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CompletedNCT07736677DIA-MIHUpdated Sep 23, 2026

Digital Intraosseous Anesthesia in MIH-Affected Permanent Molars

An interventional study of SleeperOne 5 Computer-Controlled Intraosseous Anaesthesia System and Conventional Maxillary Infiltration Anaesthesia in Molar Incisor Hypomineralization, sponsored by Ege University. Completed at 2 sites in Turkey (Türkiye). Open to participants aged 6 Years to 12 Years. Per ClinicalTrials.gov, last updated 2026-09-23.

Sponsored by Ege University · Not applicable, Interventional, and Supportive care

Phase
Not applicable
Study type
Interventional
Enrollment
110
Allocation
Randomized
Ages
6 Years to 12 Years
Sex
All
01

Study summary

This multicentre, randomized clinical trial compared digital intraosseous anaesthesia with conventional local anaesthetic techniques in children aged 6-12 years receiving restorative treatment for MIH-affected permanent first molars. Within the maxillary stratum, digital intraosseous anaesthesia was compared with conventional infiltration anaesthesia; within the mandibular stratum, it was compared with inferior alveolar nerve block. The primary outcome was child-reported pain during restorative treatment. Secondary outcomes included pain during needle penetration and anaesthetic solution delivery, observed pain-related behaviour, change in dental anxiety, and the requirement for supplemental local anaesthesia during restorative treatment.

Read the detailed description

Children with an MIH-affected permanent first molar requiring restorative treatment were randomized separately within the maxillary and mandibular strata. In the maxillary stratum, digital intraosseous anaesthesia was compared with conventional infiltration anaesthesia. In the mandibular stratum, digital intraosseous anaesthesia was compared with conventional inferior alveolar nerve block. Only one MIH-affected permanent first molar was included for each child.

Pain during needle penetration, anaesthetic solution delivery, and restorative treatment was assessed using the Wong-Baker FACES Pain Rating Scale. Pain-related behavioural responses were assessed using the Face, Legs, Activity, Cry, Consolability scale. Dental anxiety was assessed using the Modified Child Dental Anxiety Scale immediately before local anaesthesia administration and immediately after completion of restorative treatment. The requirement for supplemental local anaesthesia during restorative treatment was recorded for each participant.

02

Conditions studied

  • Molar Incisor Hypomineralization

Keywords

  • Digital intraosseous anesthesia
  • Pediatric dentistry
  • Permanent molars
  • Dental pain
  • Dental anxiety
03

Who can participate

Ages eligible
6 Years to 12 Years
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Children aged 6-12 years.
  • Confirmed diagnosis of molar-incisor hypomineralisation according to the European Academy of Paediatric Dentistry diagnostic criteria.
  • Presence of an MIH-affected permanent first molar classified as MIH-TNI Category 4a or 4b according to the updated Würzburg concept and requiring restorative treatment with either a direct resin composite restoration or a preformed stainless steel crown.
  • Positive or definitely positive behaviour according to the Frankl Behaviour Rating Scale.
  • No known allergy to local anaesthetics.
  • No relevant systemic disease.

Exclusion criteria

Exclusion Criteria:

  • Receipt of analgesic, anxiolytic, or sedative medication within 48 hours before the treatment appointment.
  • Previous experience with intraosseous anaesthesia.
  • Presence of an acute dentoalveolar infection at the planned treatment site.
04

Study design

Phase
Not applicable
Primary purpose
Supportive care
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
110 participants (actual)

Study arms

  • Experimental
    Maxillary Digital Intraosseous Anaesthesia Group

    Children in this arm received computer-controlled digital intraosseous anaesthesia using the SleeperOne 5 system before restorative treatment of one MIH-affected permanent first molar in the maxillary arch.

    Device: SleeperOne 5 Computer-Controlled Intraosseous Anaesthesia System

  • Active comparator
    Conventional Maxillary Infiltration Anaesthesia Group

    Children in this arm received conventional supraperiosteal infiltration anaesthesia in the buccal sulcus adjacent to one MIH-affected maxillary permanent first molar before restorative treatment.

    Procedure: Conventional Maxillary Infiltration Anaesthesia

  • Active comparator
    Conventional Mandibular Inferior Alveolar Nerve Block Group

    Children in this arm received conventional inferior alveolar nerve block anaesthesia before restorative treatment of one MIH-affected mandibular permanent first molar.

    Procedure: Conventional Inferior Alveolar Nerve Block Anaesthesia

  • Experimental
    Mandibular Digital Intraosseous Anesthesia Group

    Children in this arm received computer-controlled digital intraosseous anaesthesia using the SleeperOne 5 system before restorative treatment of one MIH-affected permanent first molar in the mandibular arch.

    Device: SleeperOne 5 Computer-Controlled Intraosseous Anaesthesia System

Interventions

  • DeviceSleeperOne 5 Computer-Controlled Intraosseous Anaesthesia System

    Digital intraosseous anaesthesia was administered using the SleeperOne 5 computer-controlled system (Dental Hi Tec, Cholet, France). Initial mucosal anaesthesia was achieved using 0.1-0.2 mL of 4% articaine with 1:100,000 epinephrine (Ultracain D-S forte), followed by intraosseous administration of an additional 1 mL of the same anaesthetic solution at the device-controlled slow flow rate.

  • ProcedureConventional Maxillary Infiltration Anaesthesia

    Supraperiosteal infiltration anaesthesia was performed using a standard aspirating dental syringe and a 27-gauge short needle. One millilitre of 4% articaine with 1:100,000 epinephrine (Ultracain D-S forte) was deposited slowly into the buccal sulcus adjacent to the MIH-affected maxillary permanent first molar.

