Citation Information :
Al-Melh MA, Badr H, Andersson L. Comparison between Topical and Injection Anesthetics on Pain Related to Orthodontic Miniscrew Placement: A Split-mouth Study. J Contemp Dent Pract 2021; 22 (6):637-643.
Aims and objectives: The aims of this study were to compare the anesthetic effect of a lidocaine/prilocaine (L/P) topical anesthetic with placebo on pain from needle sticks and to compare the anesthetic effect of the L/P topical anesthetic with an infiltrative anesthetic on pain from orthodontic miniscrew placement.
Materials and methods: Pain elimination was analyzed from two interventions: (a) needle stick and (b) miniscrew insertion. When assessing pain from needle stick, one side of the mandible received 2.5% lidocaine/2.5% prilocaine topical anesthetic, and the other side received placebo. When evaluating pain from miniscrew placement, one side of the mandible received L/P topical anesthetic and the other side received infiltrative anesthetic. The findings were recorded on a Visual Analogue Scale after needle stick and after miniscrew placement. Subjective assessment was analyzed by a questionnaire.
Results: The L/P topical anesthetic significantly eliminated the pain from needle stick (Mann–Whitney test of medians, 29.0 vs 0.0, respectively, p<0.001). However, the injection anesthetic eliminated the pain from the miniscrew placement better than the L/P topical anesthetic (Mann–Whitney test of medians, 0.0 vs 5.5, respectively, p<0.001). Eighty percent of the subjects felt more comfortable with L/P topical anesthetic than injection anesthetic. Pain from needle stick pain was reported to be the most uncomfortable part of the study.
Conclusion: The L/P topical anesthetic efficiently eliminated pain from needle stick. The L/P topical anesthetic did not completely eliminate pain from miniscrew placement as the injection anesthesia, but it did reduce pain to tolerable levels.
Clinical significance: L/P topical anesthetics can significantly eliminate pain from needle stick injections, and L/P topical anesthetics can reduce pain from orthodontic miniscrew placement to tolerable levels.
Carano A, Velo S, Leone P, et al. Clinical applications of the Miniscrew Anchorage System. J ClinOrthod 2005;39(1):9–24. PMID: 15735349.
Baumgaertel S, Razavi MR, Hans MG. Mini-implant anchorage for the orthodontic practitioner. Am J Orthod Dentofacial Orthop 2008;133(4):621–627. DOI: 10.1016/j.ajodo.2007.03.022.
Lee JS, Park HS, Kyung HM. Micro-implant anchorage for lingual treatment of a skeletal Class II malocclusion. J Clin Orthod 2001;35(10):643–647. PMID: 11764608.
Buschang PH, Carrillo R, Ozenbaugh B, et al. 2008 survey of AAO members on miniscrew usage. J ClinOrthod 2008;42(9):513–518. PMID: 18974458.
Kanomi R. Mini-implant for orthodontic anchorage. J Clin Orthod 1997;31(11):763–767. PMID: 9511584.
Kravitz ND, Kusnoto B. Placement of mini-implants with topical anesthetic. J Clin Orthod 2006;40(10):602–604. PMID:17062912.
Graham JW. Profound, needle-free anesthesia in orthodontics. J ClinOrthod 2006;40(12):723–724. PMID: 17261909.
Baumgaertel S. Compound topical anesthetics in orthodontics:putting the facts into perspective. Am J Orthod Dentofacial Orthop2009;135(5):556–557. DOI: 10.1016/j.ajodo.2009.01.001.
Reznik DS, Jeske AH, Chen JW, et al. Comparative efficacy of 2 topical anesthetics for the placement of orthodontic temporary anchorage devices. AnesthProg 2009;56(3):81–85. DOI: 10.2344/0003-3006-56.3.81.
Friedman PM, Mafong EA, Friedman ES, et al. Topical anesthetics update: EMLA and beyond. DermatolSurg 2001;27(12):1019–1026. PMID: 11849263. DOI: 10.1046/j.1524-4725.2001.01855.x.
Meechan JG. The use of EMLA for an intraoral soft-tissue biopsy in a needle phobic: a case report. Anesth Prog 2001;48(1):32–34. PMID: 11495404.
Donaldson D, Gelskey SC, Landry RG, et al. A placebo-controlled multi-centred evaluation of an anaesthetic gel (Oraqix) for periodontal therapy. J Clin Periodontol 2003;30(3):171–175. DOI: 10.1034/j.1600-051x.2003.00017.x.
Friskopp J, Nilsson M, Isacsson G. The anesthetic onset and duration of a new lidocaine/prilocaine gel intra-pocket anesthetic (Oraqix) for periodontal scaling/root planning. J Clin Periodontol 2001;28(5):453–458. DOI: 10.1034/j.1600-051x.2001.028005453.x.
Al-Melh MA, Andersson L, Behbehani E. Reduction of pain from needle stick in the oral mucosa by topical anaesthetics: a comparative study between lidocaine/prilocaine and benzocaine. J Clin Dent 2005;16(2):1–4. PMID: 16170977.
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.
Al-Melh MA, Andersson L. Reducing pain from palatal needle stick by topical anesthetics: a comparative study between two lidocaine/prilocaine substances. J Clin Dent 2008;19(2):43–47. PMID: 18763685.
Al-Asfour A, Al-Melh M, Andersson L, et al. Healing pattern of experimental soft tissue lacerations after application of novel topical anesthetic agents - an experimental study in rabbits. Dent Traumatol 2008;24(1):27–31. DOI: 10.1111/j.1600-9657.2006.00482.x.
Musawi AA, Andersson L. Use of topical as only anesthetic for suturing a traumatic facial laceration. Dent Traumatol 2010;26(3):292–293. DOI: 10.1111/j.1600-9657.2010.00881.x.
Al-Melh M, Andersson L. The effect of a lidocaine/prilocainetopical anesthetic on pain and discomfort associated with orthodontic elastomeric separator placement. ProgOrthod 2017;18(1):1. DOI: 10.1186/s40510-016-0156-7.
Lacerda-Santos R, Bravin TC, Carvalho FG, et al. Efficacy of topical anesthetics in pain perception during mini-implant insertion: systematic review of controlled clinical trials. AnesthProg 2019;66(3):119–132. DOI: 10.2344/anpr-66-01-11.
Kwong TS, Kusnoto B, Viana G, et al. The effectiveness of Oraqix versus TAC (a) for placement of orthodontic temporary anchorage devices. Angle Orthod2011;81(5):754–759. DOI: 10.2319/020811-91.1.
Lamberton JA, Oesterle LJ, Shellhart WC, et al. Comparison of pain perception during miniscrew placement in orthodontic patients with a visual analog scale survey between compound topical and needle-injected anesthetics: acrossover, prospective, randomized clinical trial. Am J Orthod Dentofacial Orthop 2016;149(1):15–23. DOI: 10.1016/j.ajodo.2015.08.013.
Valieri MM, Freitas, Valarelli FP, et al. Comparison of topical and infiltration anesthesia for orthodontic mini-implant placement. Dental Press J Orthod 2014;19(2):76–83. DOI: 10.1590/2176-9451. 19.2.076-083.oar.
Park J, Cho HJ. Three-dimensional evaluation of interradicular spaces and cortical bone thickness for the placement and initial stability of microimplants in adults. Am J Orthod Dentofacial Orthop 2009;136(3):314. DOI: 10.1016/j.ajodo.2009.01.023.