Supplemental Injection Techniques Flashcards
Breakdown of Intaosseous supplemental anesthesia techniques
- PDL injection
- intraseptal injection
- IO anesthesia (intraosseous)
PDL injection AKA - when? (general)
intraligamentary injection
when IAN not adequate
Indications for PDL injection
1, if dont want IAN but need anesthetic for 1 or 2 manidbular teeth in a quarant
- bilateral isolated mandibular teeth (don’t want to give two blocks)
- tx in children
- tx when nerve blockis contraindicated
- use as a possible aid in diagnosis of mandibular paion
contraindictions for PDL injection
- infection or severe inflammation in injection site
- primary teeth, when the permanent tooth bud is present
- patient who requires a “numb” sensation for comfort (not geeting anesthesia of lip, tongue, other soft tissue)
PDL injection advantages
- prevents anesthesia of lip, tongue, other soft tissue
- minimum doses of LA required (.2 ml per root)
- alternative to partially successful regional blcok
- rapid onset
- less traumatic than conventional blocks
- well suite in children
minimum doses of LA required for PDL injection?
.2ml per root
disadvantages of PDL injection
- proper needle placement may be difficult to achieve
- leakage of LA into pt’s mouth produces unpleasant taste
- excess pressure can have adverse effects
technique for PDL injection needle? insert? landmarks? orient bevel?
needle? 27 short needle (not 30)
insert? = long axis of the tooth, on its mesial and distal roots interproximally
landmarks? = roots of tooth and periodontal tissues
orient bevel? = toward root of tooth and advance apically until resistance is met
if one root – make needle safe
multi-rooted? - repeat procedure on other root
administer rate of LA in PDL injection?
.2ml of LA over 20 seconds
patient position in PDL injection?
supine or semi-supine position
indication of success in PDL injection?
significant resistance to deposition of the LA
may be ischemia of soft tissue adjacent to the injection site
intraseptal injection?
useful when?
path of diffusion?
similar to PDL
useful – in prividing osseous and soft tissue anesthesia and hemostasis for perio currettage and flap procedures
path of diffusion = LA is thourgh the medullary bone, as in PDL
areas anesthetized in intraseptal injection?
bone, soft tissue, root
indications for intraseptal injection?
pain control and hemostasis for sfot and osseous tissue perio treatemnt
advantages to intraseptal injection
similar to the PDL one-
- no lip or tongue numbness, minimum volume of LA, decreases bleeing, atraumatic, immeiate onset of action, few post-op complications, useful for periondtially involved teeth
disadvantages to to intraseptal injection
- mutliple tissue punctures
- bitter taste of LA if leakage occurs
- short duration of action of pulpal anesthesia
- requires clinical experience for success
technique for intraseptal injection needle? insert? landmarks? orient bevel?
needle? = 27 g short insert?= center of the interdental papilla adjacent to the tooth being treated
landmarks? = papillary triangle, 2 mm below the tip of papilla, equidistant from adj. teeth (on either side)
orient bevel? = towards the apex
syringe orientation in intraseptal injection?
orient needle 45 degrees to long axis of the tooth, at a right angle to the soft tissue, with the bevel facing the APEX of the tooth
advance needle until when in intraseptal technique?
until bone contact – then push needle slightly deeper (1-2 mm) into the interdental septum
administer rate of LA in intraseptal injection?
.2 to .4 ml of LA over 20 seconds
complications in intraseptal?
rare – may be some post op pain and duration of the anesthetic is variable
intraosseous injection - general description
necessitated round bur into interseptal bone that has been surgically exposed then needle inserte into the site for LA administration
3 types of intraosseous injection
- stabident system – 2 parts so harder to place LA into previous drilled hole– led to the alternative stabident system
- X-tip - eliminates problem of re-entering needle into previously positioned hole
- intraflow
X-tip description
eliminates problem of re-entering needle into previously positioned hole
composed of a rill gude an guide sleeve
drill leads the guide sleeve through the cortical plate, after which it is separated and withdrawn — then guide sleeve remains in the bone and the LA can be administered
intraflow system
specially modified slow-speed hanpiece with needle / drill that does perforation through bone and delivers th eLA
type of LA for IO and why?
a “plain” LA is recommended b/c high incidence of palpations noted when vasopressor-containing LA’s are used
site is relatively vascular so volume of LA administered should be kept to minimum to avoid overdose
indication for IO?
pain control for tc on single or multiple teeth in quadrant
advantages to IO?
- lack of lip or tongue
- atraumatic
- immediate onset of action
- few post-op complications
disadvantages to IO?
requires special syringe
positive aspiration with IO? alternative to what?
0% alternative - other methods - PDL -intraseptal - supraperiosteal -regional nerve block
X-tip technique
- prepare soft tissue site
- perforation of cortical plate – hold perpendicular to the corticol plate and gently push through gingiva until rest against bone then go through pecking motion until feel loss of resistance
- dont hold in one spot - can overheat the bone
- take drill out but leave sleeve in duration of procedure
injection with x-tip uses what needle?
ultrashort needle into the cancellous bone
complications with IO injection?
- palpations
- postinjection pain? - unlikely
- fistula at site of perforation
- separation of the perforator or cannula (rare)
- perforation of lingual plate of bone
duration of LA in IO injection?
pulpal = 15-30 minutes vascon= 30 mins plain = 15 minutes
intrapulpal injection?
pulp needs to be exposed fisrt but deposited directeld into chamber of tooth involve providing adequate LA.
disadvantages of Intrapulpal?
HURTS - but lasts very short
bitter taste if leaks
may be difficult to enter certain canals
need opening into pulp chamber for optimal effectiveness
advantages if intrapulpal?
lac of lip and tongue being anesthetized, minimum amount of LA needed and quick rapid onset of action and few post-op complications
alternative to intrapulpal?
IO
deposition of LA in intrapulpal? how much and what needle?
25 to 27 short or long needle
deposit under pressure
.2-.3 ml of LA
oraverse?
phentolamine mesylate- reversal of soft tissue anesthetisia caused by LA with vasoconstrictors (with epi)
has to be administered in same technique and area of LA deposition
Electronic Dental anesthesia?
transcutaneous electrical nerve stimulation (TENS)
- vibrations before injection so may not perceive the pain
use of EMLA contraindicate in who? and why?
below the age of 6 months because of possible developement of methemoglobinemia
onpharma only used for which LA’s
those with a vasoconstrictor in it and it is a bicarbonate neutralizing solution added to the LA (NaHCO3) - sodium bicarbonate
because these ph’s are low (like lidocaine with epi)
oraverse not recommended in who?
use in children less than 6 years of age or weighing less than 15 kg
oraverse chemical name
phentoalamine mesylate
