Objectives: 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.
Results: 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.
Conclusion: 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.
Keywords: Comparison; Dental extraction; Inferior alveolar nerve block; Intraligamentary anesthesia; Mechanical injection syringe; Periodontal ligament injection; Pistol type syringe; Ultraject® syringe.