Intraligamentary and Supraperiosteal Anesthesia Efficacy Using a Computer Controlled Delivery System in Mandibular Molars

Purpose: The purpose of this study was to compare pain, efficacy and postoperative complications of anesthesia in first primary mandibular molars anesthetized with either intraligamentary (IL) or supraperiosteal (SP) anesthesia using a computer-controlled delivery system (CCDS). Study design: This randomized, controlled-crossover, blind clinical trial was conducted with 90 children requiring bilateral extraction, pulpotomy or restorative treatment of first mandibular primary molars. A CCDS was used to deliver IL anesthesia to 1 deciduous tooth and SP anesthesia to the contralateral tooth in each patient. Severity of pain and efficacy of anesthesia during the treatments were evaluated using the Wong-Baker Faces Pain Rating Scale (PRS) and comfort and side effects were assessed using post-injection and post-treatment questionnaires. Data were analyzed using χ2 and Mann-Whitney U tests. Results: According to PRS scores, pain levels during extraction were significantly higher with IL when compared to SP. Patients reported significantly less pain during needle insertion with SP when compared to IL; however, rates of postoperative complications were significantly higher with SP when compared to IL. Conclusions: CCDS-administered IL anesthesia and SP anesthesia were similarly effective when used during restorative treatment and pulpotomy of primary mandibular molars; however, SP was more effective than IL when used during extraction procedures.

intraligamentary, supraperiosteal anesthesia, computer-controlled delivery system

1. Conlon PM. Assessment of pain in the paediatric patient. Paediatrics and Child Health;19(1):85-7. 2009.

2. Zarbock SF. Pediatric pain assessment. Home Care Provid 2000;5(5):181-4.

3. Sixou JL, Barbosa-Rogier ME. Efficacy of intraosseous injections of anesthetic in children and adolescents. Oral Surg Oral Med Oral Pathol Oral Radiol Endod;106(2):173-8. 2008.

4. Milgrom P, Coldwell SE, Getz T, Weinstein P, Ramsay DS. Four dimensions of fear of dental injections. J Am Dent Assoc;128(6):756–66. 1997.

5. Ram D, Amir E. Comparison of articaine 4% and lidocaine 2% in pediatric dental patients. Int J Paediatr Dent;16(4):252-6. 2006.

6. Lackey AD. New horizons in local anesthesia. Dent Today;17(8):78-9. 1998.

7. Ozer S, Yaltirik M, Kirli I, Yargic I. A comparative evaluation of pain and anxiety levels in 2 different anesthesia techniques: locoregional anesthesia using conventional syringe versus intraosseous anesthesia using a computer- controlled system (Quick sleeper). Oral Surg Oral Med Oral Pathol Oral Radiol;114(5):132-9. 2012.

8. Sumer M, Misir F, Koyuturk AE. Comparison of the Wand with a conventional technique. Oral Surg Oral Med Oral Pathol Oral Radiol Endod;101(6):106-9. 2006.

9. Ram D, Peretz B. The assessment of pain sensation during local anesthesia using a computerized local anesthesia (Wand) and a conventional syringe. J Dent Child;70(2):130-3. 2003.

10. Ran D, Peretz B. Assessing the pain reaction of children receiving periodontal ligament anesthesia using a computerized device (Wand). J Clin Pediatr Dent 2003;27(3):247-50.

11. Klein U, Hunzeker C, Hutfless S, Galloway A. Quality of anesthesia for the maxillary primary anterior segment in pediatric patients: comparison of the P-ASA nerve block using CompuMed delivery system vs traditional supraperiosteal injections. J Dent Child;72(3):119-25. 2005.

12. Allen KD, Kotil D, Larzelere RE, Hutfless S, Beiraghi S. Comparison of a computerized anesthesia device with a traditional syringe in preschool children. Pediatr Dent;24(4):315-20. 2002.

13. Wong JK. Adjuncts to local anesthesia: separating fact from fiction. J Can Dent Assoc;67(7):391-7. 2001.

14. Malamed SF. Techniques of Mandibular Anesthesia. Handbook of Local Anesthesia. 5th ed. St. Louis: Elsevier Mosby;:227-53. 2004.

15. Berlin J, Nusstein J, Reader A, Beck M, Weaver J. Efficacy of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod;99(3):361-6. 2005.

16. Malamed SF. Supplemental Injections Techniques. In: Malamed SF, eds. Handbook of Local Anesthesia. 5th ed. St. Louis: Elsevier Mosby;:255-68. 2004.

17. Malamed SF. Local Complications. Handbook of Local Anesthesia. 5th ed. St. Louis: Elsevier Mosby;:285-381. 2004,

18. Ashkenazi M, Blumer S, Eli I. Effectiveness of computerized delivery of intrasulcular anesthetic in primary molars. JADA;136(10):1418-25. 2005. 19. Versloot J, Veerkamp JS, Hoogstraten J. Computerized anesthesia delivery system vs. traditional syringe: comparing pain and pain-related behavior in children. Eur J Oral Sci;113(6):488-93. 2005.

20. Brannstorm M, Lindskoq S, Nordenvall K. Enamel hypoplasia in permanent teeth induced by periodontal ligament anesthesia of primary teeth. JADA;109:735-736. 1984.

21. Ashkenazi M, Blumer S, Eli I. Effect of computerized delivery intraligamental injection in primary molars on their corresponding permanent tooth buds. Int J Paediatr Dent;20(4):270-5. 2010.

