periodontal ligament injection indications anesthesia for 1-2 teeth anesthesia for 1-2 teeth...
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Periodontal Ligament InjectionPeriodontal Ligament Injection
IndicationsIndications
Anesthesia for 1-2 teethAnesthesia for 1-2 teeth
Bilateral mandibular treatment neededBilateral mandibular treatment needed
Isolated treatment in childrenIsolated treatment in children
Nerve blocks contraindicated Nerve blocks contraindicated (hemophiliacs)(hemophiliacs)
Aid diagnosis of mandibular painAid diagnosis of mandibular pain
Periodontal Ligament InjectionPeriodontal Ligament Injection
ContraindicationsContraindications
Primary teethPrimary teeth
Infection/inflammationInfection/inflammation
Psychological need for “feeling numb”Psychological need for “feeling numb”
Periodontal Ligament InjectionPeriodontal Ligament Injection
AdvantagesAdvantages
Avoid unecessary areas of anesthesiaAvoid unecessary areas of anesthesia
Minimizes dosage of anestheticMinimizes dosage of anesthetic
Supplements partially effective blockSupplements partially effective block
Periodontal Ligament InjectionPeriodontal Ligament Injection
DisadvantagesDisadvantages
Administration difficult in some areasAdministration difficult in some areas
May cause post-op discomfort, tooth May cause post-op discomfort, tooth extrusion, &/or tissue necrosisextrusion, &/or tissue necrosis
Excess pressure may break cartridgeExcess pressure may break cartridge
Periodontal Ligament InjectionPeriodontal Ligament Injection
TechniqueTechnique
Insert needle on long axis of toothInsert needle on long axis of tooth
Deposit 0.2 ml slowly (30 secs)Deposit 0.2 ml slowly (30 secs)
Should feel resistance to depositionShould feel resistance to deposition
Intraosseous InfiltrationIntraosseous Infiltration
IndicationsIndications
Local factors preclude adequate anesthesiaLocal factors preclude adequate anesthesia
dense cortical platedense cortical plate
infection / inflammationinfection / inflammation
severe pulpal irritationsevere pulpal irritation
Intraosseous InfiltrationIntraosseous Infiltration
Injection siteInjection site
Lateral - distil to tooth treatedLateral - distil to tooth treated
avoid mental foramen areaavoid mental foramen area
Vertical - for edentulous areaVertical - for edentulous area
on alveolar crest, mesial or distilon alveolar crest, mesial or distil
to treatment areato treatment area
Intraosseous Infiltration Intraosseous Infiltration Stabident SystemStabident System
TechniqueTechnique
Apply topical, consider local infiltrationApply topical, consider local infiltration
Push perforator through tissue to bonePush perforator through tissue to bone
Activate in short spurts until resistance is Activate in short spurts until resistance is lost ( approx. 2 secs)lost ( approx. 2 secs)
Hold syringe in pen grip, into perforationHold syringe in pen grip, into perforation
Inject “plain” anesthetic (0.6 ml-1-2 teeth)Inject “plain” anesthetic (0.6 ml-1-2 teeth)
Mylohyoid Nerve InfiltrationMylohyoid Nerve Infiltration
Mylohyoid nerve may provide sensation to Mylohyoid nerve may provide sensation to molar teethmolar teeth
May be used as a supplement to IAN blockMay be used as a supplement to IAN block
Supplements lingual anesthesiaSupplements lingual anesthesia
Mylohyoid Nerve InfiltrationMylohyoid Nerve Infiltration
TechniqueTechnique
Retract tongue mediallyRetract tongue medially
Penetrate mucosa of floor of mouth by Penetrate mucosa of floor of mouth by alveolusalveolus
Aspirate, deposit 0.5 ml solutionAspirate, deposit 0.5 ml solution
Extraoral Nerve BlocksExtraoral Nerve Blocks
MaxillaryMaxillary
InfraorbitalInfraorbital
MandibularMandibular
Extraoral Nerve BlocksExtraoral Nerve Blocks
IndicationsIndications
InfectionInfection
Inability to open mouthInability to open mouth
Presence of pathologyPresence of pathology
TraumaTrauma
Diagnostic or Theraputic reasonsDiagnostic or Theraputic reasons
Extraoral Maxillary/Mandibular Extraoral Maxillary/Mandibular Nerve BlockNerve Block
Target areaTarget area
Foramen Rotundum / Foramen OvaleForamen Rotundum / Foramen Ovale
Penetration PointPenetration Point
Skin overlying sigmoid notchSkin overlying sigmoid notch
LandmarksLandmarks
Pterygoid platesPterygoid plates
Extraoral Maxillary/Mandibular Extraoral Maxillary/Mandibular Nerve BlocksNerve Blocks
ArmamentariumArmamentarium
20-22 gauge spinal needle (3-5 inch)20-22 gauge spinal needle (3-5 inch)
3 ml syringe3 ml syringe
Alcohol skin prepAlcohol skin prep
Extraoral Maxillary/Mandibular Extraoral Maxillary/Mandibular Nerve BlocksNerve Blocks
TechniqueTechnique
Prep skin overlying sigmoid notch,Prep skin overlying sigmoid notch,
Anesthetize skin and masseter muscleAnesthetize skin and masseter muscle
Pass spinal needle through sigmoid notch until Pass spinal needle through sigmoid notch until the pterygoid plate is contactedthe pterygoid plate is contacted
Extraoral Maxillary/Mandibular Extraoral Maxillary/Mandibular Nerve BlocksNerve Blocks
TechniqueTechnique
Withdraw, then re-direct anterior/superior to Withdraw, then re-direct anterior/superior to 4.5 cm for maxillary block4.5 cm for maxillary block
Re-direct posterior/superior toward Re-direct posterior/superior toward Foramen Ovale for mandibular blockForamen Ovale for mandibular block
Extraoral Maxillary/Mandibular Extraoral Maxillary/Mandibular Nerve BlocksNerve Blocks
TechniqueTechnique
Remove styletteRemove stylette
Place filled syringe on spinal needlePlace filled syringe on spinal needle
Aspirate and deposit 3 ml of anesthetic Aspirate and deposit 3 ml of anesthetic solutionsolution
Extraoral Infraorbital Nerve Extraoral Infraorbital Nerve BlockBlock
LandmarksLandmarks
Infraorbital rimInfraorbital rim
Infraorbital foramenInfraorbital foramen
PupilPupil
Extraoral Infraorbital Nerve Extraoral Infraorbital Nerve BlockBlock
TechniqueTechnique
Palpate foramen- 6 mm below rim on Palpate foramen- 6 mm below rim on pupillary linepupillary line
Prep skinPrep skin
Penetrate skin and contact bonePenetrate skin and contact bone
Redirect until foramen enteredRedirect until foramen entered
Advance 2-3 mm and deposit solutionAdvance 2-3 mm and deposit solution