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Patient discomfort and intensity of intraseptal anesthesia of computer-controlled articaine/epinephrine delivery for scaling and root planing

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Abstract

Objectives

The primary aim was to assess the pain during intraseptal anesthesia (ISA) administration, as well as during and after scaling and root planing (SRP). The secondary aims pertained to comparing the pain in different jaw regions and evaluating the factors affecting pain during ISA administration, during and after SRP.

Material and methods

ISA was obtained with three different doses of 4% articaine with 1:100,000 epinephrine (4%Ar + Ep) in 360 patients. The pain levels were measured using the visual analogue scales (VAS) for pain intensity during ISA administration (VASa), during SRP (VASi), and after SRP (VASp). These findings were then correlated with periodontal parameters. Regression analysis was performed for pain during ISA, during and after SRP.

Results

Anesthesia administration was painful in 80.8% of cases. VASa negatively correlated with pocket depth (PPD). VASi showed no dose-dependency, except in mandibular premolars. VASi negatively correlated with the clinical attachment level (CAL). VASp positively correlated with PPD and CAL. Positive bleeding on probing reduced the chance of pain during ISA administration. Longer anesthesia duration and wider anesthetic field (orally) increased the prospects of painless SRP.

Conclusions

No dose-dependent differences were found regarding patient discomfort and pain intensity of ISA delivery of 4%Ar + Ep for SRP.

Clinical Relevance

The pain during ISA administration was mild and well tolerated regardless of the anesthetic dose. A lower intensity of pain during SRP can be expected in patients with greater CAL. Post-treatment pain can be anticipated after SRP in the regions with greater PPD and CAL.

Clinical Trials registration number: NCT04392804 (May 9th, 2020).

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Data availability

The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

References

  1. Newman M, Takei H, Klokkevold P, Carranza F (2019) Newman and Carranza’s clinical periodontology. In (13th ed.). Else- vier, Amsterdam

  2. Lindhe J, Lang N, Karring T (2015) Clinical periodontology and implant dentistry. In (6th ed.). Blackwell Munksgaard, Copenhagen

  3. Cobb CM, Sottosanti JS (2021) A re-evaluation of scaling and root planing. J Periodontol 92(10):1370–1378. https://doi.org/10.1002/JPER.20-0839

    Article  PubMed  Google Scholar 

  4. Greenstein G (1992) Periodontal response to mechanical non-surgical therapy: a review. J Periodontol 63(2):118–130. https://doi.org/10.1902/jop.1992.63.2.118

    Article  PubMed  Google Scholar 

  5. Grant DA, Lie T, Clark SM, Adams DF (1993) Pain and discomfort levels in patients during root surface debridement with sonic metal or plastic inserts. J Periodontol 64:645–650. https://doi.org/10.1902/jop.1993.64.7.645

    Article  PubMed  Google Scholar 

  6. Karadottir H, Lenoir L, Barbierato B, Bogle M, Riggs M, Sigurdsson T et al (2002) Pain experienced by patients during periodontal maintenance treatment. J Periodontol 73:536–542. https://doi.org/10.1902/jop.2002.73.5.536

    Article  PubMed  Google Scholar 

  7. Canakci V, Canakci CF (2007) Pain levels in patients during periodontal probing and mechanical non-surgical therapy. Clin Oral Investig 11:377–383. https://doi.org/10.1007/s00784-007-0126-z

    Article  PubMed  Google Scholar 

  8. Leung WK, Duan YR, Dong XX, Yeung K, Zhou SY, Corbet EF, Meng HX (2016) Perception of non-surgical periodontal treatment in individuals receiving or not receiving local anesthesia. Oral Health Prev Dent 14:165–175. https://doi.org/10.3290/j.ohpd.a35001

    Article  PubMed  Google Scholar 

  9. Donaldson D, Gelskey SC, Landry RG, Matthews DC, Sandhu HS (2003) A placebo-controlled multicentred evaluation of an anaesthetic gel (Oraqix) for periodontal therapy. J Clin Periodontol 30(3):171–175. https://doi.org/10.1034/j.1600-051x.2003.00017.x

    Article  PubMed  Google Scholar 

  10. Jeffcoat MK, Geurs NC, Magnusson I, MacNeill SR, Mickels N, Roberts F et al (2001) Intrapocket anesthesia for scaling and root planing: results of a double-blind multicenter trial using lidocaine prilocaine dental gel. J Periodontol 72(7):895–900. https://doi.org/10.1902/jop.2001.72.7.895

