Pain Reduction in Extensive Apical Surgery of the Anterior Maxilla: A Comparative Clinical Study

The purpose of this study was to compare the outcomes of 2 different anesthetic techniques (local infiltration vs infraorbital nerve block) for eliminating pain during apical surgeries that are associated with extensive periapical pathology in the anterior maxilla.

Patients were randomly divided into 2 groups: patients in group I were anesthetized labially by local infiltration injections, whereas those in group II received a single infraorbital nerve block. Palatal injections were given for the 2 groups. Once the pain was initiated during surgery, the procedure was discontinued until profound anesthesia was secured. The studied variables were age, gender, onset of anesthesia, operative time, and intraoperative pain. Any complication associated with the injection techniques, intraoperatively and postoperatively, also was assessed and recorded. Then, the collected data were analyzed using proper statistical methods. The significance level was set at a P value less than or equal to .05.

One hundred patients (50 per group; age range, 16 to 43 yr), predominantly men, were enrolled in this study. The results showed rapid onset of anesthesia in group II with a highly significant difference from group I (P ≤ .05). Duration of the operation ranged from 44 to 57 minutes. Pain during the surgical procedure was reported by most patients in group I (92%). Collateral anesthesia (82%) and increased numbness of the upper lip (72%) were reported in group I. Ecchymosis at the infraorbital foramen or rim (8%) and paresthesia in the skin over the infraorbital region (6%) and cheek (4%) were observed in group II.

In apical surgeries, the anesthetic efficiency of the infraorbital nerve block was superior to that of local infiltration. It had rapid onset, longer duration, and greater potency and avoided multiple transmucosal injections. Furthermore, it was associated with minor and transient side effects.