Comparison of the Wand with a conventional technique

Pain Experienced during Various Dental Procedures: Clinical Trial Comparing the Use of Traditional Syringes with the Controlled-Flow Delivery Dentapen® Technique

Background and Objectives: Currently, one of the most discouraging aspects for many patients undergoing dental procedures is the administration of anaesthesia. Consequently, there is a constant search for new techniques to avoid the invasive and painful nature of the injection. A new motorised syringe system (Dentapen^®) has recently been developed, standing out for its convenience and ease of use. Material and Methods: Randomised, controlled, single-blind, and single-centre study including 178 voluntary adult participants aged between 18 and 90 years. Individuals were randomly assigned using a randomised table. Patients were asked to rate the level of pain experienced during the injections, using a 10-point visual analogue scale (VAS). The following data were recorded: pain index, heart rate, blood pressure, and saturation, both before and after anaesthesia. Results: Of the total 178 participants, 87 participants (48.9%) were men and 91 (51.1%) were women. The first variable to be assessed was the pain experienced by patients when anaesthetised with a syringe, obtaining a mean value of 2.63 ± 1.86 on the VAS with the conventional syringe and 1.06 ± 1.28 with the Dentapen^® syringe, showing statistically significant differences (p-value < 0.01). When stratifying, based on the procedure that was undertaken, differences were also significant for all treatments (p-value < 0.01) except for endodontics, where differences were likely to be significant (p-value = 0.02). Conclusions: In conclusion, from a clinical standpoint, the Dentapen^® syringe is a valid alternative to traditional infiltration syringes, causing minimum pain with the injection.

Do Computerized Delivery System Promote Less Pain and Anxiety Compared to Traditional Local Anesthesia in Dental Procedures? A Systematic Review of the Literature

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.

Patient evaluations after local anesthesia with a computer-assisted method and a conventional syringe before and after reflection time: A prospective randomized controlled trial

Objectives

This prospective randomized controlled trial aimed to evaluate and compare patient response to a conventional syringe and a computer-controlled local anesthetic delivery system (CCLAD) both immediately and after reflection time, including the impact of anesthesia duration.

Methods

Twenty adult patients (10 men and 10 women) with at least two tooth-neck defects each in different quadrants were treated with local buccal infiltration anesthesia. Using split-mouth design, one quadrant was anesthetized using a conventional syringe, the other with CCLAD. The time elapsed between time of injection and time of disappearance of numbness was recorded. Patients were asked to mark on a Visual Analog Scale their visual impression of the device regarding anxiety-inducement, their sensation of mucosal puncture, pain during administration, and pain perception during treatment for the two different methods as well as future preference immediately after treatment and after reflection time.

Results

The level of anxiety-inducement and pain during administration were ranked three times higher with the conventional syringe (35.95%-11.85%, p < 0.001 and 21.3%-7.7%, p = 0.005, respectively). There was no difference in mean sensation of mucosal puncture, nor a statistically significant correlation between duration of administration and time until disappearance of numbness. Once anesthesia was administered, no pain during treatment was detected using either method. Patients' preference of methods changed significantly with time in favor of CCLAD (p = 0.01).

Conclusions

The use of CCLAD increased patients' comfort visually and in terms of administration; patients' preference in favor of CCLAD increased with time.

Clinical significance

Patients' preference of CCLAD over against the conventional syringe, even more so after reflection time, can imply the preference of CCLAD for clinicians, too, in order to enhance patients' and clinicians' comfort.

"Comparative study of conventional anesthesia technique versus computerized system anesthesia: a randomized clinical trial"

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.

Influence of information concerning a computerized anesthesia system on dental anxiety: a randomized controlled clinical trial

BACKGROUND

A single-blinded randomized controlled trial among patients requiring an upper third molar extraction was performed to evaluate the anxiety degree after receiving information or not about the functioning of The Wand system. Secondarily, perceived pain and the need of re-anesthesia were assessed.

