Palatal Injection Research Articles

Evaluation of EMLA cream with microneedle patches in palatal anesthesia in children: a randomized controlled clinical trial

Palatal injections are considered to be one of the most painful dental procedures. As a result, it was important to find alternatives to this painful injection to improve children's cooperation. The dental literature mentioned using EMLA cream as a possible alternative to conventional injections, but its anesthetic effect was debated. Therefore, it was valuable to research the impact of microneedle patches to enhance the effectiveness of this cream. The purpose of this randomized controlled clinical trial was to compare the effectiveness of different methods of anesthesia and pain levels in children aged 7–11 years. The study compared the use of EMLA cream, EMLA with microneedles, and conventional palatal injections. A total of 90 children were randomly assigned to three groups: Group 1 received conventional palatal anesthesia (control), Group 2 received EMLA cream only, and Group 3 received EMLA with microneedles. Pain levels were assessed using the FLACC and Wong-Baker scales at three different time points: T1(during anesthesia), T2(on palatal probing), and T3(during extraction). The FLACC scale revealed a significant difference in pain between groups only at T1 (P value = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value = 1.00). Similarly, the Wong-Baker scale also demonstrated a statistically significant difference in pain between groups only at T1 (P value = 0.000). It was found that the conventional palatal injection group had a higher pain level than the EMLA cream-only group and the group using microneedle patches with EMLA cream (P value = 0.000). However, the other groups did not show significant differences in pain levels during the anesthesia (P value = 0.091). The study concludes that both EMLA cream alone and EMLA with microneedles can be used as an alternative to conventional palatal anesthesia for children.

Is it possible to extract primary maxillary molars without palatal injection?: a controlled clinical trial

ObjectivesThe absolute necessity of a palatal injection for the extraction of primary maxillary molars has never been explored, despite the fact that it is widely known that children do not tolerate local anesthetic injections into the palatal tissue well. The aim of this study was to compare separately the perception of pain in the absence of palatal injection after anesthesia and maxillary primary molar tooth extraction using different anesthetic solutions and different post-anesthetic waiting times.Materials and methodsA single-blinded randomized controlled study was conducted in 78 participants (26 patients with palatal anesthesia (the control groups), and 26 patients with 5 min and 26 patients with 8 min post-anesthetic waiting time without palatal anesthesia (the study groups)). Subjective experiences of pain were evaluated separately after anesthesia and tooth extraction using the Visual Analog Scale (VAS) and the Wong-Baker Faces Pain Rating Scale (WBS).ResultsIn terms of VAS scores obtained following administration of anesthesia, there was a statistically significant difference between the groups (p<0.05). VAS pain scores were reported to be lower in the groups without palatal anesthesia than in the groups with palatal anesthesia. No statistically significant difference was observed in VAS and Wong-Baker scores after tooth extraction between the groups with and without palatal anesthesia (P>0.05).ConclusionsWhile the pain reported following administration of anesthesia was found to be higher in the groups receiving palatal anesthesia, no difference was found between the groups in the pain reported after tooth extraction.Clinical relevanceExtraction of maxillary primary molars is possible without palatal injection by injecting 4% articaine or 2% lidocaine into the buccal vestibule of the tooth with a waiting time of 5 or 8 min.

Buffered versus Non-buffered Local Anaesthesia in Minor Oral Surgery - A Comparative Study.

Commercially available local anaesthetics are acidic solutions associated with the vasopressor sting on injection, relatively slower onset of action and pain during palatal injections. The above drawbacks can be addressed by anaesthetic buffering. This prospective study was aimed at comparing the efficacy of buffered and non-buffered local anaesthesia in the extraction of grossly decayed maxillary molar teeth in relation to pain on local infiltration, onset and duration of action of local anaesthesia. This is a prospective randomised controlled trial done on 100 patients who required bilateral extraction of maxillary molar teeth. In the study group, patients were given buffered local anaesthesia (which was prepared by mixing 2% lignocaine with 1:80,000 adrenaline and 8.4% sodium bicarbonate) before extraction. In the control group, non-buffered local anaesthesia (2% lignocaine with 1:80,000 adrenaline) was given before extraction. Statistical data confirmed that buffering reduces pain on infiltration, decreases the onset and increases the duration of action of the local anaesthesia compared to non-buffered local anaesthesia. All the parameters measured were statistically significant (P = 0.001). The study concludes that buffered local anaesthesia was more beneficial than non-buffered local anaesthesia in reducing pain on injection, providing a quicker onset of local anaesthesia and increasing the duration of action of the local anaesthesia. Buffering is a safe, easy and efficient process and should be routinely followed to provide a better experience to the patients.

