5. Advanced Techniques in LA

Question 1

Types of advanced LA techniques (6)

Answer 1

Palatal anaesthesia
Intraligamentary 
Intraosseous
Jet techniques
Alternative IAN block techniques
New technology

Question 2

Method of chasing the anaesthetic (5)

Answer 2

Interpapillary injection given buccally
Blanching occurs on gingivae buccally and palatally
Interpapillary injection given palatally
Palatal area blanches
Injection given more palatally into already anaesthetised area

Question 3

Features of intraligamentary injections (4)

Answer 3

Injection directly into PDL to allow quicker diffusion of anaesthetic agent into alveolus
May cause root resorption
Difficult – tight space/lots of resistance
Mainly used for extractions

Question 4

PDL anaesthesia efficacy is dependent on (4)

Answer 4

Procedure
Tooth
Resistance to injection
Anaesthetic solution

Question 5

Features of intraosseous injections (2)

Answer 5

Injection directly into bone

Allows quicker application - more direct

Question 6

Advantages of topical jet injectors (4)

Answer 6

For bleeding diatheses, where deep injections are contraindicated
Sole means of achieving LA
Prior to conventional technique
No needle

Question 7

Disadvantages of topical jet injectors (4)

Answer 7

Expensive
Could cause soft tissue damage if careless
Frightening sight and sound (gunshot – compressed air)
Taste of solution (LA leaks out into mouth if not firmly pressed against mucosa)

Question 8

Types of alternative IAN blocks (2)

Answer 8

Gow Gates method

Vazirani-Akinosi Technique

Question 9

Gow Gates method (3)

Answer 9

Open mouth technique
Patient lying flat
Aim for neck of condylar process (higher than usual)

Question 10

Vazirani-Akinosi Technique method (3)

Answer 10

Closed mouth technique
Useful for patients with trismus
Needle inserted into same side of mouth as injection site (between buccal aspect of teeth and buccal mucosa)

Question 11

Types of new technology (2)

Answer 11

The Wand

CC Syringe

Question 12

Features of the wand (3)

Answer 12

Utilised in paediatric dentistry
Looks like a pen/wand with small needle
Injects constant pressure, reducing pain sensation

Question 13

Pressure during intraligamentary LA (4)

Answer 13

Hand-held syringe – 600psi
Peripress (intraligamentary device) – 1000psi
Typical car tyre – 30psi
The Wand – 265psi