Effectiveness of Computerized Delivery Local Anesthesia in Primary Maxillary Molars

Objectives: The purpose of this study was to compare the effectiveness of infiltration and intrasulcular injection, Delivered by a computerized delivery system (CDS) (Wand, Milestome Scientific, USA), to primary maxillary molars. Methods: The study population consisted of 178 children (2-4 years old) who received local infiltration (buccal and palatal) or intrasulcular injection to primary maxillary molars with the use of a CDS. Behavior was managed using: (1) behavioral management techniques; (2) N2O inhalation; or (3) sedation. Measured dependent variables included the: (1) child's subjective perception of well-being before and immediately after anesthesia (scale = 0-100); (2) child's pain behavior during anesthesia, as measured by Children's hospital of Eastern Ontario pain scale (CHEOPS; range= 4-13); and (3) effectiveness of anesthesia during dental treatment. Results: Low stress levels were shown for most children before and immediately after anesthesia (range=12-23). The CHEOPS rating for pain-distractive behavior associated with palatal and buccal infiltration and intrasulcular anesthesia by CDS was similar (6.0±1.9, 5.8±1.7, and 5.9±1.6, respectively). Children treated under sedation, compared to behavioral management techniques, showed higher CHEOPS scores (P=.004). The effectiveness of anesthesia using a CDS (infiltration and intrasulcular) had a downward trend, but was not significantly different for restoration (91%), pulpotomy and performed crowns (79%) ,or extraction (74%; mean=86%). There was no significant difference between infiltration and intrasulcular effectiveness or for age, gender, or tooth location (primary maxillary first vs second molars). Conclusion: CDS caused low levels of stress and pain reaction after palatal infiltration equal to that for buccal infiltration. All procedures achieved anesthesia effectiveness (86%), with no differences between primary maxillary first and second molars.