Shirani Mohammadjavad, Looha Mehdi Azizmohammad, Emami Maryam
Department of Restorative Dentistry, Maurice H. Kornberg School of Dentistry, Temple University, Philadelphia, PA, USA.
Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Dent. 2025 Jun;157:105770. doi: 10.1016/j.jdent.2025.105770. Epub 2025 Apr 18.
This systematic review aimed to evaluate the effectiveness of computer-controlled local anesthetic delivery (CCLAD) systems in reducing injection pain in pediatric patients aged 3-14 years, including subgroup analysis across different injection techniques.
Randomized controlled trials comparing pain perception associated with CCLAD versus conventional injection methods in children published from January 2015 to November 2024 were included.
Comprehensive searches were performed in Embase, Medline (via PubMed), Cochrane Library, Scopus, Web of Science, and Google Scholar, limited to articles published in English.
From 1253 identified studies, 20 met the inclusion criteria. Meta-analysis revealed that CCLAD significantly reduced pain perception based on the Wong-Baker Pain Rating Scale (WBS) (SMD = -0.98, p = 0.011) and heart rate (HR) measurements (SMD = -0.25, p = 0.013), with high and moderate heterogeneity, respectively. Subgroup analysis indicated significant pain reduction with CCLAD compared to conventional Inferior Alveolar Nerve Block (IANB) on WBS, though findings varied across other scales and injection methods, demonstrating some non-significant differences. No significant differences were observed in other pain assessment parameters. The overall risk of bias was low in five studies, with evidence certainty ranging from very low to moderate.
CCLAD demonstrates potential as a non-pharmacological tool for reducing injection pain in children, particularly as assessed by WBS and HR. Furthermore, CCLAD significantly reduced pain compared to conventional IANB injections in subgroup analyses. Additional research is necessary to optimize treatment protocols and further evaluate the impact of CCLAD on objective pain measures.
This study highlights the benefits of CCLAD in pediatric dentistry, particularly its effectiveness in minimizing pain and stress during local anesthetic injections, especially for IANB procedures. Using CCLAD can enhance patient comfort, improve cooperation, and foster a positive dental experience, thereby supporting better treatment outcomes in pediatric patients requiring precise and low-pain care.
本系统评价旨在评估计算机控制局部麻醉给药（CCLAD）系统在减轻3至14岁儿科患者注射疼痛方面的有效性，包括对不同注射技术的亚组分析。
纳入了2015年1月至2024年11月发表的比较CCLAD与传统注射方法在儿童中疼痛感知的随机对照试验。
在Embase、Medline（通过PubMed）、Cochrane图书馆、Scopus、科学引文索引和谷歌学术进行全面检索，仅限于英文发表的文章。
从1253项已识别的研究中，20项符合纳入标准。荟萃分析显示，基于面部表情疼痛评分量表（WBS）（标准化均数差[SMD]= -0.98，p = 0.011）和心率（HR）测量，CCLAD显著降低了疼痛感知（SMD = -0.25，p = 0.013），分别具有高和中度异质性。亚组分析表明，与传统下牙槽神经阻滞（IANB）相比，CCLAD在WBS上显著减轻了疼痛，尽管在其他量表和注射方法上结果有所不同，显示出一些无显著差异。在其他疼痛评估参数中未观察到显著差异。五项研究的总体偏倚风险较低，证据确定性范围从极低到中度。
CCLAD显示出作为一种非药物工具减轻儿童注射疼痛的潜力，特别是通过WBS和HR评估时。此外，在亚组分析中，与传统IANB注射相比，CCLAD显著减轻了疼痛。需要进一步研究以优化治疗方案并进一步评估CCLAD对客观疼痛指标的影响。
本研究强调了CCLAD在儿童牙科中的益处，特别是其在局部麻醉注射期间最小化疼痛和应激方面的有效性，尤其是对于IANB程序。使用CCLAD可以提高患者舒适度、改善合作并促进积极的牙科体验，从而支持需要精确和低疼痛护理的儿科患者获得更好的治疗结果。
