Intraseptal and Periodontal Ligament Anaesthesia for Tooth Extraction in Patients With Type 2 Diabetes

Efficacy and Safety of Intraseptal and Periodontal Ligament Anaesthesia for Extraction of Upper Lateral Incisors and Lower First Premolars in Patients With Type 2 Diabetes Mellitus

The goal of this clinical trial is to compare two local anesthesia techniques, intraseptal anesthesia (ISA) and periodontal ligament anesthesia (PLA), in patients with controlled type 2 diabetes mellitus undergoing tooth extraction.

The main questions it aims to answer are:

Which technique provides more effective local anesthesia for tooth extraction? Do ISA and PLA differ in their effects on blood pressure and heart rate during the procedure?

Researchers will compare ISA and PLA to determine which method is more effective and safer in this patient population.

Participants will:

Receive local anesthesia (ISA or PLA) using articaine with epinephrine delivered with a computer-controlled system Undergo extraction of a maxillary lateral incisor or mandibular first premolar Have blood pressure and heart rate measured before, during, and after anesthesia and extraction

This randomized clinical trial was designed to evaluate and compare the clinical efficacy and safety of intraseptal anesthesia (ISA) and periodontal ligament anesthesia (PLA) in patients with controlled type 2 diabetes mellitus undergoing tooth extraction.

Local anesthetic administration in diabetic patients requires careful consideration due to potential cardiovascular responses and altered tissue sensitivity. Alternative injection techniques such as ISA and PLA may provide effective anesthesia while minimizing systemic effects.

A total of 120 participants were randomly assigned to receive either ISA or PLA. All anesthetic procedures were performed using a computer-controlled local anesthetic delivery system (CCLADS) with 0.6 mL of 4% articaine with 1:100,000 epinephrine (Septanest).

The study included extraction of maxillary lateral incisors and mandibular first premolars. Outcomes included anesthetic success rate, onset time, duration and extent of anesthesia, as well as changes in systolic and diastolic blood pressure, mean arterial pressure, and heart rate measured before, during, and after the procedure.

Inclusion Criteria:

• Controlled Type 2 diabetes mellitus
• Age 35-77 years
• Patients requiring extraction of maxillary lateral incisors or mandibular first premolars
• Teeth free of acute periodontal disease
• No acute dentoalveolar abscess
• No dental treatment within last 48 hours
• No smoking
• No alcohol or drug dependence
• No contraindications to local anesthetic or vasoconstrictor

Exclusion Criteria:

• Smokers
• Patients with alcohol or drug dependence
• Contraindications to local anesthetics or vasoconstrictors
• Acute periodontal disease at the site of injection
• Acute dentoalveolar abscess
• History of tooth trauma or hypersensitivity in target teeth
• Dental treatment within the last 48 hours prior to procedure
• Non-controlled diabetes mellitus (implied, since study includes controlled DM only