Anestesia dental local sin aguja: Una revisión integrativa de la literatura.

  • Jessica Alvarez-Sarmiento
Palabras clave: anestesia dental local, anestesia sin aguja, anestesia dental a presión, anestesia intranasal


La anestesia local sigue siendo uno de los pilares de las técnicas de control del dolor en Odontología y, es ampliamente administrada empleando jeringuilla y aguja de inyección. Sin embargo, las técnicas anestésicas que no emplean aguja son también importantes elementos del arsenal odontológico para el control del dolor, aunque son poco conocidas y empleadas. El propósito de esta revisión es describir las técnicas anestésicas libres de aguja disponibles, así como sus dispositivos y perspectivas futuras. Se realizó una revisión integrativa de la literatura en el idioma inglés para evaluar las publicaciones de las últimas dos décadas, utilizando las bases de datos PubMed, Scopus, EBSCO, Science Direct y Wiley Online Library, empleando las siguientes palabras clave: anestesia dental local, anestesia sin aguja, anestesia dental a presión y anestesia intranasal. Se seleccionaron únicamente artículos y libros de mayor relevancia. Finalmente, se obtuvo 33 artículos y 1 libro. Las técnicas de anestesia dental sin aguja disponibles actualmente son: anestesia a presión, intrasulcular e intranasal, todas ellas emplean dispositivos diferentes y poseen aplicaciones, ventajas, desventajas y limitaciones inherentes que podrían ser mejoradas o superadas en un futuro próximo.


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Malamed S. Handbook of local anesthesia. 7th ed. St. Louis, MO: Elsevier; 2019.

Kaufman E, Epstein J, Naveh E, Gorsky M, Gross A, Cohen G. A survey of pain, pressure, and discomfort induced by commonly used oral local anesthesia injections. Anesth Prog. 2005; 52: 122–7.

Hamilton J. Needle phobia: a neglected diagnosis. J Fam Pract. 1995; 41: 169–75.

Dionne R, Gordon S, Mccullagh L, Phero J. Assessing the need for anesthesia and sedation in the general population. J Am Dent Assoc. 1998; 129: 167–73.

Blanton P, Jeske A. Avoiding complications in local anesthesia induction: anatomical considerations. J Am Dent Assoc. 2003; 134: 888–93.

Ciancio S, Marberger A, Ayoub F, Garlapo D, Pantera E, Pantera C, et al. Comparison of 3 intranasal mists for anesthetizing maxillary teeth in adults: A randomized, double-masked, multicenter phase 3 clinical trial. J Am Dent Assoc. 2016; 147: 339–47.

Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005; 52: 546–53.

Dabarakis N, Alexander V, Tsirlis A, Parissis N, Nikolaos M. Needle-less local anesthesia: clinical evaluation of the effectiveness of the jet anesthesia Injex in local anesthesia in dentistry. Quintessence Int. 2007; 38: E572-576.

Margetis P, Quarantillo E, Lindberg R. Jet injection local anesthesia in dentistry: a report of 66 cases. U S Armed Forces Med J. 1958; 9: 625–34.

Taberner A, Hogan N, Hunter I. Needle-free jet injection using real-time controlled linear Lorentz-force actuators. Med Eng Phys. 2012; 34: 1228–35.

Munshi A, 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; 25: 131–6.

Kale T, Momin M. Needle free injection technology - An overview. Farm Syst Health. 2014; 5: 1-8

Schramm-Baxter J, Mitragotri S. Needle-free jet injections: dependence of jet penetration and dispersion in the skin on jet power. J Control Release. 2004; 97: 527–35.

Grant T, Stockwell K, Morrison J, Mann Dd Effect of injection pressure and fluid volume and density on the jet dispersion pattern of needle-free injection devices. Biosyst Eng. 2015; 138: 59–64.

Zeng D, Kang Y, Xie L, Xia X, Wang Z, Liu W. A Mathematical Model and Experimental Verification of Optimal Nozzle Diameter in Needle-Free Injection. J Pharm Sci. 2018; 107: 1086–94.

Ocak H, Akkoyun EF, Çolpal HA, Demetoğlu U, Yücesoy t, Kiliç E, et al. Is the jet injection effective for teeth extraction?. Stomatol Oral Maxillo Fac. 2019; 700: 1-6.