Effectiveness of pre-injection use of cryoanesthesia as compared to topical anesthetic gel in reducing pain perception during palatal injections: a randomized controlled trial.

Palatal injections are often painful. We aimed to compare topical ice and 20% benzocaine gel for pre-injection anesthesia before greater palatine nerve block (GPNB) injections. A randomized split-mouth clinical trial was conducted among patients aged 15-60-years needing bilateral GPNB injections. A total of 120 palatal sites from 60 patients were randomly allocated to Group A (topical ice) or Group B (20% benzocaine gel). Pain was evaluated using sound, eye, motor (SEM), and the visual analog scale (VAS) in both groups. Inferential analysis was performed using the Mann-Whitney U test. The mean age of the participants was 20.5 ± 3.9 years. The median VAS score for group A was 11 (Q1 - Q3: 5.25 - 21.75), which was slightly higher than the 10 (Q1 - Q3: 4.0 - 26.75) reported in group B. However, the difference was not statistically significant (P = 0.955). The median SEM score for group A and group B was 3.5 (Q1 - Q3: 3.0 - 4.0) and 4.0 (Q1 - Q3: 3.0 - 4.0), respectively, which was statistically insignificant (P = 0.869). Using ice as a form of topical anesthetic for achieving pre-injection anesthesia before GPNB was as effective as 20% benzocaine gel.

Novel dental anesthetic and associated devices: a scoping review.

The efficient management of pain and discomfort is essential for successful dental treatment and patient compliance. Dental professionals are commonly evaluated for their ability to perform treatment with minimal patient discomfort. Despite advancements in traditional local dental anesthesia techniques, the pain and discomfort associated with injections remain a concern. This scoping review aims to provide a comprehensive overview of the literature on novel dental anesthetics and associated devices designed to alleviate pain and discomfort during dental procedures. The Joanna Briggs Institute and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used to prepare the review. Six databases and two sources of gray literature were searched. This review analyzed 107 sources from 1994 to 2023. Local anesthesia devices were grouped into computer-controlled local anesthetic delivery (CCLAD) systems, intraosseous anesthesia (IOA), vibratory stimulation devices, and electronic dental anesthesia (EDA). CCLAD systems, particularly the Wand and Single-Tooth Anesthesia, have been the most researched, with mixed results regarding their effectiveness in reducing pain during needle insertion compared to traditional syringes. However, CCLAD systems often demonstrated efficacy in reducing pain during anesthetic deposition, especially during palatal injections. Limited studies on IOA devices have reported effective pain alleviation. Vibrating devices have shown inconsistent results in terms of pain reduction, with some studies suggesting their primary benefit is during needle insertion rather than during the administration phase. EDA devices are effective in reducing discomfort but have found limited applicability. These findings suggest that the CCLAD systems reduce injection pain and discomfort. However, the evidence for other devices is limited and inconsistent. The development and research of innovative technologies for reducing dental pain and anxiety provides opportunities for interdisciplinary collaboration and improved patient care in dental practice.

