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Objectives: This in vivo study aimed to assess the impact of needle bevel design on puncture pain, anesthetic success, and mechanical deformations in intraligamentary injection (ILA) cases, comparing a short triple facet cut (STF) to a triple lancet cut (TL) after single or repetitive use. Materials and methods: In a prospective single-blind trial, 200 ILA needles (STF, n = 100; TL, n = 100) were randomly assigned for dental procedures. Patients received ILA either with STF or TL needles, used once (group A; n = 50 each) or repeatedly (group B; n = 50). Puncture pain was assessed using a numerical rating scale (NRS). Anesthetic success was determined via cold spray (yes/no), and scanning electron microscopy (SEM) analyzed needle tip deformations. Results: Puncture pain did not significantly differ between STF and TL, regardless of needle use or injection area. Success rates were comparable in single use (82% STF vs. 79% TL; p > 0.05). For repetitive use, STF exhibited a significantly higher success rate (80% vs. 69%; p = 0.012). Mechanical deformations were prevalent in 97.5% of needles, with TL showing greater deformations than STF after single and repeated uses. Barbs were more common in TL (90/100) than STF (84/100), with a higher relative risk for barbed-like deformation in TL (RR single use: 1.26; p < 0.001; multiple use: 7.87, p < 0.001). Conclusions: The short triple facet-designed bevel demonstrated significantly less mechanical deformation, suggesting potential advantages in maintaining needle lumen patency. Clinical relevance: The intraligamentary needle bevel design is linked to mechanical deformation and anesthetic success after repetitive use, but not to puncture pain. [ABSTRACT FROM AUTHOR]

The purpose of this prospective study was to determine the effect of a combination of nitrous oxide/oxygen and 1 set of supplemental intraligamentary/periodontal ligament (PDL) injections followed by a second set of PDL injections on anesthetic success in patients with symptomatic irreversible pulpitis (SIP). Ninety-four patients with a mandibular posterior tooth diagnosed with SIP received nitrous oxide/oxygen and an inferior alveolar nerve block (IANB) with 2% lidocaine with 1:100,000 epinephrine. Patients rated the pain of PDL injections and endodontic access on a visual analog scale. If moderate to severe pain was felt during treatment, the operator administered 1 set of supplemental PDL injections with 4% articaine with 1:100,000 epinephrine. If moderate to severe pain was felt again during treatment, the operator administered a second set of supplemental PDL injections. Anesthetic success was defined as having no to mild pain during endodontic treatment. The success of the IANB with nitrous oxide was 44% (95% confidence interval [CI], 34%–54%). The overall anesthetic success rate (IANB with PDL injections) was increased from 69% (95% CI, 60%–78%) with 1 set of PDL injections to 80% (95% CI, 72%–88%) with a second set of PDL injections. Although the second set of PDL injections increased anesthetic success, it was not sufficient to ensure complete pulpal anesthesia. [ABSTRACT FROM AUTHOR]

Peer W Kämmerer, Monika Daubländer Department of Oral, Maxillofacial and Facial Plastic Surgery, University Medical Centre Mainz, Mainz, GermanyWe read the article by Al-Shayyab1 with great interest, though we think that there is a methodical bias. Usage of standard dental syringes with 27-gauge needles is not recommended for periodontal ligament (PDL) injections as they are very unlikely to achieve the correct pressure needed for successful single tooth anesthesia. In accordance with this, specialized syringes with short 30-gauge needles are commonly used all over the literature.2 The author addresses this in the “Discussion” section and writes that “a standard conventional dental syringe was used in the present study, not a special PDL syringe, since the former is readily available in the clinic and proves equally successful when a standard 27-gauge short needle was used,” citing Malamed from 1982 (a time during which the modern PDL syringes were not developed yet3) and Madan et al who write that “intraligamentary injection technique is equally effective when a standard 27-gauge needle is used”.4 The second assumption refers to the needle only, not the syringe. In addition, this needle issue is not proven by any reference or study. Therefore, one might come to the conclusion that PDL was not carried out correctly. Also, the authors did not evaluate pulp or tissue anesthesia and started the extraction procedure after a latency period of 5 minutes in all cases. In accordance with this, the success rates of the PDL injection cannot be given, but would be of interest.View the original paper by Al-Shayyab and colleagues.

