The bevel effect: a prospective, randomized investigation into needle design in dental intraligamentary anesthesia.

OBJECTIVES: This in vivo study aimed to assess the impact of needle bevel design on puncture pain, anesthetic success, and mechanical deformations in intraligamentary injection (ILA) cases, comparing a short triple facet cut (STF) to a triple lancet cut (TL) after single or repetitive use. MATERIALS AND METHODS: In a prospective single-blind trial, 200 ILA needles (STF, n = 100; TL, n = 100) were randomly assigned for dental procedures. Patients received ILA either with STF or TL needles, used once (group A; n = 50 each) or repeatedly (group B; n = 50). Puncture pain was assessed using a numerical rating scale (NRS). Anesthetic success was determined via cold spray (yes/no), and scanning electron microscopy (SEM) analyzed needle tip deformations. RESULTS: Puncture pain did not significantly differ between STF and TL, regardless of needle use or injection area. Success rates were comparable in single use (82% STF vs. 79% TL; p > 0.05). For repetitive use, STF exhibited a significantly higher success rate (80% vs. 69%; p = 0.012). Mechanical deformations were prevalent in 97.5% of needles, with TL showing greater deformations than STF after single and repeated uses. Barbs were more common in TL (90/100) than STF (84/100), with a higher relative risk for barbed-like deformation in TL (RR single use: 1.26; p < 0.001; multiple use: 7.87, p < 0.001). CONCLUSIONS: The short triple facet-designed bevel demonstrated significantly less mechanical deformation, suggesting potential advantages in maintaining needle lumen patency. CLINICAL RELEVANCE: The intraligamentary needle bevel design is linked to mechanical deformation and anesthetic success after repetitive use, but not to puncture pain.

Impact of Telemedicine Tools on Record Keeping and Compliance in Haemophilia Care.

BACKGROUND: Record keeping is integral to home treatment for haemophilia. Issues with paper diaries include questionable compliance, data validity and quality. Implementation of electronic diaries (e-diaries) in haemophilia patients could improve documentation of home treatment. AIM: This article evaluates the effects of an e-diary, Haemoassist, on recording and patient compliance with therapy. PATIENTS AND METHODS: An explorative study was used to assess the sequential use of paper diaries and e-diaries by 99 patients with severe haemophilia A or B and 1 with severe factor VII deficiency. Median age was 41 years. Information was obtained from paper records for 3 years preceding the introduction of an electronic record system and the first 6 to 12 months of Haemoassist use. Data from the 3-year period were averaged. Missing data for rounded 12 months of e-diary use were extrapolated to correspond to a full year. RESULTS: Enhancement of 23% in record delivery was observed for the period of Haemoassist use (p = 0.013). Twenty-one percent increase in patients' compliance for data reporting (from 65% 35 to 86% 22, p = 0.003) and 16% increase for documentation of bleedings (from 68 to 84% of patients, p = 0.01) were detected. Compliance to prescribed therapy of patients for the whole studied period improved by 6% (from 82% ± 29 to 88% ± 25, p = 0.05). Major advances were demonstrated predominantly in the age groups of between 13 and 20 and 21 and 40 years. CONCLUSION: e-Diaries' use enables improved recording of information about patients' home treatment and bleeding episodes. Enhanced compliance with therapy may be a further benefit.