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Alzoubi F, Alajmi S, Alkandari A, Alqahtani S, Alanezi A, Setzer FC. Post-operative pain in non-surgical root canal treatment after sealer-based obturation versus warm vertical compaction: A randomized clinical trial. Int Endod J 2024; 57:1168-1179. [PMID: 38813933 DOI: 10.1111/iej.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 05/04/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
AIM Post-operative pain may occur after non-surgical root canal treatment (NSRCT). The root filling technique and choice of sealer may be contributing factors. This randomized controlled clinical trial compared post-operative pain and analgesics intake after NSRCT using a sealer-based obturation technique (SBO) with single-cone gutta-percha and calcium silicate sealer (CSS) versus a warm-vertical compaction (WVC) technique with gutta-percha and a resin-based sealer (RBS). METHODOLOGY This study was designed as a parallel-two arm, double-blind, randomized superiority clinical trial registered at www. CLINICALTRIALS gov (NCT04753138). Patients referred for NSRCT fulfilling the inclusion criteria participated in this study. Pre-operative periapical radiographs and CBCT scans were taken and numerical rating scale (NRS) pain scores were recorded. Upon completion of canal instrumentation, participants were randomly allocated to either Group SBO: SBO with CSS or Group WVC: Warm-vertical compaction with RBS. Post-operative pain and analgesics intake were recorded at 1, 3 and 7 days after endodontic treatment completion. Non-parametric Mann-Whitney U and Friedman tests and a generalized estimating equation were used to assess differences in pain scores between the groups, within each treatment group at different time points and for correlations, respectively. RESULTS The study included 195 participants (212 teeth). One participant declined to submit the NRS form. Therefore, 194 participants (211 teeth) were included in the final analysis (99.5% response rate). No statistically significant differences in post-operative pain or analgesic intake existed between the two groups at any time point (p > .05). Age, pre-operative pain, apical diagnosis and post-operative analgesic intake were significantly related to post-operative pain (p < .05). CONCLUSIONS Sealer-based obturation technique with CSS was associated with similar post-operative pain levels and analgesics intake as WVC with RBS. Regarding post-operative pain, SBO with CSSs may be a suitable clinical alternative.
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Affiliation(s)
- Fahad Alzoubi
- Kuwait Board of Endodontics, Specialized Dental Center, Salmiya, Kuwait
| | - Samhan Alajmi
- Kuwait Board of Endodontics, Specialized Dental Center, Salmiya, Kuwait
| | | | - Saad Alqahtani
- Kuwait Institute for Medical Specializations, Sulaibkhat, Kuwait
| | - Amer Alanezi
- Kuwait Board of Endodontics, Specialized Dental Center, Salmiya, Kuwait
| | - Frank C Setzer
- Department of Endodontics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Monteiro CMC, Martins ACR, Reis A, de Geus JL. Effect of endodontic sealer on postoperative pain: a network meta-analysis. Restor Dent Endod 2023; 48:e5. [PMID: 36875812 PMCID: PMC9982236 DOI: 10.5395/rde.2023.48.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 01/11/2023] Open
Abstract
This systematic review and network meta-analysis aimed to answer the following focused research question: "Does the type of endodontic sealer affect the postoperative pain in patients who received endodontic treatment?" Different databases and grey literature were surveyed. Only one randomized controlled trial were included. The risk of bias in the studies was evaluated by using the Cochrane Collaboration's tool. A random-effects meta-analysis was conducted to compare the risk and intensity of postoperative pain. The quality of the body of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Out of 11,601 studies, 15 remained for qualitative analyses and 12 for meta-analysis. Seven studies were classified at high risk of bias, and 8 studies raised some concerns. No significant differences between the endodontic materials were observed in the direct comparisons, both in risk and in intensity of postoperative pain (pairwise comparisons with 2 studies: I2 = 0%; p > 0.05 and 8 studies: I2 = 23%; p > 0.05, respectively). The certainty of the evidence was graded as low or moderate. There was no difference in the risk and intensity of postoperative pain after filling with different endodontic sealers. Further systematic reviews should be conducted. Trial Registration PROSPERO Identifier: CRD42020215314.
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Affiliation(s)
| | | | - Alessandra Reis
- Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
| | - Juliana Larocca de Geus
- Department of Endodontics, Paulo Picanço School of Dentistry, Fortaleza, CE, Brazil.,Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
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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; 23:979. [PMID: 36471427 PMCID: PMC9720960 DOI: 10.1186/s13063-022-06915-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 11/11/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Irreversible pulpitis is a highly painful inflammatory condition of the dental pulp. The recommended care is the removal of the coronal pulp (pulpotomy) for emergency treatment in multi-rooted teeth. However, achieving adequate analgesia in the case of mandibular molars presents many difficulties according to the dental literature. Intraosseous computerised anaesthesia (ICA), in particular, the QuickSleeper™ system, has already been demonstrated to be clinically efficient, but ICA is known to increase the heart rate reversibly in a manner that depends on the speed of injection. Therefore, accelerated heart rate was examined as a potential adverse effect of this injection. This trial aims to compare the cardiovascular effects and the anaesthetic efficacy of ICA versus inferior alveolar nerve block anaesthesia (IANB) in acute irreversible pulpitis of mandibular molars. METHODS This study is a non-inferiority prospective, randomised, controlled, single-blind, two-group trial conducted at the Nantes University Hospital. The study design included two parallel arms at a ratio of 1:1 that will allocate seventy-two patients into two groups: the first group will receive QuickSleeper™ intraosseous anaesthesia; the second will receive an inferior alveolar nerve block before emergency treatment (pulpotomy). This study will include patients requiring emergency dental care under local anaesthesia with confirmed irreversible pulpitis in mandibular molars. The primary outcome is the time taken for the fluctuations in the cardiovascular parameters to return to baseline values during endodontic treatment in two different anaesthetic techniques. The secondary outcomes include efficacy of the technique, patient's pain perception before and after care, any post-operative effects, and factors associated with the delay of recovery of cardiovascular parameters between the 2 anaesthetic techniques. DISCUSSION This trial will evaluate the factors associated with heart rate increase during local anaesthesia administration. The use of blood pressure and cardiovascular measurements can be considered an asset and additional safety in managing local anaesthesia. Detecting early signs of potential adverse events (AEs), particularly patients with certain medical conditions (cardiac rhythm disorders), would suggest caution in administering anaesthesia. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03802305 registered January 14, 2019. (version no. 1.2; 5 November 2021).
