Dental blocks & tooth extraction Flashcards
Local and regional anesthesia in dentisty.
What are the most common blocks? (8)
Infraorbital nerve block
Maxillary nerve block
Inferior alveolar nerve block
Middle mental nerve block
Major palatine nerve block
‘splash block’,
local infiltration,
periodontal ligament infiltration
(last one requires special syringe)
Remember systemic safe dose for local anesthetics – rule of thumb?
stay below 2 mg/kg total in cats, up to 4 mg/kg is okay for dogs (cats more
sensitive, dogs safer; different max doses
given).
Lidocaine, bupivacaine, mepivacaine used –
different times of onset + duration.
There is some evidence that combining opioids extends the duration of the local anesthetics.
Innervation branches of trigeminal nerve.
Mandibular nerve distribution and its oral branches.
Name these block locations.
top left: Rostral Maxillary (Infraorbital) Nerve Block
top middle red arrow + left top: Caudal Maxillary Nerve Block
lower blue circle: Rostral Mandibular (Mental) Nerve Block
lowest: Caudal Mandibular (Inferior Alveolar) Nerve Block
Name this block location.
intraoral (maxillary tuberosity) / Caudal Maxillary Nerve Block
Name this block location.
Caudal Mandibular (Inferior Alveolar) Nerve Block
dogs have a notch to palpate in their mandible, cats have a thin area in theirs
If you hit the bone, always…
change the needle for the next block.
What type of needle should you use for local dental blocks?
Use sharp thin (short) needles (grey) + 1 ml
syringe, change needle often, train
technique.
Always aspirate before injection to avoid
intravascular injection (systemic
consequences).
Possible iatrogenic damage to structures.
Possibility for block not working
(inflammation, anatomic variation, bad
technique) – have a backup plan too (FLK, ketamine, methadone etc.).
Tooth extractions: ‘non-surgical’ or ‘closed’
X-ray first
Severe gingival attachment w scalpel
blade or luxator/elevator blade
(Luxation and) elevation of the root
NB! Luxator (thinner, sharper blade) only
for cutting, elevator also for rotation/elevation/stretching; luxating
elevator/extractor is a combo of both.
Removal of root from alveolus, check root
apex – is it smooth, no pieces missing.
X-ray again
Debridement/flushing of alveolus as
needed (Ringers, not chlorhexidine),
wound closure with sutures (if tensionless
closure possible) or left open.
Tooth extraction: ‘surgical’ or ‘open’
X-ray first
Raise a full-thickness flap: cut to the bone, lift with periosteal elevator, periosteum will be separated from the bone as the lowermost layer of flap.
Removal of alveolar bone (round bur, or
fissure bur if alveolar bone contour suitable), sectioning tooth according to number of roots (fissure bur).
(Luxation and) elevation of root(s); elevating hold tension on rotation 10-20 sec, avoid excess force (‘2 fingers force’ usually) or over-rotating the instrument.
Removal of tooth from alveolus, check the apex.
X-ray again.
Debridement/flushing of alveolus, severing the periosteum (lowest layer) to stretch the flap, closure with single interrupted resorbable sutures.
Flaps can be: (3)
envelope, triangular, pedicle
Flaps should include
be Full thickness – 3 layers (periosteum, submucosa, mucosa), use periosteal elevator.
Be gentle w flap (protect, don’t crush, flush w. Ringers to prevent drying)
Closure: first sever periosteum layer (cut
parallel to base of flap) to allow for stretch
and tensionless closure.
Absorbable monofilament, 5/0 or 4/0,
single interrupted sutures 2 – 3 mm
distance.
How to remove a very well seated tooth?
Remove alveolar bone w bur (round or
fissure) as necessary (1/2 root upwards
usually).
Sectioning tooth into root-corresponding
fragments w fissure bur: locate furcation
(anatomy + visual); if necessary make
room for elevator.
DON’T use too much force, controlled
movement, when elevating stretch for 20
sec to tear periodontal ligament fibers.
Before flap closure smooth the sharp bone edges w bur.
High vs low speed handpiece – water vs
sterile NaCl – generally high speed+water
Ok, but flush w Ringer’s before closure.
What to do when Root tip fracture
x-ray, removal of more bone, flushing + light to visualize, gentle removal (never push onto fragment)
