What Is Computer-Controlled Local Anesthetics Delivery (CCLAD)?
Computer-controlled local anesthetics delivery (CCLAD) is an automated or computer-controlled method to reduce patient pain for the administration of local anesthesia. This method of administering anesthesia is painless compared to the conventional anesthetic techniques commonly employed by dental surgeons. These devices slowly administer the local anesthetic during a dental surgical procedure using a computerized gadget to control the injection speed.
These devices were introduced primarily in the dental profession around the late 1990s and were initially based upon the consistent speed of the anesthetic. Hence, this solution would be delivered by automatic compression of the plunger in the carpule. Dentists, after the onset of CCLAD technology, can maintain slow and safe deposition rates in recent decades compared to conventional operator-induced anesthesia techniques.
The benefit of this system is that it also provides rapid onset during administration for intraligamentary injection. In addition, CCLAD also offers the dentist ergonomic benefits, such as reduced muscle activity and reduced force for injection administration. This technology mainly adopts or works on the principle of slow increase in rate over time, allowing effective diffusion of the anesthetic into the region to be anesthetized in the oral cavity.
What Is the Rationale For CCLAD?
Local anesthesia is mainly administered before any dental surgical procedure to reduce pain during treatments. However, it may still cause pain if they are not cooperative and contribute to dental fear or phobias.
Dental fear or phobia is the most common reason patients avoid visiting the dentist. It can be caused due to a variety of reasons, including noise or the vibrations caused by tooth-cutting devices such as conventional handpieces, the smell or taste of materials used in dentistry, fear of pain during dental treatment, and irrational fears due to lack of patient awareness about local anesthesia.
Appropriate local anesthesia is necessary and mandatory for the dental surgeon to reduce patient pain and discomfort during most surgical treatments like endodontic, periodontal, or oral and maxillofacial procedures.
The irony, however, is that most patients who suffer from dental phobias often fear pain caused by the anesthetic injection itself than the pain caused during the dental treatment. CCLAD technique can be beneficial to alleviate fear and discomfort in these patients.
What Is the Principle of CCLAD?
Though it is a recently developed technology, it is yet to find its way into many modern-day dental clinics, the computer-controlled local anesthetic delivery (CCLAD) system has been mainly developed utilizing the principle of pain reduction. A pressure-activated foot control pedal controls the flow of a local anesthetic solution. In contrast, the pump part of the device permits deposition of local anesthetics at two different, gradual, but consistent rates of deposition.
The computer thus nullifies the difference in the flow resistance of the solution. As a result, even during the insertion of the needle, a positive pressure gradient can be maintained, leading to the creation of an anesthetic pathway. Over time, CCLAD has been a proven effective method for painless administration of local anesthetics.
What Are the Different Speeds In CCLAD?
The CCLAD system can monitor three speeds for administering anesthesia:
1. First Speed Used for Palatal Anesthetic Injections:
It is the slowest possible rate of the anesthetic solution via injection. It can be given up to 3 minutes and 20 seconds.
2. Second Speed for Infiltration Blocks:
It is slightly faster because the tissue used for the infiltration is not as dense, thicker, or even bony, and hence diffusion rate is more rapid.
3. Third Speed for the Mandibular Block Technique:
It is precisely for dispensing the whole cartridge of anesthetic in less than a minute, with the ideal speed of up to two minutes for a single anesthetic cartridge.
What Clinical Research Is Available For CCLAD?
According to Lee et al., upon assessment of CCLAD technology, the effect on anterior and middle superior alveolar nerves showed no significant difference in both the onset and duration time as compared to conventional local anesthesia; however, CCLAD still showed higher efficacy concerning the success rate and patient comfort during the dental surgical procedures. In addition, in clinical studies, CCLAD can reduce the pressure generated because the anesthetic solution diffuses effectively as the dental operator can control injection speed.
According to Loomer et al., a significant difference or efficacy was observed by CCLAD during anesthesia of the greater palatine and nasopalatine nerves compared to the accessory maxillary nerves. Hence, clinical research and studies have supported the CCLAD devices, which can automatedly control speed and pressure during anesthesia even for thick mucosal or bulky regions like the palatal mucosa.
What Are the Types of Devices Available for CCLAD?
Reducing the rate of the injection speed is the most effective method of relieving pain, while controlling or even maintaining the flow, amount, or speed of injection in surgical clinical settings is challenging to the dentist.
In recent decades, there are devices that can inject a local anesthetic into the tissues at a pre-set operator set speed. These devices slow down and maintain the injection speed and consistency in infiltrating the anatomical tissues, each different in operator penetration due to their tissue thickness.
The most popular or widely used is the comfort control syringe (CCS). Other devices like Wand and Quicksleeper, similar to CCS, have injection speed controls of three, four, or five stages. These stages offer the potential to have diverse injection speed control. Hence all these devices utilizing CCLAD are effective, especially in intraligamentary anesthesia blocks in dentistry.
Some devices like the ICT device allow a three-stage injection with controlled speed so that the full cartridge can be injected within a time range of set 250, 120, or even 50 seconds. Other CCLAD devices may have the option of foot control as well. Also, the advantage of the handpiece of CCLAD systems is that it is more pen-like than a syringe that fearful patients find less threatening compared to a conventional anesthetic cartridge syringe or needle.
Conclusion:
To conclude, this technology of CCLAD induces less pain and is efficacious in administering local anesthesia in adults. The dental surgeon should consider the differences in shape, weight, or injection speeds for choosing a device to aid local anesthetic. Recent advances in CCLAD have products that are lightweight and easier to use. Computer-controlled local anesthetic delivery (CCLAD) is becoming a popular option among modern-day dental clinics today with a breakthrough technology behind anesthetic administration, making the process and effect of anesthesia more convenient for the doctor and patient both during dental procedures.
