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61 Cards in this Set
- Front
- Back
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PDL Injections |
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PDL injections deposit solution where |
under pressure into the ligament forcing the drug through the bone to the apex Does not diffuse through the PDL follows the path of least resistance, which includes the thin, porous layer of alveolar bone proper and the spongy underlying bone surroundings the ligament and tooth. Must not enter the sulcus will black flow into the patients mouth |
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Where is the penetration site for the PDL |
Within the sulcus that surrounds a tooth Multiple sites are necessary |
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How many sites of penetration are usually required for a single rooted tooth |
2 sites(Mesial and Distal) |
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How many sites of penetration are usually required for multi rooted teeth |
3-4 sites |
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Which sites are the easiest to approach |
Mesial and Distal Maxillary= Buccal Mandibular= Lingual |
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What is the needle pathwat for the PDL injection |
Penetrates the JE using the tooth root as the guide |
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What is the depostion site of the PDL |
Any point in which the tip is wedged between the root of a tooth and the PDL Usually only able to bury the bevel 3-4mm This ensures an adequate depth withouth back flow Light blanching in the attached gingiva of the tooth being anesthetized , because it confirms that solution is being retained in the tissues |
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What is the needle selection for the PDL injection |
Any Size of Standard Needles Ultra short may be beneficial Long needles are bent to a 45 degree angle |
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What are the steps of performing the PDL injection (6) |
Pre anesthesia Select injection site based on ease of access and previous anesthesia Beven orientation is irrelevant Slip beneath sulcular epithelium through PDL attachment until resistance is met Deposit solution (Aspiration is unnecessary) Once tissues blanched and no back flow is confirmed deposit solution |
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How much solution is deposited for the PDL injection |
0.2 ml at a rate of 0.2 ml/20 seconds |
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How is anesthesia verified for the PDL injection |
Numbness when biting down Lack of response to gentle stimulation |
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Dr. MIKE recommeded orienting the bevel how and wh |
towards the roos slightly easier to penetrate to depth |
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Describe the PDL injection |
Most universal supplemental injection |
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What is the PDL also known as |
Intraligamentary Peridental |
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Why is the PDL considered Intraosseous |
it relies on diffusion of solution through bone |
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What are the uses of a PDL injection (4) |
For single teeth when other techniques have failed When widespread anesthesia is contraindicated When total doses need to be minimized When needle insertions into vascular regions may be a risk (Patients with bleeding disorders) |
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INTRAOSSEOUS INJECTIONS |
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What are the indications for the intraosseous injections |
same as the PDL injections Used on mandibular teeth rarely maxillary teeth If used on maxillary teeth, usually for endodontic tx |
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What is the field of anesthesia |
Pulps of teeth and supporting structures immediately adjacent to the sites of deposition |
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What are the anatomical factors |
Requires surgical access to spongy bone Utilizes a special device (Stabident) (X-tip) (IntraFlow) |
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What is the penetration site of the intraosseous injections (2) |
most apical extent of the attached gingiva between adjacent teeth Distal to the tooth you are working on |
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What are the guidelines for performing Intraosseous injections |
Pre anesthesia Mark the penetration site by blanching Perforate the cortical plate and deposit solution into cancellous bone |
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What should be avoided during the intraosseous injections |
Vasoconstrictors and observe all MRD recommendations |
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Why should vasoconstrictors be avoided during intraosseous injections |
Contristics the vessels Can cause an epi effect because the cancellous bone is more vascular |
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What are suggested volumes for the mandible 1 tooth 2 teeth 3 teeth 6 anterior teeth |
.45-0.6 ml ( 1/4) mesial distal to tooth 0.6-0.9m (1/4 to 1/2) Between the two 0.9 ml(1/2) distal to the middle tooth 0.9ml (1/2) One injection on each side between canines and premolars |
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What are suggested volumes in the maxilla teeth 1 tooth 2 teeth 4 adj teeth Up to 8 teeth on one side |
0.45ml (1/4) 0.45 ml (1/4) 0.9ml (1/2) 1.8ml 1 cartridge |
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INTRASEPTAL INJECTIONS |
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The intraseptal injections provide anesthesia to what |
the periodontium lingual to a tooth Particulary useful when palatal tissues require anesthesia and clinicians and/or patients wish to avoid palatal injections |
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The intraseptal injection is a substitute for what |
Substitute for PDL Injections when infection is present |
