Journal of dentistry · 2025
Comparison of injection pain levels using conventional and computer-controlled local anesthetic delivery systems in pediatric dentistry: A systematic review and meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Shirani Mohammadjavad, Looha Mehdi Azizmohammad, Emami Maryam
Аннотация
OBJECTIVES: This systematic review aimed to evaluate the effectiveness of computer-controlled local anesthetic delivery (CCLAD) systems in reducing injection pain in pediatric patients aged 3-14 years, including subgroup analysis across different injection techniques.
DATA: Randomized controlled trials comparing pain perception associated with CCLAD versus conventional injection methods in children published from January 2015 to November 2024 were included.
SOURCES: Comprehensive searches were performed in Embase, Medline (via PubMed), Cochrane Library, Scopus, Web of Science, and Google Scholar, limited to articles published in English.
STUDY SELECTION: From 1253 identified studies, 20 met the inclusion criteria. Meta-analysis revealed that CCLAD significantly reduced pain perception based on the Wong-Baker Pain Rating Scale (WBS) (SMD = -0.98, p = 0.011) and heart rate (HR) measurements (SMD = -0.25, p = 0.013), with high and moderate heterogeneity, respectively. Subgroup analysis indicated significant pain reduction with CCLAD compared to conventional Inferior Alveolar Nerve Block (IANB) on WBS, though findings varied across other scales and injection methods, demonstrating some non-significant differences. No significant differences were observed in other pain assessment parameters. The overall risk of bias was low in five studies, with evidence certainty ranging from very low to moderate.
CONCLUSION: CCLAD demonstrates potential as a non-pharmacological tool for reducing injection pain in children, particularly as assessed by WBS and HR. Furthermore, CCLAD significantly reduced pain compared to conventional IANB injections in subgroup analyses. Additional research is necessary to optimize treatment protocols and further evaluate the impact of CCLAD on objective pain measures.
CLINICAL SIGNIFICANCE: This study highlights the benefits of CCLAD in pediatric dentistry, particularly its effectiveness in minimizing pain and stress during local anesthetic injections, especially for IANB procedures. Using CCLAD can enhance patient comfort, improve cooperation, and foster a positive dental experience, thereby supporting better treatment outcomes in pediatric patients requiring precise and low-pain care.
DATA: Randomized controlled trials comparing pain perception associated with CCLAD versus conventional injection methods in children published from January 2015 to November 2024 were included.
SOURCES: Comprehensive searches were performed in Embase, Medline (via PubMed), Cochrane Library, Scopus, Web of Science, and Google Scholar, limited to articles published in English.
STUDY SELECTION: From 1253 identified studies, 20 met the inclusion criteria. Meta-analysis revealed that CCLAD significantly reduced pain perception based on the Wong-Baker Pain Rating Scale (WBS) (SMD = -0.98, p = 0.011) and heart rate (HR) measurements (SMD = -0.25, p = 0.013), with high and moderate heterogeneity, respectively. Subgroup analysis indicated significant pain reduction with CCLAD compared to conventional Inferior Alveolar Nerve Block (IANB) on WBS, though findings varied across other scales and injection methods, demonstrating some non-significant differences. No significant differences were observed in other pain assessment parameters. The overall risk of bias was low in five studies, with evidence certainty ranging from very low to moderate.
CONCLUSION: CCLAD demonstrates potential as a non-pharmacological tool for reducing injection pain in children, particularly as assessed by WBS and HR. Furthermore, CCLAD significantly reduced pain compared to conventional IANB injections in subgroup analyses. Additional research is necessary to optimize treatment protocols and further evaluate the impact of CCLAD on objective pain measures.
CLINICAL SIGNIFICANCE: This study highlights the benefits of CCLAD in pediatric dentistry, particularly its effectiveness in minimizing pain and stress during local anesthetic injections, especially for IANB procedures. Using CCLAD can enhance patient comfort, improve cooperation, and foster a positive dental experience, thereby supporting better treatment outcomes in pediatric patients requiring precise and low-pain care.