    Article  PubMed  Google Scholar 

  11. Magnusson I, Geurs NC, Harris PA, Hefti AF, Mariotti AJ, Mauriello SM et al (2003) Intrapocket anesthesia for scaling and root planing in pain-sensitive patients. J Periodontol 74(5):597–602. https://doi.org/10.1902/jop.2003.74.5.597

    Article  PubMed  Google Scholar 

  12. Derman SHM, Lowden CE, Kaus P, Noack MJ (2014) Pocket-depths-related effectiveness of an intrapocket anaesthesia gel in periodontal maintenance patients. Int J Dent Hyg 12(2):141–144. https://doi.org/10.1111/idh.12036

    Article  PubMed  Google Scholar 

  13. Friskopp J, Nilsson M (2001) Isacsson G (2001) The anesthetic onset and duration of a new lidocaine/prilocaine gel intrapocket anesthetic (Oraqix) for periodontal scaling/root planing. J Clin Periodontol 28(5):453–458. https://doi.org/10.1034/j.1600-051x.2001.028005453.x

    Article  PubMed  Google Scholar 

  14. van Steenberghe D, Bercy P, Boever JD, Adriaens P, Geers L, Hendrickx E et al (2004) Patient evaluation of a novel non-injectable anesthetic gel: a multicenter crossover study comparing the gel to infiltration anesthesia during scaling and root planing. J Periodontol 75(11):1471–1478. https://doi.org/10.1902/jop.2004.75.11.1471

    Article  PubMed  Google Scholar 

  15. Santuchi CC, Cortelli SC, Cortelli JR, Cota LOM, Alencar CO, Costa FO (2015) Pre- and post-treatment experiences of fear, anxiety, and pain among chronic periodontitis patients treated by scaling and root planing per quadrant versus one-stage full-mouth disinfection: a 6-month randomized controlled clinical trial. J Clin Periodontol 42(11):1024–1031. https://doi.org/10.1111/jcpe.12472

    Article  PubMed  Google Scholar 

  16. Pandit N, Gupta R, Chandoke U, Gugnani S (2010) Comparative evaluation of topical and electronic anesthesia during scaling and root planing. J Periodontol 81(7):1035–1040. https://doi.org/10.1902/jop.2010.090702

    Article  PubMed  Google Scholar 

  17. Antoniazzi RP, Cargnelutti B, Freitas DN, Guimarães MB, Zanatta FB, Feldens CA (2015) Topical intrapocket anesthesia during scaling and root planing: a randomized clinical trial. Braz Dent J 26(1):26–32. https://doi.org/10.1590/0103-6440201300131

    Article  PubMed  Google Scholar 

  18. Collins F (2006) Scaling and root planing: case acceptance and practice building. Dent Econ 96:25

    Google Scholar 

  19. de Souza TL, Barbisan Souza A, Girardi AA, Romito GA, Araújo MG (2015) The anesthetic effect of anterior middle superior alveolar technique (AMSA). Anesth Prog 62:153–158. https://doi.org/10.2344/13-00013.1

    Article  Google Scholar 

  20. Loomer PM, Perry DA (2004) Computer-controlled delivery versus syringe delivery of local anesthetic injections for therapeutic scaling and root planing. J Am Dent Assoc 135(3):358–65. https://doi.org/10.14219/jada.archive.2004.0188

    Article  PubMed  Google Scholar 

  21. Malamed S (2004) Handbook of local anesthesia. In (5th ed.). The C.V. Mosby Company, St. Louis

  22. Biocanin V, Brkovic B, Milicic B, Stojic D (2013) Efficacy and safety of intraseptal and periodontal ligament anesthesia achieved by computer-controlled articaine plus epinephrine delivery: a dose-finding study. Clin Oral Investig 17:525–533. https://doi.org/10.1007/s00784-012-0724-2

    Article  PubMed  Google Scholar 

  23. Brkovic B, Savic M, Andric M, Jurisic M, Todorovic L (2010) Intraseptal vs. periodontal ligament anesthesia for maxillary tooth extraction: quality of local anesthesia and haemodynamic response. Clin Oral Investig 14:675–681. https://doi.org/10.1007/s00784-009-0352-7

    Article  PubMed  Google Scholar 

  24. Fowler S, Crowley C, Drum M, Reader A, Nusstein J, Beck M (2018) Inferior alveolar nerve block injection pain using a Computer-Controlled Local Anesthetic Device (CCLAD): a prospective randomized study. Anesth Prog 65(4):231–236. https://doi.org/10.2344/anpr-65-03-11