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What is the field of anesthesia for the intraseptal injections |
Localized and specific to one or two teeth Pulpal anesthesia of associated teeth is unreliable or very short term in nature |
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What are some anatomical factors |
Similiar to PDL, intraosseus and intrapulpal injections however does not provide reliable pulpal anesthesia |
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What is the penetration site for the intraseptal injections |
Center of the interdental papillae adjacent to the tooth to be treated Below the height of the interdental papilla but within the attached gingiva |
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What is the needle pathway for the intraseptal injections |
Through soft tissue until bone is contacted, then forced deeper into the interdental bone |
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What is the deposition site for the intraseptal injection |
Just inside the coritical plate of bone, however no perforation is made |
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What type of needle is used for intraseptal injections |
27 gauge short is recommended |
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Describe the injection procedure |
Insert needle at appropriate penetration site Orient bevel towards the apex Advance the needle until bony resistance is met Apply pressure to syringe the force the needle deeper |
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How much solution is administered for the Intraseptal injection |
0.2 to 0.4 ml (0.2ml/20 sec) If tissue does not blanch and blackflow is oberseved needle is not deep enough |
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INTRAPULPAL INJECTIOn |
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What is the field of anesthesia for the intrapulpal injection |
Confined to pulpal tissue |
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What is the anatomical factors for the intrapulpal injections |
Relies on direct access to the coronal or radicular pulp Requires endodontic access to have already been accomplished |
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What is the penetration site for the intrapulpal injection |
Pulpal tissue of the pulp chamber ( within root canal) |
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What is the deposition site for the intrapulpal injection |
Wedged into the chamber or root of the tooth |
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Anesthesia for the Intrapulpal injection is provided in two ways what are they |
Pressure Direct action of drug |
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Describe the injection procedure for the intrapulpal injection |
After endodontic access or partial access has been accomplished, the injection is performed Patient should be warned that there may be a brief but intense pain experienced |
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GOW GATES INJECTIOn |
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What is the Gow gates injection |
True mandibular blocks they routinely anesthetize the full extent of a mandibular quadrant |
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The Gow Gates injection will anesthetize structures innervated by what (6) |
Inferior alveolar Mental incisive Lingual Mylohyoid Auriculotemporal nerves to the midline |
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What is the penetration site for Gow Gates |
Established using extra and intraoral landmarks In buccal mucosa membrane, directly posterior to maxillary second molar At level of mesiolingual cusp |
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What is the needle pathway |
Through thin mucosal tissues and limited amounts of superficial fascia Typically less resistance to forward movement is encountered in the upper portion of the pterygomandibular space |
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What is the deposition site for Gow Gates injection |
Anterolateral surface of neck of condyle
Just below insertion of lateral pterygoid muscle At highest point in pterygomandibular space of all mandibular block techniques |
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What is the needle selection for Gow Gates |
25 gauge long needle is recommended |
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Describe the rate of aspiration |
positive aspiration is considered relatively low (2%) but some sources place this rate much higher |
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What are the two key landmarks |
A line visualized from intertragic notch to labial commissure The Height or most occlusal aspect of the mesiolingual cusp of the second molar |
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what technique is used |
WIDE OPEN |
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Describe the injection procedure for Gow Gates (6) |
Mouth must remain wide open during the entire procedure Retract lip laterally Keep thumb on coronoid process, place index finger over the intertragic notch ( this line provides the upward orientation angle for the syringe) Penetrate tissue and advance slowly until gentle contact with bone is made Withdraw slighly, aspirate, administer Sit patient upright and ask them to hold mouth open for one minute |
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What is the insertion depth |
Varies but often 25 mm |
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How much of a cartridge of solution is administered in the Gow Gates |
1 cartridge |
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How do you confirm anesthesia for the Gow Gates injection |
A sense of numbness of buccal and lingual soft tissues of the ramus and body of the mandible, the lower lip and chin, and the tongue Pulps and periodontium of teeth in quadrant |
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Describe the onset |
Onset is slow and increased quantities may need to be administered |
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What is the common cause of injection failure for Gow Gates |
Lack of experience Declaring failure too soon |
