Combined posterior superior alveolar and anterior middle superior alveolar nerve blocks with labial infiltration versus nerve blocks alone for pain management in minimally invasive non-surgical periodontal therapy: a split-mouth randomized controlled trial

• Published in: BMC oral health Vol. 25; no. 1; pp. 746 - 9
• Main Authors: Cai, Ting-Ting, Zhang, Jia-Qi, Han, Meng-Ran, Fu, Yong-Wei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 21.05.2025; BioMed Central; BMC
• Subjects: Adult; Adverse events; Alveoli; Analgesia; Anesthesia; Anterior middle superior alveolar nerve block; Care and treatment; Clinical trials; Enrollments; Ethics; Female; Gum disease; Humans; Informed consent; Injection; Local anesthesia; Male; Maxilla; Middle Aged; Minimally invasive non-surgical periodontal therapy; Mouth; Nerve Block - methods; Pain; Pain Management - methods; Pain Measurement; Patient compliance; Patient Satisfaction; Patients; Periodontitis; Periodontitis - therapy; Single-Blind Method; Statistical analysis; Subgingival instrumentation; Systemic diseases; France; Anterior middle superior alveolar nerve block; Minimally invasive non-surgical periodontal therapy; Periodontitis; Subgingival instrumentation; Local anesthesia
• ISSN: 1472-6831; 1472-6831
• DOI: 10.1186/s12903-025-06175-z

To compare the efficacy of combining posterior superior alveolar (PSA) block, anterior middle superior alveolar (AMSA) block, and labial infiltration of the maxillary central incisor versus PSA + AMSA alone for pain control during minimally invasive nonsurgical periodontal therapy (MINST). Twenty-four patients with stage II-III periodontitis were enrolled in the single-center, single-blind, split-mouth randomized controlled trial. The maxillary right and left quadrants were randomized to receive either PSA + AMSA blocks and labial infiltration (test group) or PSA + AMSA alone (control group) during subgingival instrumentation. Pain levels during injection and treatment were assessed using a 100 mm visual analog scale (VAS). Primary outcomes included intraoperative and injection-related pain scores, while secondary outcomes comprised treatment duration, injection time, patient satisfaction, and adverse events. Data were analyzed using GraphPad Prism 9. Twenty-one subjects completed the study. No significant difference in injection pain was observed between groups (test: 22.74 ± 14.10 mm vs. control: 20.21 ± 12.27 mm; P = 0.248). However, the test group exhibited a statistically significant reduction in intraoperative pain (test: 11.07 ± 10.36 mm vs. control: 16.43 ± 11.55 mm; P = 0.021). Patient satisfaction was significantly higher in the test group [test: 90 (IQR 90-100) vs. control: 90 (80-90); P = 0.004]. No clinically meaningful differences were detected in treatment duration or adverse event rates (P > 0.05). The combined PSA + AMSA blocks and labial infiltration protocol reduced intraoperative pain and improved satisfaction versus PSA + AMSA blocks, without prolonging treatment. Despite clinical promise, the small sample size limits generalizability, necessitating multicenter trials to validate efficacy and broader applicability. The trial protocol was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2400086566) on 05-07-2024.