Insturments & techniques of LA

Requirements of good LA
Good accessability Good light Proper equipments Sharp gauge Slow injection even under sedation...this will decrease pain & prevent the direction of the solution rapidly to the heart in case of intravascular injection
2

Local anesthesia kit

Anesthetic Gel

Gauze Syringe Cotton tip

Anesthetic solution= carpool

Needles
Short Long
3

Local anesthesia

Cardboard needlecap-holding device makes recapping needles safer

4

Before the injection, the patient needs topical anesthesia

Advantages of TA
Decreases the risk of toxicity Provides comfortabel anesthesia

Types of topical anesthesia

Spray Ointment Gel Oral rinse anesthesia

MUST DRY FIRST, will not work with saliva

Spray
Spray into the cotton roll Place over dry mucosa Wait for 1 min

Ointment

Gel
Effective as the ointment Applied to the cotton roll Then apply on a dry mucosa for 1 min

Oral rinse anesthesia

Used for very sensitive patients that do not allow any touch in the mouth Let the patient rinse for 2 min Then you can give the injection

10

Insturments of LA
Mirror: for retration Probe: for insturmentation Syringe Needle; short& long

11

Types of syringes according to manufactures

12

Disposable syringes Single use

13

Sterizable syringes Multiple use

Made of metal\lasts for long Firm No breakage if the patients bites suddenly

14

Types of syringes according to the method used

Aspirating syringe, for nerve block Infilteration syringe

15

What is aspiration?
For the nerve block, always aspirate (pull in) to ensure your needle is not inside the artery If inside blood will come in the carpule If nothing, the needle is in the right place
16

17

The carpool

18

Needles
Short Long Bevel towards the tissue

19

Types of LA
Local infiltration
Small terminal nerve endings in the area of the dental treatment are flooded with LA solution Mainly in maxilla

Nerve block
Local anaesthetic solution is deposited close to the main nerve block, usually at a distance from the operation site Mainly in mandible
20

Choice the method of LA technique

The ideal method is the
Simplest Least traumatic Require a minimum amount of LA solution This depends on several factors.....

21

Factors that affect the choice of the method of LA technique

The area to be anesthetised Type of tissue to be anesthetized Potency & duration of LA Age of the patient Presence of infection?? Need of haemostasis Systemic condition of the patient
22

MAXILLARY TECHNIQUES OF LA
Local infiltration Nasopalatine nerve block Greater palatine nerve block

23

Local infiltration
Very useful for the maxilla bcz of its porosity For the mandible its difficult bcz denseness In the mandible, infilteration can be used for young individuals, 6 anterior teeth, teeth with resorbed bone

24

Infiltration in the maxilla

25

Local infiltration
Indications: 1 or 2 maxillary teeth Will aneasetize the pulp, alveolar bone, buccal periostium, connective tissue, mucose membrane of the infilterated teeth Contraindication:
Presence of infection
26

Local infiltration
The needle should be 45 degree to tooth, bone Bevel towards bone Opposite to the tooth Inserted the whole depth of the mucobuccal fold close to the root apex

27

Nasopalatine nerve block

28

Greater palatine nerve block

29

MANDIBULAR TECHNIQUES Of LA
IANB Mental nerve block

30

Inferior alveolar nerve block

The primary injection for the mandible Always associated withbuccal nerve blocks It provides
Pulpal anaesthesia of mandibular teeth Soft and hard tissue of the mandible

31

Inferior alveolar nerve block

The foramen can be palpated half way between the last (3rd) molar and the angular process The needle is directed with the forefinger and inject the solution
32

Mental nerve block

The mental nerve emerges from the mental foramen, which lies between the pms Indications: anterior aspect of the mandible

33

Other LA techniques
Can be used as a suppliment to other techniques, infiltration or nerve block For the mandible or the maxilla 2 main types: intrapulpal & interligamnetary

34

Intrapulpal injection
Indications: after pulp exposure, sever pain the pt will jump!! The effect is in 2 ways:
Pharmacological action of LA By the applied pressure

35

Intraligamintary (PDL) injection

A short needle should be bended first The needle is placed firmly between the PDL and the tooth to be aneasthetized Insert the needle bevel towards the tooth 0.2-0.3 ml is deposited at all sites of the tooth
36

Intraligamintary PDL injection

37

EXTRA ORAL TECHNIQUES

Upper lip aneathesia Lower lip aneathesia Infraorbital nerve block

38

Wy do we need EXTRAORAL technique??

Trauma Severe infection

39

Upper lip anesthesia

Upper lips are anesthetized from two points, one on each side of the angle of the mouth 5 to 10 mL of anesthetic is injected along two lines in the direction of the nasal alae.

40

Lower lip anesthesia

The needle is injected at the midpoint of the chin and soft tissues are infiltrated obliquely upward toward the angle of the mouth A total of 10 to 15 mL of anesthetic generally is required.

41

42

Infraorbital Nerve Block

The infraorbital nerve supplies
The central area of the face (upper lip, cheeks, the external nose)

The needle is inserted approximately 1 cm inferior to the infraorbital foramen and advanced upward toward the foramen The needle is directed upward and laterally to avoid passing through the foramen into the orbit
43

Infraorbital Nerve Block

44

Dont forget..!!

45

Remember Dont show the patient your needle...

46

Thank you..

47