Advanced Techniques

Question 1

what techniques are covered under advanced techniques

Answer 1

Palatal anaesthesia Intraligamental
Intraosseous
Alternative IAN Block Techniques

Question 2

why is a LA injection to the palate so painful

Answer 2

palatal tissue is very tight - there is no space for the LA to enter

Question 3

how can a palatal anaesthesia injection be made painless

Answer 3

modified technique

new technology

Question 4

what is the modified technique for carrying out painless palatal anaesthesia

Answer 4

Give buccal infiltration
& Allow it to work

Inject into interdental papilla

Slowly advance needle while injecting until palatal tissues blanch

Inject into blanched area

Sticking needle into areas already anesthetised
Chasing the numbness as it advances

Time consuming but effective in achieving a painless palatal injection

Question 5

why is intraligamental anaesthesia not great for restorative dentistry but okay for extractions

Answer 5

these injections can be too high pressure and this can cause damage to the ligament

if the tooth is being removed it doesn’t matter that the ligament is damaged

but for a tooth being restored you want to maintain the health of the tooth

Question 6

what is difficult about intraligemantal anaesthesia

Answer 6

space in the PDL is very tight so it can be difficult to make sure you produce the right amount of pressure to make sure the LA goes down the PDL space and doesn’t shoot out from the gingival crevice into the patient’s mouth

Question 7

how are the problems of pressure / force with intraligamental anaesthetia over come

Answer 7

devices developed to give ability to produce more force / pressure when injecting
- peripress syringe
- peripress pen syringe
these mean you are more likely to get the LA into the PDL space

can still damage PDL and cause pain for the patient

Question 8

when liquid is injected into the PDL space where does it go

Answer 8

through the cribiform plate and into the alveolar bone to anaesthetise the tooth around the apex

Question 9

what do the effects of periodontal ligament anaesthetia depend on

Answer 9

• procedure
• tooth
• resistance to injection (should not feel easy to inject - need the resistance)
• anaesthetic solution

Question 10

what are the effects of periodontal ligament anaesthesia independent of

Answer 10

○ Age
○ Sex
○ Needle gauge
○ Syringe

Question 11

what tooth has the poorest success rate interligamentarly

Answer 11

canines

Question 12

where is the least pulpal anaesthesia achieved

Answer 12

lower laterals

Question 13

is the success rate of intraligamentary anaesthesia high for plain anaesthesia or anaesthesia with adrenaline / epinephrine

Answer 13

adrenaline has a 92% success rate

plain has a 42% success rate

Question 14

give an example of when the intraosseous injection would be used

Answer 14

Extraction of the lower 6

Giving IDB and long buccal infiltration

Lips, tongue, cheek, soft tissues numbed no problem

Tooth doesn’t numb - pulp really hyperaemic

Want to give LA as close as possible to the apex of the tooth but don’t want to give lots more injections

Question 15

name the instrument used to allow intraossesous injection to occur

Answer 15

stabident perforator

single use, disposable
latch hook
metal hollow tube

Question 16

explain how the procedure for an intraosseous injection

Answer 16

attach the stabident perforator to the slow speed handpiece

cut hole into the osseous bone through the mucosa using this
(patient is already numb so the patient won’t feel this in the mucosa)

be careful not to damage roots - remember anatomy
check radiograph if there is one available

channel into the cancellous bone

channel created to insert the LA needed so the LA can be injected directly at the apex of the tooth

Question 17

what is another option for carrying out an intraosseous injection

Answer 17

not using the stabident perforator

raise a buccal flap

use a small round bur and make a little hole in the mucosa

same idea as stabident perforator but this way is more invasive

Question 18

why would you use the topical jet injectors

Answer 18

no needles

good for palatal anaesthesisation

Question 19

what are topical jet injectors

Answer 19

like a compressed air gun - press the latch and compressed air along with LA is released at a high pressure

released at such a high pressure that it goes into the soft tissues

Question 20

what are the advantages of topical jet injectors

Answer 20

Bleeding diatheses, where deep injections contraindicated

Sole means achieving LA

Prior to conventional techniques

Question 21

what are the disadvantages to topical jet injectors

Answer 21

Expensive

Could cause soft tissue damage if careless
§ Can splatter
§ Can burn mucosa

Frightening sight and sound
§ Bad for anxious patients

Taste of solution is unpleasant

Question 22

name alternative techniques to the IDB

Answer 22

gow gate

akinosi technique

Question 23

explain the gow gate technique

Answer 23

• open mouth technique (across the mouth)
• patient needs to be lying flat
• aim for the neck of condylar process of the mandible (aim for the tragus)

Question 24

what is the problem with the gow gate technique

Answer 24

If you miscalculate / inject wrong area could hit the infratemporal fossa or the needle could come out the patient’s face
Dangerous

Question 25

what is good about the gow gate technique

Answer 25

makes everything on that side of the face go numb in one go

Question 26

why would you use the akinosi technique

Answer 26

patients with severe trismus have limited mouth opening so can’t use the cross mouth techniques

Question 27

explain the akinosi technique

Answer 27

pull cheek away from teeth

go in horizontally parallel to the floor / occlusal plane using a long needle

go in just above the gingival margin of the upper molar

Question 28

what does the akinosi technique anaesthetise

Answer 28

most branches of the mandibular division of the trigeminal nerve

wont anaesthetise them completely but will usually allow for some mouth opening (as the anaesthetic takes away some of the pain of the trismus) and this then allows you to carry out the stand nerve block

like a stepping stone

Question 29

what is the advantage of using the wand technology

Answer 29

releases LA at a constant pressure

allows you to safely inject into intraligamentary space without causing harm to patient

very effective with minimal pain

Question 30

what is important to ensure when carrying out the modifeid PDL injection

Answer 30

insert into the space parallel to the long axis of the tooth