Comparison of Five Anesthetic Delivery Systems for Palatal Infiltration

Comparison of Five Anesthetic Delivery Systems for Palatal Infiltration: A Randomized Clinical Trial

This study is a randomized clinical trial evaluating five different anesthetic delivery systems for palatal infiltration in adults undergoing maxillary molar extraction. A total of 200 healthy volunteers were enrolled and randomly assigned to receive anesthesia using one of the following devices: conventional dental syringe, manual pressure syringe, spring-activated syringe, needle-free jet injector, or computer-controlled local anesthetic delivery system.

The purpose of the study is to compare patient-reported pain, dental fear, and physiological responses (pulse rate and oxygen saturation) associated with each system. The results are expected to provide evidence on which devices may improve patient comfort and cooperation during palatal infiltration procedures.

This randomized, parallel-arm superiority trial was conducted at Istanbul Aydın University, Faculty of Dentistry, between September 2023 and March 2025. Two hundred healthy adults (≥18 years) requiring maxillary molar extraction under palatal infiltration anesthesia were equally randomized into five groups (n=40).

All participants received 0.4 mL of 4% articaine with 1:100,000 epinephrine, delivered with one of the five systems. The primary outcome was pain perception measured immediately after injection using a visual analog scale (VAS). Secondary outcomes included changes in dental fear, pulse rate, oxygen saturation, and any adverse events.

The study was approved by the Istanbul Aydın University Ethics Committee. Written informed consent was obtained from all participants.

Inclusion Criteria:

• Age ≥ 18 years
• ASA physical status I or II
• No systemic conditions affecting anesthetic metabolism
• No known allergy to local anesthetics or vasoconstrictors
• No psychiatric disorders or anxiolytic medication
• Ability to provide written informed consent

Exclusion Criteria:

• Pregnancy or lactation
• Active infection at the injection site
• Diagnosed needle phobia
• Prior exposure to any of the tested injection systems
• Use of premedication, sedatives, or topical anesthetics on the day of the procedure