The route of periodontal ligament injection of local anesthetic solution

doi:10.1016/S0099-2399(83)80161-7

Journal of Endodontics

Volume 9, Issue 11, November 1983, Pages 471-474

https://doi.org/10.1016/S0099-2399(83)80161-7 Get rights and content

Summary

This study was undertaken to establish the route of spread in periodontal ligament injections. Periodontal ligament injections containing a carbon marker were performed in a baboon to give observation times ranging from 7 days to 5 to 15 min. It was found that the apical spread of the carbon occurred within the periodontal ligament capillaries, probably as a retrograde phenomenon. Furthermore, the relative size of a 30-gauge needle did not allow penetration of the periodontal ligament except at its coronal opening. In this study only slight transient damage to the periodontal tissues was noted.

References (5)

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The periodontal ligament injection: a clinical evaluation
J Am Dent Assoc
(1981)
MalamedSF
The periodontal ligament (PDL) injection: an alternative to inferior alveolar nerve block
Oral Surg
(1982)

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Cited by (20)

Intraligamentary anaesthesia as a possible anaesthetic option in oral implantology: a retrospective analysis
2020, International Journal of Oral and Maxillofacial Surgery
This investigation was conducted to analyse the usefulness of intraligamentary anaesthesia (ILA) as an alternative anaesthetic procedure in oral implantology. Forty consecutive patients with single-tooth gaps in the posterior mandible were included in the analysis. Implant insertion was performed after ILA of the gap-delimiting teeth (two injections distal to the mesial tooth, two injections mesial to the distal tooth). Implant surgery was performed successfully under ILA of the gap-delimiting teeth in 39 cases. Injection pain correlated significantly with lower periodontal probing depths (<3 mm) of the delimiting teeth (P = 0.003). The total amount of anaesthetic solution and the pain during surgery were significantly higher if a root canal-treated tooth was present in the area of surgery (P = 0.010 and P = 0.020, respectively). Overall, the mean pain score during treatment was low at 0.76 ± 0.51 on a numerical rating scale from 0 to 10. At the control visit, no major complication was encountered. All implants were successfully restored with single crowns after a healing period of 2 months. Taking into consideration the limitations of the study, ILA seems to fulfil all conditions to be defined as an alternative, minimally invasive anaesthetic technique for the insertion of single-gap implants.
A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth
2012, Journal of Endodontics
Citation Excerpt :
With intraligamentary injection (PDL), a specialized intraligamentary dental cartridge syringe was fitted with an ultra-short needle (6 mm). After application of an antiseptic solution to the site of penetration (10–13), the needle was inserted at 30° to the long axis of the tooth at the mesiobuccal aspect of the roots (14), penetrating until it was wedged between the tooth and the crestal bone (15). The needle bevel faced the root to ease advancement of the needle.
The objective of this study was to compare the efficacy of supplementary repeat inferior alveolar nerve block with 2% lidocaine and epinephrine, buccal infiltration with 4% articaine with epinephrine, intraligamentary injection, or intraosseous injection (both with 2% lidocaine with epinephrine) after failed inferior alveolar nerve block (IANB) for securing pain-free treatment in patients experiencing irreversible pulpitis in mandibular permanent teeth.
This randomized clinical trial included 182 patients diagnosed with irreversible pulpitis in mandibular teeth. Patients received 2.0 mL of 2% lidocaine with 1:80,000 epinephrine as an IANB injection. Patients who did not experience pain-free treatment received randomly 1 of 4 supplementary techniques, namely repeat lidocaine IANB (rIANB), articaine buccal infiltration (ABI), lidocaine intraligamentary injection (PDL), or lidocaine intraosseous injection (IO). Successful pulp anesthesia was considered to have occurred when no response was obtained to the maximum stimulation (80 reading) of the pulp tester, at which time treatment commenced. Treatment was regarded as being successfully completed when it was associated with no pain. Data were analyzed by χ² and Fisher exact tests.
