With respect to postoperative pain, the 2 subjects who were reperforated (1 Stabident and 1 X-Tip™) could have had a small effect on postoperative pain. However, it is very unlikely that the administration of an additional 0.3 mL of anesthetic solution for the infiltration would have had an effect on postoperative pain.

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For the Stabident and X-Tip™ techniques, needle insertion for the infiltration injection, into alveolar mucosa, resulted in mild pain ratings, with 2-10% of the subjects reporting moderate pain and no reports of severe pain (Table 1). The mean VAS ratings were 34 for the Stabident technique and 28 for the X-Tip™ technique, which would be in the range of weak pain (Figure 3). There was no significant difference (P > .05) between the X-Tip™ and Stabident techniques. This would be expected because the technique and location of needle insertion was identical regardless of the IO system utilized. Coggins et al reported a 20% incidence of moderate pain and no reports of severe pain with needle insertion, into the attached gingiva, for the infiltration injection of the mandibular first molar. Replogle et al reported only a 2% incidence of moderate pain with infiltration, into attached gingiva, of the mandibular first molar. Generally, the results of the current study and the studies by Replogle et al and Coggins et al would indicate that needle insertion, either into attached gingiva or alveolar mucosa, may result in a 2-20% incidence of moderate pain. No topical anesthetic was applied in this study, although it is recommended by the Stabident and X-Tip™ manuals. Topical anesthetic was not applied to the mucosal injection site because we wanted to measure the pain of the infiltration injection. The use of topical anesthetic has been advocated as an aid in reducing the pain of needle insertion. While Rosivack et al demonstrated the effectiveness of topical anesthetic, Gill and Orr and Kincheloe et al showed no significant pain reduction with the use of topical anesthetic. Martin et al found that if the patient thought they were receiving topical, whether they did or not, pain ratings were lower. Therefore, the most important aspect of using topical anesthetic may not be its clinical effectiveness but rather the psychological effect on the patient who feels the practitioner is doing everything possible to prevent pain.

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Forty-one adult subjects, 24 men and 17 women, from age 19 to 43 years with an average age of 26 years, participated. Because we studied a young adult population, the results of this study may not apply to children or the elderly.

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Forty-one adult subjects, 24 men and 17 women, participated in this study. The subjects were in good health and were not taking any medications that would alter pain perception. The Ohio State University Human Subjects Review Committee approved the study and written informed consent was obtained from each subject.

Twenty-four mandibular left and 17 right sides were tested, with the first molar chosen as the tooth to receive the IO injections. Clinical examinations indicate that all teeth were free of caries, large restorations, and periodontal disease, and that none had a history of trauma or sensitivity.

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The intraosseous injection (IO) allows placement of a local anesthetic directly into the cancellous bone adjacent to the tooth to be anesthetized. Currently, there is an intraosseous injection system marketed under the name Stabident (Fairfax Dental Inc, Miami, Fla). This system is comprised of a slow-speed handpiece driven perforator, a solid 27-gauge wire with a beveled end, that when activated drills a small hole through the cortical plate (Figure 1). The anesthetic solution is delivered to cancellous bone through the 27-gauge ultrashort injector needle placed into the hole made by the perforator. Injection pain and postoperative pain of the Stabident system have been evaluated as a primary injection. Replogle et al and Coggins et al reported 0-7% of subjects had moderate pain and none had severe pain with a primary Stabident perforation at the mandibular first molar site. Replogle et al and Coggins et al also reported 2-15% of subjects had moderate pain and 0,2% had severe pain with anesthetic solution deposition at the mandibular first molar site. Postoperative pain, at the time subjective numbness wore off, has been reported by various authors to range from 2-16% moderate pain with a 0-3% incidence of severe pain. The postoperative pain ratings decreased over the next 3 postoperative days. Swelling and purulence at the Stabident IO injection sites have been reported less than 5% of the time.

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