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Affiliation(s)
- Amany Laham
- grid.4817.a0000 0001 2189 0784Nantes Université, CHU Nantes, Unité d’Investigation Clinique en Odontologie, UIC 11, F-44000 Nantes, France
| | - Roselyne Clouet
- grid.4817.a0000 0001 2189 0784Nantes Université, CHU Nantes, F-44000 Nantes, France
| | - Gilles Amador del Valle
- grid.4817.a0000 0001 2189 0784Nantes Université, CHU Nantes, Unité d’Investigation Clinique en Odontologie, UIC 11, F-44000 Nantes, France
| | - Alexis Gaudin
- grid.4817.a0000 0001 2189 0784Nantes Université, Oniris, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, F-44000 Nantes, France
| | - Tony Prud’homme
- grid.4817.a0000 0001 2189 0784Nantes Université, CHU Nantes, Unité d’Investigation Clinique en Odontologie, UIC 11, F-44000 Nantes, France
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O'Neal LY, Nusstein J, Drum M, Fowler S, Reader A, Ni A. Comparison of Maxillary Lateral Incisor Infiltration Pain Using the Dentapen and a Traditional Syringe: A Prospective Randomized Study. J Endod 2022; 48:840-844. [PMID: 35421407 DOI: 10.1016/j.joen.2022.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The anterior maxillary infiltration is one of the more painful dental injections. The Dentapen is an electronic syringe that utilizes computer-controlled delivery technology to administer dental local anesthesia at a slow controlled rate. The purpose of this prospective, randomized, single-blind study was to evaluate solution deposition pain of a maxillary lateral incisor infiltration using the Dentapen with the slow flow rate (1.8 mL/162 seconds) and ramp-up setting compared to a traditional syringe infiltration at a flow rate of 1.8 mL/60 seconds. METHODS One hundred thirty adults were administered a maxillary lateral incisor infiltration with the Dentapen and a traditional syringe at two separate appointments in a single blind manner. The infiltrations of 2% lidocaine with 1:100,000 epinephrine were given at a rate of 1.8 mL/162 seconds with the ramp-up feature for the Dentapen and 1.8 mL/60 seconds for the traditional infiltration. The pain of solution deposition was recorded on a visual analog scale. At the conclusion of the study, subjects selected their preferred injection technique. The data were analyzed statistically using paired t-tests, a mixed-effect model, and odds ratio. RESULTS The pain of solution deposition was significantly less for the Dentapen injection than the traditional injection (p<0.001). With the Dentapen device, 16% experienced moderate pain and for the traditional syringe, 39% experienced moderate pain. Overall, 75% of subjects preferred the Dentapen injection over the traditional injection. CONCLUSION The Dentapen, using the slow flow rate and ramp-up mode, significantly reduced the pain of solution deposition for maxillary lateral incisor infiltrations.
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Affiliation(s)
- Leigh Yarborough O'Neal
- Former Graduate Student in Endodontics, The Ohio State University. Currently she is practicing endodontics in Charleston, SC
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University
| | - Melissa Drum
- Professor and Graduate Program Director, Division of Endodontics, The Ohio State University
| | - Sara Fowler
- Associate Professor and Predoctoral Director, Division of Endodontics, The Ohio State University
| | - Al Reader
- Emeritus Professor, Division of Endodontics, The Ohio State University.
| | - Ai Ni
- Assistant Professor, Division of Biostatistics, College of Public Health, The Ohio State University
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Crump B, Reader A, Nusstein J, Drum M, Fowler S, Draper J. Prospective Study on PDL Anesthesia as an Aide to Decrease Palatal Infiltration Pain. Anesth Prog 2022; 69:10-17. [PMID: 35377934 DOI: 10.2344/anpr-68-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/04/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The purpose of this prospective randomized study was to assess using a periodontal ligament (PDL) injection as an aide to decrease palatal infiltration pain. METHODS A total of 133 subjects randomly received a PDL injection and alternative palatal infiltration or a mock PDL injection and conventional palatal infiltration at 2 separate appointments. PDL injection was given in the mid-palatal sulcus of the maxillary first molar. Mock PDL injection consisted of only needle insertion. All subjects then received a palatal infiltration administered into the blanched gingival tissue 3 mm (alternative palatal infiltration) or 7 mm (conventional palatal infiltration) from the gingival collar. Subjects recorded needle insertion and solution deposition pain using a Heft-Parker visual analog scale (VAS). RESULTS The combined PDL injection and alternative palatal infiltration had significantly decreased mean VAS ratings for needle insertion and solution deposition pain (P < .0001). Incidence of moderate/severe pain for needle insertion and solution deposition was reduced from 65% to 1% and from 65% to 2%, respectively. CONCLUSION Providing PDL anesthesia into the mid-palatal sulcus of the maxillary first molar and then administering an alternative palatal infiltration into the blanched collar around the PDL molar site led to significant reductions in needle insertion and solution deposition pain compared with a mock PDL and conventional palatal infiltration.
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Affiliation(s)
- Brian Crump
- Former Graduate Student in Endodontics, The Ohio State University, Columbus, Ohio
| | - Al Reader
- Emeritus Professor, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Melissa Drum
- Professor and Graduate Program Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - Sara Fowler
- Associate Professor and Predoctoral Director, Division of Endodontics, The Ohio State University, Columbus, Ohio
| | - John Draper
- Assistant Professor, Fisher College of Business, The Ohio State University, Columbus, Ohio
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Parirokh M, Abbott P. Present status and future directions - Mechanisms and management of local anaesthetic failures. Int Endod J 2022; 55 Suppl 4:951-994. [PMID: 35119117 DOI: 10.1111/iej.13697] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/05/2022]
Abstract
Pain control during root canal treatment is of utmost importance for both the patient and the dental practitioner and many studies have investigated ways of overcoming problems with gaining adequate anaesthesia during treatment. The PubMed and Cochrane databases were searched for evidence-based studies regarding local anaesthesia for root canal treatment. Many variables, including premedication, pain during needle insertion, pain on injection, premedication with various types of drugs, volume of anaesthetic solutions, supplemental anaesthetic techniques, and additives to the anaesthetic solutions, may influence pain perception during root canal treatment. Differences between teeth with healthy pulps versus those with irreversible pulpitis should be considered when the effects of variables are interpreted. There are several concerns regarding the methodologies used in studies that have evaluated anaesthesia success rates. There are some conditions that may help to predict a patient's pain during root canal treatment and these conditions could be overcome either by employing methods such as premedication with a non-steroidal anti-inflammatory drug prior to the treatment visit or by using supplementary anaesthetic techniques before or during the treatment. However, authors need to be more careful when reporting details of their studies to reduce concerns regarding their study bias.
