Impacted mandibular third molar surgery (IMTMS) is one of the dental surgical procedures where pain and anxiety are frequently encountered. The aim of this study was to compare the effects of the computer-assisted local anesthesia system (CALAS) and conventional local anesthesia (CLA) on pain, anxiety, and hemodynamic changes during IMTMS.

This prospective, randomized, split-mouth clinical trial included 40 patients with bilateral impacted mandibular third molars. CALAS and CLA were administered in separate surgical sessions at least three weeks apart. Pain was assessed using the Visual Analog Scale for Pain (VAS-P), whereas anxiety was assessed using the Visual Analog Scale for Anxiety (VAS-A), the State-Trait Anxiety Inventory (STAI-S and STAI-T), the Modified Dental Anxiety Scale (MDAS), and the Dental Fear Scale (DFS). Postoperative satisfaction was evaluated using a four-item questionnaire. Hemodynamic parameters, including respiratory rate (RR), pulse rate (PR), systolic blood pressure, diastolic blood pressure, and oxygen saturation (SpO₂), were recorded at eight predefined stages of the surgical procedure.

Postoperative pain and anxiety scores were significantly higher in CLA sessions than in CALAS sessions. Postoperative VAS-P and VAS-A scores were also higher in CLA applications than in CALAS applications (VAS-P: 6.62±1.59 vs 1.90±0.87; VAS-A: 6.75±1.67 vs 2.40±1.79; p < 0.001 for both). Similarly, higher values were observed for STAI-S, MDAS, and other psychometric measurements in CLA applications. In the hemodynamic assessment, pulse rate (PR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) showed more pronounced increases during some surgical stages in CLA sessions, whereas inter-technique differences remained limited for respiratory rate (RR) and SpO₂. In the postoperative satisfaction survey, participants rated CALAS as more effective than CLA in reducing anxiety and pain (p = 0.002 and p = 0.001, respectively).

The findings suggest that CALAS may limit increases in pain and anxiety during IMTMS and may be associated with less pronounced physiological fluctuations during some surgical stages. Clinically, the potential advantage of CALAS appears to be related to more controlled anesthetic delivery rather than elimination of needle use. However, these findings should be interpreted cautiously because the study was based on a single-center split-mouth design with a limited sample size.

NCT06852066