Novel dental anesthetic and associated devices: a scoping review

Comparison of injection pain levels using conventional and computer-controlled local anesthetic delivery systems in pediatric dentistry: A systematic review and meta-analysis

OBJECTIVES

This systematic review aimed to evaluate the effectiveness of computer-controlled local anesthetic delivery (CCLAD) systems in reducing injection pain in pediatric patients aged 3-14 years, including subgroup analysis across different injection techniques.

DATA

Randomized controlled trials comparing pain perception associated with CCLAD versus conventional injection methods in children published from January 2015 to November 2024 were included.

SOURCES

Comprehensive searches were performed in Embase, Medline (via PubMed), Cochrane Library, Scopus, Web of Science, and Google Scholar, limited to articles published in English.

STUDY SELECTION

From 1253 identified studies, 20 met the inclusion criteria. Meta-analysis revealed that CCLAD significantly reduced pain perception based on the Wong-Baker Pain Rating Scale (WBS) (SMD = -0.98, p = 0.011) and heart rate (HR) measurements (SMD = -0.25, p = 0.013), with high and moderate heterogeneity, respectively. Subgroup analysis indicated significant pain reduction with CCLAD compared to conventional Inferior Alveolar Nerve Block (IANB) on WBS, though findings varied across other scales and injection methods, demonstrating some non-significant differences. No significant differences were observed in other pain assessment parameters. The overall risk of bias was low in five studies, with evidence certainty ranging from very low to moderate.

CONCLUSION

CCLAD demonstrates potential as a non-pharmacological tool for reducing injection pain in children, particularly as assessed by WBS and HR. Furthermore, CCLAD significantly reduced pain compared to conventional IANB injections in subgroup analyses. Additional research is necessary to optimize treatment protocols and further evaluate the impact of CCLAD on objective pain measures.

CLINICAL SIGNIFICANCE

This study highlights the benefits of CCLAD in pediatric dentistry, particularly its effectiveness in minimizing pain and stress during local anesthetic injections, especially for IANB procedures. Using CCLAD can enhance patient comfort, improve cooperation, and foster a positive dental experience, thereby supporting better treatment outcomes in pediatric patients requiring precise and low-pain care.

Analysis of Pain and Effectiveness in Digital Block of the First Toe Using Syringe vs. Carpule: Frost's H vs. Modified Frost's H Randomized Clinical Trial

Background: Currently, there is no scientific evidence regarding pain in the anesthetic block of the first toe according to the method of application. However, clinical evidence has highlighted the use of the carpule due to the low pain it causes during the administration of the anesthetic. Most studies on anesthesia and pain, especially using the carpule and distraction methods, belong to the field of dentistry. Objective: To compare the pain and effectiveness between the anesthetic block of the first toe using a carpule and syringe with Frost's H technique and the modified Frost's H technique. Method: A total of 564 subjects were selected and divided into four groups. Subjects were subjected to experimental conditions (randomization through the Random Allocation Software program 2.0), and divided into group 1 = 138 subjects, corresponding to the block with syringe and Frost's H, group 2 = 141 subjects, corresponding to the syringe group and modified Frost's H, group 3 = 141 subjects, corresponding to the carpule group and modified Frost's H, and group 4 = 144 subjects, corresponding to the carpule group and Frost's H. The same researcher generated the random allocation sequence, enrolled the participants, and assigned them to the interventions. Each subject was unaware of the anesthetic procedure assigned by the researcher. Outcome parameters were pain after anesthetic infiltration and its effectiveness. Results: The anesthetic block with carpule showed a lower pain score compared to the anesthetic block with syringe (2.8 vs. 5.3; p < 0.001). However, when analyzing effectiveness, a higher efficacy rate was obtained in the anesthetic blocks performed using the modified Frost's H technique (97.5% vs. 88.1%; p < 0.001). Conclusions: The anesthetic block with carpule and the modified Frost's H technique is less painful and more effective than the traditional anesthetic block.