22. Wright GZ, Weinberger SJ, Marti R, Plotzke O. The effectiveness of infiltration anesthesia in the mandibular primary molar region. Pediatr Dent;13(5):278-83. 1991.

23. Sharaf AA. Evaluation of mandibular infiltration versus block anesthesia in pediatric dentistry. ASDC J Dent Child;64(4):276-81. 1997.

24. Naidu S, Loughlin P, Coldwell SE, Noonan CJ, Milgrom P. A randomized controlled trial comparing mandibular local anesthesia techniques in children receiving nitrousoxide-oxygensedation. Anesth Prog;51(1):19-23. 2004.

25. Oulis CJ, Vadiakas GP, Vasilopoulou A. The effectiveness of mandibularinfiltration compared to mandibular block anest hesia in treating primary molars in children. Pediatr Dent;18(4):301-5. 19.96

26. Raadal M, Lundeberg S, Haukali G. Pain, Pain Control and Sedation in Children and Adolescents. In: Koch G, Paulsen S, eds. A Clinical Approach, 2nd ed. Oxford: Blackwell Publishing;:44-59. 2009.

27. Guideline on Use of Local Anesthesia for Pediatric Dental Patients. Available at: “http://www.aapd.org/media/Policies_Guidelines/G_LocalAnesthesia.pdf”. Accessed May, 2013.

28. Meechan J. Infiltration anesthesia in the mandible. Dent Clin North Am;54(4):621-9. 2010.

29. Salomon E, Mazzoleni S, Sivolella S et al. Age limit for infiltration anaesthesia for the conservative treatment of mandibular first molars: A clinical study on a pediatric population. Eur J Paediatr Dent;13(3):259-62. 2012.

30. Tudeshchoie DG, Rozbahany NA, Hajiahmadi M. Comparison of the efficacy of two anesthetic techniques of mandibular primary first molar: A randomized clinical trial. Dent Res J;10(5):620-3. 2013.

31. Dudkiewicz A, Schwartz S, Laliberté R, Barifar E. Effectiveness of mandibular infiltration in children using the local anesthetic Ultracaine (articaine hydrochloride). J Can Dent Assoc;53(1):29-31. 1987.

32. Corbett IP, Kanaa MD, Whitworth JM, Meechan JG. Articaine infiltration for anesthesia of mandibular first molars. J Endod 2008;34(5):514-8.

33. El-Kholey KE. Infiltration anesthesia for extraction of the mandibular molars. J Oral Maxillofac Surg;71(10):1658-5. 2013.

34. Leong KJ1, Roberts GJ, Ashley PF. Perioperative local anesthetic in young pediatric patients undergoing extractions under outpatient ‘short-case’ general anesthesia. A double-blind randomized controlled trial. Br Dent J;203(6):334-5. 2007.

35. Ashkenazi M, Blumer S, Eli I. Effectiveness of various modes of computerized delivery of local anesthesia in primary maxillary molars. Pediatr Dent;28(1):29-38. 2006.

36. Abdellatif MA. Pain assessment of two palatal anethesia techniques and their effects on the child’s behaviour. Pediatric Dental Journal;21(2) 129-37.2011.

37. Wright GZ. Non pharmacologic management of children’s behaviors. In: Mc-Donald RE, Avery DR, Dean JA, eds. Dentistry for the Child and Adolescent. 8th ed. Maryland: Mosby-Elsevier;:33-49. 2004.

38. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs 1988;14(1):9-17.

39. Yassen GH. Evaluation of mandibular infiltration versus mandibular block anesthesia in treating primary canines in children. Int J Paediatr Dent;20(1):43-9. 2010.

40. Yilmaz Y1, Eyuboglu O, Keles S. Comparison of the efficacy of articaine and prilocaine local anesthesia for pulpotomy of maxillary and mandibular primary molars. Eur J Paediatr Dent;12(2):117-22. 2011.

41. Ram D, Hermida LB, Peretz B. A comparison of warmed and room-temperature anesthetic for local anesthesia in children. Pediatr Dent;24(4):333-6. 2002.

42. Lawaty I, Drum M, Reader A, Nusstein J. A prospective, randomized, double-blind comparison of 2% mepivacaine with 1: 20,000 levonordefrin versus 2% lidocaine with 1: 100,000 epinephrine for maxillary infiltrations. Anesth Prog;57(4):139-44. 2010.

43. Merkel S, Malviya S. Pediatric Pain, Tools, and Assessment. J Perianesth Nurs;15(6):408-14. 2000.

44. Koyuturk AE, Avsar A, Sumer M. Efficacy of dental practitioners in injection techniques: Computerized device and traditional syringe. Quintessence Int;40(1):73-7. 2009.

45. Yenisey M. Comparison of the pain levels of computer-controlled and conventional anesthesia techniques in prosthodontic treatment. J Appl Oral Sci;17(5):414-20. 2009.

46. Zhao X, Liu H, Qin M. Application of computer-controlled local anesthetic delivery system in children. Hua Xi Kou Qiang Yi Xue Za Zhi;29(4):389- 92. 2011.

47. Sammons HM, Unsworth V, Gray C, Choonara I, Cherrill J, Quirke W. Randomized controlled trial of the intraligamental use of a local anesthetic (lignocaine 2%) versus controls in pediatric tooth extraction. Int J Paediatr Dent;17(4):297-303. 2007.

48. Kuster CG, Udin RD. Frequency of hematoma formation subsequent to injection of dental local anesthetics in children. Anesth Prog.;31(3):130-2. 1984.