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Affiliation(s)
- Masoud Parirokh
- Endodontology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Paul Abbott
- School of Dentistry, University of Western Australia, Perth, Australia
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Areenoo P, Manmontri C, Chaipattanawan N, Chompu-inwai P, Khanijou M, Kumchai T, Wongsirichat N. Anesthetic efficacies of buccal with palatal injection versus buccal with intra-septal injection in permanent maxillary first molars of pediatric patients. J Dent Anesth Pain Med 2022; 22:239-254. [PMID: 35991357 PMCID: PMC9358269 DOI: 10.17245/jdapm.2022.22.4.239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/27/2022] Open
Abstract
The high success rate of dental treatment is dependent on the cooperation of pediatric patients during procedures. Dental treatment often causes pain, particularly in children. The factors in providing treatment to pediatric patients include the characteristics and location of the tooth, profoundness of the anesthesia including the type of local anesthetic, and cooperation of the patient. Previous studies have examined several techniques to successfully achieve profound pulpal anesthesia in maxillary permanent teeth. The dentist should select the injection technique to be used based on patient needs. In children, either buccal with palatal injections or buccal with intra-septal injections may be used to anesthetize the permanent maxillary first molar. Buccal with palatal injections are commonly used prior to routine maxillary dental procedures. Currently, there are only a few studies on the employment of buccal with intra-septal injections to anesthetize permanent maxillary first molars in pediatric patients. This review will focus on efficacy of buccal with palatal versus buccal with intra-septal pulpal anesthesia of the permanent maxillary first molars in pediatric patients and aim to determine which technique should be used during routine dental procedures.
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Affiliation(s)
- Peecharat Areenoo
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Chanika Manmontri
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Nattakan Chaipattanawan
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Papimon Chompu-inwai
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
| | - Manop Khanijou
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi University, Bangkok, Thailand
| | - Thongnard Kumchai
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi University, Bangkok, Thailand
| | - Natthamet Wongsirichat
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Bangkokthonburi University, Bangkok, Thailand
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de França AJB, da Silva Barbirato D, de Holanda Vasconcellos RJ, Pellizzer EP, de Moraes SLD, Vasconcelos BCDE. Do Computerized Delivery System Promote Less Pain and Anxiety Compared to Traditional Local Anesthesia in Dental Procedures? A Systematic Review of the Literature. J Oral Maxillofac Surg 2021; 80:620-632. [PMID: 34942152 DOI: 10.1016/j.joms.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE The aim of this study is to assess whether the use of computerized devices to deliver local anesthesia results in less pain and anxiety compared to traditional anesthesia in adult dental procedures. METHODS This review was registered at PROSPERO (CRD 42021265046), based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was structured according to the PICO strategy. The studies were selected based on eligibility criteria, and data were collected by 1 author and reviewed by another. RESULTS Nine of the 10 studies included were randomized controlled trials. Differences related to pain and anxiety were observed, which favored computerized techniques; however, caution should be exercised when interpreting these results due to differences in assessment methods. The studies used different local anesthetics, including 2% lidocaine, 4% articaine, or 3% mepivacaine with epinephrine diluted 1:80,000 to 1:200,000. A total of 560 patients were evaluated. CONCLUSIONS Computerized anesthesia devices yielded better results than conventionally delivered anesthesia after qualitative evaluation. Nevertheless, conventional anesthesia is widely used, safe, and effective. Due to the heterogeneity among the included studies, it is strongly recommended that new randomized clinical trials using well-defined methodologies be performed to improve the quality of evidence regarding this topic.
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Affiliation(s)
- Arthur José Barbosa de França
- MSc Student, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Pernambuco (UPE), Recife, PE, Brazil
| | - Davi da Silva Barbirato
- Postdoctoral Fellow, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Pernambuco (UPE), Recife, PE, Brazil
| | | | - Eduardo Piza Pellizzer
- Full Professor, Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), Araçatuba, SP, Brazil
| | - Sandra Lúcia Dantas de Moraes
- Associate Professor, Division of Oral Rehabilitation, Faculty of Dentistry, University of Pernambuco (UPE), Recife, PE, Brazil.
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Razmara F, Baghi A, Afkhami F. Effect of Transcodent painless needles on injection pain in maxillary anterior infiltration: a split-mouth controlled randomized clinical trial. Clin Exp Dent Res 2021; 8:191-196. [PMID: 34472194 PMCID: PMC8874068 DOI: 10.1002/cre2.475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 05/12/2021] [Accepted: 05/15/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives The present study aimed to determine the pain perceived during supraperiosteal (infiltration) injection in anterior maxillary region by Transcodent painless needle tips in comparison to the regular needle tips. Material and methods In this split‐mouth controlled randomised clinical trial, 30 patients were selected as candidates for cosmetic treatment who needed infiltration injections on both sides of canine area. They were each administered 0.9 mL of Lidocaine HCl 2% with epinephrine 1:100,000 in the buccal vestibules using two types of needle tips, Transcodent painless needle tip or regular needle tip. Immediately after the injection, the pain was measured using a 100 mm visual analog scale. The level of pain was statistically analyzed in the two groups using the parametric paired t‐test. A 5% significance level was considered for statically significant difference between two means. Results In accordance with the results, the patients' level of pain were estimated as 18.3 ± 10.7 mm with Transcodent painless needle tips and 43.1 ± 13.1 mm in regular needle tip (p < 0.05). Conclusion The Transcodent painless needle showed considerable reduction of pain in the anterior maxillary infiltration when compared to the regular needle tips.
