The purpose of this prospective randomized study was to assess using a periodontal ligament (PDL) injection as an aide to decrease palatal infiltration pain. A total of 133 subjects randomly received a PDL injection and alternative palatal infiltration or a mock PDL injection and conventional palatal infiltration at 2 separate appointments. PDL injection was given in the mid-palatal sulcus of the maxillary first molar. Mock PDL injection consisted of only needle insertion. All subjects then received a palatal infiltration administered into the blanched gingival tissue 3 mm (alternative palatal infiltration) or 7 mm (conventional palatal infiltration) from the gingival collar. Subjects recorded needle insertion and solution deposition pain using a Heft-Parker visual analog scale (VAS). The combined PDL injection and alternative palatal infiltration had significantly decreased mean VAS ratings for needle insertion and solution deposition pain (P < .0001). Incidence of moderate/severe pain for needle insertion and solution deposition was reduced from 65% to 1% and from 65% to 2%, respectively. Providing PDL anesthesia into the mid-palatal sulcus of the maxillary first molar and then administering an alternative palatal infiltration into the blanched collar around the PDL molar site led to significant reductions in needle insertion and solution deposition pain compared with a mock PDL and conventional palatal infiltration.
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The Heft Parker VAS. The numbers at the top of the scale were omitted on the patients' VAS. VAS indicates visual analog scale.
PDL injection. Placement of the 27-gauge ultra-short needle in the gingival sulcus and initial blanching of the gingival collar at the start of the PDL injection. PDL indicates periodontal ligament.
Pain ratings by VAS category. The first 4 columns represent needle insertion and solution deposition for the PDL and mock PDL injections. The last 4 columns represent needle insertion and solution deposition for the PDL-aPI injections and the mPDL-cPI injections. VAS indicates visual analog scale; PDL, periodontal ligament; PDL-aPI, PDL injection and alternative palatal infiltration; mPDL-cPI, mock PDL injection and conventional palatal infiltration.
Models of the Extent of Palatal Anesthesia. The top image is the PDL-aPI technique, and the bottom image is the mPDL-cPI technique. The small “dot” on each image is the location of the approximate palatal injection site. The mPDL-cPI technique produced a larger area of soft tissue anesthesia. PDL-aPI indicates PDL injection and alternative palatal infiltration; mPDL-cPI, mock PDL injection and conventional palatal infiltration.
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eISSN: 1878-7177
ISSN: 0003-3006