COMPARISON OF SEDATION TECHNIQUES IN PEDIATRIC DENTAL SURGERIES: A SYSTEMATIC REVIEW OF SAFETY AND BEHAVIORAL OUTCOMES

Background: Pediatric dental procedures often require sedation to manage anxiety and ensure safe completion of treatment. Various sedation techniques are available, each with distinct safety profiles and behavioral outcomes. This systematic review aimed to compare the safety and effectiveness of different sedation techniques in pediatric dental
surgeries.
Methods: A comprehensive systematic review was conducted following PRISMA 2020 guidelines. Electronic databases including PubMed, EMBASE, Cochrane Library, and Web of Science were searched from January 2015 to December 2024. Studies comparing sedation techniques in pediatric dental patients were included. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool and ROBINS-I for observational studies. Meta-analyses were performed where appropriate using random-effects models.
Results: From 3,698 initially identified records, 33 studies met inclusion criteria, encompassing 8,765 pediatric patients. The most commonly studied techniques were nitrous oxide (n=8 studies), oral midazolam (n=12 studies), and propofol (n=4 studies). Success rates varied significantly: propofol demonstrated the highest success rate (99.6%, 95% CI: 95%-100%), followed by sevoflurane (90%, 95% CI: 85%-95%) and combined techniques (85%, 95% CI: 80%-90%). Adverse events were generally mild, with agitation being most common (47.5%), followed by prolonged sedation (19.6%) and emesis (8.1%). Respiratory complications occurred in 4.5% of cases, with laryngospasm in 3.5%.
Conclusion:Propofol and sevoflurane showed superior efficacy but require specialized monitoring. Nitrous oxide and midazolam remain safe first-line options despite moderate success rates. The choice of sedation technique should consider patient factors, procedure complexity, and available expertise. Further research is needed to optimize sedation protocols and minimize adverse events.