Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of articaine anesthesia with needle-free/Comfort-in method and conventional needle injection in dental patients with irreversible pulpitis: a randomized clinical trial

  • Research
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objective

To assess the anesthetic efficacy of articaine with the needle-free/Comfort-in™ method compared to the conventional needle method. To assess pain during anesthesia application, onset of anesthesia and patient`s self-reported quality of life-related to oral health after the dental emergency appointment.

Materials and methods

This parallel, randomized clinical trial was conducted by a single operator/dentist in the state of Maranhao, northeast of Brazil. Included participants were adult dental patients with one molar (maxillary) or premolar (maxillary or mandibular) tooth diagnosed with symptomatic irreversible pulpitis. The primary outcome was the anesthetic efficacy, measured using a combination of electrical and cold pulp tests (cold + EPT) and the Numerical Rating Scale (NRS). Secondary outcomes were pain during anesthesia application, onset of anesthesia, and patient`s quality-of-life (measured with the OHIP-14).

Results

62 patients were randomized in the anesthesia needle-free group and Comfort-in group (34.26 ± 10.786 × 33.29 ± 8.399 years old, respectively). The group of patients in the Comfort-in group had 71.0% success. Patients from the Comfort-in group reported statistically lower pain during the anesthesia application than patients from the conventional group (2.13 ± 2.172 × 6.03 ± 3.146 NRS scores, respectively) as well as immediately after the anesthetic procedure. Patients self-reported negative impact in quality of life was similar between groups before (p > 0.05) and after (p > 0.05) the dental emergency.

Conclusions

Comfort-in™ had similar efficacy to the conventional needle method.

Clinical relevance

This trial showed that it is possible to anesthetize patients with tooth pulpits without using needles to provide comfort mainly to anxious patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

All the research data used in this manuscript will be available whenever requested.

References

  1. Zanini M, Meyer E, Simon S (2017) Pulp Inflammation Diagnosis from Clinical to Inflammatory Mediators: A Systematic Review. J Endod. 2017;43(7):1033–1051. https://doi.org/10.1016/j.joen.2017.02.009

  2. Erdogan O, Malek M, Gibbs JL (2021) Associations between Pain Severity, Clinical findings, and Endodontic Disease: a cross-sectional study. J Endod 47(9):1376–1382. https://doi.org/10.1016/j.joen.2021.07.004

    Article  PubMed  Google Scholar 

  3. Fouad AF, Levin LG (2020) Pulp reactions to Caries and Dental procedures. In: Berman LH, Hargreaves KM, Rotstein I (eds) Cohen`s pathways of the pulp, 12th edn. St Lous, Missouri, USA. Chapter 14. pg. 557. 2021.

    Google Scholar 

  4. Ogle OE, Mahjoubi G (2012) Local anesthesia: agents, techniques, and complications. Dent Clin North Am. 2012;56(1):133 – 48. https://doi.org/10.1016/j.cden.2011.08.003

  5. Parirokh M, Abbott PV (2022) Present status and future directions-mechanisms and management of local anaesthetic failures. Int Endodontic J - IEJ 55(Suppl 4):951–994. https://doi.org/10.1111/iej.13697

    Article  Google Scholar 

  6. Guimaraes CC, Lopes Motta RH, Bergamaschi CC, Araújo JO, Andrade NK, Figueiró MF, Ramacciato JC, Lopes LC (2017) Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis protocol. BMJ Open. 2017;7(11). https://doi.org/10.1136/bmjopen-2020-044357

  7. Gupta R, Kaur S, Dahiya P, Kumar M (2018) Comparative evaluation of efficacy of EMLA and needleless jet anesthesia in non-surgical periodontal therapy. J Oral Biology Craniofac Res 8(2018):118–121. https://doi.org/10.1016/j.jobcr.2018.04.001

    Article  Google Scholar 

  8. Capetillo J, Drum M, Reader A, Fowler S, Nusstein J, Beck (2019) Anesthetic Efficacy of Intranasal 3% Tetracaine plus 0.05% Oxymetazoline (Kovanaze) in Maxillary Teeth. J Endod. 2019;45(3):257–262. https://doi.org/10.1016/j.joen.2018.12.003

