armamentarium for la.pptx
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Armamentarium for
Local Anesthesia
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The Armamentarium4 PARTS :1) The Syringe2) The Needle3) The Cartridge4) Preparation
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THE SYRINGE
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Types of Syringes1) Non-disposable syringesa. Breech-loading, metallic, cartridge-type, aspiratingb. Breech-loading, plastic, cartridge-type, aspiratingc . Breech-loading, plastic, cartridge-type, self-aspiratingd. Pressure syringe for periodontal ligament injection
2 ) Disposable syringe
3 ) Safety syrin ge
4 ) Computer controlled local anesthetic deliverysystems
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ADA Standards for Injection Syringes
1. They must be durable and able to withstand repeatedsterilization without damage
2. They should be capable of accepting a wide variety ofcartridges and needles from different manufacturers and
permit repeated use
3. They should be inexpensive, self-contained, lightweight
and simple to use with one hand
4. Provide aspiration so blood can be seen through the glasscartridge
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Breech-Loading, Metallic, Cartridge-Type,Aspirating Syringe
-breech loading implies thatthe dental cartridge isloaded from the side
-a needle is attached to the barrel of the syringe at theneedle adaptor
-the needle passes into the barrel and pierces thediaphragm of the localanesthetic cartridge
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Aspirating Syringe-the harpoon is a sharp tip attached to the piston and is
responsible for penetrating the thick silicone rubberstopper (bung) at the other end of the cartridge
- negative pressure is applied to the thumb ring by theadministrator, if blood enters the glass local anesthetic
cartridge (carpule) then the tip of the needle is insertedinto the lumen of a blood vessel
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Breech-Loading, Plastic,Cartridge-Type, Aspirating Syringe
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Self-Aspirating Syringes -incidence of positive aspiration is between 10-15% for some
injections-aspiration before injection of local anesthetic is accepted in
the practice of dentistry and is overlooked to a great extent
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-these syringes use the elasticity of the rubber diaphragmin the anesthetic cartridge to obtain the necessarynegative pressure for aspiration
- multiple aspirations are possible with very littleeffort due to a small metal projection that applies pressure to the rubber diaphragm when the thumbring is depressed negative pressure aspiration
-this type of aspiration is as reliable as using theharpoon to check for blood aspiration
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-Major factor for aspiration is the gauge of theneedle being used
-Most doctors using the harpoon-type syringe, retractthe thumb ring back too far and with excessive forcewhich frequently disengages the harpoon from the
silicone rubber stopper of the cartridge
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-1st generation self-aspirating syringes required a thumb diskwhich forced the operator to remove their index and middlefingers from the thumb ring to the thumb disk to aspirate
-2nd generation self-aspirating syringes have removed thisthumb disk
-Dentists only need to stop applying pressure to the thumbring for aspiration; aspiration becomes very easy to do
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Pressure Syringes-PDL (intraligamentary) injections make it possible to achieve single tooth pulpalanesthesia in the mandible when, in the past,complete IANB was necessary
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-pressure syringes can allow too easy of an administration oflocal anesthetic producing pain and post-operative discomfort
-pressure syringes are expensive > $200.00
-can shatter glass cartridge if too much pressure is applied too
quickly
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2000 psi Jet Syringes ($1,600)
-needle-less injection
-liquids forced through very small openings, called
jets, at very high pressure can penetrate skin or intactmucous membrane
-Syrijet is the most popular used today
-Syrijet holds any 1.8 ml cartridge of local anesthetic
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-Syrijet is calibrated to deliver .05 to .2 ml of solution at2000 psi; traditional syringes deliver 600 psi maximum
-primary use is to obtain topical anesthesia before using aneedle
-regional nerve blocks/supraperiosteal injections are stillnecessary
-topical anesthetics provide the same effect at a fraction of
the cost
-patients complain of soreness where the 2000 psi hit theirtissue
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Disposable Syringes Luer-Lok screw on needle Manual aspiration No cartridges
Definitely preferred when diphenhydramine isused as LA
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Safety Syringe
-Aspiration is possible
-some brands come with an autoclavable plunger and disposable self-contained
injection unit
-all dental safety syringes are made to be single use items
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-sliding the index and middle finger forward against thefront collar of the guard makes the needle safe by slidinga protective plastic sheath over the needle tip that locks into
place
-more expensive than reusable syringe units
-large disadvantage arises when it comes to re-injecting;complication ensues due to the needle tips newly acquired
safety coping
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CCLAD (Computer Controlled LocalAnesthetic Delivery) The Wand
-designed to improve ergonomics and precision of injectiontechnique
-foot activated delivery of solution using finger tip precision
-pen-like grasp offers increased tactile sensation-flow rates of solution delivery are computer controlled and remain
consis tent
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- operator is able to focus attention on the position of theneedle tip while the motor of the machine delivers local
anesthetic at a preprogrammed rate of flow
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-The Wand is less threatening to the patients visually
-allows two rates of delivery:1) Slow: .5 ml/minute2) Fast: 1.8 ml/minute
-releasing the foot rheo-stat will tell the machine toaspirate automatically; the aspiration cycle is
approximately 4.5 seconds
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THE NEEDLE
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Parts of Needle
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Important Factors Bevel Gauge
Length
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Problems Pain on insertion Breakage
Pain on withdrawal Injury
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CARTRIDGE
C t idg
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Cartridge
1.8 mL (United States) 2.2 mL (UK and Australia) should not be autoclaved stored at room temperature (21
C to 22 C (70 F to 72 F) should not soak in alcohol should not be exposed to
direct sunlight
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Problems Bubble in the cartridge Extruded stopper
Burning on injection Sticky stopper Corroded cap
Leakage during injection Broken cartridge
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Additional armamentarium Topical antiseptic Topical anesthetic
Applicator sticks Cotton gauze Hemostats
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