Efficacy and safety of intraseptal and periodontal ligament anaesthesia for extraction of upper lateral incisors and lower first premolars in patients with type 2 diabetes mellitus.

INTRODUCTION: The use of local anesthetics with vasoconstrictors in patients with Type 2 diabetes mellitus (DM) requires particular caution because of possible cardiovascular effects and increased susceptibility of diabetic nerve fibers to ischemic injury. Intraseptal anaesthesia (ISA) and periodontal ligament anaesthesia (PLA) may represent effective alternatives to conventional local anaesthesia in diabetic patients. This study aimed to compare the clinical efficacy and safety profiles of ISA and PLA administered with a computer-controlled local anesthetic delivery system (CCLADS) for extraction of maxillary lateral incisors and mandibular first premolars in patients with controlled Type 2 DM. MATERIALS AND METHODS: A total of 120 patients with controlled Type 2 DM were randomly allocated into either the ISA (n = 60) or PLA (n = 60) group using a computer-generated randomization sequence. All patients received 0.6 mL of 4% articaine with 1:100,000 epinephrine (Ar + Ep) delivered using CCLADS. Each group comprised 30 patients undergoing extraction of a maxillary lateral incisor and 30 patients undergoing extraction of a mandibular first premolar. Evaluated parameters included anesthetic success rate, onset time, duration of soft tissue anaesthesia, width of anesthetic field, systolic and diastolic blood pressure, mean arterial pressure, and heart rate before, during, and after anaesthesia administration. RESULTS: Immediate onset of anaesthesia was achieved in all successful cases. ISA demonstrated a higher success rate than PLA, particularly for extraction of mandibular first premolars, although the difference was not statistically significant. ISA provided significantly longer duration of soft tissue anaesthesia and significantly wider distribution of the anaesthetic field than PLA for both investigated teeth. Cardiovascular parameters remained generally stable throughout the observation period in both groups. anaesthesia in blood pressure and heart rate were observed during and after anesthetic administration, without clinically relevant hemodynamic alterations. CONCLUSION: Both ISA and PLA administered with CCLADS were safe and clinically effective anesthetic techniques in patients with controlled Type 2 DM, without clinically relevant cardiovascular alterations. The longer duration and wider distribution of soft tissue anaesthesia achieved with ISA may support its use as a reliable option for tooth extraction in diabetic patients.