Effectiveness of anterior middle superior alveolar injection using a computer-controlled local anesthetic delivery system for maxillary periodontal flap surgery

BACKGROUND: Profound anesthesia with adequate duration is required in periodontal flap surgery, which involves the manipulation of both hard and soft tissues. The anterior middle superior alveolar (AMSA) injection may be an alternative to multiple injections required for this purpose in the maxilla. The present study aimed to assess the effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth. METHODS: Thirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective. RESULTS: The AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females. CONCLUSIONS: The AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.

Comparison of anxiety and pain perceived with conventional and computerized local anesthesia delivery systems for different stages of anesthesia delivery in maxillary and mandibular nerve blocks

BACKGROUND: Fear of local anesthesia (LA) is a significant impediment to dental care as many patients delay or avoid treatment to avert pain. Computer-controlled local anesthetic delivery system (CCLAD), with constant and controlled rate of flow, present a painless alternative. The present study aimed to compare anxiety and pain perceived with conventional and computerized systems, for different stages of anesthesia delivery when administering various nerve blocks. METHODS: One hundred patients requiring bilateral LA participated in the study. One side was anesthetized using one system and the contralateral side was anesthetized using the other, in two separate appointments. Patients assigned anxiety scores on a 5-point scale and used the visual analogue scale (VAS) for pain determination at needle insertion, during delivery of anesthetic solution, immediately after injection, and at the end of the periodontal procedure. Each patient's preference for the delivery system of future injections was also recorded. RESULTS: Patients reported significantly lower anxiety levels with CCLAD compared to the syringe. Significantly lower mean VAS scores for anesthesia deposition, pain immediately after, and at the end of the periodontal procedure were also noted. However, pain at needle insertion was comparable between the two systems, with no statistical significance. Overall, 64.4% patients preferred CCLAD for future anesthesia. CONCLUSION: Lower pain perceived with CCLAD and higher preference for the system suggest that CCLAD should replace conventional syringes to allow pain-free dental treatment.

Effect of antimicrobial photodynamic therapy as an adjunct to nonsurgical treatment of deep periodontal pockets: a clinical study

Introduction: deep periodontal pockets pose a great challenge for nonsurgical periodontal treatment. Scaling and root planing [SRP] alone may not suffice in cases where surgical therapy cannot be undertaken. Various recent studies have suggested the use of antimicrobial Photodynamic Therapy [aPDT] for the management of periodontal infections. The aim of this study was to evaluate the effects of using aPDT along with SRP, compared to SRP alone for the management of deep periodontal pockets

Methods: thirty patients with chronic periodontitis, who met the criteria of having periodontal pockets with depth ? 6 mm and bleeding on probing [BOP] in at least 2 different quadrants, were included. After SRP, one quadrant was randomly selected for aPDT [test], while another served as control. Clinical parameters i.e. plaque index [PI], modified sulcular bleeding index [mSBI], probing depth [PD] and clinical attachment level [CAL] were measured at baseline, 1 month and 3 months post-treatment intervals

Results: all clinical parameters significantly improved in both groups after 1 and 3 months. At 1-month interval, inter-group difference in mean change was statistically significant [P < 0.05] in terms of mSBI [0.85 +/- 0.41in test vs 0.54 +/- 0.47 in control group] and PD [1.77+/-0.86 in test vs 1.3 +/- 0.95 in control group]. At 3 months interval, no statistically significant difference was observed between test and control groups except in terms of mSBI [0.97 +/- 0.45 in test vs 0.73 +/- 0.42 in control group]

Conclusion: aPDT appears to play an additional role in reduction of gingival inflammation when used along with nonsurgical mechanical debridement of deep periodontal pockets

Evaluation of the effects of Er,Cr:YSGG laser, ultrasonic scaler and curette on root surface profile using surface analyser and scanning electron microscope: an in vitro study

Introduction: the periodontal therapy is primarily targeted at removal of dental plaque and plaque retentive factors. Although the thorough removal of adherent plaque, calculus and infected root cementum is desirable, it is not always achieved by conventional modalities. To accomplish more efficient results several alternative devices have been used. Lasers are one of the most promising modalities for nonsurgical periodontal treatment as they can achieve excellent tissue ablation with strong bactericidal and detoxification effects

Methods: thirty freshly extracted premolars were selected and decoronated. The mesial surface of each root was divided vertically into four approximately equal parts. These were distributed into four group based on the root surface treatment. Part A [n = 30] was taken as control and no instrumentation was performed. Part B [n = 30] was irradiated by Erbium, Chromium doped Yttrium Scandium Gallium Garnet [Er,Cr:YSGG] laser. Part C [n = 30] was treated by piezoelectric ultrasonic scaler. Part D [n = 30] was treated by Gracey curette. The surface roughness was quantitatively analyzed by profilometer using roughness average [Ra] value, while presence of smear layer, cracks, craters and melting of surface were analyzed using scanning electron microscope [SEM]. The means across the groups were statistically compared with control using Dunnett test

Results: among the test groups, Er,Cr:YSGG laser group showed maximum surface roughness [mean Ra value of 4.14 micro m] as compared to ultrasonic scaler [1.727 micro m] and curette group [1.22 micro m]. However, surface with smear layer were found to be maximum [50%] in curette treated samples and minimum [20%] in laser treated ones. Maximum cracks [83.34%] were produced by ultrasonic scaler, and minimum [43.33%] by curettes. Crater formation was maximum [50%] in laser treated samples and minimum [3.33%] in curette treated ones. 63.33% samples treated by laser demonstrated melting of root surface, followed by ultrasonic scaler and curettes

Conclusion: Er,Cr:YSGG laser produced maximum microstructural changes on root surface that can influence the attachment of soft periodontal tissues as well as plaque and calculus deposition. In vivo studies are needed to validate these results and to evaluate their clinical effects