Arapostathis K, Dabarakis N, 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; 57: 3–12.

Barolet D, Benohanian A. Current trends in needle-free jet injection: an update. Clin Cosmet Investing Dermatol. 2018; 11: 231–8.

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; 8: 118–21.

Makade C, Shenoi P, Gunwal M. 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; 17: 169.

Mika Medical Co (2019). Comfort-in Needle Free Injection System. Introductions for use. [WWW document]. URL [accessed on 20 October 2019].

Kumar D, Agrawal A, Gupta H, Gupta S, Mehra H, Singh J. Needle-less injectors : clinical evaluation of effectiveness of jet injector as local infiltration anesthesia for dental extractions. Int J Sci Res. 2019; 8: 11-15.

Ogle O, Mahjoubi G. Advances in Local Anesthesia in Dentistry. Dent Clin N Am. 2011; 55: 481–99.

Oliveira A, Amorim K, Nascimento Júnior E, Duarte A, Groppo F, Takeshita W, et al. Assessment of anesthetic properties and pain during needleless jet injection anesthesia: a randomized clinical trial. J Appl Oral Sci. 2019; 27: 1-7.

Angelo Z, Polyvios C. Alternative practices of achieving anaesthesia for dental procedures: a review. J Dent Anesth Pain Med. 2018; 18: 79-88.

Graham J. Profound, needle-free anesthesia in orthodontics. J Clin Orthod. 2006; 40: 723–4.

Kumar S. Newer delivery systems for local anesthesia in dentistry. Int J Pharm Sci Res. 2015; 7: 252–5.

Boyce Ra, Kirpalani T, Mohan N. Updates of Topical and Local Anesthesia Agents. Dent Clin N Am. 2016; 60: 445–71.

US Food And Drug Administration (2016). Kovanaze. Available from: URL: [Accessed on 23 September 2019].

Capetillo J, Drum M, Reader A, Fowler S, Nusstein J, Beck M. Anesthetic Efficacy of Intranasal 3% Tetracaine plus 0.05% Oxymetazoline (Kovanaze) in Maxillary Teeth. J Endod. 2019; 45: 257–62.

Kumar A, Raj J. Knowledge, attitude, and practices regarding the use of nasal spray anesthesia by dental practitioners. Drug invent today. 2018; 10: 2023-28.

Hersh E, Saraghi M, Moore P. Intranasal tetracaine and oxymetazoline: a newly approved drug formulation that provides maxillary dental anesthesia without needles. Curr Med Res Opin. 2016; 32: 1919–25.

Ciancio S, Hutcheson M, Ayoub F, Pantera E, Pantera C, Garlapo D, et al. Safety and efficacy of a novel nasal spray for maxillary dental anesthesia. J Dent Res. 2013; 92: 43S-8S.

Hersh E, Saraghi M, Moore P. Two Recent Advances in Local Anesthesia: Intranasal Tetracaine/Oxymetazoline and Liposomal Bupivacaine. Curr Oral Health Rep. 2017; 4: 189–196.

Giannakopoulos H, Levin L, Chou J, Cacek A, Hutcheson M, Secreto S, et al. The cardiovascular effects and pharmacokinetics of intranasal tetracaine plus oxymetazoline: preliminary findings. J Am Dent Assoc. 2012; 143: 872–80.

Higgins T, Hwang P, Kingdom T, Orlandi R, Stammberger H, Han J. Systematic Review of Topical Vasoconstrictors in Endoscopic Sinus Surgery. Laryngoscope. 2011; 121: 422–32.

Hersh E, Pinto A, Saraghi M, Saleh N, Pulaski L, Gordon S, et al. Double-masked, randomized, placebo-controlled study to evaluate the efficacy and tolerability of intranasal K305 (3% tetracaine plus 0.05% oxymetazoline) in anesthetizing maxillary teeth. J Am Dent Assoc. 2016; 147: 278–87.

Cacek A, Gobburu J, Gopalakrishnan M. Population Pharmacokinetics of an Intranasally Administered Combination of Oxymetazoline and Tetracaine in Healthy Volunteers. J Clin Pharmacol. 2017; 57: 247–54.

Misra A, Shahiwala A. Novel drug delivery technologies innovative strategies for drug re-positioning, 1st ed. Springer Singapore, 2019.

