Advanced Techniques Flashcards
what techniques are covered under advanced techniques
Palatal anaesthesia Intraligamental
Intraosseous
Alternative IAN Block Techniques
why is a LA injection to the palate so painful
palatal tissue is very tight - there is no space for the LA to enter
how can a palatal anaesthesia injection be made painless
modified technique
new technology
what is the modified technique for carrying out painless palatal anaesthesia
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
why is intraligamental anaesthesia not great for restorative dentistry but okay for extractions
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
what is difficult about intraligemantal anaesthesia
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
how are the problems of pressure / force with intraligamental anaesthetia over come
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
when liquid is injected into the PDL space where does it go
through the cribiform plate and into the alveolar bone to anaesthetise the tooth around the apex
what do the effects of periodontal ligament anaesthetia depend on
- procedure
- tooth
- resistance to injection (should not feel easy to inject - need the resistance)
- anaesthetic solution
what are the effects of periodontal ligament anaesthesia independent of
○ Age
○ Sex
○ Needle gauge
○ Syringe
what tooth has the poorest success rate interligamentarly
canines
where is the least pulpal anaesthesia achieved
lower laterals
is the success rate of intraligamentary anaesthesia high for plain anaesthesia or anaesthesia with adrenaline / epinephrine
adrenaline has a 92% success rate
plain has a 42% success rate
give an example of when the intraosseous injection would be used
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
name the instrument used to allow intraossesous injection to occur
stabident perforator
single use, disposable
latch hook
metal hollow tube
explain how the procedure for an intraosseous injection
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
what is another option for carrying out an intraosseous injection
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
why would you use the topical jet injectors
no needles
good for palatal anaesthesisation
what are topical jet injectors
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
what are the advantages of topical jet injectors
Bleeding diatheses, where deep injections contraindicated
Sole means achieving LA
Prior to conventional techniques
what are the disadvantages to topical jet injectors
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
name alternative techniques to the IDB
gow gate
akinosi technique
explain the gow gate technique
- 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)
what is the problem with the gow gate technique
If you miscalculate / inject wrong area could hit the infratemporal fossa or the needle could come out the patient’s face
Dangerous