The Efficacy of Articaine Single Buccal Injection for Maxillary Premolars Extraction: A Randomized Clinical Study

Background: The palatal injection is the most frequently used painful injection, but there is evidence that articaine 4% administered through buccal injection alone can extract maxillary teeth painlessly. Objective: A comparative study is conducted to evaluate the anesthetic efficacy of articaine 4% buccal without palatal injection for extraction of maxillary premolars compared to lidocaine 2% buccal and palatal injection. Methods: A randomized, single-blinded clinical trial was carried out involving 200 patients, of whom 104 were females and 96 were males, who were indicated for extraction of maxillary premolar teeth. The patients were randomly divided into two groups: Group A, control group: The maxillary premolar tooth extraction was performed under buccal and palatal infiltration anesthesia with 1.8 mL of 2% lidocaine hydrochloride with 1:80,000 epinephrine. Group B, a study group, extracted the maxillary premolar’s teeth under buccal anesthesia without palatal infiltration anesthesia with articaine hydrochloride 1.8 mL, 4% with 1:100,000 epinephrine. The outcome variable was the pain experienced during the extraction using the Visual Analogue Scale (VAS). Results: Statistical analysis showed that the difference in pain perception during extraction by VAS scores was statistically non-significant between the control and the study groups. Conclusions: The painful palatal injection in the extraction of maxillary premolars can be overcome by using only a buccal injection of articaine 4%.

A Comparison of the Effects of EMLA Cream and Topical 5% Lidocaine on Discomfort During Palatal Injection

A Comparison of the Effects of EMLA Cream and Topical 5% Lidocaine on Discomfort During Palatal Injection

Can Single Buccal Infiltration With 4% Articaine Induce Sufficient Analgesia for the Extraction of Maxillary Teeth? A Systematic Literature Review.

This systematic review evaluates the efficacy of single buccal infiltration of articaine for extracting upper teeth. A search of the PubMed, Ovid SP, Scopus, Embase, and Cochrane databases for English-language studies published between 2000 and 2021 was performed on August 26, 2022, based on the pre-specified question using the MeSH terms [(buccal) and (articaine) and (infiltration) and (dental)]. Of the 16 clinical trials identified involving 1,339 patients, six compared the subjective procedural pain associated with single buccal infiltration of articaine with that of lidocaine, three of which reported reduced pain and the other three greater success in extraction for the articaine group. Four of the 16 studies compared the procedural pain associated with single buccal infiltration of 4% articaine with double (buccal and palatal/lingual) infiltration; two reported insignificant differences between the groups; and the other two reported greater success using buccal and palatal injections. Five of the 16 studies compared the procedural pain associated with single buccal articaine with double buccal and palatal/lingual infiltration of 2% lidocaine and reported insignificant differences. The other of the 16 studies compared the subjective pain associated with single buccal infiltration of 4% articaine 1:100:000 with single buccal infiltration of 4% articaine 1:200:000 and found a statistically significant difference. All of these studies concluded that upper permanent maxillary teeth can be extracted using only a 4% articaine buccal infiltration, but further investigation is necessary to determine whether this approach can replace the gold standard of buccal and palatal infiltration.

A Split-Mouth Clinical Comparative Evaluation of the Anesthetic Efficacy of Articaine and Lignocaine for Maxillary Bicuspids Extraction.

Aim The study compared the anesthetic effectiveness of articaine and lignocaine when premolars are extracted bilaterally for orthodontic purposes. Material and methods This prospective split-mouth study was performed on 30 cases selected from orthodontic referral patients reporting to the Oral and Maxillofacial Surgery Department at Maharaja Ganga Singh Dental College and Research Center, Rajasthan, India, for bilateral extraction of premolars under local anesthesia. We used 4% articaine hydrochloride and adrenaline 1:100000 (AH) as group A and 2% lignocaine hydrochloride with adrenaline 1:100000 (LH) on the control side as group B. For premolar anesthetization, 0.6-1.6 ml of AH and 1-2 ml of LH were injected submucosally in the buccal vestibular area. The extraction procedure was then carried out after achieving adequate anesthesia. The pain was assessed with Visual Analog Scale. The average onset time and duration of anesthesia were recorded. Data collected were summarized with descriptive statistics.The SPSSversion 23.0 (IBM Corp., Armonk, New York) was used for data entry, validation, and analysis. Means of continuous variables were compared using the student t-test. All tests were 2-tailed and significant at equal or less than 0.05. (p≤0.05). Results When comparing the overall anesthetic efficiency, Group A had a lower overall pain score of 0.43 while Group B had a higher overall pain score of 2.9. The average onset time of anesthesia in Group A was 1.2 minutes and 2.55 minutes in Group B. In Group A, the average duration of anesthesia was 70 minutes, and 46.5 minutes in Group B. These parameters were statistically significant with a p-value of <0.05. Conclusion The study concluded that as an alternative to lignocaine, articaine could be used effectively for maxillary premolar extractions for orthodontic reasons obviating palatal injection which is very painful to the patient.