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Affiliation(s)
- Farnoosh Razmara
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzaneh Afkhami
- Department of Endodontics, School of Dentistry, Tehran University of Medical Sciences, International Campus, Tehran, Iran
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Berrendero S, Hriptulova O, Salido MP, Martínez-Rus F, Pradíes G. "Comparative study of conventional anesthesia technique versus computerized system anesthesia: a randomized clinical trial". Clin Oral Investig 2020; 25:2307-2315. [PMID: 32862249 DOI: 10.1007/s00784-020-03553-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the present study was to compare in terms of pain perception the use of conventional anesthesia and a computerized system. MATERIALS AND METHODS Forty patients in need for extractions, dental restorative, or periodontal treatment bilaterally, were selected. Each patient served as his/her own control being subjected to two anesthesia techniques: conventional and electronically controlled anesthesia with Calaject® (Rønvig Dental MFG, Daugaard, Denmark). Each patient received both treatments in a blind way 1 week apart. The order was previously randomized. After performing the anesthesia (upper dental nerve, palatal posterior nerve, or inferior alveolar nerve), the patients evaluated their pain sensation with a visual analogue scale (VAS) (0-10). After treatment, the patients were asked about the presence of pain during the procedure. Finally, the patients selected their preference between the conventional and electronic anesthesia technique. Differences in assessment of pain's injection were analyzed using the Wilcoxon test and the Kruskal-Wallis test (α = 0.05). RESULTS The mean general pain experienced was 3.73 (1.55 SD) for the conventional anesthesia, and 1.95 (0.53 SD) for computerized anesthesia. Statistical differences (p < 0.05) were found. There was no difference between the treatments (p value = 0.061). Most patients did not feel any pain during the treatment. Finally, 92.5% of the patients preferred the electronic system. CONCLUSIONS Computerized anesthesia system produces significantly less pain compared with a conventional anesthesia syringe. Although both obtained sufficient anesthetic depth to perform treatments, the majority of patients chose electronic anesthesia as the most satisfactory. CLINICAL RELEVANCE Computerized anesthesia devices are valid and more comfortable alternative to conventional anesthesia.
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Affiliation(s)
- S Berrendero
- Department of Conservative Dentistry and Prostheses, Faculty of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal, S/N Ciudad Universitaria, 28040, Madrid, Spain.
| | - O Hriptulova
- Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - M P Salido
- Department of Conservative Dentistry and Prostheses, Faculty of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal, S/N Ciudad Universitaria, 28040, Madrid, Spain
| | - F Martínez-Rus
- Department of Conservative Dentistry and Prostheses, Faculty of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal, S/N Ciudad Universitaria, 28040, Madrid, Spain
| | - G Pradíes
- Department of Conservative Dentistry and Prostheses, Faculty of Dentistry, Complutense University of Madrid, Plaza Ramón y Cajal, S/N Ciudad Universitaria, 28040, Madrid, Spain
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Ghorbanzadeh S, Alimadadi H, Zargar N, Dianat O. Effect of vibratory stimulation on pain during local anesthesia injections: a clinical trial. Restor Dent Endod 2019; 44:e40. [PMID: 31799168 PMCID: PMC6875536 DOI: 10.5395/rde.2019.44.e40] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/24/2019] [Accepted: 08/16/2019] [Indexed: 11/11/2022] Open
Abstract
Objectives This study aimed to assess the effect of DentalVibe on the level of pain experienced during anesthetic injections using 2 different techniques. Materials and Methods This randomized crossover clinical trial evaluated 60 patients who required 2-session endodontic treatment. Labial infiltration (LI) anesthesia was administered in the anterior maxilla of 30 patients, while inferior alveolar nerve block (IANB) was performed in the remaining 30 patients. 1.8 mL of 2% lidocaine was injected at a rate of 1 mL/min using a 27-gauge needle. DentalVibe was randomly assigned to either the first or second injection session. A visual analog scale was used to determine participants' pain level during needle insertion and the anesthetic injection. The paired t-test was applied to assess the efficacy of DentalVibe for pain reduction. Results In LI anesthesia, the pain level was 12.0 ± 15.5 and 38.1 ± 21.0 during needle insertion and 19.1 ± 16.1 and 48.9 ± 24.6 during the anesthetic injection using DentalVibe and the conventional method, respectively. In IANB, the pain level was 14.1 ± 15.9 and 35.1 ± 20.8 during needle insertion and 17.3 ± 14.2 and 39.5 ± 20.8 during the anesthetic injection using DentalVibe and the conventional method, respectively. DentalVibe significantly decreased the level of pain experienced during needle insertion and the anesthetic injection in anterior LI and mandibular IANB anesthesia. Conclusions The results suggest that DentalVibe can be used to reduce the level of pain experienced by adult patients during needle insertion and anesthetic injection.
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Affiliation(s)
- Sajedeh Ghorbanzadeh
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hoda Alimadadi
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nazanin Zargar
- Department of Endodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Dianat
- Division of Endodontics, University of Maryland School of Dentistry, Baltimore, MD, USA
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Ahad A, Haque E, Tandon S. Current status of the anterior middle superior alveolar anesthetic injection for periodontal procedures in the maxilla. J Dent Anesth Pain Med 2019; 19:1-10. [PMID: 30859128 PMCID: PMC6405350 DOI: 10.17245/jdapm.2019.19.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 12/26/2022] Open
Abstract
Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.
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Affiliation(s)
- Abdul Ahad
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, India
| | - Ekramul Haque
- Department of Periodontics, Dr. Ziauddin Ahmad Dental College, Faculty of Medicine, Aligarh Muslim University, Aligarh, India
| | - Shruti Tandon
- Department of Periodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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Fowler S, Crowley C, Drum M, Reader A, Nusstein J, Beck M. Inferior Alveolar Nerve Block Injection Pain Using a Computer-Controlled Local Anesthetic Device (CCLAD): A Prospective, Randomized Study. Anesth Prog 2019; 65:231-236. [PMID: 30715932 DOI: 10.2344/anpr-65-03-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
There is evidence that the Computer-Controlled Local Anesthetic Device (CCLAD) decreases the pain of oral injections. The purpose of this study was to evaluate injection pain of the inferior alveolar nerve block (IANB) using the CCLAD in an upright position versus a supine position. Additionally, we evaluated solution deposition pain with the CCLAD when compared to previous studies using a traditional syringe. One hundred ten asymptomatic subjects were randomly given IANBs using 2% lidocaine with 1:100,000 epinephrine while in an upright sitting position and supine position, at 2 different appointments, spaced at least 2 weeks apart. Each subject rated the pain for needle insertion, needle placement, and solution deposition on a Heft-Parker visual analogue scale. Pain ratings were compared between the upright and supine positions using a repeated-measures analysis of variance with post hoc testing using the Tukey-Kramer procedure. Moderate to severe pain was reported by 10% to 13% of the patients for needle insertion, 74% to 75% for full needle placement, and 8% to 10% for solution deposition. There was no significant difference between groups for phases of the injection. When comparing the injection phases within the groups, the needle placement phase of the injection was statistically more painful than both the needle insertion phase and solution deposition phase ( p = .0001). Using the CCLAD, IANB injection pain of the supine and upright positions was not statistically different. Needle placement was the most painful phase of the injection. Solution deposition pain was less with the CCLAD when compared to other studies of the IANB using a traditional syringe.
