Pain & Relief Kämmerer, J Pain Relief 2012, 1:5 http://dx.doi.org/10.4172/2167-0846.1000108 Research Article Open Access Volume 1 • Issue 5 • 1000108 J Pain Relief ISSN: 2167-0846 JPAR an open access journal Clinical and Histological Comparison of Pulp Anaesthesia and Local Diffusion after Periodontal Ligament Injection and Intrapapillary Infiltration Anaesthesia Peer W. Kämmerer 1 *, Victor Palarie 2 , Eik Schiegnitz 1 , Thomas Ziebart 1 , Bilal Al-Nawas 1 and Monika Daubländer 3 1 Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, Mainz, Germany 2 Clinic for Oral & Maxillofacial Surgery, State Medical and Pharmaceutical University “Nicolae Testemitanu,” Chisinau, Moldova 3 Department of Oral Surgery, University Medical Centre Mainz, Germany Abstract Background: Periodontal ligament injection (PDL) is used to achieve single tooth pulp anaesthesia; iniltrative, non-osseous intrapapillary anaesthesia (IPA) may be an alternative with a minor complication rate. Therefore, the aim of the study was an evaluation and comparison of PDL and IPA techniques via clinical human and animal histological methods. Methods: For clinical evaluation, 30 healthy volunteers were injected with both techniques in a split mouth design with 2 mandibular premolars on each side. Pain of injection (VAS) as well as an electric pulp testing via pulp vitality scanner was performed. Length of anaesthesia was measured. Two male sheep were injected with coloured anaesthetic solution in a split mouth design with 3 teeth on each side. Macroscopic surfaces of the non-decalciied bone parts, microscopic evaluation of the non-decalciied bone parts and histological sections with decalciied cut surfaces were examined. Results: Human clinical examinations could show no signiicant difference in injection pain; though, PDL resulted in a more profound and longer pulp anaesthesia (both p<0.0001) than IPA in all cases. In animal histological examinations, the local spread of anaesthetic agent into surrounding bone after PDL could be shown. In contrast, for IPA, mainly soft tissue diffusion was seen. Conclusion: According to clinical and histological data, profound bone diffusion – as to be seen in PDL - seems to be the essential factor for successful single tooth pulp anaesthesia. *Corresponding author: Peer W. Kämmerer MD, DMD Assistant Professor, Department of Oral and Maxillofacial Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131 Mainz, Germany, Tel: 00496131-175086; Fax: 06131/17- 6602; E-mail: peer.kaemmerer@unimedizin-mainz.de Received April 10, 2012; Accepted June 11, 2012; Published June 18, 2012 Citation: Kämmerer PW, Palarie V, Schiegnitz E, Ziebart T, Al-Nawas B, et al. (2012) Clinical and Histological Comparison of Pulp Anaesthesia and Local Diffusion after Periodontal Ligament Injection and Intrapapillary Iniltration Anaesthesia. J Pain Relief 1:108. doi:10.4172/2167-0846.1000108 Copyright: © 2012 Kämmerer PW, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Clinical study; Histological study; Intraligamentary injection; Intraosseous resorption; Intrapapillary injection; Periodontal ligament; Iniltration; Dental local anaesthesia Introduction Improvements in local anaesthetic techniques may minimize pain during dental treatment. Block techniques of the trigeminal branches (II and III) are considered to be the most used and trusted methods in dentistry [1]. However, the incidence of inadequate anaesthesia and technical complications is reported to be between 15-30% of cases [2,3]. Other possibilities to achieve local anaesthesia are iniltration, intra-pulpal injection, intraosseous [4], intraseptal [5] and periodontal ligament injection (PDL). In the present time, PDL technique increases in popularity, especially because of specialized high pressure syringe systems [6] and computer controlled local anaesthesia devices [7,8]. PDL has shown to provide suicient anaesthesia of the pulp. It is less unpleasant and painful than inferior alveolar and palatinal injections. Other advantages are well documented: single tooth anaesthesia, minimal anaesthetic agent dosage, rapid onset and safety in patients with bleeding problems as well as in medical compromised patients [6, 9-11]. hough, disadvantages like damage of periodontal tissue, damage of interdental septal crest, root resorption and severe bacteraemia are reported as well [12-15, 8]. Infection and/or inlammation may decrease the anaesthetic eicacy [16] and PDL may induce systemic reactions manifested in cardiovascular parameters changes [17]. Intraseptal- intraosseous anaesthesia (ISA) is described to be an alternative to PDL in order to overcome inconveniences associated with PDL, especially in compromised periodontal tissues [16,5]. Still, probably because of the enosseous pathway, ISA has shown to cause cardiovascular changes similar to PDL [18]. Intrapapillary iniltration anaesthesia (IPA) is an intermediate of PDL and ISA and consists of application of the local anaesthetic agent into the mesial and distal papillae without touching the periodontal ligament and without application in the bone. herefore, cardiovascular side efects may be reduced. Such as for ISA, potential side efects like damage of periodontal tissue and bacteraemia are limited. For IPA, normal syringes as well as pressure delivery systems can be used [18]. In order to minimize all possible side efects in general practice, we tested the new IPA technique for pulp anaesthesia. To our knowledge, there are no published studies that compare PDL and IPA. herefore, the aim of the present study was to evaluate pulp anaesthesia (clinical setting) as well as local difusion of the anaesthetic agent (histological setting) in both methods. Material and Methods he experimental solution tested was 4% Articaine with epinephrine 1:200.000 (Ultracain DS ® , Sanoi-Aventis GmbH, Berlin, Germany) in dental cartridges. For both methods of anaesthesia, a system composed from Varioject INTRA ® syringe and single use plastic device VarioSafe ® with a pressure limit at 70 N (both Pajunk ® GmbH Medizintechnologie, Geisingen, Germany, Figure 1) was used. A 27-gauge short needle was