Cementum and epithelial attachment response to the sulcular and periodontal ligament injection techniques.

This investigation studied the effect of the sulcular and periodontal ligament injection techniques on certain periodontal tissues. Eleven monkeys (Macaca nemistrina) were given injections of local anesthetic into the sulcular tissue or the periodontal ligament on the lingual side of maxillary molars. Contralateral teeth served as controls. After three months biopsies were taken and made into histologic sections. Of 6 teeth receiving a sulcular injection, 1 had a small area of cementum resorption. 0£ the 16 teeth which received a periodontal ligament injection, 2 had areas of cementum resorption and I showed an area of hypercementosis. No detrimental changes were found in the level of epithelial attachment. l/~..~tandard(~ techniques" are used most often to achieve nerve block and infiltration anesthesia in dentistry. However, on occasion these techniques have proved to be either uncomfortable to the patient or have resulted in inadequate anesthesia. Consequently, practitioners have begun to modify existing techniques and develop new ones that meet their clinical needs. The sulcular and periodontal ligament injections are examples of such modifications. The sulcular injection technique is especially useful in the maxillary-posterior-lingual areas of the primary and mixed dentition. For example, it may be used in combination with a buccal infiltration before extraction, or when applying rubber dam clamps. In this technique the needle is inserted gently approximately 0.5-1.0 mm into the tissue at the bottom of the gingival sulcus and a small amount of solution is injected slowly (Figure 1). Clinically, the use of this method in pediatric dentistry causes no apparent damage to the periodontium. In addition, the procedure seems to be less painful and therefore better tolerated by patients than alternative injection techniques. Figure 1. Site of needle insertion when using the sulcular injection technique. 0.5-1 mm Figure 2. Site of needle insertion when using the periodontal ligament injection technique. The periodontal ligament (PDL) injection has been described by Mead,1 Roberts and Sowray,2 and Walton and Abbott.3 In this technique the needle is inserted into the PDL where the solution is injected (Figure 2). Favorable clinical experience using the sulcular and PDL injection techniques encourages further study. However, Mead1 and Roberts and Sowray2 expressed concern about possible detrimental effects from the intraPDL injection. These concerns apparently were based on clinical impressions.