Should Maxillary Buccal Infiltration Anesthesia be Given in a Closed Mouth Technique? - a Clinical Study
Phase: NA
Conditions: Anesthesia, Local, Pain Control
Sponsor: University of Jordan

Study title: Should maxillary buccal infiltration anesthesia be given in a closed 
mouth technique? – a clinical study 
 
Research proposal submitted for approval by Jordan University Hospital review 
board committee on 01 March 2018 
Approved on 20 March 2018 
NCT number: 10/2018/3686 
 
Main researcher:  
Dr. Ahmad El-Ma’aita 
School of Dentistry – University of Jordan 
a.maaita@ju.edu.jo 
 

Should maxillary buccal infiltration anesthesia be given in a closed mouth 
technique? – a clinical study 
 
Background: Local anesthesia is an essential part of dentistry. The most commonly used 
technique to anesthetise maxillary posterior teeth is buccal infiltration with a local 
anesthetic agent [1]. The technique described in the literature focuses on the location of 
injection, the direction of the needle insertion in relation to the root apex, the direction of 
needle bevel in relation to the cortical bone plate, the size of needle and the type and 
amount of the local anesthetic agent used [2, 3]. However, there is no mention to whether 
the patient should open their mouth or maintain their teeth in intercuspation during the 
injection procedure.  
Aims: This research aims to a) compare two techniques of injection (open and closed-mouth 
techniques) in terms of the discomfort experienced by patients during the injection 
procedure and b) evaluate the dentists' preference of performing either technique. 
Methods:  
Part 1: 100 patients scheduled for root canal treatment for a vital maxillary posterior tooth 
(from first premolar to the second molar teeth) will be included in this study and randomly 
divided into 2 groups according to the anesthesia technique used; group A: open-mouth 
technique and group B: closed-mouth technique. The two anesthetic techniques will be 
performed using the same needle size (20mm, gauge 25), anesthetic agent type (4% 
Articaine with 1:100,000 adrenaline) and quantity (1.8ml), and the same operator.  
Patients will be asked to answer questions (Appendix A) regarding the level of discomfort 
they experienced during the injection procedure. 
Exclusion criteria: patients diagnosed with psychological issues, intraoral soft tissue 
abnormalities, or necrotic pulp and/ or apical pathology will be excluded from this study. 
Statistical analysis: the independent t-test at a significance level of 0.05 will be used to 
detect any statistically significant difference between the discomfort level experienced 
during the two techniques.  
Part 2: A questionnaire will be designed and distributed to 50 dentists regularly performing 
root canal treatments. The dentists will be asked to complete 10 questionnaires for 10 

different patients using each technique 5 times and register their own perception of the two 
techniques. Statistical analysis will be performed using the independent sample t-test and 
Chi-square test at 5% significance level. 
 
References : 
1 . 
Costa, C.G., et al., Onset and duration periods of articaine and lidocaine on maxillary 
infiltration. Quintessence Int, 2005. 36(3): p. 197-201 . 
2 . 
Kanaa, M.D., J.M. Whitworth, and J.G. Meechan, A comparison of the efficacy of 4% 
articaine with 1:100,000 epinephrine and 2% lidocaine with 1:80,000 epinephrine in 
achieving pulpal anesthesia in maxillary teeth with irreversible pulpitis. J Endod, 2012. 
38(3): p. 279-82 . 
3 . 
Kandiah, P. and J.F. Tahmassebi, Comparing the onset of maxillary infiltration local 
anaesthesia and pain experience using the conventional technique vs. the Wand in 
children. Br Dent J, 2012. 213(9): p. E15 . 
 

Appendix A:  
Patient general information:  
Patient's gender:  M  /  F                                                                  Patient ID: 
__________ 
Age: ________________________ 
Tooth #: ____________________ 
 
Apprehensiveness towards dental injections in general: 
Not apprehensive at all 
Moderately apprehensive 
Severely apprehensive 
 
Technique:                  Open-mouth     /      closed-mouth 
 
Using the 0-10 scale below, please rate the discomfort experienced during the 
injection procedure in terms of: 
 
 
i- Needle penetration _________________________ 
ii- Cheek retraction ___________________________ 
iii- Overall discomfort during the injection procedure ______________ 
 
 

Appendix B: 
Part 1:  Dentist general information: 
 
Gender:   M / F 
Age: ____________ 
Speciality: ________________________________________________________ 
Years of experience: ________________________

Appendix B: 
Part 2: Technique- specific information 
 
Patient's details: 
 
          Gender:    M /  F                              Age: ____________                    Tooth #: ____________ 
 
Technique used:        Open-mouth      /      Closed-mouth        (please circle one) 
 
Using the standard visual analogue scales provided, please rate the following: 
 
a- Visibility to the injection site (0: poor visibility, 10: Excellent visibility): ________________ 
 
 
b- Ease of cheek retraction (0: extremely difficult, 10: extremely easy): __________________ 

 
Appendix B:  
 
Part 3: Conclusion page: 
 
After completing the experiment for 10 different patients (using the 2 techniques 5 times 
each) please choose your preference: 
a- I prefer the closed-mouth technique 
b- I have no preference 
c- I prefer the open mouth technique 
 
Reasons for your answer: 
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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