Patient Discomfort and Intesity of Intraseptal Anesthesia of Controlled Articaine/Epinephrine Delivery for Scaling and Root Planing

Abstract

Abstract Objectives: The primary aim was assessing the pain during intraseptal anesthesia (ISA) administration, during and after scaling and root planing (SRP). The secondary aims were comparing the pain in different regions of jaws and evaluating factors affecting pain during SRP. Materials and Methods: ISA was obtained with different doses (0.1 ml, 0.2 ml, and 0.3 ml) of 4% articaine with 1:100,000 epinephrine (4%Ar+Ep) in 360 patients. The pain during ISA administration (VASa), the pain during SRP (VASi), and the pain after SRP (VASp) were evaluated by visual analogue scale (VAS) and correlated with clinical periodontal parameters. Multiple regression analysis was performed for pain during SRP (absence vs. presence) as dependent variable for different factors. Results: During the anesthetic delivery 80.8% of patients reported pain. VASa negatively correlated with periodontal pocket depth (PPD) (ρ=-0.109, p=0.047). VASi showed no dose-dependency, except in the mandibular premolars (p=0.049). VASi negatively correlated with clinical attachment level (CAL) (ρ=-0.138, p=0.012). VASp reported 13.5% of patients. The regression analysis indicated that increasing the anesthesia duration and the anesthetic field width orally were followed by the greater chance of achieving painless SRP. Conclusions: ISA obtained with 0.3 ml 4%Ar+Ep will provide a painless SRP. Clinical Relevance: The pain during ISA administration was mild and well tolerated by the patients. The pain during SRP can be expected in patients with greater CAL. The post-treatment pain can be anticipated after SRP in region with greater PPD and CAL. Study was registered in a Clinical Trials database (NCT04392804, May 9th, 2020).