Advanced Techniques in LA Flashcards
Give examples of painless palatal injection delivery (2)
- Modified technique (Chasing Anaesthesia)
2. New technology
Describe the modified technique (chasing anaesthesia) (4)
- Inject interdental papilla from buccal side (as its not as sore as palatal)
- Allows anaesthetic to spread to palatal side as well
- Wait until palate appears blanched
- Then inject palate to allow further spread along the palatal mucosa
Advantage of the modified technique
Every time you stick the needle into an area its already partially numbed
Why is the intraligamentary freehand technique not recommended for restorative work?
Might end up producing too much pressure on the ligament (not a problem for oral surgery as the tooth will be removed)
What type of syringes are used for the intraligamentary freehand technique? (2)
- Peripress syringe
2. Peripress pen syringe
How does an intraligamentary anaesthesia reach the tooth (3)
- Tip of needle inserted into PDL space
- Travels into the alveolar bone
- Then down to anaesthetise the tooth itself around the apex
What does the efficacy of PDL anaesthesia depend on? (4)
- Procedure
- Don’t do it before an extraction as you can increase root absorption - Tooth
- Resistance to injection
- Anaesthetic solution
What is the PDL anaesthesia independent of? (4)
- Age
- Sex
- Needle gauge
- If in the right place you should have a significant amount of resistance - Syringe
What teeth have the poorest success for PDL intraligamentary anaesthesia?
Canines
What type of tooth gives you the least pulpal anaesthesia?
Lower laterals
When is an intraosseous injection used? (2)
> 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
What type of perforator does an intraosseus injection have?
Stabident perforator - single use
How does an intraosseus anaesthesia reach the bone?
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
List 2 alternative IAN block techniques
- Gow gates
2. Akinosi technique
Advantages of topical jet injectors (2)
- Bleeding diatheses where deep injections contraindicated
2. Reduces fear of needles
Disadvantages of topical jet injectors (4)
- Expensive
- Can cause soft tissue damage through burns to mucosa
- Frightening sight and sound when it shoots LA
- Taste
Describe the process of the Gow Gates technique
- Open mouth technique
- Patient lying flat
- Aim for neck of condylar process
- Needle goes in closer to the palate than the mandible
- So aim higher than IDB
When may the akinosi technique be used?
It’s a closed mouth technique so useful if a patient has trismus and can’t open mouth
Why should the Gow Gates technique be avoided?
If you miss calculate you will end up in the infra temporal fossa or dripping out the patients face
Injecting the condylar process in the Gow Gates technique leads to effective anaesthesia in which areas? (4)
- IAN
- Lingual nerve
- Mylahyoid nerve
- Long buccal nerve
All with one injection so everything on that side goes numb
What do both Akinosi and Gow Gates target? (4)
Most of the branches of the mandibular division of the trigeminal nerve
- Lingual nerve
- Mylohyoid nerve
- Long buccal nerve
- IAN
Describe the process of the Akinosi technique 92)
- Go in horizontally on the same side that u want to anaesthetise rather than crossing the mouth
- Hold syringe and needle at the height of the mucogingival junction above the maxillary third molar
List examples of newer LA technology (2)
- The wand
2. CC syringe
What components make up the wand? (3)
- Disposable handpiece
- Microprocessor
- Foot control
Advantages of the wand (2)
- Releases LA with a constant pressure and allows us to safely inject into the intraligamentary space without causing harm
- Only thing required don’t need to use standard infiltrations too
Advantages of the wand (2)
- Releases LA with a constant pressure and allows us to safely inject into the intraligamentary space without damage to PDL
- Only thing required don’t need to use standard infiltrations too
How much pressure does a hand held syringe from an intraligamentary LA produce?
600 psi
How much pressure does a peripress syringe from an intraligamentary LA produce?
1000 psi
How much pressure does the wand from an intraligamentary LA produce?
265 psi
Fixed pressure
Without risk of damage to PDL
Describe the modified PDL injection technique
Placed into space parallel to the long axis of the tooth
When is the modified PDL injection technique most often used?
Paediatrics