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Affiliation(s)
- Sara Fowler
- Assistant Professor and Predoctoral Director, Division of Endodontics, The Ohio State University, Columbus
| | - Chase Crowley
- Former Graduate Student in Endodontics, The Ohio State University, Columbus
| | - Melissa Drum
- Associate Professor and Graduate Program Director, Division of Endodontics, The Ohio State University, Columbus
| | - Al Reader
- Professor, Division of Endodontics, The Ohio State University, Columbus
| | - John Nusstein
- Professor and Chair, Division of Endodontics, The Ohio State University, Columbus
| | - Mike Beck
- Emeritus Associate Professor, Division of Biosciences, The Ohio State University, Columbus
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Patini R, Staderini E, Cantiani M, Camodeca A, Guglielmi F, Gallenzi P. Dental anaesthesia for children – effects of a computer-controlled delivery system on pain and heart rate: a randomised clinical trial. Br J Oral Maxillofac Surg 2018; 56:744-749. [DOI: 10.1016/j.bjoms.2018.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/08/2018] [Indexed: 10/28/2022]
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Affiliation(s)
- Paul V. Abbott
- UWA Dental School; The University of Western Australia; Nedlands Western Australia Australia
| | - Masoud Parirokh
- Endodontology Research Centre; Kerman University of Medical Sciences; Kerman Iran
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Campanella V, Libonati A, Nardi R, Angotti V, Gallusi G, Montemurro E, D'Amario M, Marzo G. Single tooth anesthesia versus conventional anesthesia: a cross-over study. Clin Oral Investig 2018. [PMID: 29525923 DOI: 10.1007/s00784-018-2413-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The aim of the present study was to compare an electronic device, the Wand Injection System (Milestone Scientific Livingstone), with conventional anesthesia in terms of the following: pain sensation during anesthetic injection; effectiveness in achieving adequate anesthesia for a complete painless dental treatment; post-operative discomfort; and patient's anxiety toward dental treatment. MATERIALS AND METHODS Eighty adults from 18 to 70 years were enrolled in this cross-over study. Each patient served as his/her own control being subject to two anesthesia techniques: conventional and Single Tooth Anesthesia (STA) performed with the Wand. A split-mouth design was adopted in which each tooth undergoing conservative restorative or endodontic treatment received anesthesia with both techniques at 1-week interval. Before anesthetic administration, the patients' anxiety levels were determined. Physiological parameteres were measured before, during, and after the two injection procedures, and the Visual Analogue Scale (VAS) was used to assess pain of injection, discomfort, and anesthetic efficacy. Differences in assessment of pain's injection, discomfort, anesthetic efficacy, vital parameters (heart rate, blood pressure, and oxygen saturation), and state anxiety levels were analyzed using Student's t test (p value < 0.001). RESULTS The mean injection pain and post-operative discomfort ratings with Wand were lower than those with conventional syringe (p = 0.022 and p < 0.001, respectively). No differences were found in the assessment of anesthetic efficacy. Blood pressure and heart rate mean values were lower during the anesthesia performed with the Wand than with the conventional syringe (p < 0.001). The anxiety level was higher during the first appointment, independently from the device used for the injections. CONCLUSION The STA technique resulted in lower pain, discomfort, and lower intensity of physiological parameters. CLINICAL RELEVANCE Single Tooth Anesthesia could be an efficacious alternative to conventional procedures.
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Affiliation(s)
- Vincenzo Campanella
- Department of Clinical and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Antonio Libonati
- Department of Surgical Sciences, Catholic University of Our Lady of Good Counsel of Tirane, Tirana, Albania
| | - Roberto Nardi
- Department of Clinical and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Vincenzo Angotti
- Department of Clinical and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Gianni Gallusi
- Department of Clinical and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Edoardo Montemurro
- Department of Clinical and Translational Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Maurizio D'Amario
- Department of Life, Health and Environmental Sciences, School of Dentistry, Dental Clinic, University of L'Aquila, Via Vetoio, Delta 6, 67010, Coppito, L'Aquila, Italy.
| | - Giuseppe Marzo
- Department of Life, Health and Environmental Sciences, School of Dentistry, Dental Clinic, University of L'Aquila, Via Vetoio, Delta 6, 67010, Coppito, L'Aquila, Italy
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Re D, Del Fabbro M, Karanxha L, Augusti G, Augusti D, Fessi S, Taschieri S. Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index. ACTA ACUST UNITED AC 2017; 9. [PMID: 28544653 DOI: 10.1111/jicd.12275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/29/2017] [Indexed: 12/31/2022]
Abstract
AIM The aim of the present prospective study was to evaluate the impact of a computer-controlled anesthesia on patients' comfort and to investigate, through the willingness-to-pay (WTP) index, and patients' acceptance of this new technology. METHODS Fifty patients undergoing a class I or II restorative procedure were enrolled. A computer-controlled device for anesthetic delivery was utilized, and a questionnaire on the level of discomfort and WTP was given to all patients. RESULTS A total of 86% of participants declared less discomfort than that perceived during their last traditional procedure for pain control; 58% of patients were willing to pay an additional fee for a modern anesthesia technique, with a median WTP value of 20$. CONCLUSIONS Computer-controlled systems for local anesthesia represent a relevant tool for reducing patients' discomfort during dental treatment. The WTP index helps to quantify its relevance.
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Affiliation(s)
- Dino Re
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,Italian Institue Stomatologico, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Lorena Karanxha
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | | | | | - Sabrine Fessi
- Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia
| | - Silvio Taschieri
- Department of Biomedical, Surgical, and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy
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Kwak EJ, Pang NS, Cho JH, Jung BY, Kim KD, Park W. Computer-controlled local anesthetic delivery for painless anesthesia: a literature review. J Dent Anesth Pain Med 2016; 16:81-88. [PMID: 28879299 PMCID: PMC5564086 DOI: 10.17245/jdapm.2016.16.2.81] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 06/22/2016] [Accepted: 06/22/2016] [Indexed: 11/15/2022] Open
Abstract
Local anesthesia is administered to reduce pain during dental treatments, but may itself cause pain and contribute to increased dental fear. Computer-controlled local anesthetic delivery (CCLAD) is one the method to reduce patient pain during local anesthesia; it is a device that slowly administers anesthetics by using a computerized device to control the injection speed. This literature review aims to provide an objective assessment of the usefulness of CCLAD for controlling pain by reviewing papers published to date that have used CCLAD.