Intraligamentary anesthesia was described in France early in the 20th century as a novel and effective method of dental local anesthesia, but the method did not become established because of the inadequacy of dental instruments available at the time. Today, the use of a state-of-the-art armamentarium and the administration of well-proven anesthetic agents with intraligamentary anesthesia reduce the experience of typical unwanted effects, that is, sensation of elongation, pressure pain, precontact after the end of the analgesia, and reversible tissue changes. Dosing lever and dosing wheel syringes in combination with system-adapted injection needles enable the operator to feel the back-pressure and inject the anesthetic smoothly into the periodontal ligament. The results of most recent studies show that periodontal ligament injections do not generate unwanted effects when sensible instruments are used, proven anesthetics are administered, and the anesthesia method is practiced lege artis and mastered safely by the operator. This article discusses the advantages and technique of intraligamentary anesthesia and presents results from recent studies in the literature. [ABSTRACT FROM AUTHOR]

Purpose: To extract the lower anterior teeth, the oral surgeon needs to anesthetize the pulpal tissue of the accused tooth and the surrounding tissues. The lingual nerve innervates the lingual soft tissue to the lower teeth, this nerve usually anesthetized alongside the inferior alveolar nerve by a block technique. However, the lingual tissue of the lower anterior teeth usually anesthetized by either infiltration or periodontal ligament injection (PDL) techniques. This study was intended to compare between these two techniques. Methods: Forty-eight teeth were extracted from 24 patients. Non-adjacent two lower anterior teeth in the same patient were selected. The lingual soft tissue in one of them was anesthetized by PDL injection technique while the other tooth by infiltration technique. Results: The study included 24 patients (14 males and 10 females). There was no significant difference in relation to the pain during injection between the two groups, while there was a significant difference between the two groups in relation to bleeding. Conclusions: A recommendation was made to use the PDL injection technique to anesthetize the lingual soft tissue during extraction of the lower anterior teeth. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the study was to compare the efficacy of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) for extraction of mandibular posterior teeth.Materials and methods: In a prospective clinical trial, a total of 301 mandibular posterior teeth were extracted in 266 patients. Randomization was conducted into those who received ILA (patients n = 98; teeth n = 105) and those who received IANB (patient n = 140; teeth n = 140). Twenty-eight patients were subjected to bilateral mandibular dental extractions and received both ILA und IANB (teeth n = 56 (ILA n = 28; IANB n = 28)). The primary objective was to evaluate the differences in pain during injection, in pain during tooth extraction (numeric rating scale (NRS)), and in anesthetic quality (complete/sufficient vs. insufficient/no effect). Differences in latency time, amount of anesthetic solution, need for second injection, and duration of local numbness as well as in the incidence of dry socket were assessed.Results: ILA had significant lower pain of injection (p < 0.001), shorter latency time (p < 0.001), and shorter duration of local numbness (p < 0.001) and required lesser amount of local anesthetic solution (p < 0.001) together with a similar anesthetic quality (p = 0.082) compared to IANB. Concerning pain during extraction (p = 0.211), frequency of second injection (p = 0.197), and incidence of dry socket (p = 0.178), no significant differences were detected.Conclusion: ILA fulfills the requirements of a minimal invasive and patient-friendly local anesthetic technique. In accordance, it represents a safe and reliable alternative to IANB for extraction of mandibular posterior teeth.Clinical relevance: ILA can be recommended for routine dental extractions. [ABSTRACT FROM AUTHOR]

ABSTRACTAims The periodontal ligament injection in isolated areas of the mandible was clinically evaluated us-ing only a conventional dental cartridge syringe. Materials and Methods: One hundred subjects requir-ing extractions of either premolars or molars participated in the study. Results: A high percentage of success rate (85%) was achieved but with unfavorable comment from the patient in regard to a painful injection. Duration of surgical anesthesia following the injection proved to be adequate in almost all extractions performed. Conclusions: New devices for performing this injection appear to have some advantage over the conventional syringe technique. However, these devices were unfortunately unavail-able at the area of study. Further studies are recommended to further evaluate its success and also to determine the response of both the periodontal ligament and pulpal tissue in cases were restorative treatment of teeth is to be undertaken for example crowns, bridges and fillings

