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Clinical and Histological Comparison of Pulp Anaesthesia and Local Diffusion after Periodontal Ligament Injection and Intrapapillary Infiltration Anaesthesia

Peer W. Kammerer, Victor Palarie, Eik Schiegnitz, Thomas Ziebart, Bilal Al-Nawas and Monika Daublander

Improvements in local anaesthetic techniques may minimize pain during dental treatment. Block techniques of the trigeminal branches (II and III) are considered to be the most used and trusted methods in dentistry . However, the incidence of inadequate anaesthesia and technical complications is reported to be between 15-30% of cases. Other possibilities to achieve local anaesthesia are infiltration, intra-pulpal injection, intraosseous , intraseptal  and periodontal ligament injection (PDL). In the present time, PDL technique increases in popularity, especially because of specialized high pressure syringe
systems and computer controlled local anaesthesia devices. PDL has shown to provide sufficient anaesthesia of the pulp. It is less unpleasant and painful than inferior alveolar and palatinal injections.
Other advantages are well documented: single tooth anaesthesia, minimal anaesthetic agent dosage, rapid onset and safety in patients with bleeding problems as well as in medical compromised patients. Though, disadvantages like damage of periodontal tissue, damage of interdental septal crest, root resorption and severe bacteraemia are reported as well. Infection and/or inflammation may decrease
the anaesthetic efficacy and PDL may induce systemic reactions manifested in cardiovascular parameters changes  Intraseptalintraosseous anaesthesia (ISA) is described to be an alternative to PDL in order to overcome inconveniences associated with PDL, especially in compromised periodontal tissues. Still, probably because of the enosseous pathway, ISA has shown to cause cardiovascular
changes similar to PDL. Intrapapillary infiltration anaesthesia (IPA) is an intermediate of PDL and ISA and consists of application of the local anaesthetic agent into the mesial and distal papillae without
touching the periodontal ligament and without application in the bone. Therefore, cardiovascular side effects may be reduced. Such as for ISA, potential side effects like damage of periodontal tissue and
bacteraemia are limited. For IPA, normal syringes as well as pressure delivery systems can be used [18]. In order to minimize all possible side effects in general practice, we tested the new IPA technique for pulp anaesthesia. To our knowledge, there are no published studies that compare PDL and IPA. Therefore, the aim of the present study was to evaluate pulp anaesthesia (clinical setting) as well as local diffusion of the anaesthetic agent (histological setting) in both methods.