Title	The Periodontal Ligament (PDL) Injection for Anesthesia of Primary Mandibular Teeth is Less Traumatic and as Effective as the Inferior Alveolar Nerve Block (IANB) Injection
Clinical Question	In the treatment of mandibular primary teeth, how effective is periodontal ligament injection for pain control compared to the inferior alveolar nerve block?
Clinical Bottom Line	PDL injection is less traumatic, and as effective as, IANB injection in the treatment of mandibular primary teeth.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 26028895 Haghgoo/2015 80 children aged 3-7 needing pulpotomy Randomized Controlled Trial Key results This double blind, randomized controlled study included children in need of bilateral mandibular pulpotomy treatments. The study investigated inferior alveolar block (IANB) and periodontal ligament injection (PDL). The study utilized a dental assistant as a reviewer blinded to the injection allocation to evaluate and chart the patient’s pain based on eye movement, hand and body tension, complaining and crying (SEM scale). Hanghoo calculated a single p-value for the overall procedure, comparing (a) success rates between PDL injection and IANB; (b) pain based on the patient's age and gender between the two groups; (c) difference in pain between the first and second primary molars. P=0.250, demonstrating that there was no statistical significance between the PDL and IANB techniques for pain control during pulpotomy. 26504907 Alamoudi/2016 91 children aged 5-9 needing pulpotomy Randomized Controlled Trial Key results This RCT used the SEM scale to capture pain levels at five intervals during pulpotomies. Patients were randomized to receive traditional IANB, IANB using a computer-controlled local anesthetic delivery (CCLAD) system, or PDL injection using CCLAD. Total P values were as follows: P=0.635 at clamp application, P=0.996 at drilling of the tooth, P=0.630 entering the pulp, P=0.945 at pulp extirpation, P=0.101 at removal of clamp. These values indicate that there was no statistical significance in the effectiveness between PDL or IANB (traditional or computer controlled) in pain relief for pediatric patients during major dental treatment of mandibular teeth.
Evidence Search	periodontal ligament injections; inferior alveolar nerve block; primary teeth; pulpotomy
Comments on The Evidence	Validity: After completing a comprehensive detailed search for relevant evidence on this clinical question, two random control studies are cited as best current evidence. Both studies are randomized controlled trials (RCTs) that included double-blinded evaluators. In both studies the investigators used a validated scale (SEM) to evaluate the patient's level of pain, and P-values were calculated. However, while Alamoudi states that the sample size calculation was based on a power analysis, Haghgoo only states that the current study is based on a pilot study. It was unclear how it was decided to enroll only 80 children. Perspective: The sample size in both studies seems appropriate, and the evidence was collected appropriately. In Haghgoo's study, however, the author did not report the results in a clear, transparent way. The SEM scores for the two groups were not reported.
Applicability	PDL injection is effective for treating one or more teeth in the mandibular arch of a pediatric patient. Current evidence supports PDL as a strong choice when providing restorative and endodontic dental treatment because it provides profound anesthesia and offers quicker post-operative recovery. Administering local anesthesia is an important part of behavioral management in pediatric dentistry. IANB is commonly used but can induce higher post-operative trauma due to residual numbing affect to lip and tongue, risk of trismus, and facial nerve palsy. PDL injection is a simpler technique that provides adequate pain control, shorter post-operative anesthesia and overall, and uses less anesthetic solution.
Specialty	(Endodontics) (General Dentistry) (Pediatric Dentistry) (Restorative Dentistry)
Keywords	anesthesia, inferior alveolar nerve block, intraligamental injection, periodontal ligament injection, primary teeth, single tooth anesthesia
ID#	3326
Date of submission	09/13/2018
E-mail	taherizadega@livemail.uthscsa.edu
Author	Dona Taherizadegan
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Christy Tyson, BSDH, MLIS
Faculty mentor e-mail	TysonC@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available