  9. Yıldırım S, Tokuç M, Aydın MN (2020) The effect of pre-anesthesia with a needle-free system versus topical anesthesia on injection pain of the inferior alveolar nerve block: a randomized clinical trial. Clin Oral Invest, May 2020. https://doi.org/10.1007/s00784-020-03301-9

  10. Altan H, Belevcikli M, Coşgun A, Demir O (2021) Comparative evaluation of pain perception with a new needle-free system and dental needle method in children: a randomized clinical trial. BMC Anesthesiol 21(1):301. https://doi.org/10.1186/s12871-021-01524-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Belevcikli M, Altan H, Demir O (2023) Effect of the new needle-free injection system on pain perception and dental anxiety during anesthesia: randomized controlled split-mouth study. J Dent Anesth pain Med 23(1):1–8. https://doi.org/10.17245/jdapm.2023.23.1.1

    Article  PubMed  PubMed Central  Google Scholar 

  12. Oliveira ACA, Amorim KS, Nascimento EMJ, Duarte ACB, Groppo FC, Takeshita WM, Souza LMA (2019) Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial. J Appl Oral Sci. 2019. https://doi.org/10.1590/1678-7757-2018-0195

  13. Robertson D, Nusstein J, Reader A, Beck M, McCartney M (2007) The anesthetic efficacy of articaine in buccal infiltration of mandibular posterior teeth. JADA, Vol. 138 August 2007. https://doi.org/10.14219/jada.archive.2007.0324

  14. Jaber A, Whitworth JM, Corbett IP, Al-Baqshi B, Kanaa MD, Meechan JG (2010) The efficacy of infiltration anaesthesia for adult mandibular incisors: a randomised double-blind cross-over trial comparing articaine and lidocaine buccal and buccal plus lingual infiltrations. Br Dent J. 2010;209(9):E16. https://doi.org/10.1038/sj.bdj.2010.974

  15. Nagendrababu HF, Duncan J, Whitworth MH, Nekoofar SJ, Pulikkotil1 SK, Veettil PMH (2020) Dummer. Is articaine more effective than lidocaine in patients with irreversible pulpitis? An umbrela review. International Endodontic Journal, 53, 200–213, 2020. https://doi.org/10.1111/iej.13215

  16. Pope RLE, Brown AM (2020) A primer on tissue pH and local anesthetic potency. Adv Physiol Educ 44: 305–308, 2020. https://doi.org/10.1152/advan.00018.2020

  17. Instruction Manual. Comfort-intm Needle Free Injection System [Internet]. [acessed Jan 22 2017]. Available from: http://www.comfort-in.com/file/English-French%20manual.pdf

  18. Oliveira BH, Nadanovsky P (2005) Psychometric properties of the Brazilian version of the Oral Health Impact Profile-short form. Community Dent Oral Epidemiol. 2005;33(4):307 – 14. https://doi.org/10.1111/j.1600-0528.2005.00225.x

  19. Lorentz MN, Albergaria VF, De Lima FAZ (2007) Anesthesia for Morbid Obesity. Rev Bras Anestesiol 2007; 57: 2: 199–213. https://doi.org/10.1590/s0034-70942007000200010

  20. Sharma S, Arora L (2020) Anesthesia for the Morbidly Obese Patient. Anesthesiol Clin. 2020;38(1):197–212. https://doi.org/10.1016/j.anclin.2019.10.008

  21. O’Neal LY, Nusstein J, Drum M, Fowler S, Reader A, Ni A (2022) Comparison of Maxillary Lateral Incisor Infiltration Pain Using the Dentapen and a Traditional Syringe: A Prospective Randomized Study. J Endod. 2022;48(7):840–844. https://doi.org/10.1016/j.joen.2022.04.008