Laube B, Sharpless G, Vikani A, Harrand V, Zinreich S, Sedberry K, et al. Intranasal Deposition of AccusprayTM Aerosol in Anatomically Correct Models of 2-, 5-, and 12-Year-Old Children. J Aerosol Med Pulm Drug Deliv. 2015; 28: 320–33.

Evans G, Yiming L. A phase 3, multi-center, randomized, double-blind, parallel-groups clinical trial comparing the efficacy and safety of intranasally administered K-305 to placebo for anesthetizing maxillary teeth in pediatric patients. 2016 [citado 2 de abril de 2020]. Available from:URL:

Madurantakam P. Kovanaze Vs. Articaine in Achieving Pulpal Anesthesia of Maxillary Teeth - Pediatric. 2019 [citado 2 de abril de 2020]. Available from: URL::

Szmuk P, Szmuk E, Ezri T. Use of needle-free injection systems to alleviate needle phobia and pain at injection. Expert Rev Pharmacoenomics Outcomes Res. 2005; 5: 467–77.

Milani A, Froughreyhani M, Rahimi S, Zand V, Jafarabadi Ma. Volume of Anesthetic Agents and IANB Success: A Systematic Review. Anesth Prog. 2018; 65: 16–23.

Abazarpoor R, Parirokh M, Nakhaee N, Abbott P. A Comparison of Different Volumes of Articaine for Inferior Alveolar Nerve Block for Molar Teeth with Symptomatic Irreversible Pulpitis. J Endod. 2015; 41: 1408–11.

Mikesell A, Drum M, Reader A, Beck M. Anesthetic Efficacy of 1.8 mL and 3.6 mL of 2% Lidocaine with 1:100,000 Epinephrine for Maxillary Infiltrations. J Endod. 2008; 34: 121–5.

Aggarwal V, Singla M, Miglani S, Kohli S, Sharma V, Bhasin S. Does the volume of supplemental intraligamentary injections affect the anaesthetic success rate after a failed primary inferior alveolar nerve block? A randomized-double blind clinical trial. Int Endod J. 2018; 51: 5–11.

Brunetto P, Ranali J, Ambrosano G, De Oliveira P, Groppo F, Meechan J, et al. Anesthetic efficacy of 3 volumes of lidocaine with epinephrine in maxillary infiltration anesthesia. Anesth Prog. 2008; 55: 29–34.

Singla M, Subbiya A, Aggarwal V, Vivekanandhan P, Yadav S, Yadav H, et al. Comparison of the anaesthetic efficacy of different volumes of 4% articaine (1.8 and 3.6 mL) as supplemental buccal infiltration after failed inferior alveolar nerve block. Int Endod J. 2015; 48: 103–8.

Pfeil L, Drum M, Reader A, Gilles J, Nusstein J. Anesthetic Efficacy of 1.8 Milliliters and 3.6 Milliliters of 2% Lidocaine with 1:100,000 Epinephrine for Posterior Superior Alveolar

Vreeland D, Reader A, Beck M, Meyers W, Weaver J. An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endod. 1989; 15: 6–12.

Nusstein J, Reader A, Beck F. Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks. Gen Dent. 2002; 50: 372–5.

Parirokh M, Satvati S, Sharifi R, Rekabi A, Gorjestani H, Nakhaee N, et al. Efficacy of combining a buccal infiltration with an inferior alveolar nerve block for mandibular molars with irreversible pulpitis. Oral Surg, Oral Med, Oral Pathol, Oral Radiol, and Endod. 2010; 109: 468–73.

Wali M, Drum M, Reader A, Nusstein J. Prospective, Randomized Single-blind Study of the Anesthetic Efficacy of 1.8 and 3.6 Milliliters of 2% Lidocaine with 1:50,000 Epinephrine for Inferior Alveolar Nerve Block. J Endod. 2010; 36: 1459–62.

Fowler S, Reader A. Is a Volume of 3.6 mL Better than 1.8 mL for Inferior Alveolar Nerve Blocks in Patients with Symptomatic Irreversible Pulpitis? J Endod. 2013; 39: 970–2.

Ballantyne J, Fishman S, Rathmell J. Bonica’s management of pain, 5th ed. Philadelphia: Wolters Kluwer, 2019.

Chesterton L, Barlas P, Foster N, Baxter D, Wright C. Gender differences in pressure pain threshold in healthy humans: Pain. 2003; 101: 259–66.

