Computer-assisted vs conventional local anesthesia in impacted mandibular third molar surgery: a split-mouth randomized clinical trial
In brief
Computer-assisted anesthesia reduces pain by two-thirds and anxiety by half in wisdom-tooth surgery
In a split-mouth trial of 40 patients, the computer-guided injection lowered postoperative pain scores from about 6.6 to 1.9 and anxiety scores from 6.8 to 2.4 compared with conventional injection. Patients also reported higher satisfaction and showed smaller spikes in heart rate and blood pressure, though the study was small and single-center.
- Journal
- Journal of stomatology, oral and maxillofacial surgery (Q2)
- Published
- 5 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- İsmail Çalışkan, Ömer Ekici
- PMID
- 42556464
- DOI
- 10.1016/j.jormas.2026.102938
Why clinicians should know about it
- Picked for Otorhinolaryngology (top studies of the week, 9 August 2026): Computer‑assisted vs conventional anesthesia for third molar surgery
Abstract
INTRODUCTION: Impacted mandibular third molar surgery (IMTMS) is one of the dental surgical procedures where pain and anxiety are frequently encountered. The aim of this study was to compare the effects of the computer-assisted local anesthesia system (CALAS) and conventional local anesthesia (CLA) on pain, anxiety, and hemodynamic changes during IMTMS. MATERIAL AND METHODS: This prospective, randomized, split-mouth clinical trial included 40 patients with bilateral impacted mandibular third molars. CALAS and CLA were administered in separate surgical sessions at least three weeks apart. Pain was assessed using the Visual Analog Scale for Pain (VAS-P), whereas anxiety was assessed using the Visual Analog Scale for Anxiety (VAS-A), the State-Trait Anxiety Inventory (STAI-S and STAI-T), the Modified Dental Anxiety Scale (MDAS), and the Dental Fear Scale (DFS). Postoperative satisfaction was evaluated using a four-item questionnaire. Hemodynamic parameters, including respiratory rate (RR), pulse rate (PR), systolic blood pressure, diastolic blood pressure, and oxygen saturation (SpO₂), were recorded at eight predefined stages of the surgical procedure. RESULTS: Postoperative pain and anxiety scores were significantly higher in CLA sessions than in CALAS sessions. Postoperative VAS-P and VAS-A scores were also higher in CLA applications than in CALAS applications (VAS-P: 6.62±1.59 vs 1.90±0.87; VAS-A: 6.75±1.67 vs 2.40±1.79; p<0.001 for both). Similarly, higher values were observed for STAI-S, MDAS, and other psychometric measurements in CLA applications. In the hemodynamic assessment, pulse rate (PR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) showed more pronounced increases during some surgical stages in CLA sessions, whereas inter-technique differences remained limited for respiratory rate (RR) and SpO₂. In the postoperative satisfaction survey, participants rated CALAS as more effective than CLA in reducing anxiety and pain (p=0.002 and p=0.001, respectively). DISCUSSION: The findings suggest that CALAS may limit increases in pain and anxiety during IMTMS and may be associated with less pronounced physiological fluctuations during some surgical stages. Clinically, the potential advantage of CALAS appears to be related to more controlled anesthetic delivery rather than elimination of needle use. However, these findings should be interpreted cautiously because the study was based on a single-center split-mouth design with a limited sample size. TRIAL REGISTRATION: NCT06852066.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.