Abstract Aim: To evaluate the effectiveness of periodontal ligament injection of 2% lidocaine with 1:80,000 adrenaline in producing profound pulp anaesthesia and soft tissue anaesthesia. Materials and Methods: The sample of this study included 120 dental students, 72 males and 48 females, ranging in age from 18 to 23 years. The periodontal injection was administered to the periodontal space on the mesial and distal aspects of the central incisor, first premolar and first molar of both arches. The injection was administered by a standard dental syringe using 0.2 ml of 2% lidocaine with 1:80,000 adrenaline. The pulp anaesthesia was evaluated by electric pulp tester and soft tissue anaesthesia was evaluated by probing. Results: The success rate of pulp anaesthesia in this study was 57.5% (60% in the maxilla and 55% in the mandible). In both arches, first premolar and first molar teeth showed a significantly higher success rate than that of central incisor (p0.05). The duration of pulp anaesthesia was 18.34 minutes. The duration of pulp anaesthesia was significantly longer in the mandibular than maxillary teeth (p0.05). Conclusion: The periodontal ligament injection anaesthesia has a higher success rate in premolars and molars as compared to incisors. The duration of pulp anaesthesia was 18.34 minutes. The extent of soft tissue anaesthesia was 14.77 mm on the labial aspect and 11.18 mm on the lingual aspect.

Objective To evaluate the effectiveness and safety of a computer-controlled periodontal ligament (PDL) injection system to the local soft tissues as the primary technique in endodontic access to mandibular posterior teeth in patients with irreversible pulpitis. Methods A total of 162 Chinese patients who had been diagnosed with irreversible pulpitis in their mandibular posterior teeth without acute infection or inflammation in the periodontal tissues were enrolled in this clinical study. The patients were divided into 3 groups according to the position of the involved tooth: the premolar group (PM, n =38), first molar group (FM, n =66), and second molar group (SM, n =58). All the patients received computer-controlled PDL injection with 4% articaine and 1?100 000 epinephrine. Immediately after the injection, endodontic access was performed, and the degree of pain during the treatment was evaluated by the patients using Visual Analogue Scale for pain. The success rates were compared among the 3 groups. The responses of local soft tissues were evaluated 3-8 days and 3 weeks after the procedure. Results The overall success rate was 76.5%. There was a significant difference in success rates among the PM, FM, and SM groups (92.1%, 53.0%, 93.1%, respectively; χ 2 =34.3, P <0.01). Both the PM and SM groups showed higher success rates than that of the FM group ( v =1, χ 2 =16.73, P <0.01; v =1, χ 2 =24.5, P <0.01). No irreversible adverse effects on the periodontal soft tissues at the injection sites were observed in the follow-up visits in any of the groups. Conclusion The computer-controlled PDL injection system demonstrates both satisfactory anesthetic effects and safety in local soft tissues as primary anesthetic technique in endodontic access to the mandibular posterior teeth in patients with irreversible pulpitis. [ABSTRACT FROM AUTHOR]

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The objective of this research was to assess how aware house officers and post graduate trainees are about periodontal ligament injections. 150 questionnaires were distributed but only 105 responses were received. The questionnaire consisted of 10 questions in which participants were asked basic questions about injection technique for extractions and knowledge about periodontal ligament injection. All 105 responses were sent for statistical analysis. Out of 105 participants; 49.5% used nerve infiltration, 35.2% used nerve block, 13.3% used both and 1% used periodontal ligament injection for extraction. The technique used for effective anaesthesia for extraction of tooth was nerve block 82.8%, periodontal ligament injection 7.6%, 6.7% Nerve infiltration, 2.9% pulpal injection. It is concluded that many house officers and post graduate trainees know about the PDL injection but they apply this method of anesthesia in circumstances when the routine infiltration and block (IANB) fail to be effective. [ABSTRACT FROM AUTHOR]