Conservative Dentistry 4 : 5-Managment Of Local Anastehsia / First Semester

Front 1

What are the factors that affect endotinc anastehsia ?

Back 1

Apprehension and Anxiety
Fatigue
Tissue inflammation (hyperalgesia)
Previous unsuccessful anesthesia ( psychologic management, supplemental techniques)

Front 2

What are the conventional anasthesia ?

Back 2

Maxiallary anasthesia

mandibular anasthesia

Front 3

what are the supplemental anastehsia ?

Back 3

Periodontal Ligament Injection
Intraosseous Anesthesia
Intrapulpal Injection

Front 4

Success of local anesthesia is variable, a number of factors affect the anesthesia, such as ... ?

Back 4

The type of the procedure
Arch location
Anxiety level
Presence of inflammation

Front 5

Talk about Mandbidular anasthesia

Back 5

Anesthetic agent ( 2% lidocaine with 1:100,000 epinephrine )Related FactorsLip numbness (5-7 min)Onset of pulpal anesthesia ( 10-15 min)Duration ( 2 ½ hrs)Success ( M, PM > Inc)

Front 6

What are other alternative techinques for mandbiualr anastehsia ?

Back 6

Increasing the volume
Alternative injection locations
Infiltration injections
Long- acting anesthesia
Accessory innervation
Cross innervation
Pain and inflammation

Front 7

talk about maxaillary anastehsia

Back 7

Lip numbness (quick)Success and failure ( infiltration> ID block)Onset of pulpal anesthesia (3-5 min)Duration ( 30-60 min)

Front 8

What are other alternative for conventional anastehsia ?

Back 8

Volume of solution
Alternative solution
Other techniques
Pain and inflammation

Front 9

What are the indction of using supplemental anastehtic methods ?

Back 9

The supplemental injection used if the standard technique is not effective

Front 10

When is it useful to repeat conventional techinque ?

Back 10

It is useful to repeat the conventional technique only if the patient is not exhibiting the classic signs of soft tissue numbness

Front 11

talk about Peridontal Ligment Injection (part 1 )

Back 11

Useful if conventional is unsuccessful
Particularly if rubber dam is in place
Standard syringe or pressure syringe
30,27,25 gauge short needle
The needle is inserted into the mesial gingival sulcus at a 30 degree angle

The needle is supported, positioned with maximum penetration( wedged between root and crestal bone)
Heavy pressure is slowly applied for 10-20 sec
Back pressure is important
The injection is then repeated on the distal surface (0.2 ml on each side)

Front 12

Describe the mechinesim of action of Periondtal ligment injection

Back 12

Mechanism of action: the PDL injection forces anesthetic solution through the cribriform plate into the marrow spaces and into the vasculature in and around the tooth.
The primary route is not the periodontal ligament, the mechanism of action is not related to direct pressure on the nerve

Front 13

talk about Peridontal Ligment Injection (part 2)

Back 13

Onset of anesthesia (rapid, no waiting)
Success ( primary injection good, as supplemental good)
Duration 10-20 min
Postoperative discomfort ( mild from 14 hr-3days)

Front 14

Talk about the intra-osseuous anastehsia

Back 14

The IO injection allows placement of local anesthetic directly into the cancellous bone adjacent to the tooth

Front 15

What are the systems for IO injection ?

Back 15

Two components system,\
slow speed handpiece - driven perforator
matching 27-gauge
ultrashort injector needle

Front 16

Describe the techinque of IO injection

Back 16

The area of perforation and injection is on a horizontal line of the buccal gingival margins of the adjacent teeth and a vertical line that passes through the interdental papilla distal to the tooth to be injected. A point approximately 2mm below the intersection of these lines is selected as the perforation site.
Slow injection over a period of 1-2 min

Perforator breakage (rarely)
Selection of perforator site ( distal except 2nd molar mesial)
Onset of anesthesia ( no waiting period)
Success ( primary injection good, supplemental injection excellent )

Failure (if the anesthetic solution squirts out of the perforation, redo the perforation)
Duration ( primary injection less than 1 hr, supplemental very good duration)
Postoperative problems ( no or mild pain)

Front 17

What are the indcitons for intra-pulpal injection ?

Back 17

On occasion the IO and PDL injections do not produce profound anesthesia
IP injection shouldn’t be used without trying other supplemental method, it is very painful

Front 18

Talk about Intra-pulpal injection

Back 18

The patient must be informed that there will be a sharp sensation
Strong back-pressure has been shown to be the major factor in producing anesthesia
Duration of pulpal anesthesia ( 15-20 min)

Front 19

Describe the techinque of intra-pulpal injection

Back 19

Either to inject each canal after the chamber is unroofed, or give the pulp chamber after stoppering the access with cotton pellet, wax, rubber…..
A standard syringe with a bent short needle is used.
Fingers support the needle shaft to prevent buckling


The needle is positioned in the access opening and then moved down the canal, while slowly expressing the anesthetic to the point of wedging
Maximum pressure is applied slowly in to the syringe for 5-10 sec.
If there no back- pressure go deeper, change gauge