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Prospective Study on PDL Anesthesia as an Aide to Decrease Palatal Infiltration Pain
Brian Crump DMD, MS,
 Al Reader DDS, MS,
 John Nusstein DDS, MS,
 Melissa Drum DDS, MS,
 Sara Fowler DMD, MS, and
 John Draper PhD
Article Category: Research Article
Volume/Issue: Volume 69: Issue 1
Online Publication Date: Apr 04, 2022
DOI: 10.2344/anpr-68-03-03
Page Range: 10 – 17

insertion pain, moderate discomfort during solution deposition may occur 32% to 38% of the time. 1 For palatal infiltration, solution deposition pain would be little affected by topical anesthetics or other surface methods involving application of pressure or cold. Moderate/severe pain may be experienced 42% to 68% of the time during the palatal deposition of anesthetic solution. 1 , 2 Periodontal ligament (PDL) injections have been extensively studied for pulpal anesthesia as either a primary or supplemental technique. However, there are no objective studies on

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Figure 3. ; Pain ratings by VAS category. The first 4 columns represent needle insertion and solution deposition for the PDL and mock PDL injections. The last 4 columns represent needle insertion and solution deposition for the PDL-aPI injections and the mPDL-cPI injections. VAS indicates visual analog scale; PDL, periodontal ligament; PDL-aPI, PDL injection and alternative palatal infiltration; mPDL-cPI, mock PDL injection and conventional palatal infiltration.
Brian Crump,
 Al Reader,
 John Nusstein,
 Melissa Drum,
 Sara Fowler, and
 John Draper
<bold>Figure 3.</bold>  
Figure 3.  

Pain ratings by VAS category. The first 4 columns represent needle insertion and solution deposition for the PDL and mock PDL injections. The last 4 columns represent needle insertion and solution deposition for the PDL-aPI injections and the mPDL-cPI injections. VAS indicates visual analog scale; PDL, periodontal ligament; PDL-aPI, PDL injection and alternative palatal infiltration; mPDL-cPI, mock PDL injection and conventional palatal infiltration.

Figure 2. ; PDL injection. Placement of the 27-gauge ultra-short needle in the gingival sulcus and initial blanching of the gingival collar at the start of the PDL injection. PDL indicates periodontal ligament.
Brian Crump,
 Al Reader,
 John Nusstein,
 Melissa Drum,
 Sara Fowler, and
 John Draper
<bold>Figure 2.</bold>  
Figure 2.  

PDL injection. Placement of the 27-gauge ultra-short needle in the gingival sulcus and initial blanching of the gingival collar at the start of the PDL injection. PDL indicates periodontal ligament.

Figure 4. ; Models of the Extent of Palatal Anesthesia. The top image is the PDL-aPI technique, and the bottom image is the mPDL-cPI technique. The small “dot” on each image is the location of the approximate palatal injection site. The mPDL-cPI technique produced a larger area of soft tissue anesthesia. PDL-aPI indicates PDL injection and alternative palatal infiltration; mPDL-cPI, mock PDL injection and conventional palatal infiltration.
Brian Crump,
 Al Reader,
 John Nusstein,
 Melissa Drum,
 Sara Fowler, and
 John Draper
<bold>Figure 4.</bold>  
Figure 4.  

Models of the Extent of Palatal Anesthesia. The top image is the PDL-aPI technique, and the bottom image is the mPDL-cPI technique. The small “dot” on each image is the location of the approximate palatal injection site. The mPDL-cPI technique produced a larger area of soft tissue anesthesia. PDL-aPI indicates PDL injection and alternative palatal infiltration; mPDL-cPI, mock PDL injection and conventional palatal infiltration.

Figure 2.; Comparison of Numbee and periodontal ligament (PDL) injection. (a) Gingival sulcus is the target for a Numbee injection. (b) Numbee. (c) Dental needle. (d) PDL is the target for a traditional intraligamentary injection using a needle.
Coleman Christensen,
 Stephen C. Arnason,
 Ross Oates,
 Michael Crabtree,
 John W. Kersey Jr, and
 Kraig S. Vandewalle
Figure 2.
Figure 2.

Comparison of Numbee and periodontal ligament (PDL) injection. (a) Gingival sulcus is the target for a Numbee injection. (b) Numbee. (c) Dental needle. (d) PDL is the target for a traditional intraligamentary injection using a needle.

