Methodical bias for comparison of periodontal ligament injection and local infiltration anesthesia for routine extractions in the maxilla
Peer W Kämmerer, Monika Daubländer
Department of Oral, Maxillofacial and Facial Plastic Surgery, University Medical Centre Mainz, Mainz, Germany
We read the article by Al-Shayyab1 with great interest, though we think that there is a methodical bias.
Usage of standard dental syringes with 27-gauge needles is not recommended for periodontal ligament (PDL) injections as they are very unlikely to achieve the correct pressure needed for successful single tooth anesthesia. In accordance with this, specialized syringes with short 30-gauge needles are commonly used all over the literature.2 The author addresses this in the “Discussion” section and writes that “a standard conventional dental syringe was used in the present study, not a special PDL syringe, since the former is readily available in the clinic and proves equally successful when a standard 27-gauge short needle was used,” citing Malamed from 1982 (a time during which the modern PDL syringes were not developed yet3) and Madan et al who write that “intraligamentary injection technique is equally effective when a standard 27-gauge needle is used”.4 The second assumption refers to the needle only, not the syringe. In addition, this needle issue is not proven by any reference or study. Therefore, one might come to the conclusion that PDL was not carried out correctly. Also, the authors did not evaluate pulp or tissue anesthesia and started the extraction procedure after a latency period of 5 minutes in all cases. In accordance with this, the success rates of the PDL injection cannot be given, but would be of interest.
View the original paper by Al-Shayyab and colleagues.
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