Traditionally palatal injections are used for the extraction of maxillary teeth under local anaesthesia. Patients find these uncomfortable owing the firm mucosal attachment and rich nerve supply. The need for these injections has been questioned by a number of authors.

The aim of this review was to examine the outcomes of maxillary tooth extractions using buccal injection of local anaesthetic only.

Methods

Searches were conducted in the PubMed, Embase, and Cochrane CENTRAL databases with no language restrictions. Studies that examined any outcome of the extraction of maxillary teeth (anterior and/ or premolar and/or molar), where one or more test groups used buccal injection of local anaesthetic only, were considered. Two reviewers independently selected studies and assessed risk of bias. A single reviewer carried out data abstraction. A narrative summary of the findings was presented.

Results

• 15 studies (6 RCTs, 4 CCTs, 5 uncontrolled) involving a total of 1318 patients were included.
• Sample sizes ranged from 30-200.
• 4 studies included only 3^rd molars while 2 studies excluded them, two studies involved only premolars, and one study included only molars and premolars. Only 1 study involved incisor teeth.
• Lignocaine and Articaine were used for anaesthesia and all except 1 study used the same agent fro buccal and palatal injections.
• 9 controlled studies examining pain during the procedure found no statistically significant difference between the test and control groups.

Conclusions

The authors concluded:-

Nine controlled studies examining pain during the procedure found no statistically significant difference between the test and control groups. More randomized controlled trials, particularly with larger sample sizes and similar protocols, are necessary to further examine this question, which is relevant to the everyday practice of oral surgery procedures, both by general dentists and oral and maxillofacial surgeons.

Comments

A broad range of databases have been searched for this review identifying only a small number of randomised trials. None of the included studies are large and none of them could be considered to be at low risk of bias. While a majority of the included controlled studies found no differences between the test and control groups these findings need to be interpreted cautiously because of the limited quality of the included studies.

Links

Primary paper

Badenoch-Jones EK, Lincoln T. Palatal injection for removal of maxillary teeth: is it required? A systematic review. Int J Oral Maxillofac Surg. 2016 May 30. pii: S0901-5027(16)30060-1. doi: 10.1016/j.ijom.2016.05.005. [Epub ahead of print] Review. PubMed PMID: 27256010.