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VOLUME 19 , ISSUE 9 ( 2018 ) > List of Articles


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

Mokshi Jain, Nabeel Nazar

Keywords : Anesthesia, Infiltration, Intraligamentary, Pain, Visual analog scale

Citation Information : Jain M, Nazar N. Comparative Evaluation of the Efficacy of Intraligamentary and Supraperiosteal Injections in the Extraction of Maxillary Teeth: A Randomized Controlled Clinical Trial. J Contemp Dent Pract 2018; 19 (9):1117-1121.

DOI: 10.5005/jp-journals-10024-2391

License: CC BY-NC 3.0

Published Online: 01-10-2016

Copyright Statement:  Copyright © 2018; The Author(s).


Aim: 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. Materials and methods: 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. Results: 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). Conclusion: Periodontal ligament injections may not be optimal, “stand-alone” alternatives to supraperiosteal injections in the exodontia of maxillary teeth. Clinical significance: 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.

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  1. Malamed SF. Handbook of local anesthesia. 6th ed. St. Louis: Elsevier; 2013.
  2. Milgrom P, Coldwell SE, Getz T, Weinstein P, Ramsay DS. Four dimensions of fear of dental injections. J Am Dent Assoc 1997 Jun;128(6):756-766.
  3. Kaufman E, Epstein JB, Naveh E, Gorsky M, Gross A, Cohen G. A survey of pain, pressure and discomfort induce by commonly used oral local anesthesia injections. Anaesth Prog 2005 Winter;52(4):122-127.
  4. Brunetto PC, Ranali J, Ambrosano GM. Anesthetic efficacy of 3 volumes of lidocaine with epinephrine in maxillary infiltration anesthesia. Anaesth Prog 2008;55(2):29-34.
  5. Smith GN, Walton RE. Periodontal ligament injection: distribution of injected solutions. Oral Surg Oral Med Oral Pathol 1983 Mar;55(3):232-238.
  6. Malamed SF. The periodontal ligament (Intra-ligamentary) injection: an alternative to inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol 1982;53(2):117-121.
  7. Ram D, Peretz B. The assessment of pain sensation during local anesthesia using a computerised local anesthesia (Wand) and a conventional syringe. J Dent Child (Chic) 2003;70(2): 130-133.
  8. Elbay US, Elbay M, Kaya E, Cilasun U. Intra-ligamentary and supra-periosteal anesthesia efficacy using a computer controlled delivery system in mandibular molars. J Clin Pediatr Dent 2016;40(3):193-199.
  9. Katz J, Melzack R. Measurement of pain. Surg Clin North Am 1999 Apr;79(2):231-252.
  10. Santosh Kumar MP. Newer delivery systems for local anesthesia in dentistry. J Pharm Sci Res 2015;7(5):252-255.
  11. Briggs M, Closs JS. A descriptive study of the use of visual analog scales and verbal rating scales for the assessment of post-operative pain in orthopedic patients. J Pain Symptom Manage 1999 Dec;18(6):438-446.
  12. Al Shayyab MH. Periodontal ligament injection versus routine supra-periosteal injections for non surgical single posterior maxillary permanent tooth extraction: comparative doubleblinded randomised clinical study. Therap Clin Risk Manage 2017;13:1323-1331.
  13. Collins SL, Moore RA, McQuay HJ. The visual analog pain intensity scale: what is moderate pain in millimeters? Pain 1997 Aug;72(1-2):95-97.
  14. Fan S, Chen WL, Yang ZH, Huang ZQ. 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 Oral Endod 2009 Mar;107(3):359-363.
  15. Hamad SA. Anesthetic efficacy of periodontal ligament injection of 2% lidocaine with 1:80,000 adrenaline. Al-Rafidain Dent J 2006;6(1):26-34.
  16. Prasanna N, Sharmraaj S. Local anesthesia in dentistry— clinical considerations. Int J Drug Dev Res 2013;5(4):30-36.
  17. Wong JK. Adjuncts to local anesthesia: separating fact from fiction. J Can Dent Assoc 2001 Jul-Aug;67(7):391-397.
  18. Quinn CL. Injection techniques to anesthetize the difficult tooth. J Calif Dent Assoc 1998 Sep;26(9):665-667.
  19. Prasanna N, Kee YL. Local anesthetics in dentistry-newer methods of delivery. Int J Pharm Clin Res 2014;6(1):4-6.
  20. Fan S, Chen WL, Pan CB. Anesthetic efficacy of inferior alveolar nerve block plus buccal infiltration or periodontal ligament injections with articaine in patients with irreversible pulpitis in the mandibular first molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009 Nov;108(5):e89-e93.
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