Intraligamentary Anesthesia in Pediatric Patients: Is It an Effective Technique? A Systematic Review and Meta-Analysis

Background: Effective pain control is fundamental in pediatric dentistry. Supraperiosteal infiltration (SPA) and inferior alveolar nerve block (IANB) are the most used local anes- thesia (LA) techniques. This review evaluated the available evidence on intraligamentary anesthesia (ILA) to assess its efficacy, safety, and viability as an alternative to conventional techniques. Methods: The review protocol was registered in PROSPERO (CRD420261284494) and conducted in accordance with PRISMA guidelines. Three data- bases were searched for RCTs published in English after 2000 involving children. Studies that compared ILA, delivered via either traditional or computer-controlled systems (CC- ILA), with other LA techniques were included. Risk of bias was assessed using the Cochrane’s RoB 2.0 tool. Meta-analysis was performed using a random-effects model with Stata/SE 18.0. Results: The database search yielded 347 records; after duplicate removal, 153 articles were screened. Thirty-four papers were assessed, of which thirteen studies were included, and three were retained for the meta-analysis. Significantly lower pain perception and improved physiological parameters were reported with ILA compared with IANB. CC-ILA demonstrated greater efficacy and reduced procedural discomfort than conventional ILA. Patients favored CC-ILA over IANB (68.0% vs. 32.0%). Postoper- ative lip biting occurred more frequently following IANB and CC-SPA than after ILA. Overall risk of bias was low. Meta-analysis revealed no significant difference in pain per- ception between ILA and IANB (z = −0.26; p = 0.79). Conclusions: ILA, particularly CC- ILA, appears to be an effective, safe, and well-tolerated technique and may be considered a valid anesthetic option in pediatric dentistry. The review did not receive any funding.