Transpapillary Injection Technique as a Substitute for Palatal Infiltration: A Split-mouth Randomized Clinical Trial
Maria A Sruthi, Mahesh Ramakrishnan
LA administration, Pain during injection, Palatal infiltration, Randomized clinical trial, Transpapillary injection technique
Citation Information :
Sruthi MA, Ramakrishnan M. Transpapillary Injection Technique as a Substitute for Palatal Infiltration: A Split-mouth Randomized Clinical Trial. Int J Clin Pediatr Dent 2021; 14 (5):640-643.
Aim and objective: To assess and compare the degree of pain during local anesthesia administration and to evaluate the efficacy of transpapillary injection as a substitute for palatal injection in simple maxillary tooth extractions.
Materials and methods: A split-mouth study was conducted among children aged 7–11 years who required bilateral extraction of maxillary molars. The individuals were subjected to conventional buccal and palatal infiltration for the first extraction. The transpapillary injection was administered for the subsequent extraction in place of palatal administration. 2% lignocaine with 1:100,000 adrenaline was used for both techniques. Faces pain score scale and visual analog scale were utilized to record pain during injection administration and during the extraction process. A p < 0.05 was considered to be statistically significant.
Results: The difference in pain scores was observed during injection administration and was found to be statistically significant (p < 0.05) whereas pain scores for extraction were insignificant (p > 0.05).
Conclusion: The transpapillary injection technique was efficacious in eliminating the pain of the palatal injection technique for maxillary extractions.
Clinical significance: Owing to the results of this study, the transpapillary injection technique can be used as a distinguished substitute for conventional palatal infiltration, thereby lessening the level of distress experienced by a pediatric patient during local anesthesia administration.
Janjua OS, Luqman U, Ibrahim MW, et al. Transpapillary versus palatal injection technique for maxillary tooth extractions. J Coll Physicians Surg Pak 2012;22(3):143–146. DOI: 02.2012/JCPSP.143146.
Uckan S, Dayangac E, Araz K. Is permanent maxillary tooth removal without palatal injection possible? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102(6):733–735. DOI: 10.1016/j.tripleo.2005.12.005.
Fan S, Chen WL, Yang ZH, et al. Comparison of the efficiencies of permanent maxillary tooth removal performed with single buccal infiltration versus routine buccal and palatal injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107(3):359–363. DOI: 10.1016/j.tripleo.2008.08.025.
Versloot J, Veerkamp JS, Hoogstraten J. Assessment of pain by the child, dentist, and independent observers. Pediatr Dent 2004;26(5):445–449.
Al-Melh MA, Andersson L. Comparison of topical anesthetics (EMLA/Oraqix vs. benzocaine) on pain experienced during palatal needle injection. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;103(5):e16–e20. DOI: 10.1016/j.tripleo.2006.11.033.
Malamed SF. Handbook of local anesthesia. 5th ed., St Louis: Mosby; 2004. pp. 189–225.
Berlin J, Nusstein J, Reader A, et al. 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 2005;99(3):361–366. DOI: 10.1016/j.tripleo.2004.11.009.
Meechan JG, Gowans AJ, Welbury RR. The use of patient controlled transcutaneous electronic nerve stimulation (TENS) to decrease the discomfort of regional anaesthesia in dentistry: a randomised controlled clinical trial. J Dent 1998;26(5-6):417–420. DOI: 10.1016/s0300-5712(97)00062-6.
Sixou JL, Barbosa-Rogier ME. Efficacy of intraosseous injections of anesthetic in children and adolescents. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106(2):173–178. DOI: 10.1016/j.tripleo.2007.12.004.
Jensen J, Nusstein J, Drum M, et al. Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection. J Endod 2008;34(2):126–130. DOI: 10.1016/j.joen.2007.11.020.
Badcock ME, Gordon I, McCullough MJ. A blinded randomized controlled trial comparing lignocaine and placebo administration to the palate for removal of maxillary third molars. Int J Oral Maxillofac Surg 2007;36(12):1177–1182. DOI: 10.1016/j.ijom.2007.06.001.
Milgrom P, Coldwell SE, Getz T, et al. Four dimensions of fear of dental injections. J Am Dent Assoc 1997;128(6):756–766. DOI: 10.14219/jada.archive.1997.0301.
Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs 1988;14(1):9–17.
McGrath PA, Gillsepie J. Pain assessment in children and adolescents. in Handbook of pain assessment Turk DC, Melzack R, ed. 2nd ed., New York, NY, USA: Gilford Press; 2001. pp. 97–118.
Badcock ME, McCullough MJ. Palatal anaesthesia for the removal of maxillary third molars as practised by oral and maxillofacial surgeons in Australia and New Zealand. Aust Dent J 2007;52(4):329–332. DOI: 10.1111/j.1834-7819.2007.tb00510.x.
White JJ, Reader A, Beck M, et al. The periodontal ligament injection: a comparison of the efficacy in human maxillary and mandibular teeth. J Endod 1988;14(10):508–514. DOI: 10.1016/S0099-2399(88)80109-2.
Meechan JG. A comparison of ropivacaine and lidocaine with epinephrine for intraligamentary anesthesia. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;93(4):469–473. DOI: 10.1067/moe.2002.121390.