  22. Gao Q, Noël G, Khatchadourian ZD, Taqi D, Abusamak M, Henley A, Menassa K, Velly A, Emami E, Mongeau L, Tamimi F (2021) Needle-free injection: Dental infiltration anestesia. Int J Pharm 2021;604:120765

  23. Liu P, McGrath C, Cheung G (2014) What are the key endodontic factors associated with oral health-related quality of life? Int Endod J. 2014;47(3):238 – 45. https://doi.org/10.1111/iej.12139

  24. Neelakantan P, Liu P, Dummer PMH, McGrath C (2020) Oral health-related quality of life (OHRQoL) before and after endodontic treatment: a systematic review. Clin Oral Investig. 2020;24(1):25–36. https://doi.org/10.1007/s00784-019-03076-8

  25. Fristad I, Berggreen E (2021) Structure and Functions of the Dentin-Pulp Complex. In: Berman LH, Hargreaves KM, Rotstein I. Cohen`s Pathways of the Pulp. 12th Ed. St Lous, Missouri, USA. Chapter 13. pg. 512. 2021

Download references

Funding

This research was funded by Foundation for the Support of Scientific and Technological Research of Maranhão, grant number FAPEMA EDITAL BM-01425/20 and FAPEMA UNIVERSAL-00944/18.

Author information

Authors and Affiliations

  1. Dentistry Postgraduate Program, University Ceuma, R. Josué Montello, 1, Renascença II, São Luís, Maranhão, 65075-120, Brazil

    Amanda Palmeira Arruda Nogueira, Meire Coelho Ferreira, Bruna Laís Lins Gonçalves, Etevaldo Maia Filho, Cyrene Piazera Costa  & Ceci Nunes Carvalho

  2. Dentistry Postgraduate Program, Dentistry Biomaterials Laboratory (Biomma), School of Dentistry, Federal University of Maranhão (UFMA), Av. dos Portugueses, 1996, São Luís, 65080-805, Brazil

    Amanda Palmeira Arruda Nogueira

  3. Dentistry Graduate Program, Faculdade Florence, São Luís, MA, Brazil

    Cláudia de Castro Rizzi MAIA

  4. Department of Restorative Dentistry, School of Dentistry, University of São Paulo (FOUSP), Av. Lineu Prestes, 2227, São Paulo, 05508-000, Brazil

    Giulio Gavini

  5. Division of Endodontics, Dept. of Oral Biological and Medical Sciences, Faculty of Dentistry University of British Columbia UBC, Vancouver, Canada

    Renata Grazziotin-Soares

Authors
  1. Amanda Palmeira Arruda Nogueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Meire Coelho Ferreira
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cláudia de Castro Rizzi MAIA
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bruna Laís Lins Gonçalves
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Etevaldo Maia Filho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cyrene Piazera Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giulio Gavini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Renata Grazziotin-Soares
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ceci Nunes Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization, C.N.C., C.C.R.M.; methodology, A.P.A.N, E.M.F., C.P.C.; validation, M.C.F, G.G; formal analysis, C.N.C; investigation, A.P.A.N, B.L.L.S.;, resources, C.N.C; G.G; data curation, M.C.F; writing—original draft preparation, A.P.A.N, C.N.C., C.C.R.M.; writing—review and editing, M.C.F, R.G.S.; supervision, C.N.C; project administration, C.N.C; funding acquisition, C.N.C. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Ceci Nunes Carvalho.

Ethics declarations

Ethical approval

Ethical approval for the trial protocol was obtained from the CEUMA University Research Ethics Committee (#4,776,212) and was registered in REBEC (RBR-107dyj7w).

Informed consent

All individual participants provided written and signed informed consent.

Conflicts of interest

The authors declare no conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nogueira, A.P.A., Ferreira, M.C., MAIA, C. et al. Efficacy of articaine anesthesia with needle-free/Comfort-in method and conventional needle injection in dental patients with irreversible pulpitis: a randomized clinical trial. Clin Oral Invest 28, 205 (2024). https://doi.org/10.1007/s00784-024-05582-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00784-024-05582-w

Keywords

Search

Navigation