    Article  PubMed  PubMed Central  Google Scholar 

  25. Alamoudi NM, Baghlaf KK, Elashiry EA, Farsi NM, El Derwi DA, Bayoumi AM (2016) The effectiveness of computerized anesthesia in primary mandibular molar pulpotomy: a randomized controlled trial. Quintessence Int Berl Ger 47(3):217–224. https://doi.org/10.3290/j.qi.a34977. (1985)

    Article  Google Scholar 

  26. Kwak EJ, Pang NS, Cho JH, Jung BY, Kim KD, Park W (2016) Computer-controlled local anesthetic delivery for painless anesthesia: a literature review. J Dent Anesth Pain Med 16(2):81–8. https://doi.org/10.17245/jdapm.2016.16.2.81

    Article  PubMed  PubMed Central  Google Scholar 

  27. Singh S, Garg A (2013) Comparison of the pain levels of computer controlled and conventional anesthesia techniques in supra- periosteal injections: a randomized controlled clinical trial. Acta Odontol Scand 71:740–743. https://doi.org/10.3109/00016357.2012.715200

    Article  PubMed  Google Scholar 

  28. Oertel R, Rahn R, Kirch W (1997) Clinical pharmacokinetics of articaine. Clin Pharmacokinet 33(6):417–425. https://doi.org/10.2165/00003088-199733060-00002

    Article  PubMed  Google Scholar 

  29. Vree TB, Gielen MJ (2005) Clinical pharmacology and the use of articaine for local and regional anesthesia. Best Pract Res Clin Anaesthesiol 19:293–308. https://doi.org/10.1016/j.bpa.2004.12.006

    Article  PubMed  Google Scholar 

  30. Bonar T, Nusstein J, Reader A, Drum M, Fowler S, Beck M (2017) Anesthetic efficacy of articaine and lidocaine in a pri- mary intraseptal injection: a prospective, randomized double- blind study. Anesth Prog 64:203–211. https://doi.org/10.2344/anpr-64-04-10

    Article  PubMed  PubMed Central  Google Scholar 

  31. Doman SM (2011) An audit of the use of intra-septal local anaesthesia in a dental practice in the South of England. Prim Dent Care J Fac Gen Dent Pract UK 18(2):67–71. https://doi.org/10.1308/135576111795162848

    Article  Google Scholar 

  32. Djoric J, Djinic Krasavcevic A, Barac M, Kuzmanovic Pficer J, Brkovic B, Nikolic-Jakoba N (2023) Efficacy of intraseptal anesthesia obtained by computer-controlled articaine with epinephrine delivery in scaling and root planing. Clin Oral Invest 27(6):2913–2922. https://doi.org/10.1007/s00784-023-04889-4

    Article  Google Scholar 

  33. Polson AM (1997) The research team, calibration, and quality assurance in clinical trials in periodontics. Ann Periodontol 2:75–82. https://doi.org/10.1902/annals.1997.2.1.75

    Article  PubMed  Google Scholar 

  34. Ainamo J, Bay I (1975) Problems and proposals for recording gingivitis and plaque. Int Dent J 25:229–235

    PubMed  Google Scholar 

  35. O’Leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43(1):38. https://doi.org/10.1902/jop.1972.43.1.38

    Article  PubMed  Google Scholar 

  36. Papapanou PN, Sanz M, Buduneli N, Dietrich T, Feres M, Fine DH et al (2018) Periodontitis: consensus report of workgroup 2 of the 2017 world workshop on the classification of periodontal and peri-implant diseases and conditions. J Periodontol 89:S173–S182. https://doi.org/10.1002/jper.17-0721

    Article  PubMed  Google Scholar 

  37. Fitzgerald BP, Hawley CE, Harrold CQ, Garrett JS, Polson AM, Rams TE (2022) Reproducibility of manual periodontal probing following a comprehensive standardization and calibration training program. J Oral Biol (Northborough) 8(1):0063. https://doi.org/10.13188/2377-987X.1000063

    Article  PubMed  Google Scholar 

  38. Pak DJ, Yong RJ, Kaye AD, Urman RD (2018) Chronification of pain: mechanisms, current understanding, and clinical implications. Curr Pain Headache Rep 22(2):9. https://doi.org/10.1007/s11916-018-0666-8

    Article  Google Scholar 

  39. Ogle OE, Mahjoubi G (2012) Local anesthesia: agents, techniques, and complications. Dent Clin North Am 56(1):133–48. https://doi.org/10.1016/j.cden.2011.08.003

