Original Article

Comparative Efficacy of MadaJet®XL and Conventional Injection Technique for Primary Maxillary Molar Local Anesthesia: A Randomized Clinical Trial

Abstract

Objectives: This study aimed to compare the efficacy of a needle-free system (MadaJet®XL) and the conventional injection technique for primary maxillary molar local anesthesia before restorative procedures in 6 to 12-year-old patients.

Materials and Methods: This cross-over randomized clinical trial was conducted on 30 children requiring restoration of at least two primary maxillary molars. The two molars requiring restoration in each patient were randomized using quaternary random blocks to receive either local anesthesia with MadaJet®XL or the conventional injection technique. To assess the efficacy of the techniques, pain score during injection was recorded using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale, and the number of patients with failed local anesthesia after MadaJet®XL administration was reported. The Wilcoxon Signed Ranks test was employed for data analysis (alpha=0.05).

Results: The highest score was reported with the conventional injection technique (FLACC score=9). The mean pain score was 4.1±2.6 in the conventional group and 2.3±1.3 in the MadaJet®XL group. The Wilcoxon Signed Ranks test showed significantly higher pain score in the conventional injection technique than the MadaJet®XL (P<0.001). Re-injection was performed for 19 patients (63.3%) due to their discomfort during dental procedure when MadaJet®XL was used.

Conclusion: Despite the lower level of pain and discomfort experienced during local anesthesia administration by MadaJet®XL, this device is not suitable for restorative procedures of primary maxillary molars, due to failure to achieve complete anesthesia.

