STA™ SCIENCE
Review of the Literature
1. Asarch T, Allen K, Petersen B, Beiraghi S. Efficacy of a computerized local anesthesia device in pediatric dentistry. Pediatr Dent. 1999;21:421-424.
Evaluated the efficacy of computerized anesthesia on the reduction of pain during injection compared to conventional systems in 57 children (5 to 13 years old) needing restorative procedures. Randomization was conducted by drawing before the procedure to select the anesthetic technique to be applied. Inferior alveolar nerve block and buccal infiltrations were conducted. Anesthetic procedures were filmed and scored by one examiner. Painful perception was reported by the patient through a visual analogue scale (VAS). Additionally, a questionnaire about patient’s satisfaction and approval of dentist and treatment received was also applied.
CONCLUSION: No significant difference was observed between the local anesthetic methods in patients’ preferences and manifestations.
COMMENT: In a subsequent publication regarding the methodology used by Asarch et al. it was determined that the test system (Wand system) was not used in accordance with the instructions of the manufacturers and adversely affected the results obtained in this study.
*Casagrande ER. The Wand revisted. Pediatr Dent. 2000;22:186.
2. Gibson RS, Allen K, Hutfless S, Beiraghi S. The Wand vs. traditional injection: a comparison of pain related behaviors. Pediatr Dent. 2000 Nov-Dec;22(6):458-62.
PURPOSE: The purpose of this study was to evaluate the efficacy of a computerized anesthesia delivery system (e.g., Wand) compared to a traditional anesthesia administration, with respect to reducing disruptive pain related behavior during injections.
METHODS: Subjects consisted of 62 patients between the ages of 5 and 13 requiring local anesthesia for dental restorations in the maxilla. Patients were randomly assigned to either the Wand or the traditional anesthetic delivery system. A palatal approach to the anterior and middle superior alveolar nerves and the anterior superior alveolar nerve was used with the Wand injections. Buccal infiltration and palatal injections were used for the traditional method. Pain behavior was observed and coded. Pain ratings were obtained. Subjects also rated their satisfaction with treatment.
RESULTS: Results of chi-square tests found that the Wand injections produced significantly fewer patients who exhibited disruptive behavior during the initial 15 seconds of an injection when compared with those who received a traditional palatal injection. Wand patients were significantly less likely to cry, to exhibit disruptive body movements, and to require physical restraint. In contrast, there were no significant differences in disruptive behavior when comparing the Wand with the traditional buccal injection. Pain ratings showed no statistical difference between the Wand and the traditional injections. The evaluation also consisted of painful sensations, VAS and an acceptance questionnaire. Compared to the conventional technique, the application of electronic anesthesia resulted in significantly less situations of children crying (42% and 74%), abrupt body movements (3% and 39%), need for physical containment (1.5% and 9%) and behavioral alterations (42% and 77%).
CONCLUSION: Wand injections can deliver proper anesthesia, utilizing one palatal injection site, while significantly reducing the likelihood of disruptive behaviors during the initial moments of an injection.
3. Allen KD, Kotil D, Larzelere RE, Hutfless S, Beiraghi S. Comparison of a computerized anesthesia device with a traditional syringe in preschool children. Pediatr Dent. 2002 Jul-Aug;24(4):315-20.
PURPOSE: The purpose of this investigation was to evaluate the efficacy of a computerized injection device (Wand) on reducing pain behavior during injections with preschool-aged children.
METHODS: Subjects consisted of 40 patients between the ages of 2 and 5 requiring local anesthesia for dental restorations in the maxilla. Patients were randomly assigned to either the Wand or the traditional anesthetic delivery system. A palatal approach to the anterior and middle superior alveolar nerves and the anterior superior alveolar nerve was used with the Wand injections. Buccal infiltration and palatal injections were used for the traditional method. Pain behavior was observed and coded.
RESULTS: Results of Fisher Exact tests found that using the Wand to deliver anesthetic lead to significantly fewer (P < .01) disruptive behaviors in preschool-aged children when compared with a traditional injection regimen. In addition, none of the preschool-aged children exposed to the Wand required restraint during the initial interval, while nearly half of the children receiving a traditional injection required some type of immediate restraint.
CONCLUSION: These results demonstrate that the Wand can significantly reduce disruptive behaviors in a population of young children who are traditionally more difficult to manage and may be one method of creating a more positive experience for the young child and the practitioner. None of the patients subjected to the electronic technique needed physical containment, while approximately half of the patients receiving the conventional anesthesia needed some kind of immediate movement restraint.
4. Ran D, Peretz B. J Clin Pediatr Dent. 2003 Spring;27(3):247-50.Assessing the pain reaction of children receiving periodontal ligament anesthesia using a computerized device (Wand).
PURPOSE: The purpose of the study was to compare the reaction of children who received a local anesthesia to the upper incisors with a conventional buccal infiltration and a periodontal ligament injection (PDLi) with a computerized device (Wand); to assess the efficacy of the anesthesia and the reactions by children after treatment.
