success may be limited by anatomical variations. The Gow-Gates technique is considered a potential alternative offering broader mandibular anesthesia. Objectives: To evaluate and compare the classical inferior alveolar nerve block and Gow-Gates nerve block for surgical removal of mandibular third molars in terms of Anesthetic success rate, Onset and duration of anesthesia, and patient-reported pain using a visual analog scale. Methods: A quasi-experimental, comparative study was performed in which a total of 160 patients were selected and randomly allocated to receive Gow-Gates (GG) nerve block or inferior alveolar nerve block (IANB) for the extraction of mandibular molars. Onset time, pain levels, and volume of anesthesia were recorded as data. SPSS statistical analysis version 26.0 was used for data analysis. Results: Regarding gender, females were counted more, 87, comprised 54.43 % of the sample, whereas 73 men accounted for 45.57 %. The onset time of the Gow-Gates group took 6.16 minutes, which is slower than IANB, 2.78 minutes; however, the success rate of both techniques is about the same, 87.5%. Furthermore, the mean volume of local anesthesia used to anesthetize tissues was higher in the IANB group than in the GG group. Conclusions: Both methods are useful in mandibular anesthesia, and Gow-Gates has a high rate of success and less chance of aspiration, though IANB has a quicker onset. Patient and clinician factors determine the technique to be used.
References
Sarfaraz I, Pascoal S, Macedo JP, Salgado A, Pereira J. Anesthetic Efficacy of Gow-Gates Versus Inferior Alveolar Nerve Block for Irreversible Pulpitis: A Systematic Quantitative Review. Journal of Dental Anesthesia and Pain Medicine. 2021 Jul; 21(4): 269. doi: 10.17245/jdapm.2021.21.4.269.
Pandey S, Yadav P, Roychoudhury A, Bhutia O, Goswami D. A Randomized Controlled Trial to Compare Functional, Combined Rigid and Functional, and Rigid Fixation in Double Mandibular Fractures. Journal of Oral Biology and Craniofacial Research. 2022 Mar; 12(2): 233-237. doi: 10.1016/j.jobcr.2022.02.003.
Calatayud J and Saraghi M. Local Anesthesia in Dentistry: A Locoregional Approach. John Wiley and Sons; 2024 Jan: 23. doi: 10.1002/9781394180189.
Kumar N and Shankar R. Evaluation of a Nishit–Rama Modification of a Gow-Gates Technique for Giving Mandibular Nerve Block: A Randomized Controlled Trial. Journal of Maxillofacial and Oral Surgery. 2023 Jun; 22(2): 359-364. doi: 10.1007/s12663-023-01901-y.
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: Gow-Gates Mandibular Nerve Block Versus Inferior Alveolar Nerve Block. Pakistan Journal of Health Sciences. 2024 Jul; 52-6: 1-5. doi: 10.54393/pjhs.v5i07.1621.
Chauhan N. Current Practices Used to Increase the Success Rate of The Inferior Alveolar Nerve Block in Mandibular Molars with Symptomatic Irreversible Pulpitis. West Virginia University. 2022: 1-15.
Naz S, Shah SA, Sattar R, Akbar N, Gul F. Anesthetic Effectiveness of Buccal Infiltration Alone Vs Combined Buccal and Palatal Infiltration on Symptomatic Maxillary Teeth. Indus Journal of Bioscience Research. 2025 Mar; 3(3): 215-220. doi: 10.70749/ijbr.v3i3.843.
NyoDu T, Saha N, Sil S, GhoSh S. Role of Age, Gender and Vertical Facial Type on Anatomical Location of Mandibular Foramen in Paediatric Population: A Cross-sectional Study. Journal of Clinical & Diagnostic Research. 2024 May; 18(5). doi: 10.7860/JCDR/2024/68925.19418.
Afridi RU, Shah SA, Khattak IU, Shah FA, Zain M, Ali F. Comparison of Anesthetic Efficacy of Conventional Inferior Alveolar Nerve Block and Gow Gates Technique in Patients with Symptomatic Irreversible Pulpitis Randomized Control Trail. Journal of Khyber College of Dentistry. 2019 Jun; 9(02): 58-64.
Dias-Junior LC, Bezerra AP, Schuldt DP, Kuntze MM, de Luca Canto G, da Fonseca Roberti Garcia L et al. Effectiveness of Different Anesthetic Methods for Mandibular Posterior Teeth with Symptomatic Irreversible Pulpitis: A Systematic Review and Meta-Analysis. Clinical Oral Investigations. 2021 Dec; 25(12): 6477-500. doi: 10.1007/s00784-021-04145-7.
Usama MM, Ashar A, Zafar KJ, Janjua OS, Khalid MU, Ghauri N. Comparison of Efficacy of Gow-Gates Mandibular Nerve Block Technique with Inferior Alveolar Nerve Block for Pain Management during Extraction of Mandibular Teeth. Foundation University Journal of Dentistry. 2022 Jan; 2(1): 64-70. doi: 10.33897/fujd.v2i1.277.