    Article  PubMed  Google Scholar 

  40. Aminabadi NA, Farahani RMZ, Oskouei SG (2009) Site-specificity of pain sensitivity to intraoral anesthetic injections in children. J Oral Sci 51(2):239–243. https://doi.org/10.2334/josnusd.51.239

    Article  PubMed  Google Scholar 

  41. Becker DE, Reed KL (2012) Local anesthetics: review of pharmacological considerations. Anesth Prog 59:90–101. https://doi.org/10.2344/0003-3006-59.2.90. (quiz 102–103)

    Article  PubMed  PubMed Central  Google Scholar 

  42. Jensen M (2003) Interpretation of visual analog scale ratings and change scores: a reanalysis of two clinical trials of postoperative pain. J Pain 4(7):407–414. https://doi.org/10.1016/s1526-5900(03)00716-8

    Article  PubMed  Google Scholar 

  43. Schirmer C, Dos Santos GO, Rost JF, Ferreira MBC, Weidlich P (2018) Factors associated with pain and analgesic consumption following non-surgical periodontal therapy under local anaesthesia and carried out by dental students. J Clin Periodontol 45(1):68–77. https://doi.org/10.1111/jcpe.12833

    Article  PubMed  Google Scholar 

  44. Tammaro S, Wennström JL, Bergenholtz G (2000) Root-dentin sensitivity following non-surgical periodontal treatment. J Clin Periodontol 27(9):690–697. https://doi.org/10.1034/j.1600-051x.2000.027009690.x

    Article  PubMed  Google Scholar 

  45. Gaurilcikaite E, Renton T, Grant AD (2017) The paradox of painless periodontal disease. Oral Dis 23(4):451–463. https://doi.org/10.1111/odi.12537

    Article  PubMed  Google Scholar 

  46. Nagashima H, Shinoda M, Honda K, Kamio N, Watanabe M, Suzuki T, et al (2017) CXCR4 signaling in macrophages contributes to periodontal mechanical hypersensitivity in Porphyromonas gingivalis-induced periodontitis in mice. Mol Pain. 13. https://doi.org/10.1177/1744806916689269

  47. Wang C, Zhou X, Chen Y, Zhang J, Chen W, Svensson P et al (2020) Somatosensory profiling of patients with plaque-induced gingivitis: a case–control study. Clin Oral Investig 24(2):875–882. https://doi.org/10.1007/s00784-019-02963-4

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to express our gratitude to Irena Aleksic-Hajdukovic, Assistant Professor in English Language at the School of Dental Medicine, University of Belgrade, for her thorough check and revision of the English language.

Funding

This research was supported by Grant No. 451–03-47/2023–01/200129 from the Ministry of Education, Science and Technological Development of the Republic of Serbia.

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Authors and Affiliations

  1. Department of Periodontology and Oral Medicine, School of Dental Medicine, University of Belgrade, Dr Subotica 4, Belgrade, Serbia

    Jelica Djoric, Ana Djinic Krasavcevic, Milena Barac & Natasa Nikolic-Jakoba

  2. Department of Medical Statistics and Informatics, School of Dental Medicine, University of Belgrade, Dr Subotica 1, Belgrade, Serbia

    Jovana Kuzmanovic Pficer

  3. Department of Oral Surgery, School of Dental Medicine, University of Belgrade, Dr Subotica 4, Belgrade, Serbia

    Bozidar Brkovic

Authors
  1. Jelica Djoric
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  2. Ana Djinic Krasavcevic
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Contributions

All authors have made the substantial contributions to conception and design of the study.

Jelica Djoric: methodology; investigation; data collection; data curation; formal analysis; writing – original draft preparation. Ana Djinic Krasavcevic: methodology; writing – original draft preparation; visualization; writing – review and editing. Milena Barac: methodology; investigation; data collection; data curation. Jovana Kuzmanovic Pficer: formal analysis; data curation; validation. Bozidar Brkovic: conceptualization; methodology; supervision; writing – review and editing. Natasa Nikolic-Jakoba: conceptualization; methodology; supervision; investigation; validation; writing – review and editing.

Corresponding author

Correspondence to Jelica Djoric.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The research protocol was approved by the Ethics Committee of the School of Dental Medicine, University of Belgrade, Serbia (Date: March 10th, 2020, approval No. 36/8).

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

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Djoric, J., Djinic Krasavcevic, A., Barac, M. et al. Patient discomfort and intensity of intraseptal anesthesia of computer-controlled articaine/epinephrine delivery for scaling and root planing. Clin Oral Invest 27, 6221–6234 (2023). https://doi.org/10.1007/s00784-023-05238-1

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