Figure 1. ; The Heft Parker VAS. The numbers at the top of the scale were omitted on the patients' VAS. VAS indicates visual analog scale.
Brian Crump,
 Al Reader,
 John Nusstein,
 Melissa Drum,
 Sara Fowler, and
 John Draper
<bold>Figure 1.</bold>  
Figure 1.  

The Heft Parker VAS. The numbers at the top of the scale were omitted on the patients' VAS. VAS indicates visual analog scale.

A Survey of Pain, Pressure, and Discomfort Induced by Commonly Used Oral Local Anesthesia Injections
Eliezer Kaufman DMD,
 Joel B. Epstein DMD, MSD, FRCD(C),
 Eitan Naveh DSc,
 Meir Gorsky DMD,
 Anat Gross DMD, and
 Galit Cohen DMD
Article Category: Other
Volume/Issue: Volume 52: Issue 4
Online Publication Date: Jan 01, 2005
DOI: 10.2344/0003-3006(2005)52[122:ASP]2.0.CO;2
Page Range: 122 – 127

pain, pressure, and discomfort associated with commonly used traditional intraoral injections in a private office in an open, longitudinal study. The study attempted to establish baseline data on patient subjective responses to needle insertion sensation and pressure experienced with 4 oral LA injection procedures (infiltration, mental nerve block, inferior alveolar nerve block, and periodontal ligament [PDL] injection). Previous studies have examined variables that might be involved in painful LA injections and tested possible ways of minimizing the

Efficacy of Pulpal Anesthesia Using a Needle-less Syringe
Coleman Christensen DDS, MS,
 Stephen C. Arnason DDS, MS,
 Ross Oates DMD,
 Michael Crabtree DDS, MS,
 John W. Kersey Jr DDS, MS, and
 Kraig S. Vandewalle DDS, MS
Article Category: Research Article
Volume/Issue: Volume 67: Issue 4
Online Publication Date: Dec 31, 2020
DOI: 10.2344/anpr-67-02-11
Page Range: 200 – 206

ligament (PDL). Instead, instructions state to create a seal between the Numbee tip and the PDL by advancing the tip to the base of the gingival sulcus. Local anesthetic is then infused into the tissue with slow exerted pressure on the syringe plunger. According to the manufacturer, the Numbee can be used with any dental syringe that accepts standard threaded dental needles, effectively replacing such needles. The manufacturer also sells an intraligamentary, pen-style syringe to be used with the Numbee ( Figure 1 ). BioDent's website states “Numbee is the future of

Comparison of Pain Perception Using Conventional Versus Computer-Controlled Intraligamentary Local Anesthetic Injection for Extraction of Primary Molars
Meenu Mittal BDS, MDS,
 Radhika Chopra BDS, MDS,
 Ashok Kumar BDS, MDS, and
 Dhirendra Srivastava BDS, MDS, MOMS, RCPS (Glasgow)
Article Category: Research Article
Volume/Issue: Volume 66: Issue 2
Online Publication Date: Jan 01, 2019
DOI: 10.2344/anpr-66-01-09
Page Range: 69 – 76

, to obtain sufficient anesthesia of the desired region, relatively large doses of anesthetic agent may be required. 1 In intraligamentary anesthesia (ILA), anesthetic solution is injected with pressure in the periodontal ligament (PDL) space and placed directly into the cancellous bone adjacent to the tooth to be anesthetized. 3 With ILA, specific teeth are anesthetized with less residual and soft tissue anesthesia, and thus discomfort and potential self-mutilation of nerve block anesthesia are avoided. 4 However, there are some potential problems with the

Local Anesthesia Part 2: Technical Considerations
Kenneth L. Reed DMD,
 Stanley F. Malamed DDS, and
 Andrea M. Fonner DDS
Article Category: Other
Volume/Issue: Volume 59: Issue 3
Online Publication Date: Jan 01, 2012
DOI: 10.2344/0003-3006-59.3.127
Page Range: 127 – 137

. Likewise, 25-gauge needles very rarely, if ever, break during an intraoral injection, and 99% of the needles that do break are 30-gauge needles. 12 TECHNIQUES Posterior Superior Alveolar The posterior superior alveolar (PSA) injection will anesthetize the maxillary molars except for the mesiobuccal aspect of the first molar ( Figure 1 ). The periodontal ligament (PDL), bone, periosteum, and buccal soft tissue adjacent to these teeth are also anesthetized. 13 Clinically, the PSA injection is given with the insertion point