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Affiliation(s)
- Eun-Jung Kwak
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Nan-Sim Pang
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jin-Hyung Cho
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Bock-Young Jung
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Deog Kim
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Wonse Park
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
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Chang H, Noh J, Lee J, Kim S, Koo KT, Kim TI, Seol YJ, Lee YM, Ku Y, Rhyu IC. Relief of Injection Pain During Delivery of Local Anesthesia by Computer-Controlled Anesthetic Delivery System for Periodontal Surgery: Randomized Clinical Controlled Trial. J Periodontol 2016; 87:783-9. [PMID: 26991489 DOI: 10.1902/jop.2016.150448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pain from local anesthetic injection makes patients anxious when visiting a dental clinic. This study aims to determine differences in pain according to types of local anesthetizing methods and to identify the possible contributing factors (e.g., dental anxiety, stress, and sex). METHODS Thirty-one patients who underwent open-flap debridement in maxillary premolar and molar areas during treatment for chronic periodontitis were evaluated for this study. A randomized, split-mouth, single-masked clinical trial was implemented. The dental anxiety scale (DAS) and perceived stress scale (PSS) were administered before surgery. Two lidocaine ampules for each patient were used for local infiltration anesthesia (supraperiosteal injection). Injection pain was measured immediately after local infiltration anesthesia using the visual analog pain scale (VAS) questionnaire. Results from the questionnaire were used to assess degree of pain patients feel when a conventional local anesthetic technique (CNV) is used compared with a computer-controlled anesthetic delivery system (CNR). RESULTS DAS and PSS did not correlate to injection pain. VAS scores were lower for CNR than for CNV regardless of the order in which anesthetic procedures were applied. VAS score did not differ significantly with sex. Pearson coefficient for correlation between VAS scores for the two procedures was 0.80, also indicating a strong correlation. CONCLUSION Within the limitations of the present study, relief from injection pain is observed using CNR.
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Affiliation(s)
- Hyeyoon Chang
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Jiyoung Noh
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Jungwon Lee
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Sungtae Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Ki-Tae Koo
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Tae-Il Kim
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yang-Jo Seol
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Yong-Moo Lee
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - Young Ku
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
| | - In-Chul Rhyu
- Department of Periodontology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Korea
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Saraf SP, Saraf PA, Kamatagi L, Hugar S, Tamgond S, Patil J. A comparative evaluation of anesthetic efficacy of articaine 4% and lidocaine 2% with anterior middle superior alveolar nerve block and infraorbital nerve block: An in vivo study. J Conserv Dent 2016; 19:527-531. [PMID: 27994313 PMCID: PMC5146767 DOI: 10.4103/0972-0707.194021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The ideal maxillary injection should produce a rapid onset of profound pulpal anesthesia for multiple teeth from a single needle penetration. The main objective is to compare the efficacy of articaine 4% and lidocaine 2% and to compare anterior middle superior alveolar nerve block (AMSANB) and infraorbital nerve block (IONB) for anesthesia of maxillary teeth. MATERIALS AND METHODS Forty patients undergoing root canal treatment of maxillary anteriors and premolars were included and randomly divided into four groups of ten each. Group I: patients receiving AMSANB with articaine, Group II: Patients receiving IONB with articaine, Group III: Patients receiving AMSANB with lidocaine, Group IV: Patients receiving IONB with lidocaine. The scores of onset of anesthesia and pain perception were statistically analyzed. RESULTS Onset of action was fastest for articaine with AMSANB and slowest for lidocaine with IONB by Tukey's test. A significant change was observed in the electrical pulp test readings at onset and at 30 min by paired t-test. All patients experienced mild pain during the procedure recorded by visual analog scale. CONCLUSION Articaine 4% proved to be more efficacious than lidocaine 2%, and AMSANB was more advantageous than IONB in securing anesthesia of maxillary anteriors and premolars.
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Affiliation(s)
- Suma Prahlad Saraf
- Department of Oral and Maxillofacial Surgery, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Prahlad Annappa Saraf
- Department of Conservative Dentistry and Endodontics, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Laxmikant Kamatagi
- Department of Conservative Dentistry and Endodontics, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
| | - Santosh Hugar
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Deemed University Dental College and Hospital, Sangli, Maharashtra, India
| | - Shridevi Tamgond
- Department of Pedodontics, Bharati Vidyapeeth Deemed University Dental College and Hospital, Sangli, Maharashtra, India
| | - Jayakumar Patil
- Department of Conservative Dentistry and Endodontics, Bharati Vidyapeeth Deemed University Dental College and Hospital, Sangli, Maharashtra, India
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Comparison of the effectiveness of lidocaine in permanent maxillary teeth removal performed with single buccal infiltration versus routine buccal and palatal injection. J Maxillofac Oral Surg 2014; 14:252-7. [PMID: 26028844 DOI: 10.1007/s12663-014-0624-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 04/04/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE For many dental patients, palatal injection proves to be a very traumatic experience. Diverse methods have been suggested to reduce the discomfort of palatal injection. Nevertheless, the reliability of these methods is not obviously evident and they are not found to be universally effective. The desirable method to evade pain during palatal injection is just not to have one. Hence, the present study aims at investigating if lidocaine hydrochloride could provide palatal anesthesia in maxilla when only a buccal infiltration anesthesia is done for teeth extraction. PATIENTS AND METHODS One hundred and fifty patients requiring extraction of maxillary teeth were included in the study. Patients were randomly allotted to two groups, study and control. Patients in study group received a single buccal infiltration of 1.5 mL of lidocaine with epinephrine for extraction of maxillary teeth. Patients in control group received 1.5 mL of buccal and 0.3 mL of palatal infiltration of lidocaine with epinephrine for the extraction. After achieving adequate palatal anesthesia the tooth was extracted with consistent technique. Pain level experienced by the patients during injection procedure and during tooth extraction was rated in an 11-point pain rating scale. Time taken to achieve palatal anesthesia following a single buccal infiltration of anesthetic solution was evaluated by regular pin-prick evaluation of palatal tissues. RESULTS The overall success rate of palatal anesthesia achieved with a single buccal infiltration is 81.3 %. The success rate reduced as we proceed from anterior to posterior maxilla. Time taken to achieve successful palatal anesthesia by single buccal infiltration is 7-9 min. CONCLUSION The extraction of permanent maxillary anterior teeth and premolars is possible by depositing local anesthesia to the buccal vestibule of the tooth without palatal supplementation. However, the extraction of permanent maxillary posterior teeth with similar technique would result in fewer success rates suggesting its avoidance.