METHODS: Ninety-eight children aged 2 to 4 years participated in the study. All the children were sedated with hydroxyzine and nitrous oxide. Children were randomly assigned to receive either PDLi with the Wand or conventional infiltration. During the injection, a modified Behavioral Pain Scale was used. There were 21 girls and 23 boys between the ages of 2 to 4 years in the study group (mean age 3.9 +/- 1.3 years), and 16 girls and 29 boys (mean age 3.5 +/- 1.0 years) in the control group.
RESULTS: No significant difference was found between boys and girls. More children reacted negatively, namely, crying, facial expressions and eyes squeezed, while receiving the conventional infiltrative injection, whereas children who received the anesthetic solution using the Wand reacted more positively. This difference was statistically significant. No significant difference regarding the efficacy of the anesthesia was observed in either technique. Eighty percent of the children who received the conventional buccal infiltration scratched the nose or upper lip after the treatment, while none of the children who received PDLi showed signs of discomfort.
CONCLUSION: Children displayed better behavior when they received local anesthesia with the Wand rather than with the conventional infiltration. The same efficacy of anesthesia was achieved with both techniques. Children did not show signs of discomfort after treatment with the Wand, whereas they did while receiving conventional injections. A higher number of patients reported discomfort on the lip after conventional anesthesia (80%) compared to the electronic technique (0%).
5. Palm AM, Kirkegaard U, Poulsen S. The Wand versus traditional injection for mandibular nerve block in children and adolescents: perceived pain and time of onset. Pediatr Dent. 2004;26:481–484.
PURPOSE: The purpose of this study was to compare the perception of pain and time of onset in relation to mandibular alveolar nerve block administered by a computerized anesthesia delivery system (i.e., the Wand) and a traditional anesthesia system (i.e., the syringe).
METHODS: This study was conducted according to a split-mouth design, with both types of injections being given to all patients. Subjects onsisted of 33 patients between 7 and 18 years of age requiring local anesthesia for dental restorations in both sides of the mandible. All patients were blindfolded, and the sound from the Wand machine was activated during both types of administration. Topical analgesic was placed in the area of the injection site in all cases. Pain ratings were obtained using a 10-point visual analogue scale. Time of onset was measured from withdrawal of the needle to when numbness of the lower lip was reported.
RESULTS: The computerized anesthesia delivery system resulted in significantly lower pain ratings than the traditional syringe. No difference could be found in time of onset between the two methods.
CONCLUSION: Mandibular alveolar block analgesia seems to be less painful when using the Wand than when using a traditional syringe.
6. Ashkenazi M, Blumer S, Eli I. Effectiveness of computerized delivery of intrasulcular anesthetic in primary molars. JADA. 2005;136:1418-1425.
PURPOSE: To measure pain-associated and pain-disruptive behavior during computerized delivery system [The Wand] for intrasulcular anesthesia (CDS-IS). To evaluate the effectiveness of anesthesia in primary molars using CDS-IS to Evaluate the incidence of postoperative dental pain (PDP).
METHODS: One hundred ninety-three children aged 2 to 13 years who received dental treatment in two separate pediatric dental clinics participated in the study. Clinicians used the CDS to anesthetize the primary molars according to the manufacturer’s recommendations. Anesthesia evaluation was assessed with the child’s subjective perception of well-being before and immediately after the injection using a face picture scale. Child’s pain behavior during admininstration of aneshetic was assessed according to Children’s Hospital of Eastern Ontario Pain Scale. Anesthesia effectiveness was assessed by the effectiveness of anesthesia through the presence or absence of pain-disruptive behavior during treatment as described by Oulis and colleagues. Evaluation of PDP and use of analgesic durgs 24 hours after treatment.
RESULTS: The dentist treated 82 first primary molars (65 mandibular and 17 maxillary) and 125 second primary molars (94 mandibular and 31 maxillary). Treatment included 121 amalgams, 28 stainless steel crowns, 30 pulpotomies and 28 extractions. Most children exhibited low pain-related behavior during anesthetic admininstration, with no differences between boys and girls. The CDS-IS was effective for anesthetizing primary molars, mainly for amalgam, resin-based composite and stainless steel crown restorations.
CONCLUSION: The effectiveness of CDS-IS anesthesia is equivalent, and even superior, to that of the mandibular block or mandibular buccal infiltration, according to data compared to previous studies. CDS-IS anesthesia was associated with relatively few pain-related behaviors, as reated on the CHEOPS and the FPS. Generally, children rated the experience before and after the injection as relatively nonstressful.
7. Verloot J, Veerkamp JSJ, Hoogstraten J. Computerized anesthesia delivery system vs. traditional syringe: comparing pain and pain-related behavior in children. Eur J Oral Sci. 2005;113:488-493.
PURPOSE: The aim of this study was to compare the behavioral reaction of children who receive local anesthesia with a traditional syringe with the behavioral reaction of children who receive local anesthesia with a computerized device (Wand) and to differentiate between the reactions of highly anxious children with those displaying low anxiety.