COMPARISON BETWEEN SINGLE BUCCAL INFILTRATION VERSUS CONVENTIONAL BUCCAL AND PALATAL INFILTRATION FOR REMOVAL OF MAXILLARY MOLAR TEETH.

Background: Although less painful injection techniques have been developed, most individuals still nd palatal injection to be unpleasant. The purpose of this study was to evaluate the ef Aims: cacy of single buccal inltration versus conventional buccal and palatal inltration for the removal of maxillary molar teeth. Fifty patie Materials and Methods: nts participated in a prospective randomized, split-mouth study, Group 1: 4% Articaine HCL inltration – Only buccal, Group 2: 2% Lignocaine HCL – Buccal and palatal inltration. Checking VAS score and Facial pain scale during Inltration and during extraction. Factor analysis was used to determine the signicance of the difference in mean scores between the two groups using both the independent sample t-test. Even though the Results: difference was not statistically signicant (P &gt; 0.05), patients in the articaine group reported much less discomfort during having their vital maxillary molars extracted compared to the lignocaine group. As was previously m Conclusion: entioned, it is feasible to avoid the palatal injection while removing molars from the maxilla. Specically, the extraction of the upper molars, and buccal inltration with articaine is a viable alternative to the use of traditional local anaesthetic.

COMPARISON BETWEEN SINGLE BUCCAL INFILTRATION VERSUS CONVENTIONAL BUCCAL AND PALATAL INFILTRATION FOR REMOVAL OF MAXILLARY MOLAR TEETH.

Background: Although less painful injection techniques have been developed, most individuals still nd palatal injection to be unpleasant. The purpose of this study was to evaluate the ef Aims: cacy of single buccal inltration versus conventional buccal and palatal inltration for the removal of maxillary molar teeth. Fifty patie Materials and Methods: nts participated in a prospective randomized, split-mouth study, Group 1: 4% Articaine HCL inltration – Only buccal, Group 2: 2% Lignocaine HCL – Buccal and palatal inltration. Checking VAS score and Facial pain scale during Inltration and during extraction. Factor analysis was used to determine the signicance of the difference in mean scores between the two groups using both the independent sample t-test. Even though the Results: difference was not statistically signicant (P &gt; 0.05), patients in the articaine group reported much less discomfort during having their vital maxillary molars extracted compared to the lignocaine group. As was previously m Conclusion: entioned, it is feasible to avoid the palatal injection while removing molars from the maxilla. Specically, the extraction of the upper molars, and buccal inltration with articaine is a viable alternative to the use of traditional local anaesthetic.

Evaluation of the Effect of Distant Cold Stimulation on Pain During Palatal Injection: A Randomized Split-Mouth Study.

