title: Injection pain and postinjection pain of the anterior middle superior alveolar injection administered with the Wand or conventional syringe.
abstract: OBJECTIVE
  The purpose of this prospective, randomized, blinded study was to compare the pain of injection and post-injection pain of the AMSA injection using the computer-assisted Wand Plus injection system versus a conventional syringe.
  
  
  METHODS
  Using a crossover design, 40 subjects randomly received 2 blinded AMSA injections using the Wand Plus system and a conventional syringe, at 2 separate appointments. The AMSA injection site was centered halfway between the midpalatine raphe and gingival margin of the first and second premolars. The pain of needle insertion, anesthetic solution deposition pain, and postinjection pain were recorded on a Heft-Parker VAS for the 2 AMSA injections.
  
  
  RESULTS
  For needle insertion, 38% of the subjects had moderate/severe pain with the Wand Plus((R)) and 34% moderate/severe pain with the conventional syringe, with no significant difference between techniques. There was a significant difference for solution deposition pain, with the conventional syringe causing more moderate/severe pain (42% conventional vs. 25% for the Wand Plus. Regarding postinjection pain, after numbness wore off there was no significant difference between the Wand Plus injection technique (0% moderate pain) and the conventional syringe technique (8% moderate pain). Postinjection, approximately 8% to 10% of the subjects experienced slight palatal swelling and 2% experienced temporary numbness. These problems resolved quickly and were considered minor.
  
  
  CONCLUSIONS
  The AMSA injection, using the Wand Plus, resulted in similar pain ratings for needle insertion as the conventional syringe but statistically lower pain ratings upon anesthetic solution deposition. However, the AMSA, using either the Wand Plus or a conventional syringe, has the potential to be a painful injection. We found the incidence of postinjection pain and sequelae was low with both techniques.
authors.affiliation: Department of Endodontics, College of Dentistry, Ohio State University, PO Box 182357, Columbus, OH 43218-2357, USA. nusstein.1@osu.edu
authors.forename: John
authors.initials: J
authors.lastname: Nusstein
authors.forename: Shelly
authors.initials: S
authors.lastname: Lee
authors.forename: Al
authors.initials: A
authors.lastname: Reader
authors.forename: Mike
authors.initials: M
authors.lastname: Beck
authors.forename: Joel
authors.initials: J
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000766:Anesthesia, Dental / Q000009:adverse effects / Q000295:instrumentation*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D018592:Cross-Over Studies; D005157:Facial Pain / Q000209:etiology*; D005260:Female; D006801:Humans; D007267:Injections / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D008442:Maxillary Nerve; D009407:Nerve Block / Q000009:adverse effects* / Q000295:instrumentation*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011446:Prospective Studies; D016037:Single-Blind Method; D013594:Syringes / Q000009:adverse effects; D013813:Therapy, Computer-Assisted / Q000295:instrumentation*
chemical_list: D000779:Anesthetics, Local