Comparative Evaluation of the Efficacy of Intraligamentary and Supraperiosteal Injections in the Extraction of Maxillary Teeth: A Randomized Controlled Clinical Trial

Abstract

The aim of this clinical trial was to compare the efficiency of the intraligamentary (periodontal ligament) injection with supraperiosteal injections in extraction of maxillary teeth, using pain during injection and extraction as the parameters. Thirty patients indicated for extraction of maxillary molars were randomly allocated into one of the following intervention groups (n = 15): intraligamentary injection and supraperiosteal injection. In both groups, anesthesia was given using a standard volume of 2% lignocaine with adrenaline 1:2,00,000 with a 27G needle. Patients indicated pain during injection and extraction and this was measured using the visual analog scale (VAS). Statistical analysis of the pain scores was done using chi-square test, Levene's test, and Mann-Whitney U test with the alpha error set at p = 0.05. The mean VAS score for pain during injection was higher for the intraligamentary injection group (VAS = 18.67) than for the supraperiosteal infiltration group (VAS = 16), but this was not statistically significant (p > 0.05). The VAS score during extraction was significantly higher for the intraligamentary injection group (VAS = 34.67) than for the infiltration group (VAS = 20) (p < 0.05). Periodontal ligament injections may not be optimal, "stand-alone" alternatives to supraperiosteal injections in the exodontia of maxillary teeth. Intraligamentary or periodontal injections are useful in extractions on patients with bleeding disorders, as they eliminate the risk of encountering blood vessels during injections as in the case of nerve blocks. The efficacy of intraligamentary injections in extraction of mandibular teeth has been widely studied. This study evaluates the efficacy of this alternate injection technique on maxillary teeth extraction and, if proved successful, can be useful in patients where supraperiosteal injections are contraindicated.