Topic 12: Anaesthetic methods in dentistry

Question 1

Main forms of anaesthesia and what are they used for:

Answer 1

Main forms of anaesthesia and what are they used for:
There are 2 main subgroups:
 Local:
- extractions,
- small surgical interventions 
(e.g. soft tissue excision,
intraoral incision,
biopsy,
sculptio,
dentoalveolar
and periodontal surgeries)

 General i.e. ITN (intubation Anasthesia):
- Used for bigger dentoalveolar and maxillofacial surgical interventions

Question 2

Local anaesthesia classification:

Answer 2

Local anaesthesia classification:
We classify the types of anaesthesia according to the way in which doctors
 try to reach the nerve elements
 and by which nerve types will be anesthetised.

We distinguish 2 types:
 Terminal (infiltration) anaesthesia
 Block anaesthesia

Question 3

terminal anaesthesia classification:

Answer 3

terminal anasthesia classification:
With this method we try to reach the nerve elements by the axon terminals, which direcly innervate the teeth or periodontal ligaments. (so direct deinnervation of the teeth).

There are 5 different types according to location of where we inject the anaesthesia:
 Mucous membrane anaesthesia
 Submucosal infiltration
 Intramucosal infiltration (subperiosteal)
 Intraligamental anaesthesia
 Intraosseal anaesthesia

Question 4

Mucous membrane anaesthesia:

Answer 4

Mucous membrane anaesthesia:
Anasthetics with good diffusing ability can reach from the surface anasthesia by penetrating through the mucous membrane.

Usage:
 By insertion point of the injection
 Smaller mucosal lesions
 Removal of mobile primary teeth

Question 5

Submucosal infiltration:

Answer 5

Submucosal infiltration:
 This is the most commonly used terminal method.
 We infiltrate the anaesthetic to the field of the mucous membrane within submucosa, directly to the apex of the tooth.
 the solution from the so formed pit diffuses to the desired location through the bone and periosteum.

Method:
 Insert needle into the vestibular fold, from the tooth distal to the tooth that needs anesthetising.
 Direct needle near the periosteum, parallel to the bone surface, and infiltrate with anaesthetic whilst penetrating through the mucosa while continually emptying the needle (pressing during injection).

Question 6

Intramucosal infiltration:

Answer 6

Intramucosal infiltration:
 Give the anasthetic to the gingiva propria with a thin needle.
 In this type, no pit is formed and we use a small amount of anaesthetic and the elimination is quicker.

Indications of application:
 inflamed tissues
 Abscess around the root.

Question 7

Intraligamental anaesthesia:

Answer 7

Intraligamental anaesthesia:
 We use an extremely thin needle and high pressure syringe to infiltrate the anaesthetic into the area of the circular ligaments

Question 8

Intraosseal anaesthesia:

Answer 8

Intraosseal anaesthesia:
 We give the compound through the cortical bone into the spongiosa (spongy bone) with a special drill.
Types:
 Transcortical
 Osteocentral
 Intraseptal

Question 9

Block anaesthesia:

Answer 9

Block anaesthesia:
 We block the function of a peripheral nerve trunk by forming a pit around the trunk so anasthetic can diffuse to nerve fibers through the peri- and endo-neurium
 Pressing while injecting, pit forming by directing needle slowly!

Types of block anaesthesia can be sorted by the insertion point OR the nerve to be anaesthetized

Question 10

Maxillary block anaesthesias:

Answer 10

Maxillary block anaesthesia:
 Infraorbital (Infraorbital N. and Ant. Superior Alveolar N)
 Tuberal (Post. Superior Alveolar N.)
 Matas (Maxillary N)
 Greater palatine foramen (Greater Palatine N)
 Incisive foramen (Incisive N)

Question 11

Mandibular block anaesthesias:

Answer 11

Mandibular block anaesthesias:
 Szokoloczy (Inf. Alveolar N. and Lingual N)
 Mental foramen (Mental N)
 Lingual nerve block
 Buccal nerve block
 Gow Gates
 Akinosi

Question 12

Extraoral anaesthesia:

Answer 12

Extraoral anaesthesia:
 2nd and 3rd trigeminal branches (Max. and Man. N) can be anaesthetised extraorally
 Used for bigger maxillofacial surgeries when the ITN is contraindicated.
 Preparation of the patient and sterility is very important (isolation, skin disinfection)

Question 13

Extraoral anaesthesia: types

Answer 13

Extraoral anaesthesia: types
 Payr
 Lindemann
 Braun
 Berg
 Kantorowicz

Question 14

Payr:

Answer 14

Payr:
 Insertion point at meeting point of zygomatic bone and lateral margin of the orbit.
 Needle is directed from above and foreward to back and behind.
 When we get around 5.5cm deep we reach the pterygopalatine fossa.
 First aspirate, then infiltrate with 2-3ml anaesthetic with a long needle ( atleast 6cm long)

Question 15

Lindemann:

Answer 15

Lindemann:
 Insersion point is above zygomatic arch, if we follow the fascia of the infratemporalis we reach the pterygoid process.
 After this, slightly pull back the needle and direct around 1cm dorsally to get near the foramen ovale.

 With this method we can also anesthetise the maxillary nerve as well, if we direct the needle 1cm ventrally after reaching the pterygoid process.

Question 16

Braun:

Answer 16

Braun:
 Insertion point is under the zygomatic arch with a moderately open mouth.
 Needle is directed through the incisura semilunaris.
 Getting about 5.5cm deep, we reach the pterygoid process,
 1cm dorsally is the foramen ovale,
 1cm ventrally there is the sphenopalatine fossa.
 I.E. we can anesthetise both V2 and V3.

Question 17

Berg:

Answer 17

Berg:
 Used for extraoral anesthesia of the inferior alveolar N.
 Insertion point is under angle of the mandible, on the central point of the imaginary line binding the tragus and the anterior margin of the masseter.
 Insert the needle about 30-35mm depth, reaching the lingula of the mandible

Question 18

Kantorowicz:

Answer 18

Kantorowicz:
 Used for extraoral anesthesia of the inferior alveolar N.
 Put index finger onto posterior edge of the ramus and tip of thumb onto the angle.
 Insertion point is next to nail of the thumb, we insert the needle about 30-35mm depth, reaching the lingula of the mandible