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Efficacy and safety of intraseptal and periodontal ligament anesthesia achieved by computer-controlled articaine + epinephrine delivery: a dose-finding study. Clin Oral Investig 2012; 17:525-33. [PMID: 22526891 DOI: 10.1007/s00784-012-0724-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 04/02/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The main purpose of this study was to evaluate the dose-dependent anesthetic efficacy of the intraseptal anesthesia (ISA) and periodontal ligament anesthesia (PLA) obtained with different volumes of 4 % articaine and 1:100,000 epinephrine (Ar + Ep) in human mandibular premolars, using a computer-controlled local anesthetic delivery system (CCLADS). The safety profile of Ar + Ep was also studied by investigating the stability of cardiovascular parameters. MATERIAL AND METHODS One hundred and eighty randomly selected healthy volunteers (ASA I) entered the single-blinded study to receive 16 mg + 4 μg, 24 mg + 6 μg, and 32 mg + 8 μg of Ar + Ep, obtained with different volumes (0.4, 0.6, and 0.8 ml, respectively), for the ISA and PLA. Success rate, onset, and duration of profound pulpal anesthesia were evaluated by the electrical pulp tester, while the width of the anesthetic field and duration of soft tissue anesthesia were recorded using the pinprick testing. A monitor was used for the measurement of cardiovascular parameters. RESULTS A dose-dependent duration of pulpal and soft tissue anesthesia was obtained only by the ISA. Success rate, duration of both pulpal and soft tissue anesthesia, and its width were significantly better in the ISA compared with the PLA. No significant cardiovascular changes were seen in both groups. CONCLUSIONS It can be suggested that 0.6 and 0.8 ml of 4 % Ar + 1:100,000 Ep, delivered by CCLADS, offer high success rate and effective clinical parameters of ISA as a primary anesthesia. CLINICAL RELEVANCE It seems that dental procedures requiring profound pulpal, bone, and soft tissue anesthesia could be effectively and safely obtained by mentioned anesthetic protocol.
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Drum M, Reader A, Beck M. Long buccal nerve block injection pain in patients with irreversible pulpitis. ACTA ACUST UNITED AC 2011; 112:e51-4. [DOI: 10.1016/j.tripleo.2011.01.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 01/21/2011] [Accepted: 01/22/2011] [Indexed: 11/27/2022]
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Tzafalia M, Sixou JL. Administration of anesthetics using metal syringes. An ex vivo study. Anesth Prog 2011; 58:61-5. [PMID: 21679041 DOI: 10.2344/0003-3006-58.2.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The aim of the present study was to assess injection flow rates of metal syringes, with an emphasis on injection speed and the generation of flow pulsations. A cohort of 64 operators (32 practitioners and 32 students) performed 3 consecutive ex vivo simulated injections (SIs) of 1.8-mL cartridges of anesthetic solution. Two needle diameters were tested (27-gauge and 30-gauge). Each SI was filmed and analyzed using a computer. In most cases, the SI lasted longer than 60 seconds with the 30-gauge needle (75%) but not with the 27-gauge needle (47.9%) (P < .0001). Practitioners and men delivered a full cartridge significantly faster than students and women, respectively (P = .0007 in both cases). All operators generated 1 pulse in at least 1 of the 3 SIs with both types of needles, especially during the first 3 seconds (254/384; 66.1%). Pulses occurred more frequently with practitioners (P = .0176) and with the 27-gauge needle (P = .005). Within its methodological limits, the present study showed how difficult it is to control injection pressure when using a metal syringe, especially at the beginning of the injection. Computerized systems may help overcome this problem.
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Abstract
Computer-controlled local anesthetic delivery (C-CLAD) devices and systems for intraosseous (IO) injection are important additions to the dental anesthesia armamentarium. C-CLAD using slow infusion rates can significantly reduce the discomfort of local anesthetic infusion, especially in palatal tissues, and facilitate palatal approaches to pulpal nerve block that find special use in cosmetic dentistry, periodontal therapy, and pediatric dentistry. Anesthesia of single teeth can be obtained using either C-CLAD intraligamentary injections or IO injections. Supplementary IO anesthesia is particularly suited for providing effective pain control of teeth diagnosed with irreversible pulpitis.
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Acharya AB, Banakar C, Rodrigues SV, Nagpal S, Bhadbhade S, Thakur SL. Anterior Middle Superior Alveolar Injection Is Effective in Providing Anesthesia Extending to the Last Standing Molar in Maxillary Periodontal Surgery. J Periodontol 2010; 81:1174-9. [DOI: 10.1902/jop.2010.100109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pain perception during inferior alveolar injection administered with the Wand or conventional syringe. Br Dent J 2008; 205:E10; discussion 258-9. [PMID: 18791585 DOI: 10.1038/sj.bdj.2008.757] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study compared a computerised device (the Wand) with a conventional syringe in terms of the pain of needle insertion and injection during inferior alveolar nerve (IAN) block injection. METHODS AND MATERIALS The subjects were 40 patients between the ages of 18 and 30 years requiring local anaesthesia for dental restoration in the mandible. Before anaesthetic administration, the patients' anxiety levels were determined. Contralateral IAN injections were administrated at two separate appointments with random use of either the Wand or a conventional syringe. Following the injection, the patients used both the pain rating score (PRS) and a visual analogue scale (VAS) to assess the intensity of pain. RESULTS When pain was measured after the injection, the Wand was found to be less painful than the syringe for the pain of both needle insertion and injection (p <0.05). CONCLUSION The Wand technique resulted in significantly lower pain scores during the IAN block injections. Most of the patients preferred the IAN injection with the Wand for future dental injections.
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Holtzclaw D, Toscano N. Alternative anesthetic technique for maxillary periodontal surgery. J Periodontol 2008; 79:1769-72. [PMID: 18771380 DOI: 10.1902/jop.2008.070621] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Maxillary periodontal surgery typically requires multiple injections and may inadvertently affect facial structures such as the upper lip, lateral aspect of the nose, and lower eyelid. To minimize these sequelae and reduce the number of total injections, a relatively new injection technique has been proposed for maxillary procedures. The anterior middle superior alveolar (AMSA) injection is reported to effectively anesthetize maxillary teeth and associated gingival tissues extending from the buccal root of the first molar mesially to the central incisor with a single injection while avoiding undesirable side effects. The purpose of this article is to provide background information on the AMSA injection and demonstrate its use in a variety of maxillary periodontal surgeries. METHODS Anesthesia was provided for five separate maxillary periodontal surgeries with unilateral or bilateral AMSA injections. Injections were administered via conventional syringe with a 27-gauge needle. Confirmation of anesthesia was subjectively tested with buccal mucosal sticks and palatal transgingival probing. RESULTS The AMSA injection provided promising results for a variety of maxillary periodontal surgical procedures. Benefits of the AMSA injection included outstanding palatal hemostatic control, avoidance of undesirable collateral anesthesia, and a reduced number of cumulative injections. Drawbacks of the AMSA injection included occasionally inadequate buccal hemostatic control and short-lived anesthesia of the maxillary central incisors. CONCLUSION The AMSA injection is a novel anesthetic technique that may prove useful for certain maxillary periodontal surgeries.
