Postoperative Pain of Two Intraosseous Anesthetic Techniques

In: Anesthesia

20 Oct 2009

Postoperative Pain of Two Intraosseous Anesthetic Techniques

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.

Figure 1. The Stabident perforator

Figure 1. The Stabident perforator, a solid 27-gauge wire with a beveled end, which is placed in a slow-speed handpiece.

All of the above studies used the Stabident system. Currently, a second intraosseous system is on the market. The X-Tip™ anesthesia delivery system (X-Tip™ Technologies, Lakewood, NJ) consists of an X-Tip™ that separates into 2 parts: the drill and guide sleeve component (Figure 2). The drill (a special hollow needle) leads the guide sleeve through the cortical plate, whereupon it is separated and withdrawn. The remaining guide sleeve is designed to accept a 27-gauge needle to inject the anesthetic solution. The guide sleeve is removed after the intraosseous injection is complete. flomax medication

Figure 2. The X-tipTM anesthesia

Figure 2. The X-tip™ anesthesia delivery system consists of an X-tip™ (top) that separates into 2 parts: the drill (a special hollow needle) and guide sleeve component (bottom).

Both the Stabident and X-Tip™ intraosseous systems instruct the user to locate the perforation site in attached gingiva. However, because the guide sleeve remains in place with the X-Tip™ system, we felt it could be used in alveolar mucosa at an apical location. Occasionally, the Stabident system fails or cannot be used at the coronal location due to periodontal disease (deep pockets) or lack of interproximal space (roots are too close together). Would the alternative X-Tip™ system, used in an apical location, result in similar pain ratings and postoperative discomfort as the Stabident system? There are no scientific studies on the X-Tip™ system regarding injection pain or postoperative pain. buy finasteride online

The purpose of this prospective, randomized blinded study was to compare injection pain and postoperative pain of an apical primary X-Tip™ intraosseous technique to a coronal primary Stabident intraosseous technique in mandibular first molars.


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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.

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