Objective Delivery of a robust local anesthetic injection aids in the successful management of all patients' fears, anxieties, and discomfort during dental treatments. The most expected or frightening stimuli in the dental operatory are local anesthetic injections. The objective of this trial was to study the analgesic efficacy of distant cold stimulation in relieving injection pain from the greater palatine nerve block. Before receiving local anesthetic injections, employing cryotherapy by using an ice bath changes the pain perceptions and also increases the pain threshold. Purpose The aim of this study is to evaluate the effect of distant cold stimulation on palatal injection pain using an ice-cold bath. Method This was a randomized, controlled trial conducted at an oral and maxillofacial surgery department.A split-mouth technique was employed for the study, in which patients requiring bilateral greater palatine nerve block for any dental procedures were included. The bilateral greater palatine nerve block was given one at a time, separated by an interval of three days. The inclusion criteria for this study were no history of drug allergy and an extraction site free of any active infection. There were 28 participants in this experimental study. Two groups were randomly created from this research sample: group A (palatal injection with distant cold stimulation) and group B (palatal injection without distant cold stimulation). In group A, the patient was asked to put his or her hand of the same side as the palatal injection in an ice-cold bath till the time patient could tolerate it; immediately after the patient removed his hand, the greater palatine nerve block was given, and the patient was assessed for the injection pain. In group B, the patient was directly given the greater palatine nerve block without any distant cold stimulation. The time interval between the two extractions/dental procedures was three days. Outcomes of interest were pain severity with and without distant cold stimulation which were assessed using a Visual Analogue Scale (VAS) pain scale, and a comparison was made between the two groups. Results As per our study, in terms of pain, there was a statistically significant difference between the two interventions at all time points. Patients in group A had a lower score on the VAS pain scale as compared to group B. The standard deviation (STD) for group A was 0.81, and the standard deviation for group B was 0.92. P value was derived to be P < 0.001, which is suggestive of a significant difference between the pain scores of bothgroups. Conclusion Hence, we conclude that the use of distant cryotherapy as an adjunct is an effective way to reducepain perception and increase pain threshold. This technique is comparatively simple, painless, and easy for the surgeonand for apprehensive patients, and it offers a faircost solution for the suffering often associated withdental procedures requiring local anesthetic injections.

Reliability of the electric pulp tester as an indicator of pulpal anesthesia in primary maxillary posterior teeth to assess the need for supplemental injections: An observational clinical study.

The primary maxillary molars occasionally remain sensitive during operative procedures even post the buccal supraperiosteal injection. This could be due to the widely flared palatal roots receiving accessory innervation from the palatal nerves. Identifying inadequate anesthesia upfront using the electric pulp test (EPT) would give vital information to the clinician on the need of a supplemental palatal injection. Aim: The aim of this study was to assess and evaluate the reliability of the EPT as an indicator of pulpal anesthesia in primary maxillary molars. Methodology: Fifty one primary maxillary molars were subjected to the EPT following a buccal supraperiosteal injection. During the operative procedure, the " Face Legs Activity Cry Consolability" (FLACC) scores were recorded. The outcome of the EPT was correlated with the results of the FLACC score using Pearson's Chi-square test.

Efficacy of Buccal Infiltration with or without Palatal Injection for Posterior Maxillary Teeth Extraction - A Split-Mouth Randomized Trial

Efficacy of Buccal Infiltration with or without Palatal Injection for Posterior Maxillary Teeth Extraction - A Split-Mouth Randomized Trial

Posterior superior alveolar nerve block alone in the extraction of upper third molars: a prospective clinical study.

Third molar extraction is the most commonly performed minor oral surgical procedure in outpatient settings and requires regional anesthesia for pain control. Extraction of the maxillary molars commonly requires both posterior superior alveolar nerve block (PSANB) and greater palatine nerve block (GPNB), depending on the nerve innervations of the subject teeth. We aimed to study the effectiveness of PSANB alone in maxillary third molar (MTM) extraction. A sample size comprising 100 erupted and semi-erupted MTM was selected and subjected to study for extraction. Under strict aseptic conditions, the patients were subjected to the classical local anesthesia technique of PSANB alone with 2% lignocaine hydrochloride and adrenaline 1:80,000. After a latency period of 10 min, objective assessment of the buccal and palatal mucosa was performed. A numerical rating scale and visual analog scale were used. In the post-latency period of 10 min, the depth of anesthesia obtained in our sample on the buccal side extended from the maxillary tuberosity posteriorly to the mesial of the first premolar (15%), second premolar (41%), and first molar (44%). This inferred that anesthesia was effectively high until the first molars and was less effective further anteriorly due to nerve innervation. The depth of anesthesia on the palatal aspect was up to the first molar (33%), second molar (67%), and lateromedially; 6% of the patients received anesthesia only to the alveolar region, whereas 66% received up to 1.5 cm to the mid-palatal raphe. In 5% of the cases, regional anesthesia was re-administered. An additional 1.8 ml PSANB was required in four patients, and another patient was administered a GPNB in addition to the PSANB during the time of extraction and elevation. The results of our study emphasize that PSANB alone is sufficient for the extraction of MTM in most cases, thereby obviating the need for poorly tolerated palatal injections.

Effect of a needle-free system versus traditional anesthesia on pain perception during palatal injections in children.

Needle-free injection systems can contribute to the prevention of needle-related pain during palatal infiltration anesthesia (PIA) in children. Research on this topic in children is required. The purpose of this clinical study was to evaluate the effectiveness and patient preference of a needle-free system versus traditional anesthesia (TA) on pain perception during PIA in children. The study was designed as a randomized, controlled crossover clinical study with 48 children aged 6-12 years requiring dental treatment with PIA in bilateral maxillary primary molars. TA was applied on one side and the Comfort-in™ injection system (CIS) on the other side in two separate sessions. Then, patient preference was recorded. The pain perception during PIA was evaluated using the Wong-Baker FACES Pain Rating Scale (PRS) and the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. The data were analyzed for statistical significance (p < .05). There were statistically significant differences between the TA and the CIS according to the PRS and FLACC Scale scores. On both scales, significantly higher pain ratings were observed in the TA group during PIA (p < .001). There was a statistically significant difference in terms of patient preference (p < .001). Although 77.1% (n=37) of the children preferred the CIS, 22.9% (n=11) preferred the TA. Moreover, patient preference for the CIS was significantly higher in older children (p < .01). The application of a needle-free system during PIA ensured a decrease in pain perception in children.

Prospective Evaluation of Suprazygomatic Maxillary Nerve Block in Cleft Palate Repair

INTRODUCTION: Nerve block techniques anecdotally provide superior analgesia while avoiding complications of opioids after cleft palate repair. We performed a prospective, randomized, controlled trial to compare the efficacy of a suprazygomatic maxillary nerve block (SMB) vs local anesthesia (LA) in decreasing postoperative opioid consumption. METHODS: Patients undergoing primary palatoplasty between March and November 2021 were randomized to receive either (1) SMB with 0.15 ml/kg of 0.2% ropivacaine per side and palatal injection of saline with 1:400,000 epinephrine or (2) LA using 2 ml/kg of 0.125% bupivacaine with 1:400,000 epinephrine. Paired t-tests compared pain scores (Face, Legs, Activity, Crying and Consolability [FLACC]), opioid consumption (morphine milligram equivalents [MME]), oral intake for the first 24 hours postoperatively (POD1), and length of stay (LOS; Table). Table. - A Comparison of Postoperative Outcomes Between the Nerve Block and Local Anesthesia Outcome parameter Local SMB p Value FLACC Scores POD1 2.60 1.64 0.04* Intraoperative MME 2.27 1.99 0.29 MME on POD1 2.21 1.55 0.24 Time to opioid administration (min.) 122.71 151.43 0.32 Time to oral intake (min.) 114.14 310.28 0.03* Total oral intake on POD1 (ml) 567.85 442.14 0.18 LOS (hrs.) 29 28.28 0.35 RESULTS: Fifteen patients met all study endpoints (n = 7 SMB; n = 8 LA). Mean ages at the time of repair were 11.96 (SMB) and 11.17 (LA) months. SMB patients demonstrated lower mean FLACC (1.64 SMB vs 2.60 LA; p = 0.04), yet no significant difference in MME (1.55 SMB vs 2.21 LA; p = 0.24) or in time to opioid administration postoperatively (151.43 min. SMB vs 122.71 min. LA; p = 0.32). SMB patients displayed longer time to oral intake postoperatively (310.3 min. SMB vs 114.1 min. LA; p = 0.03), but no difference in total intake (p = 0.18). CONCLUSION: SMB at the time of cleft palate repair may decrease postoperative pain scores, yet worsen the immediate ability to feed after surgery. Using pain scores to guide and standardize narcotic administration may lead to lower opioid consumption after SMB.

