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Presented by :
Dr. Suman Mukherjee
1st Yr MDS
V.S.D.C.H.
Yr : 2017-18
• Maxillary injection techniques
PSAN
Contents : ASAN
MSAN
• Introduction Nasopalatine nerve block
• Regional anesthesia Greater Palatine nerve block
Field block Maxillary nerve block
Nerve block • Mandibular Injection Technique’s
Local infiltration IANB
• Local Anesthesia Injection Incisive nerve block
Technique Gow–Gates nerve block
Supraperiosteal injections Vazirani–Akinosi nerve block
Intraligamentary injections • Regional anesthesia to soft tissue
Intraosseous injections Buccal nerve block
Intraseptal injections Mental nerve block
Subperiosteal injections • Conclusions
• Reference.
Introduction
Pain control in dentistry presents one of the greatest
challenges. (Pain leads to increased stress, release of
endogenous catecholamines and unexpected
cardiovascular responses) Before anesthetization,
dentists should evaluate the medical history of each
patient and document data on the systemic and
psychological status of the patients in order to
determine whether the patient is able to tolerate the
treatment with no risk from the systemic and
psychological points of views.
Before the injection of the local anesthetic, the dentist should
recognize the potential risks. However, most adverse reactions to local
anesthetics are not related to the drug itself, but to the injection of
the drug. The injection of the local anesthesia is the most reported
cause for fear and discomfort of dental patients.
NEEDLE GAUGE
• Gauge refers to the diameter of the lumen of the needle; the smaller the number,
the greater the diameter of the lumen.
• Needle deflection along the axis of the bevel and breakage must also be
examined.
• Field block also may be considered when operating on the ear or lips. Eg.
Gow gates technique is a kind of field block.
• Often a group of nerves, called a plexus or ganglion, that causes pain to a specific
organ or body region can be blocked with the injection of medication into a specific
area of the body. The injection of this nerve-numbing substance is called a nerve
block. Eg. IANB, PNB
• The PDL injection method of anesthetizing an individual tooth is utilized to avoid the
undesirable consequences of regional block anesthesia.
• A 27-gauge short needle with the bevel toward the tooth is inserted through the
gingival sulcus on the mesial of the tooth to be anesthetized and inserted as far
apically as possible.
PDL
injection
Intraosseous injections :
• The ASA injection will anesthetize the PDL, alveolar bone, periosteum, buccal
soft tissue, and teeth from the canine to the midline.
• The needle depth will be about 16 mm for an average sized adult with varying
depths proportional to the size of the patient and the bony structure of the
cheek.
• AREA OF INSERTION – height of the mucobuccal fold directly over the
first premolar.
• TARGET AREA – infraorbital foramen (below the infraorbital notch)
• Landmarks
• - mucobuccal fold
• -Infraorbital notch
• -Infraorbital foramen
• ORIENTATION OF THE BEVEL – Toward bone
• To transform it into Anterior Superior alveolar nerve block –
• Maintain firm pressure over injection site both during and after the
injection for 1 min.
Maintain direct pressure after withdrawal for 2 minute to allow more diffusion of solution into the foramen.
• BICUSPID APPROACH – needle is inserted into the mucosa and areolar tissue
using the maxillary bicuspid as the guide and the needle should pass beneath
and lateral to the external maxillary artery and the anterior facial vein.
• Two approaches –
• Single penetration
• Multiple penetration
• Two approaches –
• Two approaches –
Technique VOLUME, ml
Nasopalatine 0.45
NERVES ANESTHETIZED –
A 25-gauge long needle is inserted slowly to a depth of 25 to 30mm; the end point is
inferior and lateral to the condylar head.
Gow Gates Mandibular anesthesia technique
Vazirani-Akinosi (Closed-Mouth) Nerve Block
• In 1977, Dr. Sunder J. Vazirani and Dr.
Joseph Akinosi reported on a closed mouth
approach to mandibular anesthesia.
• The buccal injection will anesthetize the buccal soft tissue lateral to the
mandibular molars.
• The needle is inserted into the tissue in the distobuccal vestibule opposite the
second or third mandibular molar just medial to the coronoid notch until bone is
contacted (approximately1to 3 mm), and 0.25 mL of anesthetic is deposited.
TECHNIQUE VOLUME,ml
Buccal 0.3ml
Mental 0.6ml
• Accupal is a cordless device which applies both vibration and pressure at the
injection site.
Dental vibe
• Dental Vibe is a cordless hand held device which
gently stimulates the sensory receptors at the
injection site causing the neural pain gate to
close.
• Advantage is, the tissues are vibrated before the
needle penetrates.
• Disadvantage is, it is not directly attached to the
syringe and a separate unit is required, so both
hands are engaged.
• Dentalvibe and syringe micro vibrator uses micro-
vibration to the site where an injection is being
administered.
SAFETY DENTAL SYRINGES
• Aim of these devices is to prevent from the risk
of accidental needle stick injury occurring with a
contaminated needle after local anesthesia
administration.
• Warming
• Buffering
• Slow injection
• Bevel of the needle
• Needle guage
LOCAL ANESTHEISA COMPLICATIONS
Due to the advancement of technology, many newer delivery systems for local
anesthesia have evolved and the dental practitioners must be well aware of their
usage and applications. The required armamentarium may be chosen according to the
patient’s needs. Dentists must be well aware of these newer delivery systems, their
usage and must have an up-to-date knowledge, so as to provide the benefits of latest
technology to their patients. The ability to deliver painless injections and a
desirable level and duration of anesthesia results in reduced patient fear, reduced
patient stress and therefore reduced stress for the clinician and can aid patient
compliance with dental treatment.
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Thank you ..