The teeth of the lower incisal region, are commonly approached with a simplified anesthesia method, which usually involves a single infiltration injection at the level of the tooth’s apex, especially in the case of conservative clinical interventions (restorations, root canal therapies).

If it is necessary to ensure more effective anesthesia, not so much to the pulp, but close to periodontium and soft tissues of the lingual area – refer to an extractive operation – an additional administration is usually added, in fact, in the lingual area.

In the case of the elderly patient or in any case of a subject with widespread deterioration linked to carious and periodontal pathologies, it is quite frequent to approach the lower frontal region with reclamation operations; in these cases, all the more so, it is essential to ensure the most valid pain control regime in order to not making an overall investigation of a series of operations that tend to be non-binding.

The intraligamentary injection is widely known as a supplemental technique, although, in reality, current studies indicate it as an alternative method, in many cases, to the classic supraperostal infiltration.

In the case of single or multiple extractive operations, involving the lower incisal region, therefore, it seems necessary to ask whether the additional method by intraligmentary injection is preferable over the conventional one. This is what Abdulrazaq proposed to investigate during a simple clinical trial published recently in Oral and Maxillofacial Surgery.

The study involved a total of 24 patients, each aimed at the extraction of two lower anterior teeth from canine to canine and not adjacent. A total of 48 teeth were extracted by the same operator.

The drug used was the same in all cases, as was in the first phase of anesthesia, which consisted of a supraperostal infiltration. Topical pre-treatment was avoided. According to a design that could be defined as split-mouth, each patient received additional lingual infiltration according to a conventional technique on one tooth and an intraligamentous injection on the other. Under no circumstances, additional injections were necessary in order to complete the treatment.

The pain data, which is a sensitive aspect of lingual infiltration from common experience and which was investigated here by means of an analog visual scale (VAS), did not provide significant differences.

On the contrary, the frequency of bleeding  during needle insertion is statically significant: 8.3% of cases during the intraligamentary injection procedure compared to 33.3% in the conventional technique. In view of this advantage, the intraligamentous technique is preferred, if not advisable, in these cases considering that these are often fragile patients with a complex approach.

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