Advanced Techniques in LA

Question 1

Give examples of painless palatal injection delivery (2)

Answer 1

1. Modified technique (Chasing Anaesthesia)

2. New technology

Question 2

Describe the modified technique (chasing anaesthesia) (4)

Answer 2

1. Inject interdental papilla from buccal side (as its not as sore as palatal)
2. Allows anaesthetic to spread to palatal side as well
3. Wait until palate appears blanched
4. Then inject palate to allow further spread along the palatal mucosa

Question 3

Advantage of the modified technique

Answer 3

Every time you stick the needle into an area its already partially numbed

Question 4

Why is the intraligamentary freehand technique not recommended for restorative work?

Answer 4

Might end up producing too much pressure on the ligament (not a problem for oral surgery as the tooth will be removed)

Question 5

What type of syringes are used for the intraligamentary freehand technique? (2)

Answer 5

1. Peripress syringe

2. Peripress pen syringe

Question 6

How does an intraligamentary anaesthesia reach the tooth (3)

Answer 6

1. Tip of needle inserted into PDL space
2. Travels into the alveolar bone
3. Then down to anaesthetise the tooth itself around the apex

Question 7

What does the efficacy of PDL anaesthesia depend on? (4)

Answer 7

1. Procedure
   - Don’t do it before an extraction as you can increase root absorption
2. Tooth
3. Resistance to injection
4. Anaesthetic solution

Question 8

What is the PDL anaesthesia independent of? (4)

Answer 8

1. Age
2. Sex
3. Needle gauge
   - If in the right place you should have a significant amount of resistance
4. Syringe

Question 9

What teeth have the poorest success for PDL intraligamentary anaesthesia?

Answer 9

Canines

Question 10

What type of tooth gives you the least pulpal anaesthesia?

Answer 10

Lower laterals

Question 11

When is an intraosseous injection used? (2)

Answer 11

> IAN block + long buccal infiltration has been given but tooth isn’t numb as the pulp is very hyperaemic and struggles to anaesthetise

> Give an intraosseous injection to allow the LA to be given as directly close to apex of tooth as possible

Question 12

What type of perforator does an intraosseus injection have?

Answer 12

Stabident perforator - single use

Question 13

How does an intraosseus anaesthesia reach the bone?

Answer 13

Instead of going through the PDL into the space you directly go into space via the soft tissues and the outer cortex to allow LA to travel to the cancellous bone

Question 14

List 2 alternative IAN block techniques

Answer 14

1. Gow gates

2. Akinosi technique

Question 15

Advantages of topical jet injectors (2)

Answer 15

1. Bleeding diatheses where deep injections contraindicated

2. Reduces fear of needles

Question 16

Disadvantages of topical jet injectors (4)

Answer 16

1. Expensive
2. Can cause soft tissue damage through burns to mucosa
3. Frightening sight and sound when it shoots LA
4. Taste

Question 17

Describe the process of the Gow Gates technique

Answer 17

1. Open mouth technique
2. Patient lying flat
3. Aim for neck of condylar process
   - Needle goes in closer to the palate than the mandible
   - So aim higher than IDB

Question 18

When may the akinosi technique be used?

Answer 18

It’s a closed mouth technique so useful if a patient has trismus and can’t open mouth

Question 19

Why should the Gow Gates technique be avoided?

Answer 19

If you miss calculate you will end up in the infra temporal fossa or dripping out the patients face

Question 20

Injecting the condylar process in the Gow Gates technique leads to effective anaesthesia in which areas? (4)

Answer 20

1. IAN
2. Lingual nerve
3. Mylahyoid nerve
4. Long buccal nerve

All with one injection so everything on that side goes numb

Question 21

What do both Akinosi and Gow Gates target? (4)

Answer 21

Most of the branches of the mandibular division of the trigeminal nerve

1. Lingual nerve
2. Mylohyoid nerve
3. Long buccal nerve
4. IAN

Question 22

Describe the process of the Akinosi technique 92)

Answer 22

1. Go in horizontally on the same side that u want to anaesthetise rather than crossing the mouth
2. Hold syringe and needle at the height of the mucogingival junction above the maxillary third molar

Question 23

List examples of newer LA technology (2)

Answer 23

1. The wand

2. CC syringe

Question 24

What components make up the wand? (3)

Answer 24

1. Disposable handpiece
2. Microprocessor
3. Foot control

Question 25

Advantages of the wand (2)

Answer 25

1. Releases LA with a constant pressure and allows us to safely inject into the intraligamentary space without causing harm
2. Only thing required don’t need to use standard infiltrations too

Question 26

Advantages of the wand (2)

Answer 26

1. Releases LA with a constant pressure and allows us to safely inject into the intraligamentary space without damage to PDL
2. Only thing required don’t need to use standard infiltrations too

Question 27

How much pressure does a hand held syringe from an intraligamentary LA produce?

Answer 27

600 psi

Question 28

How much pressure does a peripress syringe from an intraligamentary LA produce?

Answer 28

1000 psi

Question 29

How much pressure does the wand from an intraligamentary LA produce?

Answer 29

265 psi

Fixed pressure
Without risk of damage to PDL

Question 30

Describe the modified PDL injection technique

Answer 30

Placed into space parallel to the long axis of the tooth

Question 31

When is the modified PDL injection technique most often used?

Answer 31

Paediatrics