MATERIAL AND METHODS

Patients were randomly assigned to the experimental group (detailed explanation about The Wand) or control group (no specific information). Local anesthesia with The Wand consisted in a supraperiosteal infiltrative technique injection 1.6 mL at the buccal and 0.2 mL at the palatal side. Distinct questionnaires for assessing dental anxiety and 100-mm visual analog scales to assess pain were delivered. Demographic data, radiological parameters, operative time and type of intervention were also registered. A descriptive bivariate analysis by non-parametric tests to detect differences in anxiety, pain and re-anesthesia was performed by SPSS 22.0 (SPPS Inc. Chicago, USA).

RESULTS

A total of 85 patients were assessed for eligibility but 17 participants were lost due to the cancellation of the visit for the surgical intervention. Finally, sixty-eight patients were included (34 participants in each group), 47 women (69.1%) and 21 men (30.9%), with an average age of 28.8 (± 9.3) years.

CONCLUSIONS

Patients that received a detailed explanation of The Wand did not have a significant reduction of the anxiety degree and perceived pain during the anesthetic act compared to patients that received no information. The need of re-anesthesia was not related to the anxiety level but was significantly related to increasing operative time.

Making inferior alveolar nerve block more comfortable via computer-controlled local anesthetic delivery: A prospective clinical study

Background

The fear of needle insertion and pain during anesthesia is a source of patient dissatisfaction in dentistry. Inferior alveolar nerve block (IANB) remains the most common type of block and is in itself painful. Computer-controlled local anesthetic delivery (CCLAD) has been proven to reduce the pain associated with injection of anesthetics in various blocks. However, the efficacy of CCLAD for IANB in adults remains unknown.

Methods

Sixty-four adult patients requiring bilateral IANB were selected and divided into two groups: group A (50 patients receiving IANB via CCLAD) and group B (50 patients receiving IANB using a conventional cartridge syringe). Pain perception and patient comfort were assessed using the visual analog scale and the 5-point semantic scale, respectively.

Results

The pain perception was compared between the two groups using the Mann-Whitney U-test, and the P value was 0.003. The patient comfort was also compared using the same test, and the P value was 0.484.

Conclusion

A significant difference was observed in the pain perception of the patients during CCLAD. The patient comfort was grossly equal for both techniques.

Inferior Alveolar Nerve Block Injection Pain Using a Computer-Controlled Local Anesthetic Device (CCLAD): A Prospective, Randomized Study

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.

Structural damage to periodontal tissues at varying rate of anesthetic injection

Background

Incorrect administration of an anesthetic during local anesthesia is one of the most important causes of pain symptoms in patients scheduled for dental procedures. The current study assessed the severity of damage to periodontal tissue following different rates of anesthetic administration.

Methods

The research was conducted on 50 outbred male rats with a body mass of 180–240 g. The anesthetic used was 1% articaine.

Results

The results showed that administration of the anesthetic at a rapid pace caused structural damage to the periodontal tissue. Further, signs of impaired microcirculation were noted at all rates of administration. Biochemical studies demonstrated changes in the level of glucose and enzymes with the rapid introduction of the anesthetic, indicating severe systemic stress response of the body.

Conclusions

Injection of local anesthetic at any rate of introduction induces vascular congestion in the microcirculatory bloodstream and exudative reactions. Rapid introduction of an anesthetic causes progression of structural changes in the gingival tissue.

Single tooth anesthesia versus conventional anesthesia: a cross-over study

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.

Avaliação da eficácia anestésica do Morpheus® através da técnica intrasseptal CaZOE na pulpotomia de dentes decíduos: estudo-piloto