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Affiliation(s)
- Dan Holtzclaw
- Department of Periodontics-U.S. Navy, Naval Hospital Pensacola, 450 Turner Street, Pensacola, FL 32508, USA
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McCartney M, Reader A, Beck M. Injection pain of the inferior alveolar nerve block in patients with irreversible pulpitis. ACTA ACUST UNITED AC 2007; 104:571-5. [PMID: 17706440 DOI: 10.1016/j.tripleo.2007.04.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 04/16/2007] [Accepted: 04/17/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this retrospective analysis was to determine the pain associated with needle insertion, placement, and solution deposition for the conventional inferior alveolar nerve (IAN) block in patients with irreversible pulpitis. STUDY DESIGN One hundred two emergency patients with irreversible pulpitis received IAN block injections using 2% lidocaine with 1:100,000 epinephrine. The patients recorded pain of the 3 injection stages on a Heft-Parker visual analog scale (VAS). RESULTS Moderate-to-severe pain may occur 57% to 89% of the time with the IAN block. Needle placement was significantly more painful than needle insertion for men and significantly more painful than either insertion or deposition for women (P < .03). There was no statistical difference between the pain for men or women with respect to needle insertion, placement, or deposition pain (P > .05). Deposition of 0.2 to 0.4 mL anesthetic during placement did not significantly reduce placement pain for either gender (P = .753). CONCLUSION In conclusion, 57% to 89% of patients presenting with irreversible pulpitis have the potential for moderate to severe pain with the IAN block.
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Affiliation(s)
- Melissa McCartney
- Section of Endodontics, Ohio State University, Columbus, Ohio 43210, USA
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Nusstein J, Steinkruger G, Reader A, Beck M, Weaver J. The Effects of a 2-Stage Injection Technique on Inferior Alveolar Nerve Block Injection Pain. Anesth Prog 2006; 53:126-30. [PMID: 17177591 PMCID: PMC1705832 DOI: 10.2344/0003-3006(2006)53[126:teoasi]2.0.co;2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 08/24/2006] [Indexed: 12/23/2022] Open
Abstract
The purpose of this prospective, randomized, single-blinded, crossover study was to compare the pain of a traditional 1-stage inferior alveolar nerve (IAN) block injection to a 2-stage IAN block technique. Using a crossover design, 51 subjects randomly received, in a single-blinded manner, either the traditional IAN block or the 2-stage IAN block in 2 appointments spaced at least 1 week apart. For the 2-stage injection, the needle was inserted submucosally and 0.4 mL of 2% lidocaine with epinephrine was slowly given over 1 minute. After 5 minutes, the needle was reinserted and advanced to the target site (needle placement), and 1.8 mL of 2% lidocaine with epinephrine was deposited. For the traditional IAN block, following needle penetration, the needle was advanced while depositing 0.4 mL of 2% lidocaine with epinephrine (needle placement) and then 1.8 mL of 2% lidocaine with epinephrine was deposited at the target site. A Heft-Parker visual analogue scale was used to measure the pain of needle insertion, needle placement, and anesthetic solution deposition. There were no significant differences, as analyzed by Wilcoxon matched-pairs signed-ranks test, between needle insertion and solution deposition for the 2 techniques in men or women. However, there was significantly less pain with the 2-stage injection for needle placement in women. In conclusion, the 2-stage injection significantly reduced the pain of needle placement for women when compared to the traditional IAN technique.
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Affiliation(s)
- John Nusstein
- Associate Professor, Section of Endodontics, The Ohio State University, Columbus, Ohio
| | - Geoffrey Steinkruger
- formerly graduate student in endodontics at The Ohio State University, currently in private practice limited to endodontics, Charleston, South Carolina
| | - Al Reader
- Professor and Program Director of Graduate Endodontics, Section of Endodontics
- Address correspondence to Dr Al Reader, Section of Endodontics, College of Dentistry, The Ohio State University, 305 West 12th Avenue, Columbus, OH 43218;
| | - Mike Beck
- Associate Professor, Section of Oral Biology
| | - Joel Weaver
- Professor and Program Director of Anesthesiology, Section of Oral Surgery, Oral Pathology, and Anesthesiology, The Ohio State University, Columbus, Ohio
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Sumer M, Misir F, Koyuturk AE. Comparison of the Wand with a conventional technique. ACTA ACUST UNITED AC 2006; 101:e106-9. [PMID: 16731373 DOI: 10.1016/j.tripleo.2005.12.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 12/02/2005] [Accepted: 12/02/2005] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the present study was to compare the Wand computer-controlled anesthetic delivery system with a conventional technique as to pain of needle insertion and the pain during injection according to the patient's dental anxiety levels. STUDY DESIGN The study sample comprised 52 healthy patients about to undergo routine tooth extraction. A dental anxiety scale was used to determine anxiety levels before anesthetic administration. Anesthesia technique selection was made according to the patients' anxiety level. After each injection, patients completed pain rating score and visual analog scale to rate their pain perception during needle insertion and injection. RESULTS The patients receiving the Wand system reported significantly less pain of needle insertion and less pain during injection (P < .05). CONCLUSION Under the conditions of this study, although the anxiety levels of patients were higher in Wand injection than conventional syringe injection, the Wand seemed to be less painful. However, the mean ratings of pain were mostly mild or no pain for both injections.
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Affiliation(s)
- Mahmut Sumer
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Ondokuz Mayis, Samsun, Turkey.
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Abstract
This study with 24 volunteers compared the discomfort produced by needle penetration in different parts of the palatal mucosa. In addition, comparing a fresh needle to one that was used for a previous penetration in the same patient, we assessed the influence of the status of the needle on insertion discomfort during buccal mucosal penetration. The results showed that needle penetration in the anterior hard palate was more uncomfortable than in the posterior palate. Although men could not differentiate between fresh and used needles for a second buccal mucosal penetration, women reported a significant increase in discomfort with used needles.
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Affiliation(s)
- J G Meechan
- School of Dental Sciences, University of Newcastle Upon Tyne, England.
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