Nurjanah N, Herijulianti E, Putri MH, Sukmasari S. Eugenia Polyantha (Wight) Infusion Against Oral Microorganisms on Toothbrushes. Scientific Dental Journal. 2020 Sep; 4(3): 105-109. doi: 10.4103/SDJ.SDJ_38_20.
Thomas AM, Mangalath U, Abida R, Aslam S, Soman S, Nair RB. Comparative Evaluation of Classical Inferior Alveolar Nerve Block and Gow-Gates Nerve Block for Surgical Removal of Mandibular Third Molar: A Prospective Study. Journal of Pharmacy and Bioallied Sciences. 2021 Nov; 13(2): 1011-1014. doi: 10.4103/jpbs.jpbs_279_21.
Laham A, Clouet R, Del Valle GA, Gaudin A, Prud’homme T. Anaesthetic Efficacy and Influence on Cardiovascular Parameters Change of Intraosseous Computerised Anaesthesia Versus Inferior Alveolar Nerve Block Anaesthesia in Acute Irreversible Pulpitis of Mandibular Molars: Study Protocol for a Prospective Randomised Controlled Trial. Trials. 2022 Dec; 23(1): 979. doi: 10.1186/s13063-022-06915-4.
Sayahpour B, Nucci L, Eslami S, Talaeipour A, Ahmadi Ranani S, Mafi R et al. Three‐Dimensional Evaluation of Mandibular Lingula: Comparisons of Skeletal Angle Classifications and Growth Patterns. Orthodontics and Craniofacial Research. 2024 Jun; 27(3): 494-503. doi: 10.1111/ocr.12757.
Karthikeyan T, Subramanian A, Narayanan V, Seetaram M. Does Peripheral Nerve Stimulator-Guided Extraoral Mandibular Nerve Block Provide Effective Anaesthesia for Third Molar Surgery: A Prospective Interventional Study. Journal of Maxillofacial and Oral Surgery. 2025 Feb; 24(1): 267-273. doi: 10.1007/s12663-024-02418-8.
Fauziya D, Anantanarayanan P, Shankar DP. Effectiveness and Distribution of Anesthesia for a Modified Extra Oral Maxillo-Mandibular Nerve Block for Dento-Alveolar Procedures: A Prospective Cohort Study. Journal of Maxillofacial and Oral Surgery. 2024 Jun; 23(3): 561-567. doi: 10.1007/s12663-022-01755-w.
Sonare S and Nikam P. Morphometric Analysis of the Human Mandibular Foramen and Its Implications in Inferior Alveolar Nerve Block. European Journal of Cardiovascular Medicine. 2025 May; 15(5).
Karamifar K, Shirali D, Saghiri MA, Abbott PV. Retromolar Canal Infiltration as a Supplement to the Inferior Alveolar Nerve Block Injection: An Uncontrolled Clinical Trial. Clinical Oral Investigations. 2021 Sep; 25(9): 5473-5478. doi: 10.1007/s00784-021-03855-2.
Jha AK. Evaluation of Mandibular Nerve Block: A Clinical Study. International Journal of Oral Care and Research. 2016; 4(1): 1-3. doi: 10.5005/jp-journals-10051-0001.
Valenzuela-Fuenzalida JJ, Cariseo C, Gold M, Díaz D, Orellana M, Iwanaga J. Anatomical Variations of the Mandibular Canal and their Clinical Implications in Dental Practice: A Literature Review. Surgical and Radiologic Anatomy. 2021 Aug; 43(8): 1259-1272. doi: 10.1007/s00276-021-02708-7.
Saatchi M, Shafiee M, Khademi A, Memarzadeh B. Anesthetic Efficacy of Gow-Gates Nerve Block, Inferior Alveolar Nerve Block, and their Combination in Mandibular Molars with Symptomatic Irreversible Pulpitis: A Prospective, Randomized Clinical Trial. Journal of Endodontics. 2018 Mar; 44(3): 384-388. doi: 10.1016/j.joen.2017.10.008.
Celikgun B and Derinsu U. Standardization of the Transient Evoked Otoacoustic Emissions Contralateral Suppression Test in Terms of Stimulus Intensity and Contralateral Noise Duration in Individuals with Normal Hearing. Journal of the American Academy of Audiology. 2022 Jan; 33(1): 29-35. doi: 10.1055/s-0041-1735523.
Noguchi T, Odaka K, Fukuda KI. Challenge of creating an inferior alveolar nerve block device that allows for safe, secure, and successful performance by any operator: Non-clinical studies on models. 2022 Oct: 1-11. doi: 10.21203/rs.3.rs-2141206/v1.
Chen Z and Li X. Measurement of mandibular anatomy associated with inferior alveolar nerve block anesthesia using 3D mandible models reconstructed by Cone Beam Computed. Quintessence International. 2025 Jan; 56(1).
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Pakistan Journal of Health Sciences

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments



