Periodontal Ligament Injection Research Articles

A cadaveric study using computerised tomography to assess the distribution of iodinated non‐ionic radiocontrast agent after periodontal ligament injection in the horse

A cadaveric study using computerised tomography to assess the distribution of iodinated non‐ionic radiocontrast agent after periodontal ligament injection in the horse

A Survey Of Dental Surgeons In Ghana On Their Utilization Of Supplemental Local Anaesthetic Methods During Root Canal Therapy

Background: Teeth with irreversibly inflamed pulps can be preserved with endodontic or root canal treatment (RCT). The primary methods used to manage pain during RCT are local infiltration injections and nerve blocks. When infiltrations are used, it is reasonable that the acidic nature of inflamed tissues, can reduce the availability of the active form of the local anaesthetic agent. In the case of nerve blocks, the acidity of the inflamed tissue is unlikely to play a significant role in the failure to achieve anaesthesia. Supplementalanaesthesia methods including periodontal ligament injection (intraligamentary), intraosseous injection, and intra-pulpal injection have been suggested as adjuncts to obtaining complete anaesthesia of the symptomatic irreversibly inflamed dental pulp.Aim: This study was to ascertain the types of supplemental anaesthesia techniques, and their levels of utilization during lower molar RCT in Ghana.Materials and methods: An online survey was done by e-mailing questionnaires to practicing dental surgeons registered on the Ghana Dental Association(GDA), google’s group platform. Data obtained was analyzed using SPSS version 21.Results: Eighty-five percent (34) of respondents indicated that they employ supplemental injections during RCT. Pulpal and intraligamentary techniques were the most commonly used, with 70.6% and 47.1% of dentists reporting utilization respectively.Conclusion: There is the need for update courses in the utilization of intraosseous supplemental local anaesthesia. Other supplemental injection techniques like the inferior alveolar nerve block (IANB) plus nitrous oxide inhalation have to be introduced to dentistscarrying out RCT, so they can add such techniques to their pain management portfolio.

Activation of the P2X7 receptor in the dental pulp tissue contributes to the pain in rats with acute pulpitis.

Treatment of acute pulpitis (AP) is beneficial for pain relief and pulp regeneration. The purinergic P2X7 receptor activation is responsible for the formation and maintenance of inflammation and pain. This study aims to determine the role of the pulp tissue P2X7 receptor to activate the mechanisms of the AP in rats. The Sprague-Dawley rats were divided into groups, namely, normal, normal saline (NS), and lipopolysaccharide (LPS) groups. Alterations in pain behavior were detected through head-withdrawal thresholds (HWTs), and the pathological changes in pulp tissue were studied through hematoxylin and eosin staining. The expression of the P2X7 receptor in pulp tissue was observed through immunohistochemistry and Western Blotting. The effect of the P2X7 receptor antagonist A-740003 on HWTs was also observed. The levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the pulp tissue of rats were analyzed through enzyme-linked immunosorbent assay. The HWTs were reduced in the rats with AP. Inflammation is formed but was found more severe in the LPS group than the NS group, and the expression levels of the P2X7 receptors in the NS and LPS groups were higher than in the normal group. The periodontal ligament injection of the A-740003 dose-dependant increases the HWTs in rats with AP. The IL-6 and TNF-α levels in the pulp in the NS and LPS groups were increased but reversed by A-740003 injection. In rats with AP, the expression level of the P2X7 receptor and IL-6/TNF-α release was upregulated. The A-740003 can relieve pain and reduce the inflammation progression in rats with AP.

Prospective Study on PDL Anesthesia as an Aide to Decrease Palatal Infiltration Pain.

The purpose of this prospective randomized study was to assess using a periodontal ligament (PDL) injection as an aide to decrease palatal infiltration pain. A total of 133 subjects randomly received a PDL injection and alternative palatal infiltration or a mock PDL injection and conventional palatal infiltration at 2 separate appointments. PDL injection was given in the mid-palatal sulcus of the maxillary first molar. Mock PDL injection consisted of only needle insertion. All subjects then received a palatal infiltration administered into the blanched gingival tissue 3 mm (alternative palatal infiltration) or 7 mm (conventional palatal infiltration) from the gingival collar. Subjects recorded needle insertion and solution deposition pain using a Heft-Parker visual analog scale (VAS). The combined PDL injection and alternative palatal infiltration had significantly decreased mean VAS ratings for needle insertion and solution deposition pain (P < .0001). Incidence of moderate/severe pain for needle insertion and solution deposition was reduced from 65% to 1% and from 65% to 2%, respectively. Providing PDL anesthesia into the mid-palatal sulcus of the maxillary first molar and then administering an alternative palatal infiltration into the blanched collar around the PDL molar site led to significant reductions in needle insertion and solution deposition pain compared with a mock PDL and conventional palatal infiltration.

Efficacy of four local anaesthesia protocols for mandibular first molars with symptomatic irreversible pulpitis: A randomized clinical trial.

To examine the efficacy rate of four anaesthetic protocols in mandibular first molars with symptomatic irreversible pulpitis (SIP). One hundred and sixty patients with a diagnosis of SIP were included in this randomized clinical trial. Patients were randomly allocated into four treatment groups (N=40) according to the administered technique: Group 1 (IANB): standard inferior alveolar nerve block (IANB) injection; Group 2 (IANB+IO): standard IANB followed by a supplemental intraosseous infusion (IO) injection; Group 3 (IANB+PDL): standard IANB followed by a supplemental periodontal ligament (PDL) injection; Group 4 (IANB+BI): standard IANB followed by a supplemental buccal infiltration. Patients rated pain intensity using a verbal rating scale when the root canal treatment procedure was initiated, that is, during caries removal, access preparation and pulpectomy. Heart rate changes were recorded before, during and after each injection. The anaesthetic efficacy rates were analysed using chi-square tests, age differences using one-way anova, gender differences using Fischer Exact tests whilst heart rate changes were analysed using Kruskal-Wallis tests. Statistical significances were set at p<.05level. All the included patients were analysed. No differences in the efficacy rate were found in relation to the age or gender of the participants amongst the study groups (p>.05). IANB+IO injections had a significantly higher efficacy rate (92.5%) when compared to other techniques (p<.05), followed by IANB+PDL injections (72.5%), IANB+BI injections (65.0%), with no significant differences between the IANB+PDL or IANB+BI injections (p>.05). IANB injection alone had a significantly lower rate (40%) compared to the other techniques (p<.05). A transient but significant rise in the heart rate was recorded in 60% (24/40) of patients who received the IANB+IO injection compared to other groups (p<.05). Inferior alveolar nerve block injection alone did not reliably permit pain-free treatment for mandibular molars with SIP. The use of an additional IO supplemental injection provided the most effective anaesthesia for patients requiring emergency root canal treatment for SIP in mandibular posterior teeth.

Comparative evaluation of anesthetic efficacy of 4% articaine using buccal infiltration technique and periodontal ligament injection technique for extraction of primary mandibular molars: An In vivo study

Introduction: Dental anxiety is patient's psychological response to the dental environment. Local anesthetic injection is the most anxiety-causing procedure for children in dentistry, especially the inferior alveolar nerve block (IANB) which is the most commonly used injection technique for achieving local anesthesia of mandibular molars. The various alternatives explored for IANB are intra-ligamentary technique/periodontal injection technique and buccal infiltration. Aim: The aim of this study was to compare the effectiveness of articaine hydrochloride 4% with adrenaline 1:100,000 for the extraction of mandibular primary molar teeth using buccal infiltration injection and intraligamentary injection. Materials and Methods: The present study was conducted on 30 children in the age group of 5–10 years requiring bilateral extraction of primary mandibular molars. The patients were randomly selected and divided into two groups. Group 1 received anesthesia using buccal infiltration injection technique and Group 2 received anesthesia using intraligamentary injection both containing 4% articaine with 1:1,00,000 adrenaline. Results: The success rate of buccal infiltration and intraligamentary injection using 4% articaine with mean sound, eye, and motor scores (± standard deviation) was found to be statistically nonsignificant, i.e., 3.07 for buccal infiltration and 2.97 for intraligamentary injection technique with P = 0.835 (P > 0.05). Conclusion: There is no significant difference between buccal infiltration technique and intraligamentary injection technique for the extraction of primary mandibular molars using 4% articaine with 1:1,00,000 adrenaline.

Periodontal ligament injection v/s oral nerve block

As we all know local anesthesia is used for reversible blockade of nerves, which leads to a transient loss of sensation. Local anesthesia is use in a variety of dental procedures such as tooth extraction, root canal treatment, traumatic injuries and the list will go on. But, it has been found that inferior alveolar nerve block technique is associated with many bad side effects. So, periodontal ligament injection technique is a safer alternative to oral nerve block in various dental procedures. In this article, we have done the comparison between the PDL injection and oral nerve block. Keywords: Local anesthesia, Periodontal ligament injection, Local infiltration techniques, Oral nerve block techniques, Inferior alveolar nerve block, Effectiveness, Comparison, Side effects, Safe, Pulpal anesthesia.

Immunohistochemical Analysis of Nerve Distribution in Mandible of Rats.

After review of the literature, there appears to be no report on the histology of the mandibular nerve fiber distribution. Therefore, using a Wistar rat model, immunohistochemical staining with protein gene product (PGP) and calcitonin gene-related peptide (CGRP) antibody for all nerves and only the pain-sensitive nerves, respectively, was performed. We also statistically compared the nerve distribution density by mandibular region. The section of the mandible from the alveolar crest to the mandibular canal was compartmentalized to several regions. Subsequently, nerve distribution density by region was measured microscopically in both the PGP- and CGRP-positive nerves. Furthermore, the ratio of CGRP- to PGP-positive nerves was measured in each region and statistically compared. In both the PGP- and CGRP-positive nerves, the nerve distribution density significantly increased vertically toward the mandibular canal from the alveolar crest and horizontally toward the periodontal ligament from the periosteum. From the CGRP- to PGP-positive nerve ratio, the pain-sensitive nerve accounted for approximately >70% in each region. Pain would therefore be more likely to develop when surgical invasiveness deepens toward the mandibular canal or periodontal ligament. Therefore, sufficient local anesthetic infiltration and/or combined use of conduction anesthesia or periodontal ligament injection may be required. These results may aid in the development of more effective surgical and anesthetic techniques for mandibular surgery.

Lingual anesthesia of the lower anterior teeth, which technique is better?

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. 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. 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. A recommendation was made to use the PDL injection technique to anesthetize the lingual soft tissue during extraction of the lower anterior teeth.

Methodical bias for comparison of periodontal ligament injection and local infiltration anesthesia for routine extractions in the maxilla.

Methodical bias for comparison of periodontal ligament injection and local infiltration anesthesia for routine extractions in the maxilla 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.

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

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.

Periodontal ligament injection versus routine local infiltration for nonsurgical single posterior maxillary permanent tooth extraction: comparative double-blinded randomized clinical study.

AimThe aim of this study was to evaluate the efficacy of, and patients’ subjective responses to, periodontal ligament (PDL) anesthetic injection compared to traditional local-anesthetic infiltration injection for the nonsurgical extraction of one posterior maxillary permanent tooth.Materials and methodsAll patients scheduled for nonsurgical symmetrical maxillary posterior permanent tooth extraction in the Department of Oral and Maxillofacial Surgery at the University of Jordan Hospital, Amman, Jordan over a 7-month period were invited to participate in this prospective randomized double-blinded split-mouth study. Every patient received the recommended volume of 2% lidocaine with 1:100,000 epinephrine for PDL injection on the experimental side and for local infiltration on the control side. A visual analog scale (VAS) and verbal rating scale (VRS) were used to describe pain felt during injection and extraction, respectively. Statistical significance was based on probability values <0.05 and measured using χ2 and Student t-tests and nonparametric Mann–Whitney and Kruskal–Wallis tests.ResultsOf the 73 patients eligible for this study, 55 met the inclusion criteria: 32 males and 23 females, with a mean age of 34.87±14.93 years. Differences in VAS scores and VRS data between the two techniques were statistically significant (P<0.001) and in favor of the infiltration injection.ConclusionThe PDL injection may not be the alternative anesthetic technique of choice to routine local infiltration for the nonsurgical extraction of one posterior maxillary permanent tooth.

Die intraligamentäre Anästhesie

Reliable analgesia can nowadays be achieved with several techniques and different anesthetic solutions, but side effects may be encountered. Severe and potentially fatal cardiovascular reactions can be the result of an intravascular injection. An easy to use, effective and safe alternative is the periodontal ligament injection. Nerve damage or cardiovascular side effects are not to be expected. This type of anesthesia can be of advantage for many dental procedures. With new devices like the computer-controlled local anesthetic delivery system, the periodontal ligament injection is a convenient way of local anesthesia for both patient and dentist.

Efficiency of Intraligamentary Anesthesia of Inferior Molars for Endodontic Treatment

Summary The periodontal ligament injection appears to be the most consistently reliable in achieving clinically adequate pulpal anaesthesia. Materials and Methods: 130 inferior molar teeth; technique: The tooth was first cleaned with chlorhexidine 0.2% solution. The penetration of the ligament is performed with special intraligamentary needle (30 G - 9, 17,21 mm) “sliding” along the side of the tooth, 300º angle between the needle and the tooth, having taken the care of determining support points which will prevent the needle from twisting. The penetration must be deep enough to obtain the seal required for the injection, injection for each root in particular points; volume of solution per root is 0.2-0.4 ml. Results: In 125 cases the technique was absolutely efficient. In only 5 cases with pulpitis chronica ulcerosa there was need for additional intrapulpal anesthesia. Conclusions: The method could be used as a primary anesthetic method for endodontic treatment.

Clinical efficacy of a computerised device (STA™) and a pressure syringe (VarioJect INTRA™) for intraligamentary anaesthesia

To evaluate the impact of experience whilst using different devices for intraligamentary anaesthesia, dental students tested clinical anaesthetic efficacy of a mechanical (PDL-S) and a computer-controlled (CCLAD) application system in restorative patients. In a prospective study, 41 Patients in need of restorative treatment in lower posterior mandible were randomised into three groups (PDL-S: teeth n = 22; CCLAD: teeth n = 20; inferior alveolar nerve block (IANB): teeth n = 20). Dental last year students conducted anaesthesia and dental treatment. Primary objectives were differences in pain during treatment [numeric rating scale (NRS)] as well as in anaesthetic efficacy (complete/sufficient vs. insufficient/no effect) between PDL-S and CCLAD. Pain of injection, need for second injections, amount of anaesthetic solution and duration of local numbness were assessed. IANB as gold standard was compared to each system descriptively. PDL-S had a significant lower pain during treatment (P = 0.017) but a similar anaesthetic efficacy (P = 0.175) compared to the CCLAD system. Concerning pain of injection (P = 0.42), quantity of second injections (P = 0.232), amount of used solution (P = 0.073) as well as duration of local numbness (P = 0.253), no differences were seen. When comparing both periodontal ligament injection (PDL)-systems with IANB, pain rating was higher when using CCLAD. Injection pain, amount of used solution as well as soft tissue anaesthesia was less for PDL-S and CCLAD. Both PDL techniques showed a good success for dental routine treatments. Although, compared to the mechanic device, the CCLAD system might need more clinical daily experience. We recommend including specific trainings in intraligamentary anaesthesia in the dental curriculum.

Effectiveness and Safety of Computer-controlled Periodontal Ligament Injection System in Endodontic Access to the Mandibular Posterior Teeth

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. 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. 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; χ² = 34.3, P<0.01). Both the PM and SM groups showed higher success rates than that of the FM group (v=1, χ² = 16.73, P<0.01; v=1, χ² = 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. 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.

A Clinical Evaluation of the Periodontal Ligament Injection

Aims 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

Comparison of the anaesthetic efficacy of and heart rate changes after periodontal ligament or intraosseous X‐Tip injection in mandibular molars: a randomized controlled clinical trial

To compare the efficacy of supplemental anaesthesia using periodontal ligament injections (PDL) and intraosseous injections with the X-Tip system in terms of the measured heart rate and patient reported pain level. In this single-blind randomized clinical trial, 40 patients (22 women, 18 men) with irreversible pulpitis who had experienced unsuccessful pain management by inferior alveolar nerve block with 2% lidocaine and 1 : 100 000 epinephrine were selected. Patients were divided equally and randomly into two groups. Supplementary anaesthesia was provided through intraosseous injection with the X-Tip system (X-Tip group) or by PDL injection (PDL group). After each step of injection, pain severity was assessed using a visual analogue scale. Patient heart rate was recorded with a pulse oximeter. Data were coded and analysed using Mann-Whitney U-test with SPSS (version 16) software. Anaesthetic success was obtained in 100% of X-Tip and 70% of PDL group patients after the first supplemental injection. Compared with the first PDL injection, the first intraosseous injection resulted in a significant increase in heart rate (P = 0.001); however, this increase was short-lived (mean increase: 9-10 beats per min). No significant difference in heart rate or anaesthesia success was observed between men and women. Intraosseous injection using the X-Tip system was more effective than PDL injection as a supplementary anaesthetic for pulpectomy in mandibular molars or second premolars. However, the former resulted in a transient increase in heart rate.

A clinical comparison between maxillary and mandibular posterior teeth using local anesthesia and normal saline by the periodontal ligament injection (An in vivo study)

Background: Local anesthesia is the primary method used in dentistry to control patients’ pain. However, even in the presence of adequate soft tissue anesthesia, there may be incomplete pulpal anesthesia. This is particularly true in the mandible where obtaining profound pulpal anesthesia may be difficult. The periodontal ligament injection has received much attention in the dental literatures. lntraligamentary anesthesia has been advocated as a primary and a supplemental injection technique. The purpose of this study is to evaluate, with electrical pulp tester, the anesthetic efficacy of the periodontal ligament injection using 2% Lidocaine with 1:80000 epinephrine and normal saline in forty volunteers. The success rate was defined as no patient’s response to the maximum output of an electrical pulp tester. Also pain rating during initial needle penetration and injection of solution were compared. Material and method: Forty adult volunteers participated in this study. The subjects were divided into four groups (10 subjects each): Group Ia: each subject received a periodontal ligament injection in mandibular first premolar and first molar right or left side with Lidocaine injection and pulp tested each minute by EPT and Ethyl chloride. Group 1b: each subject received a periodontal ligament injection in mandibular first premolar and first molar right or left side with normal saline injection and pulp tested each minute by EPT and Ethyl chloride. Group IIa: each subject received a periodontal ligament injection in maxillary first premolar and first molar right or left side with Lidocaine injection and pulp tested each minute by EPT and Ethyl chloride. Group IIb: each subject received a periodontal ligament injection in maxillary first premolar and first molar right or left side with normal saline injection and pulp tested each minute by EPT and Ethyl chloride. Results: The results showed that the duration of profound pulpal anesthesia, using 2% Lidocaine with 1:80000 epinephrine, was 10 minutes and injection of anesthetic solution and normal saline in clinically healthy teeth were only mildly discomforting. The periodontal ligament injection using normal saline was not effective in producing anesthesia. A conclusion was drawn from the study that the periodontal ligament injection can be used effectively, as a primary injection technique, to anesthetize mandibular posterior teeth especially the first molars.

Clinical and Histological Comparison of Pulp Anaesthesia and Local Diffusion after Periodontal Ligament Injection and Intrapapillary Infiltration Anaesthesia

Improvements in local anaesthetic techniques may minimize pain during dental treatment. Block techniques of the trigeminal branches (II and III) are considered to be the most used and trusted methods in dentistry . However, the incidence of inadequate anaesthesia and technical complications is reported to be between 15-30% of cases. Other possibilities to achieve local anaesthesia are infiltration, intra-pulpal injection, intraosseous , intraseptal and periodontal ligament injection (PDL). In the present time, PDL technique increases in popularity, especially because of specialized high pressure syringe systems and computer controlled local anaesthesia devices. PDL has shown to provide sufficient anaesthesia of the pulp. It is less unpleasant and painful than inferior alveolar and palatinal injections. Other advantages are well documented: single tooth anaesthesia, minimal anaesthetic agent dosage, rapid onset and safety in patients with bleeding problems as well as in medical compromised patients. Though, disadvantages like damage of periodontal tissue, damage of interdental septal crest, root resorption and severe bacteraemia are reported as well. Infection and/or inflammation may decrease the anaesthetic efficacy and PDL may induce systemic reactions manifested in cardiovascular parameters changes Intraseptalintraosseous anaesthesia (ISA) is described to be an alternative to PDL in order to overcome inconveniences associated with PDL, especially in compromised periodontal tissues. Still, probably because of the enosseous pathway, ISA has shown to cause cardiovascular changes similar to PDL. Intrapapillary infiltration anaesthesia (IPA) is an intermediate of PDL and ISA and consists of application of the local anaesthetic agent into the mesial and distal papillae without touching the periodontal ligament and without application in the bone. Therefore, cardiovascular side effects may be reduced. Such as for ISA, potential side effects like damage of periodontal tissue and bacteraemia are limited. For IPA, normal syringes as well as pressure delivery systems can be used [18]. In order to minimize all possible side effects in general practice, we tested the new IPA technique for pulp anaesthesia. To our knowledge, there are no published studies that compare PDL and IPA. Therefore, the aim of the present study was to evaluate pulp anaesthesia (clinical setting) as well as local diffusion of the anaesthetic agent (histological setting) in both methods.