The local anesthesia injection procedure is a crucial moment for subsequent treatment, not only in terms of pain control but also in building patient compliance. Pain during the procedure is, in fact, one of the fundamental triggers of dental anxiety, and it can result from trauma linked to the insertion of the needle and/or tissue relaxation during the injection of anesthetic fluid, particularly when it is conducted over a period of time excessively short (and, therefore, too fast).

Computer-controlled local anesthetic delivery (CCLAD) is an alternative solution in the field of dental anesthesiology, which focuses on the aspects previously considered.

Recently, the working group of Aggarwal has published (Journal of Dental Anesthesia and Pain Medicine, December 2018) an interesting scientific work to compare conventional and CCLAD technique in the adult periodontal patient in different locations and phases of local anesthesia. This last aspect represents the real element of originality of the study.

The prospective study was conducted according to a splitmouth model and involved a total of 100 periodontal patients, aging between 18 and 65 years. Each one was directed to bilateral treatments (subgingival scaling, curettage, gingivectomy or flap surgery) within the same arch. A randomization process was performed to determine which of the two anesthetic methods to use and on which side to use it. The investigators report a problem that has prevented the blind setup, even for the patient alone. Although a visual restriction had been imposed, the subject was able to perceive the acoustic stimulus produced by the CCLAD machine in operation. It must be said that study protocols based on the same model have found a way to overcome this problem.

Of all the patients, 270 injection procedures were conducted (135 per side and, therefore, per method). The target nerve trunks and the techniques used were multiple, demonstrating the versatility of use of CCLAD in the upper arch the posterior alveolar blocks (PSA), middle alveolar blocks (AMSA), the block of the greater palatine nerve and the infraorbital nerve, and in the lower arch the lower alveolar blocks, the buccal nerve, and the mental nerve.

The study protocol provided an evaluation for the level of anxiety before the injection (also given in the absence of blinding) by giving the patient a VAS scale to quantify the pain perceived at different stages of treatment: during the insertion of the needle, during the release of the anesthetic solution, immediately after the injection itself, or at the end of the treatment proper. The second session resumed the one just considered, replacing the injection medium with the one not yet used.

The anxiety level for the CCLAD method was 0.78 ± 0.91, significantly lower than that of the conventional syringe (1.01 ± 1.02).

The VAS values were significantly lower in the computer technique for all the phases considered, except for the first, i.e., the insertion of the needle.

The authors conclude by recommending the use of the CCLAD technique, also in agreement with two-thirds of the patients who have indicated to use it for their next treatment.


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