Resumo Introdução O medo de sentir dor é um dos principais motivos pelos quais muitos pacientes evitam submeter-se a tratamento dentário, principalmente as crianças. Em vários procedimentos odontopediátricos, o uso de anestésicos locais se faz necessário. O aparelho Morpheus® se propõe a uma introdução da agulha sem dor e anestesia satisfatória com uso de menor volume de anestésico local. Associando-o à técnica CaZOE, o paciente perceberia a pressão antes da dor, podendo assim evitá-la. Objetivo Avaliar a eficácia anestésica do Morpheus® através da técnica intrasseptal CaZOE na pulpotomia de molares inferiores decíduos. Material e método Dezenove voluntários foram selecionados de acordo com os critérios de inclusão e exclusão. O procedimento foi realizado em sessão única, utilizando 0,9 mL de Articaína 4% com epinefrina 1:100.000, através da técnica anestésica CaZOE, empregando o injetor de anestésicos Morpheus®. Esta foi realizada por um único operador, não envolvido na avaliação dos parâmetros da anestesia, e seguiu as recomendações do fabricante. Para a análise dos dados, foi realizada estatística descritiva. Resultado Dos 19 voluntários, 63% foram do sexo feminino e 37%, do masculino. Em pouco mais da metade da amostra (63%), houve sucesso na realização do procedimento. Os casos de insucesso (37%) ocorreram durante a abertura coronária e a amputação da polpa. Conclusão A eficácia anestésica do Morpheus® através da técnica intrasseptal CaZOE na pulpotomia de molares inferiores decíduos foi constatada em 63% da amostra. Para que possa ser comprovada a eficácia desse sistema, são necessários mais estudos.

Pain Experience and Behavior Management in Pediatric Dentistry: A Comparison between Traditional Local Anesthesia and the Wand Computerized Delivery System

Aim. To evaluate the pain experience and behavior during dental injection, using the Wand computerized delivery system versus conventional local anesthesia in children and adolescents. Methods. An observational crossover split mouth study was performed on 67 patients (aged 7 to 15 years), requiring local anesthesia for dental treatments in both sides of the dental arch. Patients received both types of injections in two separate appointments, one with the use of a Computer Delivery System (the Wand STA system) and one with the traditional syringe. The following data were recorded: pain rating; changes in heart rate; level of collaboration; patient satisfaction. The data were analyzed using ANOVA for quantitative outcomes and nonparametric analysis (Kruskal–Wallis) for qualitative parameters. Results. The use of the Wand system determined significantly lower pain ratings and lower increase of heart rate than the traditional syringe. During injection, the number of patients showing a relaxed behavior was higher with the Wand than with the traditional local anesthesia. The patient level of satisfaction was higher with the Wand compared to the conventional local anesthesia. Conclusions. The Wand system may provide a less painful injection when compared to the conventional local anesthesia and it seemed to be better tolerated with respect to a traditional syringe.

Comparação do nível álgico no bloqueio do nervo alveolar inferior através de duas técnicas distintas

Resumo Introdução O bloqueio do nervo alveolar inferior está entre as anestesias mais utilizadas e importantes da Odontologia; porém, não há estudos que comparem a anestesia eletrônica (Morpheus) e a anestesia tradicional manual, utilizando a seringa Carpule. Objetivo Avaliar comparativamente dois sistemas de anestesia com relação à sensibilidade dolorosa durante e após a anestesia, com a administração de lidocaína 2% associada à epinefrina 1:100.000, na técnica anestésica para o nervo alveolar inferior. Material e método Este ensaio clínico foi executado de modo randomizado, cruzado e duplamente cego, envolvendo 30 voluntários, que necessitavam de tratamento odontológico e que se submeteram ao bloqueio do nervo alveolar inferior, utilizando a seringa tipo Carpule na primeira sessão e o injetor de velocidade controlada Morpheus, o qual foi realizado em duas sessões, com intervalo de pelo menos duas semanas entre cada sessão. Ao final de cada sessão, foi aplicada a Escala Visual Analógica (EAV), para avaliação da sensibilidade dolorosa à injeção. Resultado A comparação entre os métodos revelou que o convencional mostrou induzir maiores valores na EAV do que o Morpheus. O teste do Qui-Quadrado, para proporções esperadas iguais, mostrou que a técnica com Morpheus obteve maior (p=0,0062) preferência do que a convencional. Conclusão No conjunto, os dados revelam que a técnica empregando o Morpheus foi superior à convencional nos três momentos. A execução da anestesia realizada com Morpheus mostrou ser mais confortável e ter aceitação e maior preferência dos voluntários.

