Extraction Of Permanent Maxillary Teeth Without Palatal Injection:Meta-analysis

Background: Most patients who undergo routine palatal injections for maxillary tooth extraction,as described in textbooks and papers,suffer from pain.In oral tissues,injection into the palatine mucosa is considered the most painful aspect of local anesthesia and one of the most common sources of fear associated with dental treatment.Maxillary tooth removal without palatal anesthesia has been a topic of many studies.Because the palatine mucosa is rich in nerves and vessels and is tightly attached to the bone surface,injections in this location are often painful.The number of researchers who deny the necessity of a palatal injection for the extraction of maxillary teeth continues to increase.The low complication rates associated with reliable anesthetics are based on good local anatomical factors: the relatively thin bone and the porous bone structure.Some authors made recommendations for an ideal research design that may achieve more credible outcomes based on the currently available evidence.We look forward to the topic of whether the maxillary teeth should be placed palate injection,and more rational and comparable trials have been further implemented.The purpose of the present study was to quantify the success rate of the operations via a meta-analysis,which is necessary.Methods: PubMed,Cochrane Library,Embase,SinoMed and the references of the identified full-text articles were searched for relevant studies published until Oct.1st 2017 that met the eligibility criteria.Experimental data were combined by meta-analysis using Review Manager 5.3 soft-ware(Cochrane Collaboration,Oxford,England),which was used to calculate the heterogeneity and mean differences,and 95% confidence interval of the main clinical outcomes.Results: Through preliminary searches of PubMed,Embase,the Cochrane Library,and SinoMed,245 studies in the literature were identified but only 7 randomized controlled trials were included in this meta-analysis.Compared with the control groups(were given the combination of buccal and palatal anesthesia recommended by the textbook,also known as routine Infiltration anesthesia),experimental group(single buccal anesthesia)for the removal of maxillary permanent teeth at conventional doses,which resulted in a reduction in the success rate(OR = 0.14,95% CI = 0.07–0.27,P < 0.00001).Conclusions: The results revealed that the success rate of the removal of the maxillary permanent teeth has undoubtedly been reduced by the lack of palatal injections.These findings suggest that oral and maxillofacial surgeons should consider the premise of ensuring the success rate via the use of some methods to avoid or reduce palatal injection pain rather than simply omitting the palatal injection to increase the risk of pain perception.Of course,larger and higher quality tests are needed to confirm and optimize the anesthetic procedure.