Periodontal intraligament injection as alternative to inferior alveolar nerve block--meta-analysis of the literature from 1979 to 2012.

OBJECTIVES

In a first meta-analysis, inferior alveolar nerve block (IANB) and periodontal intraligamentary injection anesthesia (ILA) were compared with focus on the failure rate of local anesthesia, pain during injection, additional injections, cardiovascular disturbances (CVD), and method-inherent differences (unwanted side effects, latency time, amount of anesthetic solution, duration of anesthesia) in adult patients.

MATERIALS AND METHODS

Prospective and retrospective studies with clinical comparison of both injection techniques considering the relevant outcome parameters in adult patients from 1979 to 2012 were included. A specific tool for assessing risk of bias in each included study was adopted. Data were assessed for methodological reliability and extracted and supplemented by sensitivity analysis by two independent reviewers.

RESULTS

Seven studies were included [evidence grade Ib (n=1), IIb (n=3), and III (n=3)]. For other parameter than CVD, the significant heterogeneity of the random effects did not allow the reporting of pooled summary effect estimates. CVD were found significantly more often after IANB [odds ratio (OR): 0.12 (0.02-0.69)]. Further analysis revealed less injection pain in cases of ILA [OR: 0.32 (0.1-1)]. For failure rates as well as for needed additional injections, no significant differences were detected. IANB showed a latency of >3 min, whereas ILA had nearly none. The effect of IANB is longer than for ILA.

CONCLUSIONS

Methodological and reporting flaws were consistently observed in the included articles. Except for CVD, it could not be shown that ILA is neither superior nor inferior compared to IANB.

CLINICAL RELEVANCE

IANB as "gold standard" for routine dental treatments should be discussed.