  • ProcedureConventional Inferior Alveolar Nerve Block Anaesthesia

    Inferior alveolar nerve block anaesthesia was administered using a standard aspirating dental syringe and a 27-gauge long needle. One millilitre of 4% articaine with 1:100,000 epinephrine (Ultracain D-S forte) was deposited slowly. Adequate anaesthesia was confirmed by patient-reported lip numbness before restorative treatment was started.

05

What researchers measure

Primary outcomes

  1. Child-Reported Pain During Dental Treatment Assessed Using the Wong-Baker FACES Pain Rating Scale

    Children rated the pain experienced during the restorative procedure using the Wong-Baker FACES Pain Rating Scale. The scale comprises six faces scored 0, 2, 4, 6, 8, and 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity.

    Time frame: During the restorative procedure after local anesthesia administration, within the single treatment visit

Secondary outcomes

  1. Child-Reported Pain During Needle Penetration Assessed Using the Wong-Baker FACES Pain Rating Scale

    Children rated the pain experienced during needle penetration using the Wong-Baker FACES Pain Rating Scale. The scale comprises six faces scored 0, 2, 4, 6, 8, and 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity.

    Time frame: At the time of needle insertion into the oral mucosa, immediately before delivery of the local anaesthetic solution, during the single treatment visit

  2. Child-Reported Pain During Local Anaesthetic Solution Delivery Assessed Using the Wong-Baker FACES Pain Rating Scale

    Children rated the pain experienced during delivery of the local anaesthetic solution using the Wong-Baker FACES Pain Rating Scale. The scale comprises six faces scored 0, 2, 4, 6, 8, and 10, where 0 indicates no pain and 10 indicates the worst imaginable pain. Higher scores indicate greater pain intensity.

    Time frame: During delivery of the local anaesthetic solution, immediately after needle penetration, during the single treatment visit

  3. Observer-Rated Pain-Related Behaviour During Local Anaesthetic Administration Assessed Using the FLACC Scale

    Pain-related behaviour was independently assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Each of the five components is scored from 0 to 2, producing a total score ranging from 0 to 10. A total score of 0 indicates a relaxed and comfortable child, 1-3 indicates mild discomfort, 4-6 indicates moderate pain, and 7-10 indicates severe pain. Higher scores indicate greater pain-related behavioural responses.

    Time frame: During the local anaesthetic injection sequence, from needle penetration through completion of anaesthetic solution delivery, before commencement of the restorative procedure, during the single treatment visit

  4. Change in Dental Anxiety From Before Local Anaesthesia to After Completion of Restorative Treatment Assessed Using the Modified Child Dental Anxiety Scale

    Dental anxiety was assessed using the eight-item Modified Child Dental Anxiety Scale (MCDAS). Each item is scored from 1 (relaxed) to 5 (extremely anxious), yielding a total score ranging from 8 to 40. Higher scores indicate greater dental anxiety. Change was calculated as the post-treatment score minus the pre-anaesthesia score; negative values indicate a reduction in dental anxiety.

    Time frame: Immediately before local anaesthetic administration and immediately after completion of restorative treatment, during the same treatment visit.

  5. Requirement for Supplemental Local Anaesthesia During Restorative Treatment

    The number and proportion of children who required an additional local anaesthetic injection because the pain control provided by the allocated technique was considered insufficient were recorded for each treatment group.

    Time frame: During restorative treatment following administration of the allocated anaesthetic technique, within the same treatment visit.

06

Study locations

2 sites
  • Istanbul Beykent University
    Istanbul, Turkey (Türkiye)
  • Ege University
    Izmir, 35110, Turkey (Türkiye)
07

References and documents

Publications

  • Smail-Faugeron V, Muller-Bolla M, Sixou JL, Courson F. Evaluation of intraosseous computerized injection system (QuickSleeper) vs conventional infiltration anaesthesia in paediatric oral health care: A multicentre, single-blind, combined split-mouth and parallel-arm randomized controlled trial. Int J Paediatr Dent. 2019 Sep;29(5):573-584. doi: 10.1111/ipd.12494. Epub 2019 Apr 8. PubMed 30883951 ↗
  • Atesci AA, Korkut Isik B, Yilmaz DO, Gergit B, Kilic MC, Oncag RO. Is Digital Anesthesia a Viable Alternative for Pain and Anxiety Control in Pediatric Dentistry? Int J Paediatr Dent. 2025 Oct 25. doi: 10.1111/ipd.70048. Online ahead of print. PubMed 41137566 ↗
  • Dogan S, Sahin M, Balci S. Effects of computer-assisted and conventional local anaesthesia on pain and anxiety in children with molar incisor hypomineralisation: a randomized controlled clinical trial. BMC Oral Health. 2026 May 30;26(1):1321. doi: 10.1186/s12903-026-08739-z. PubMed 42215951 ↗
  • Dixit UB, Joshi AV. Efficacy of Intraosseous Local Anesthesia for Restorative Procedures in Molar Incisor Hypomineralization-Affected Teeth in Children. Contemp Clin Dent. 2018 Sep;9(Suppl 2):S272-S277. doi: 10.4103/ccd.ccd_252_18. PubMed 30294157 ↗

Individual participant data

Plan to share: No — Individual participant data will not be shared. Study findings will be reported only in aggregate form to protect participant privacy, as the study involves children and no external IPD-sharing plan was established in the study protocol.

08

Registry details

Key details

Study ID
NCT07736677
Lead sponsor
Ege University
Responsible party
Alp Abidin Ateşçi (Dr., Ege University) — Principal investigator
First posted
Jul 30, 2026
Start date
Jan 15, 2025
Primary completion
Apr 15, 2026
Completion
Apr 15, 2026
Last update
Sep 23, 2026

Study contacts

Alp Abidin Atesci, PhD
principal investigator · Istanbul Beykent University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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