Of the 182 patients, 122 achieved successful pulpal anesthesia within 10 minutes after initial IANB injection; 82 experienced pain-free treatment. ABI and IO allowed more successful (pain-free) treatment (84% and 68%, respectively) than rIANB or PDL supplementary techniques (32% and 48%, respectively); this was statistically significant (P = .001).
IANB injection alone does not always allow pain-free treatment for mandibular teeth with irreversible pulpitis. Supplementary buccal infiltration with 4% articaine with epinephrine and intraosseous injection with 2% lidocaine with epinephrine are more likely to allow pain-free treatment than intraligamentary and repeat IANB injections with 2% lidocaine with epinephrine for patients experiencing irreversible pulpitis in mandibular permanent teeth.
Local Anesthesia in Endodontics
2010, Cohen's Pathways of the Pulp, Tenth Edition
The Use of Intraosseous Anesthesia among Endodontists: Results of a Questionnaire
2009, Journal of Endodontics
The purpose of this study was to investigate the use of supplemental intraosseous (IO) anesthesia among endodontists in the United States. The study also looked at the types of anesthetic solutions commonly used for IO anesthesia and in which diagnostic conditions IO anesthesia is used. A Web-based survey of 2,528 active members of the American Association of Endodontists was sent out by e-mail. Data from 833 respondents were collected with a response rate of 33%. It was discovered that 94.77% of the respondents used some form of IO anesthesia, with the periodontal ligament injection (PDL) being the most commonly administered (49.78%). Symptomatic irreversible pulpitis is the pulpal diagnosis for which respondents most often use some form of IO anesthesia (61.99%), and 2% lidocaine with epinephrine 1:100,000 is the most common anesthetic solution used in IO anesthesia (37.62%). Although more than half of the respondents use some form of IO anesthesia more than twice a week, newer IO anesthesia delivery systems such as Stabident (Fairfax Dental, San Francisco, CA) and X-Tip (Dentsply International, Johnson City, TN) are used less often than the PDL injection.
Intraligamentary injection of slow-release methylprednisolone for the prevention of pain after endodontic treatment
1994, Oral Surgery, Oral Medicine, Oral Pathology
The intraligamentary injection of a slow-release steroidal, the anti-inflammatory agent slow-release methylprednisolone (Depomedrol), was compared to a placebo and to an active placebo (Mepivacaine) in preventing postoperative pain after root canal treatment. The results clearly demonstrated that the tested drug significantly reduced the frequency and intensity of postoperative pain sequelae in the experimental set-up.
Periodontal ligament injection: Spread of the solution in the dog
1994, Journal of Endodontics
Investigations of the spread of anesthetic solutions administered with the periodontal ligament injection have reported conflicting findings. The purpose of this investigation was to study the distribution of the injected fluid by macroscopic and microscopic techniques. One third of the liquid of the carpules (2% lidocaine with 1:100,000 epinephrine) was replaced with India ink as a marker. Injections were made with a pressure syringe, (Ligmaject) at 90 sites in 12 dogs. Twenty-five control sites were injected with a marked solution without a vasoconstrictor (3% mepivacaine). Seven dogs were killed within 24 h; the others after 5 days. Spread of the ink was studied in undemineralized slices, in three-dimensional cleared specimens, and in histological sections. The solution usually reached the alveolar crest, seeped under the periosteum, and entered into bone marrow spaces alongside vascular channels. The ink spread along the path of least resistance, influenced by the intricacies of anatomical structures and fascial planes, rather than penetrating into the periodontal ligament or in the root canal. In the controls without a vasoconstrictor the spread was more diffuse. Five days postoperatively, carbon particles were present only within macrophages.

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^*: This study was supported by a grant from the South African Medical Research Council

¹: Dr. Dreyer is professor of oral medicine and periodontics, Faculty of Dentistry, University of Stellenbosch, Private Bag X1, Tygerberg, 7505 South Africa. Dr. van Heerden is a graduate student in the same department and Dr. Joubert is professor of maxillofacial and oral surgery, University of Stellenbosch.

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The route of periodontal ligament injection of local anesthetic solution*

Summary

J Am Dent Assoc

Oral Surg