Palatal Injection for the Removal of Maxillary Teeth: Current Practice Among Oral and Maxillofacial Surgeons

Abstract

Purpose:Conventional teaching regarding palatal injection for the removal of maxillary teeth dictates that both a buccal and palatal injection are to be administered. Recently, some authors have questioned the necessity of the palatal injection, suggesting that contemporary local anaesthetics might diffuse sufficiently across the buccal-palatal cortical bone distance. It has been suggested that since the buccal-palatal cortical bone distance increases anteriorly to posteriorly in the maxilla, the success of maxillary extractions with buccal injection only, might be related to anterior-posterior position of the tooth. Patients and Methods:An online survey was sent to 276 full members of the Canadian Association of Oral and Maxillofacial Surgeons. Respondents were asked about their use of palatal injection for the removal of maxillary teeth under local anaesthesia, including how often they administer a palatal injection for maxillary extractions in each region of the maxilla. Results:92 responses were received (33%). Most practitioners deliver a palatal injection for every maxillary tooth extraction under local anaesthetic. However, there is a significant number who do not always administer a palatal injection (i.e. they give it 'most of the time', 'occasionally' or 'never'). This number decreased in a linear fashion anteriorly to posteriorly in the maxilla: Conclusion:There are a number of surgeons who do not always administer a palatal injection for extraction of maxillary teeth under local anaesthetics. The number is greater for anterior compared to posterior teeth.

Can Single Buccal Infiltration With 4% Articaine Induce Sufficient Analgesia for the Extraction of Maxillary Teeth? A Systematic Literature Review

“…Reason for exclusion Majid and Ahmed 2017 [25] palatal injection was given as a placebo Badenoch-Jones et al 2017 [26] cross-sectional study (survey) Badenoch-Jones et al 2016 [27] systematic review Hassan et al 2011 [32] less than 1.5 ml articaine administered Sharma et al 2014 [33] less than 1.5 ml articaine administered Badcock 2007 [34] cross-sectional study (survey) Khan and Qazi 2017 [40] only lidocaine used Bahrololoomi and Maghsoudi 2022 [41] conducted in pediatric clinics Gholami et al 2021 [42] less than 1.5 ml articaine administered Cui et al 2018 [44] meta-analysis Gazal 2020 [49] palatal injection of articaine Deshpande et al 2020 [50] less than 1.5 ml articaine administered Azad et al 2019 [52] less than 1.5 ml articaine administered Joshi and Soni 2019 [54] less than 1.5 ml articaine administered Shalash and Eladl 2019 [55] less than 1.5 ml articaine administered Friedl et al 2012 [22] less than 1.5 ml articaine administered Lima Jr et al 2009 [24] cross-sectional study Sekhar et al 2011 [30] only lidocaine used Isik et al 2011 [39] cross-sectional study…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…387 To reduce the patients' discomfort, less and even minimally invasive local anesthesia techniques have been suggested. [387][388][389][390][391][392] The buccal and palatal infiltration of a local anesthetic has been taught to be the technique of choice to obtain appropriate numbness when performing dental extractions in the maxilla. 393 Especially, the palatal injection site causes significant pain.…”

“…It is interesting to note that a survey performed by the Canadian Association of Oral and Maxillofacial Surgeons revealed that most of the respondents performed palatal infiltration in most patients requiring maxillary exodontia. 391 This shows that some academic discussions about the benefit or burden of different procedures might be of limited clinical importance for clinicians.…”