1. Arapostathis KN, Dabarakis NN, Coolidge T, Tsirlis A, Kotsanos N. Comparison of acceptance, preference, and efficacy between jet injection INJEX and local infiltration anesthesia in 6 to 11 year old dental patients. Anesth Prog. 2010 Spring;57(1):3-12.
2. Lalabonova CK. Impact of dental anxiety on the decision to have implant treatment. Folia Med (Plovdiv). 2015 Apr-Jun;57(2):116-21.
3. Glaesmer H, Geupel H, Haak R. A controlled trial on the effect of hypnosis on dental anxiety in tooth removal patients. Patient Educ Couns. 2015 Sep;98(9):1112-5.
4. Hussain N, Younus S, Akhtar UB, Sajjad MAH, Chishty MS, Iqbal S. Comparison of pain perceived by patients undergoing intra oral local anesthesia using different needle gauges. Pak Armed Forces Med J. 2020 Dec;70(6):1702-06.
5. Munshi AK, Hegde A, Bashir N. Clinical evaluation of the efficacy of anesthesia and patient preference using the needle-less jet syringe in pediatric dental practice. J Clin Pediatr Dent. 2001 Winter;25(2):131-6.
6. Corah NL, O'Shea RM, Ayer WA. Dentists' management of patients' fear and anxiety. J Am Dent Assoc. 1985 May;110(5):734-6.
7. Giangrego E. Controlling anxiety in the dental office. J Am Dent Assoc. 1986;113:728-35.
8. Oliveira ACA, Amorim KS, Nascimento Júnior EMD, Duarte ACB, Groppo FC, Takeshita WM, et al. Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial. J Appl Oral Sci. 2019 Jan;27:e20180195.
9. Gupta R, Kaur S, Dahiya P, Kumar M. Comparative evaluation of efficacy of EMLA and needleless jet anesthesia in non-surgical periodontal therapy. J Oral Biol Craniofac Res. 2018 May-Aug;8(2):118-21.
10. Makade CS, Shenoi PR, Gunwal MK. Comparison of acceptance, preference and efficacy between pressure anesthesia and classical needle infiltration anesthesia for dental restorative procedures in adult patients. J Conserv Dent. 2014 Mar;17(2):169-74.
11. Alameeri AA, AlShamsi HA, Murad A, Alhammadi MM, Alketbi MH, AlHamwi A, et al. The feasibility of needleless jet injection versus conventional needle local anesthesia during dental procedures: a systematic review. J Korean Assoc Oral Maxillofac Surg. 2022 Dec;48(6):331-41.
12. Altan H, Belevcikli M, Coşgun A, Demir O. Comparative evaluation of pain perception with a new needle-free system and dental needle method in children: a randomized clinical trial. BMC Anesthesiol. 2021 Dec;21(1):301.
13. Nowak A, Christensen JR, Mabry TR, Townsend JA, Wells MH. Pediatric Dentistry-E-Book: infancy through adolescence: Elsevier Health Sciences; 2018:111.
14. Malamed SF. Handbook of Local Anesthesia-7th ed. St Louis, Mo: Mosby; 2020:173-185.
15. Nilsson S, Finnström B, Kokinsky E. The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years. Paediatr Anaesth. 2008 Aug;18(8):767-74.
16. von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain. 2007 Jan;127(1-2):140-50.
17. Kanaa MD, Meechan JG, Corbett IP, Whitworth JM. Speed of injection influences efficacy of inferior alveolar nerve blocks: a double-blind randomized controlled trial in volunteers. J Endod. 2006 Oct;32(10):919-23.
18. Whitworth JM, Kanaa MD, Corbett IP, Meechan JG. Influence of injection speed on the effectiveness of incisive/mental nerve block: a randomized, controlled, double-blind study in adult volunteers. J Endod. 2007 Oct;33(10):1149-54.
19. Davoudi A, Rismanchian M, Akhavan A, Nosouhian S, Bajoghli F, Haghighat A, et al. A brief review on the efficacy of different possible and nonpharmacological techniques in eliminating discomfort of local anesthesia injection during dental procedures. Anesth Essays Res. 2016 Jan-Apr;10(1):13-6.
20. Hameed MS, Kumar S, Charanya C, Muthalagu M, Anitha M. Comparison of jet injection technique with conventional injection technique in patients undergoing endodontic therapy. Contemp Clin Dent. 2021 Jan-Mar;12(1):28-31.
21. Ocak H, Akkoyun EF, Çolpak HA, Demetoğlu U, Yücesoy T, Kılıç E, et al. Is the jet injection effective for teeth extraction? J Stomatol Oral Maxillofac Surg. 2020 Feb;121(1):19-24.
22. Ben-Sasson A, Carter AS, Briggs-Gowan MJ. Sensory over-responsivity in elementary school: prevalence and social-emotional correlates. J Abnorm Child Psychol. 2009 Jul;37(5):705-16.
23. Dabarakis NN, Alexander V, Tsirlis AT, Parissis NA, Nikolaos M. Needle-less local anesthesia: clinical evaluation of the effectiveness of the jet anesthesia Injex in local anesthesia in dentistry. Quintessence Int. 2007 Nov-Dec;38(10):E572-6.
24. Angelo Z, Polyvios C. Alternative practices of achieving anaesthesia for dental procedures: a review. J Dent Anesth Pain Med. 2018 Apr;18(2):79-88.
25. Klingberg G, Berggren U, Carlsson SG, Noren JG. Child dental fear: cause-related factors and clinical effects. Eur J Oral Sci. 1995 Dec;103(6):405-12.
26. Klingberg G, Broberg AG. Temperament and child dental fear. Pediatr Dent. 1998 Jul-Aug;20(4):237-43.
27. Farooq S, Goswami M, Nangia T, Saxena A, Rahman B, Sharan S. Sensory response in the behaviour of a child in the dental environment to the various sensory stimuli routinely evoked at home. J Adv Med Dent Scie Res. 2019 Oct;7(10):150-5.
IssueVol 22 (Continuously Published Article-Based) QRcode
SectionOriginal Article
Keywords
Anesthesia Local Pediatric Dentistry Injections Jet

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Baniebrahimi G, Seraj B, Mosavi Bagheri M, Moghimi H. Comparative Efficacy of MadaJet®XL and Conventional Injection Technique for Primary Maxillary Molar Local Anesthesia: A Randomized Clinical Trial. Front Dent. 2025;22.