Use of Pre-Injection Diffusion of Local Anaesthetic as a Means of Reducing Needle Penetration Discomfort

AIM

To determine if pre-injection diffusion of local anaesthetic solution influences the discomfort of needle penetration in the palate.

METHODS

A placebo-controlled, randomised, double-blind split-mouth investigation was conducted. 25 healthy adult volunteers were recruited and each received two needle penetrations in a random order during one visit. The penetration sites were 1 cm from the gingival margin of the first maxillary premolars on each side of the mouth. 30 gauge-13 mm needles which were attached to syringes that contained either 2% lidocaine with 0.125mg/ml epinephrine or physiological saline were used. For each penetration an operator encouraged a drop of solution to appear at the end of the needle and placed this drop with the bevel of the needle flat on the palate for 20 seconds. The discomfort was noted on a 100 mm visual analogue scale with end points marked "No pain" and "Unbearable pain".

RESULTS

There was no significant difference in penetration discomfort between solutions, (mean VAS = 26.80±19.36mm for lidocaine and 26.20±18.39mm for saline) however the 2nd penetration was significantly more uncomfortable than the first (mean VAS = 31.00±19.84 mm and 22.00±16.65 mm respectively).

CONCLUSION

Pre-injection diffusion of local anaesthetic solution did not influence the discomfort of needle penetration in the palate.

Evaluation of the injection pain with the use of DentalVibe injection system during supraperiosteal anaesthesia in children: a randomised clinical trial

PURPOSE

The purpose of this study was to compare the use of a traditional syringe (TS) and the DentalVibe (DV) Injection Comfort System on the pain of needle insertion and injection of supraperiosteal (SP) anaesthesia into the mandibles and maxillas of children aged 6-12 years.

METHODS

The study was a randomised, controlled, crossover clinical trial, comprising 60 children requiring an operative procedure with SP anaesthesia on both their mandibular and maxillary molars, bilaterally. One of the molars was treated with a TS, and the contralateral tooth was treated with the DV for both arches. On each visit, subjective and objective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and the Face, Leg, Activity, Cry, Consolability Scale. Patients were asked which technique they preferred. The data were analysed using Wilcoxon signed-rank test, Spearman's correlation test, and Mann-Whitney U-test.

RESULTS

No statistically significant differences were noted between TS and DV for pain during injection and needle insertion for supraperiosteal anaesthesia in either the maxillary and mandibular operative procedures.

CONCLUSIONS

Children experienced similar pain during SP anaesthesia administered with a TS and the DV, regardless of gender and jaw differences. DV was less preferred over the traditional procedure in children.

Comparative Analysis Between Computed and Conventional Inferior Alveolar Nerve Block Techniques

OBJECTIVE

The aim of this randomized, double-blind, controlled trial was to compare the computed and conventional inferior alveolar nerve block techniques in symmetrically positioned inferior third molars.

PATIENTS AND METHODS

Both computed and conventional anesthetic techniques were performed in 29 healthy patients (58 surgeries) aged between 18 and 40 years. The anesthetic of choice was 2% lidocaine with 1: 200,000 epinephrine. The Visual Analogue Scale assessed the pain variable after anesthetic infiltration. Patient satisfaction was evaluated using the Likert Scale. Heart and respiratory rates, mean time to perform technique, and the need for additional anesthesia were also evaluated.

RESULTS

Pain variable means were higher for the conventional technique as compared with computed, 3.45 ± 2.73 and 2.86 ± 1.96, respectively, but no statistically significant differences were found (P > 0.05). Patient satisfaction showed no statistically significant differences. The average computed technique runtime and the conventional were 3.85 and 1.61 minutes, respectively, showing statistically significant differences (P <0.001).

CONCLUSIONS

The computed anesthetic technique showed lower mean pain perception, but did not show statistically significant differences when contrasted to the conventional technique.

Computer-controlled local anesthetic delivery for painless anesthesia: a literature review

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.

Relief of Injection Pain During Delivery of Local Anesthesia by Computer-Controlled Anesthetic Delivery System for Periodontal Surgery: Randomized Clinical Controlled Trial

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.

Administration of anesthetics using metal syringes. An ex vivo study

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.

Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

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.