Advance Techniques in LA

Question 1

what is an injection into the palate like

Answer 1

frequently painful due to nature of tissue

- Very tight, no space for LA to go into

Question 2

what are two techniques to make injection into palate less painful

Answer 2

modified technique

use of new technology

Question 3

chasing anaesthesia

Answer 3

technique to try and have painless palatal injection

Give buccal or labial infiltration

• Allow to work
• –Less sore than palatal injection

Inject into interdental papilla (5,6 or 4, 5)
- Palatal side more numb

Slowly advance needle while injecting until palatal tissues blanch
- Anaesthesia further up
- Feel injection less as area of numbness advances before needle
Inject into blanched area

Time consuming but effective

Question 4

when is intraligamental anaesthesia used

Answer 4

Used in oral surgery

Free hand not recommended for restorative work
- Without appropriate machine can use too much pressure and harm ligament

Question 5

why is intraligamental anaesthesia hard

Answer 5

PDL is tight space
- Difficult to make right amount of pressure to prevent ligament spilling into mouth

Safety risk of glass barrel breaking with old syringes

use Peripass (pen) syringe

Question 6

Peripass (pen) syringe

Answer 6

generates a large amount of force get LA into PDL but can harm the PDL and be painful to pt

Question 7

mode of intraligamentary anaesthesia action

Answer 7

Inject LA into intraligamentary space through cribriform plate into alveolar bone

Question 8

efficacy of periodontal ligament anaesthesia depends on (4)

Answer 8

Procedure

Tooth

Resistance to injection

• PDL and squeeze
• —easy to inject – issue, LA just going out into oral cavity
• —hard to inject – correctly wedges into PDL space

Anaesthetic solution

Question 9

4 things efficacy of periodontal ligament anaesthesia independent of

Answer 9

age

sex

needle gauge

syringe

Question 10

which type of tooth has poorest success rate for LA

Answer 10

canines (46%)

Question 11

which has poorer LA success rate lower 1st or 3rd molars

Answer 11

lower 3rd molars

Question 12

what teeth have the least pulpal anaesthesia

Answer 12

lower laterals (18.2%)

Question 13

greater success of lidocaines with or without vasoconstrictor

Answer 13

greater success with epinephrine

Question 14

how to perform intraosseous injection

Answer 14

All important structures have gone numb with LA block, but touch tooth and jump
- Pulp hyperaemic

Give as close to apex of tooth as possible

Stabident perforator

• Single use – attach to slow speed
• Hollow metal tube (Like apple corer)
• Area is numb around tooth
• Turn handpiece on cut hole, through mucosa, through buccal plate to cancellous bone
• • can be done quickly
• • In and out
• • Keep in mind anatomy to not damage roots

Create channel into cancellous bone
- Place needle in and inject LA directly into bone

If don’t have perforator (more invasive)

• Raise buccal flap
• Small round bur and hole through buccal plate

Question 15

what perforator is used for intraosseous LA injection

Answer 15

stabident perforator

Question 16

when is intraosseous LA injection used

Answer 16

Very effective, rarely used

All important structures have gone numb with LA block, but touch tooth and jump
- Pulp hyperaemic

Question 17

mode of action of intraosseous LA injection

Answer 17

Instead of through ligament into space, go directly into space through soft tissues and outer cortex

Question 18

when are topical jet injectors used

Answer 18

palatal injections mainly

avoid needle use

Compressed air gun (rarely used)

• Press latch/switch – release LA under high pressure
• –Disperses into soft tissue

Question 19

3 advantages of topical jet injectors

Answer 19

Bleeding diatheses, where deep injections contraindicated

Sole means achieving LA

Prior to conventional techniques

Question 20

4 disadvantages of topical jet injectors

Answer 20

expensive

Could cause soft tissue damage if careless

• Burns if not used properly
• Messy

Frightening sight and sound
- Very loud – not good for anxious

Taste of solution

Question 21

when would an alternative IAN block technique be used

Answer 21

cannot give standard LA infiltration technique for anatomical/medical reasons

Anaesthetise same nerve and branches but with different technique

Question 22

2 alternative IAN block techniques

Answer 22

Gow Gates

Akinosi Technique (more)

Question 23

Gow Gates Technique

Answer 23

Open mouth technique

Patient lying flat
- Blocks – usually sitting up or just slightly recline

Aim for neck of condylar process
- Closer to palate than mandible

Long needle

• Slightly deeper than normal block
• Aiming to hit pt tragus (not lingual part of ramus of mandible), higher up – hit -neck of condyle

Risky if miscalculate – infratemporal fossa or pierce cheek

Anaesthetise inferior alveolar nerve, lingual nerve, mylohyoid nerve, buccal nerve
- Everything numb on that side

Question 24

risk of older needle use for LA

Answer 24

too much pressure can cause cartridge to shatter

Question 25

akinosi Technique

Answer 25

Closed mouth technique
- Block given usually across the mouth

Useful for severe trismus pt
- Trauma, infection etc

Same side want to anaesthetise (rather than cross mouth)

• Pull cheek
• Go in horizontally parallel to floor or occlusal plane can see just above gingival margin of lower molars
• Until end of barrel at 7/8 then inject
• –Space between maxilla and ramus of mandible (Close to Gow Gates technique target)

Anaesthetise most of the branches mandibular division of trigeminal

Usually able to open slightly wider
- stepping stone to more standard techniques as able to open bit more

Question 26

when is akinosi technique as alternative for IAN block useful

Answer 26

Useful for severe trismus pt
- Trauma, infection etc

Anaesthetise most of the branches mandibular division of trigeminal

Usually able to open slightly wider
- stepping stone to more standard techniques as able to open bit more

Question 27

2 types of newer technology of LA administration

Answer 27

the wand

Comfor control syringe

Question 28

features of the wand 1997

Answer 28

• Disposable handpiece
• Micropressor
• Foot control

still short fine needle – but generally less scary

release LA at constant pressure
- inject intraligamentary without causing harm and with minimal pain
restorative and extraction
- do not need standard on top

Question 29

benefits of the wand intraligamentary LA delivery

Answer 29

release LA at constant less pressure
- inject intraligamentary without causing harm and with minimal pain
restorative and extraction

• do not need standard on top
• generally less scary

Question 30

how to use the wand

Answer 30

placed in multiple spaces in PDL space, in parallel to long axis of that tooth
- Adapt to tooth treating
Do buccal and lingual

Used in paediatric department

less pressure (265 psi instead of 600psi hand-held; 1000psi Peripress; 30psi car tyre)