Anesthesia in

Endodontics

by
AHMED
LABIB

Pain

is an unpleasant sensation
that is experienced by the patient;
however, an interpretation of pain
always exists, which is
disproportionate to the
stimulation.

Methods of pain control:

Raising

the pain threshold by using drugs

of analgesic nature.

Using

cortical depressants (general

anesthesia).

Using

subcortical depressants either

barbiturates or non-barbiturates sedation.

 Blocking

the pathway of painful

stimuli by means of local anesthesia,
which is considered one of the effective
means of relieving dental pain.

 Local

anesthetic agents are esters of

amino benzoic acid ,either:

Para group (as Novocaine,

Monocaine, Pentocaine).

Meta

group (as Uracaine, Primacaine).

Non-ester types

of local anesthesia are

also available such as Xylocaine and
carbocaine.

 The

problem of inadequate pain

control during endodontic treatment is
explained through alterations in the
pulp and periapical tissues.

 Inflammation

of pulpal and periapical

tissues leads to decrease of tissue pH below
normal .

This decreased pH will lead to incomplete

dissociation of the anesthetic solution
resulting in weak anesthetic effect.

Techniques of local anesthesia

in endodontics

Major techniques of anesthesia

1-Local infiltration anesthesia

Technique
The

tip of 25 27-gauge needle is

pushed through the mucosa until the
fibrous periosteal tissue overlying
the bone is pierced in the area of
root apex.

Then

the anesthetic solution is

deposited beneath the periostium.

2-Regional nerve block

 Nerve

block anesthesia is achieved

by depositing the local anesthetic
solution close to the main nerve
trunk.

Nerve

block anesthesia is more

successful when the infiltrating
solution (anesthetic solution) is
deposited some distance from the
inflamed or infected tissues.

II- Supplementary techniques

 Complete

anesthesia of pulp
tissue is necessary if vital
pulp tissue is to be removed
without pain. This requires
supplementary injections
beside the routine
infiltration or nerve block
anesthesia.

Intraseptal or Intraosseous-1
:injection
It

is accomplished by passing the needle tip

through the previously anaesthetized gingival
papilla and thin cortical plate, penetrating into
the cancellous bone of inter dental septum.
Few drops of anesthetic solution are deposited
under pressure.
Two separate inter septal injections are
usually used, one mesial and one distal to the
tooth to be anaesthetized.

 The

angulation of the needle should be 45 to

the long axis of the tooth.

The

needle should contact bone at the height

of the interdental crest of bone where the
cortical layer is thinnest and most easily
penetrated, by rotation of the needles as it
pressed into the crystal bone.

 Perforating

the alveolar plate of bones using

Busch power reamer if the dentist cannot
penetrate the bone by the needle. Through this
entrance, a needle can enter the cancellous
bone and a solution deposited under pressure
to anaesthetize the particularly refractory
cases.

:Interpulpal injection-2
This

technique depends on the injection of the

anesthetic solution into the pulp tissue itself.

Profound

anesthesia will only be obtained if a

drop of anesthetic solution is deposited
directly into the partially anesthetized pulp.

The

tooth is isolated and any debris in the

area of the pulp exposure is removed.

 A sharp

explorer is used to pinpoint the

exposure, then the needle deliver few drops
of anesthetic solution into the pulp tissue.

This

profoundly anesthetizes the pulp

tissue.

 Additional

intrapulpal injections are

necessary to anaesthetize
completely the deeper tissue within
the root canal(s); the needle must fit
tightly in the canal.

Periodontal ligament injection-3

:(intraligamental) technique
Technique
The needle is inserted at 30 angle, wedged with
force into the periodontal ligament space
between crystal bone and root surface.
The fingers of the operator should support the
needle to prevent buckling, and then the
anesthetic solution is injected with maximal
pressure on mesial and distal surfaces of the
treated tooth.

Thank you, merci,

gracias, obrigado,
grazzie, danke, arigato,
kitos, shukran, danku,
shishie, gracias, moltes
gracies, yuspajara,
spassiba, dankie, tak,
eskerrik asko, tesekkr,
motshakeram, efkaristo,
dziekuje, aguije, maururu,
ramsammita, salamat,

THANK YOU