Palatal Implantation Using Platelet Rich Plasma and Radio Frequency Palatal Surgery for Management of Obstructive Sleep Apnea

Background: Obstructive Sleep Apnea (OSA) is a common health problem affecting large number of people all over the world with great psychological and physiological burdens. The aim of this study is to investigate the effect of radio frequency palatal Surgery and platelet rich plasma in the soft palate as a new technique in treatment of obstructive sleep apnea OSA. Patients and Methods: This study included 30 patients with mild to moderate OSA Group A: n=15 (Tonsillectomy and palatal radio frequency surgery) and Group B n=15 (Tonsillectomy and Platelet Rich Plasma (PRP) palatal injection, this study investigate the effect of body mass index, retropalatal anteroposterior diameter, Epworth Steepness Scale Apnea Hypopnia Index in treatment of OSA in both groups. This study found that both techniques improved day time sleepiness with reduction of Apnea-Hypopnea Index (AHI), also there was marked improvement in radiological parameters in the form of increase of the anteroposterior diameter and retro-palatal cross section area, there was reduction of Body Mass Index BMI in postoperative in both groups but there was superiority of group A over group B in improvement of this parameters, group A success rate was 86.6% and Group B was 80%. Conclusion: Radio frequency palatal surgery and platelet rich plasma, both are effective as a treatment of obstructive sleep apnea due to retro-palatal collapse.

Evaluation of buffered local anaesthesia in dental extraction: A randomized controlled study

AbstractBuffering of Local anaesthesia (LA) has been suggested as a mechanism to improve injection comfort and hasten the onset of anaesthesia.AimThis study aimed to evaluate the effectiveness of buffered LA in the extraction of maxillary premolars and molars.Materials and MethodsThis randomized controlled study included 100 patients who were indicated for extraction of maxillary posterior teeth, they were randomly divided into two groups; a study group that received infiltration of buffered 2% lidocaine hydrochloride with 1:80,000 epinephrine LA, and a control group that received non‐buffered 2% lidocaine hydrochloride with 1:80,000 epinephrine LA. The buffering was performed using the Onset® LA buffering system (Onpharma®). The outcome variables included the pain during injection buccally and palatally assessed by pain Numerical rating scale, the onset of anaesthesia, the volume of local anaesthesia used, and the patient satisfaction for the whole procedure.ResultsThere were statistically significant differences in pain during injection buccally and palatally in favour of the study group (p &lt; 0.0001) with a large effect size for the palatal injection and moderate effect size for the buccal injection. The onset of anaesthesia on the buccal and palatal sides was significantly faster in the study group (p values 0.02 and 0.01, respectively). There was a non‐significant difference between the groups with respect to the volume of anaesthesia (p = 0.07). The patients in the study group reported a significantly higher satisfaction score (p &lt; 0.0001).ConclusionsBuffered LA significantly reduced the onset of action of anaesthesia and pain during injection, especially on the palatal side, and resulted in better satisfaction with the extraction procedure.

Anesthetic efficacies of buccal with palatal injection versus buccal with intra-septal injection in permanent maxillary first molars of pediatric patients.

The high success rate of dental treatment is dependent on the cooperation of pediatric patients during procedures. Dental treatment often causes pain, particularly in children. The factors in providing treatment to pediatric patients include the characteristics and location of the tooth, profoundness of the anesthesia including the type of local anesthetic, and cooperation of the patient. Previous studies have examined several techniques to successfully achieve profound pulpal anesthesia in maxillary permanent teeth. The dentist should select the injection technique to be used based on patient needs. In children, either buccal with palatal injections or buccal with intra-septal injections may be used to anesthetize the permanent maxillary first molar. Buccal with palatal injections are commonly used prior to routine maxillary dental procedures. Currently, there are only a few studies on the employment of buccal with intra-septal injections to anesthetize permanent maxillary first molars in pediatric patients. This review will focus on efficacy of buccal with palatal versus buccal with intra-septal pulpal anesthesia of the permanent maxillary first molars in pediatric patients and aim to determine which technique should be used during routine dental procedures.