Effect of Starpen Injection Device Versus Conventional Syringe During Anesthesia and Extraction of Primary Molars

Evaluation of the Effect of Computer Controlled Starpen Automatic Injection Device Versus Conventional Syringe on Pain Perception During Infiltration Anesthesia and Extraction of Maxillary Primary Molars : A Randomized Clinical Trial

To evaluate the effect of Starpen device on pain perception during anesthesia and extraction of maxillary primary molars.

After enrollment of the patients according to the eligibility criteria, taking full medical , dental history and informed consents from the parents. Clinical and radiographic examination will be done for the tooth to be extracted. A diagnostic chart with personal, medical and dental history will be filled out . Also preoperative psychological management of the child through positive reinforcement techniques should be done . Then the two parallel groups will have local anesthesia using an infiltration technique in the upper jaw ; one group with conventional syringe and the other group by Starpen automatic injection device . Both groups will have the site of injection well prepared before injection by the same way and technique. In Addition, procedures as anesthesia injection and extraction will be done according to the guidelines set by the American Academy of Pediatric Dentistry . After the procedure is done , the participants and their parents will be instructed about post-operative care and the need of a space maintainer will be taken into account. Moreover subjective and objective pain will be assessed and scored during procedure of anesthesia injection and extraction.

Inclusion Criteria:

• Children aged 6-8 years
• Cooperative children ( rating 3 or 4 based on the Frankl behavior scale )
• Medically fit children (ASA I )
• Children mentally capable of communication
• First dental visit
• Patient requiring extraction of upper primary molars due to root caries , crown fractures, periapical disease and failed pulpotomies
• No acute dental pain

Exclusion Criteria:

• Children with a behavioral management problem
• Parental refusal of participation
• Children with previous history of local anesthesia injection
• Medically unfit children (other than ASA I )
• Uncooperative children ( other than Frankl 3,4)
• Children under medications ( antibiotics and analgesics ) for the previous 48 hours that could alter the pain perception
• Teeth that showed any signs of mobility , ankylosis or root resorption affecting more than one third the root
• Acute dental pain