Defrin R, Shramm L, Eli I. Gender role expectations of pain is associated with pain tolerance limit but not with pain threshold: Pain. 2009; 145: 230–6.

Martin R. Influence of biological sex, trait gender, and state gender on pain threshold, pain tolerance, and ratings of pain severity. Pers Individ Diff. 2019; 138: 183–7.

Shaefer J, Khawaja S, Bavia P. Sex, Gender, and Orofacial Pain. Dent Clin N Am. 2018; 62: 665–82.

Rahim W, Riley J, Williams A, Fillingim R. A Quantitative Review of Ethnic Group Differences in Experimental Pain Response: Do Biology, Psychology, and Culture Matter?. Pain Med. 2012; 13: 522–40.

Ono K, Viet C, Ye Y, Dang D, Hitomi S, Toyono T, et al. Cutaneous pigmentation modulates skin sensitivity via tyrosinase-dependent dopaminergic signalling. Sci Rep. 2017; 7: 9181.

Campbell C, Edwards R. Ethnic differences in pain and pain management. Pain Manage. 2012; 2: 219–30.

Komiyama O, Kawara M, De Laat A. Ethnic Differences Regarding Tactile and Pain Thresholds in the Trigeminal Region. J Pain. 2007; 8: 363–9.

Vigil J, Coulombe P, Rowell L, Strenth C, Kruger E, Alcock J, et al. The Confounding Effect of Assessor Ethnicity on Subjective Pain Reporting in Women. TOATJ. 2017; 11: 1–11.

Lautenbacher S, Peters Jh, Heesen M, Scheel J, Kunz M. Age changes in pain perception: A systematic-review and meta-analysis of age effects on pain and tolerance thresholds. Neurosci Biobehav Rev. 2017; 75: 104–13.

El Tumi H, Johnson M, Dantas P, Maynard M, Tashani O. Age-related changes in pain sensitivity in healthy humans: A systematic review with meta-analysis. Eur J Pain. 2017; 21: 955–64.

Petrini L, Matthiesen S, Arendt-Nielsen L. The Effect of Age and Gender on Pressure Pain Thresholds and Suprathreshold Stimuli. Perception. 2015; 44: 587–96.

Crodelle J, Piltz S, Hagenauer M, Booth V. Modeling the daily rhythm of human pain processing in the dorsal horn. PLOS Comput Biol. 2019; 15: 1-23.

Kim M, Chung J, Kho H, Park J. The Circadian Rhythm Variation of Pain in the Orofacial Region. J Oral Med Pain. 2015; 40: 89–95. Thesaurus, Merriam-Webster,. “Gold standard”. [citado 24 de febrero de 2020]. Available from: URL: https://www.merriam- Legal Dictionary, Merriam-Webster,. “Standard of care.” [citado 24 de febrero de 2020]. Available from: URL:

Hardman H, Smyth T, Semo J, D’ercole F. Ultrasound-Guided Regional Anesthesia and Standard of Care. Reg Anesth Pain Med. 2018; 43: 107.

Gokul S, Prithviraj K. Standard of care in dentistry. J Orofac Sci. 2012; 4: 100–2.

Prasad V, Ioannidis J. Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices. Implement Sci. 2014; 9: 1-5.

Eliot S, Hunter P, Ali R. Neuromodulation, 2nd ed. St. Louis, MO: Elsevier; 2018.

Mourot A., Herold C., Kienzler M., Kramer R. Understanding and improving photo‐control of ion channels in nociceptors with azobenzene photo‐switches. Br J Pharmacol. 2018; 175: 2296–331.

Mourot A, Fehrentz T, Le Feuvre Y, Smith C, Herold C, Dalkara D, et al. Rapid optical control of nociception with an ion-channel photoswitch. Nat Methods. 2012; 9: 396–402.

Mourot A, Tochitsky I, Kramer R. Light at the end of the channel: optical manipulation of intrinsic neuronal excitability with chemical photoswitches. Front Mol Neurosci. 2013; 6: 1-15.

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Cómo citar
Alvarez-Sarmiento, J. (2020). Anestesia dental local sin aguja: Una revisión integrativa de la literatura. Odontología Activa Revista Científica, 6(1), 37-50.
Artículos de revisión bibliográfica