Clinical Oral Investigations

, Volume 22, Issue 3, pp 1469–1475 | Cite as

Prospective clinical study comparing intraligamentary anesthesia and inferior alveolar nerve block for extraction of posterior mandibular teeth

  • P. W. Kämmerer
  • A. Adubae
  • I. Buttchereit
  • D. G. E. Thiem
  • M. Daubländer
  • B. Frerich
Original Article



The aim of the study was to compare the efficacy of intraligamentary anesthesia (ILA) with conventional inferior alveolar nerve block (IANB) for extraction of mandibular posterior teeth.

Materials and methods

In a prospective clinical trial, a total of 301 mandibular posterior teeth were extracted in 266 patients. Randomization was conducted into those who received ILA (patients n = 98; teeth n = 105) and those who received IANB (patient n = 140; teeth n = 140). Twenty-eight patients were subjected to bilateral mandibular dental extractions and received both ILA und IANB (teeth n = 56 (ILA n = 28; IANB n = 28)). The primary objective was to evaluate the differences in pain during injection, in pain during tooth extraction (numeric rating scale (NRS)), and in anesthetic quality (complete/sufficient vs. insufficient/no effect). Differences in latency time, amount of anesthetic solution, need for second injection, and duration of local numbness as well as in the incidence of dry socket were assessed.


ILA had significant lower pain of injection (p < 0.001), shorter latency time (p < 0.001), and shorter duration of local numbness (p < 0.001) and required lesser amount of local anesthetic solution (p < 0.001) together with a similar anesthetic quality (p = 0.082) compared to IANB. Concerning pain during extraction (p = 0.211), frequency of second injection (p = 0.197), and incidence of dry socket (p = 0.178), no significant differences were detected.


ILA fulfills the requirements of a minimal invasive and patient-friendly local anesthetic technique. In accordance, it represents a safe and reliable alternative to IANB for extraction of mandibular posterior teeth.

Clinical relevance

ILA can be recommended for routine dental extractions.


Intraligamentary anesthesia Periodontal ligament injection Inferior alveolar nerve block Mechanical injection syringe Pistol type syringe Ultraject® syringe Dental extraction Comparison 


Funding information

No funding was obtained.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Approval of the local ethics committee (No. A 2014-0129) was obtained.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Foster W, Drum M, Reader A, Beck M (2007) Anesthetic efficacy of buccal and lingual infiltrations of lidocaine following an inferior alveolar nerve block in mandibular posterior teeth. Anesth Prog 54:163–169.[163:AEOBAL]2.0.CO;2 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kämmerer PW, Schneider D, Palarie V, Schiegnitz E, Daubländer M (2017) Comparison of anesthetic efficacy of 2 and 4% articaine in inferior alveolar nerve block for tooth extraction-a double-blinded randomized clinical trial. Clin Oral Investig 21:397–403. CrossRefPubMedGoogle Scholar
  3. 3.
    Kaufman E, Weinstein P, Milgrom P (1984) Difficulties in achieving local anesthesia. J Am Dent Assoc 108:205–208CrossRefPubMedGoogle Scholar
  4. 4.
    Pogrel MA (2007) Permanent nerve damage from inferior alveolar nerve blocks—an update to include articaine. J Calif Dent Assoc 35:271–273PubMedGoogle Scholar
  5. 5.
    Wright EF (2011) Medial pterygoid trismus (myospasm) following inferior alveolar nerve block: case report and literature review. Gen Dent 59:64–67PubMedGoogle Scholar
  6. 6.
    Shabazfar N, Daubländer M, Al-Nawas B, Kämmerer PW (2014) Periodontal intraligament injection as alternative to inferior alveolar nerve block—meta-analysis of the literature from 1979 to 2012. Clin Oral Investig 18:351–358. CrossRefPubMedGoogle Scholar
  7. 7.
    Chi D, Kanellis M, Himadi E, Asselin ME (2008) Lip biting in a pediatric dental patient after dental local anesthesia: a case report. J Pediatr Nurs 23:490–493. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Walton RE, Garnick JJ (1982) The periodontal ligament injection: histologic effects on the periodontium in monkeys. J Endod 8:22–26. CrossRefPubMedGoogle Scholar
  9. 9.
    Dreyer WP, van Heerden JD, de VJJJ (1983) The route of periodontal ligament injection of local anesthetic solution. J Endod 9:471–474. CrossRefPubMedGoogle Scholar
  10. 10.
    Kämmerer PW, Palarie V, Daubländer M, Bicer C, Shabazfar N, Brüllmann D, Al-Nawas B (2012) Comparison of 4% articaine with epinephrine (1:100,000) and without epinephrine in inferior alveolar block for tooth extraction: double-blind randomized clinical trial of anesthetic efficacy. Oral Surg Oral Med Oral Pathol Oral Radiol 113:495–499. CrossRefPubMedGoogle Scholar
  11. 11.
    Dumbrigue HB, Lim MV, Rudman RA, Serraon A (1997) A comparative study of anesthetic techniques for mandibular dental extraction. Am J Dent 10:275–278PubMedGoogle Scholar
  12. 12.
    Ezoddini Ardakani F, Bahrololoumi Z, Zangouie Booshehri M, Navab Azam A, Ayatollahi F (2010) The position of lingula as an index for inferior alveolar nerve block injection in 7-11-year-old children. J Dent Res Dent Clin Dent Prospects 4:47–51. PubMedPubMedCentralGoogle Scholar
  13. 13.
    Kaufman E, Epstein JB, Naveh E, Gorsky M, Gross A, Cohen G (2005) A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections. Anesth Prog 52:122–127.[122:ASP]2.0.CO;2 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Kämmerer PW, Schiegnitz E, von Haussen T, Shabazfar N, Kämmerer P, Willershausen B, Al-Nawas B, Daublander M (2015) Clinical efficacy of a computerised device (STA) and a pressure syringe (VarioJect INTRA) for intraligamentary anaesthesia. Eur J Dent Educ 19:16–22. CrossRefPubMedGoogle Scholar
  15. 15.
    Faulkner RK (1983) The high-pressure periodontal ligament injection. Br Dent J 154:103–105CrossRefPubMedGoogle Scholar
  16. 16.
    Edwards RW, Head TW (1989) A clinical trial of intraligamentary anesthesia. J Dent Res 68:1210–1213. CrossRefPubMedGoogle Scholar
  17. 17.
    Mannucci PM, Aberg M, Nilsson IM, Robertson B (1975) Mechanism of plasminogen activator and factor VIII increase after vasoactive drugs. Br J Haematol 30:81–93CrossRefPubMedGoogle Scholar
  18. 18.
    Tsirlis AT, Iakovidis DP, Parissis NA (1992) Dry socket: frequency of occurrence after intraligamentary anesthesia. Quintessence Int 23:575–577PubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • P. W. Kämmerer
    • 1
  • A. Adubae
    • 1
  • I. Buttchereit
    • 1
  • D. G. E. Thiem
    • 1
  • M. Daubländer
    • 2
  • B. Frerich
    • 1
  1. 1.Department of Oral and Maxillofacial Surgery, Facial Plastic SurgeryUniversity Medical Centre RostockRostockGermany
  2. 2.Policlinic of Oral SurgeryUniversity Medical Centre MainzMainzGermany

Personalised recommendations