METHODS: One hundred and twenty-five children aged 4–11 yrs. were randomly allocated to receive local anesthesia with the Wand or a traditional injection. Parents completed the Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS). Two independent observers scored videotapes of the anesthesia in 15-s intervals. The occurrence of muscle tension, crying, verbal protest, movement and resistance was registered and a score was given on the Venham distress scale. The mean injection time with the Wand was four times as long as with the traditional syringe.
RESULTS: During the first 15-s of the injection, low-anxious children receiving local anesthesia with the Wand displayed less muscle tension, less verbal protest and less movement than children receiving local anesthesia with the traditional syringe. Within the high-anxious group, no differences were found.
CONCLUSION: It was concluded that low-anxious children seem to benefit from the use of the Wand instead of the traditional syringe in receiving local anesthesia.
8. Öztas N, Ulusu T, Bodur H, Dogan C. The Wand in pulp therapy : An alternative to inferior alveolar nerve block. Quint. International. 2005;36:(7)559-564.
PURPOSE: The purpose of the study was to compare children's reactions to inferior alveolar nerve injection with traditional syringe and periodontal ligament injection with a computerized device (Wand); and to assess the efficacy of the anesthesia and their reaction after treatment.
METHODS and MATERIALS: Twenty-five children, aged 6 to 10 years, participated in the study. The contralateral primary mandibular second molars were treated in 2 separate visits with random use of either the Wand or traditional syringe injection. The pain perception levels for each step were assessed with Eland Color Scale during the preparation. A Mann-Whitney U test was performed to compare the results. The patients were asked their preference of technique after the treatment.
RESULTS: When pain was measured immediately after injection, the traditional syringe was found to be more painful than injections with the Wand (P <.05). Pain scores with the Wand injections were found to be significantly (P <.05) higher than those with traditional inferior alveolar nerve injections at the end of the restoration. The overwhelming majority of patients favored the periodontal ligament injection with the Wand.
CONCLUSION: The Wand technique provided significantly lower pain scores during the periodontal ligament injection. However, the pain scores during the treatment were significantly higher compared with the inferior alveolar nerve injections. Most of the patients stated that they preferred the periodontal ligament injection with the Wand to the traditional inferior alveolar nerve injection.
9. Ram D, Kassirer J. Assessment of a palatal approach-anterior superior alveolar (P-ASA) nerve block with the Wand in paediatric dental patients. Int J Pediatr Dent. 2006:16:348-3551.
PURPOSE: The purposes of the study were to compare the reaction of children while receiving local anesthesia for anesthetizing maxillary incisors with a computerized device Wand: a periodontal ligament injection (PDLi) and a palatal approach-anterior superior alveolar (P-ASA) nerve block compared with a conventional buccal infiltration (CBi), and to assess the efficacy of the anesthesia and children’s reaction after treatment.
METHODS: One hundred and thirty-eight children aged 24–48 months participated in this study.
RESULTS: More children reacted negatively during injection while receiving the CBi and positively during the injection with the Wand. After treatment, significantly more children scratched the upper lip and/or the nose or complained of numbness of the region after the CBi (P =0·000).
CONCLUSION: Same effectiveness was achieved with the Wand and the CBi. Children displayed better behavior during injection when they received local anesthesia with the Wand than they did when the CBi was used. They did not scratch the upper lip/nose and/or cried after treatment when they received the PDLi and the P-ASA, whereas they did when receiving a CBi.
10. Jälevik B, Klingberg G (Göteborg, Sweden).
Sensation of pPain when using computerized injection technique, the Wand™. IADR Pan European Federation, Sept. 13-16, 2006. Abstract #0070.
PURPOSE: Pain control when treating children and adolescents is of great importance in order to prevent future dental anxiety and treatment problems. Local anesthesia offers an almost painless dental treatment but the injection itself is often associated with fear and anxiety. Topical anesthesia, slow injection and good psychological preparing reduce the pain. In spite of that, the experience of palatal injection is often painful because of the resistance of the palatal tissue. The aim of this study was to compare the sensation of pain when using computerized injection – the Wand™ - compared to conventional technique in surgical procedures involving the palate.
METHODS: Twenty adolescents in need of bilateral identical surgical measurements, as surgical exposure of canines and/or extractions for orthodontic reasons in the upper jaw, were offered conventional anesthesia on one side and computerized low pressure anesthesia on the other side. The VAS scale was used to report the pain immediately after injection and also after the surgical procedure was finished to report the pain experience of the whole procedure. The statistical method used was Wilcoxon matched pairs test.
RESULTS: The reported sensation of pain was significantly lower (p < 0.01) when using the Wand™. However, there was no difference in the global pain report of the total surgical procedure (p > 0.2). Patients reporting fear of injection experienced much less pain when having a computerized injection (p<0.001), while there was hardly any difference in pain experience among patients with no or only little fear of injection.
CONCLUSION: Computerized injection technique in the palate was less painful compared to conventional injection technique, especially among those who reported fear of injections.
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