Local Anesthesia in Endodontics
Michael Moreno, DMDSeptember 15th, 2009
Local Anesthesia in Endodontics
Local Anesthesia – Definition
A loss of sensation to pain in a specific part of the body without loss of consciousness.
Local Anesthesia in Endodontics Types of injections used:
Infiltration Blocks PDL Intrapulpal Intraosseous
Local Anesthesia in Endodontics Infiltration
Anesthetic injected in the mucosa
Makes contact with bone
Must diffuse through spongy bone to reach the nerve endings (cortical layer must be thin)
i.e. Maxilla in adults, both jaws of children
Local Anesthesia in Endodontics
Retract lip and shake Advance 3-4mm, and deposit 0.5cc to start
Local Anesthesia in Endodontics The Mandibular Nerve
When correctly positioned, the local anesthetic is deposited above the lingula and the mandibular foramen
Inferior alveolar nerve
Lingual n.
Local Anesthesia in Endodontics Retract the lip Place thumb on the
anterior border of the ramus
Approach from the opposite side (premolar area)
Local Anesthesia in Endodontics Advance until you hit
bone Withdraw 1mm Aspirate Inject ¾ of carpule
SLOWLY 25g needle is
recommended
Local Anesthesia in Endodontics Even when properly administered, it can
still have 15-20% failure Positive aspiration in 10-15% of cases
Local Anesthesia in Endodontics Gow Gates – V3 block
Inferior alveolar nerve Lingual Mylohyoid Mental Incisive Auriculotemporal Buccal
Local Anesthesia in Endodontics
Target area is the neck of the condyle
Local Anesthesia in Endodontics
Needle is placed just below the MP cusp of the maxillary 2nd molar
Inject slowly
Local Anesthesia in Endodontics Supplemental injections:
PDL Syringes on the market: Peripress and Ligmaject
Local Anesthesia in Endodontics Anesthesia is achieved due to the solution
diffusing through the marrow spaces in intraseptal bone
Patients may experience post op discomfort for 2-3 days
Although specialized syringes are available, there is usually no need for them – however, significant force is required
Local Anesthesia in Endodontics
Intraosseous Injection – Stabident, X-Tip, Intraflow
Local Anesthesia in Endodontics
Local Anesthesia in Endodontics
Advantages of intraosseous injections
More predictability of achieving anesthesia
Less post op discomfort
The gingival ligaments are not affected
Local Anesthesia in Endodontics
Local Anesthesia in Endodontics
Intraosseous anesthesia – latest news
The Intraflow System by Pro-Dex
Local Anesthesia in Endodontics Claims to provide great pulpal anesthesia by itself Great for emergencies Great to anesthetize “hot teeth”
Intrapulpal anesthesia
Pinpoint exposure of the pulp The needle tip is inserted in the exposure Backpressure is built up into the chamber, and
the pressure is causing anesthesia Warn your patients
Local Anesthesia in Endodontics
A note on anesthetics
Lidocaine is the most commonly used anesthetic
Amide anesthetic, metabolized in the liver
In conjunction with epinephrine, it provides 30-60 mins of pulpal anesthesia, and 120-240 mins of soft tissue anesthesia
Local Anesthesia in Endodontics
Septocaine (articaine)
Studies show the same efficacy as lidocaine
No significant difference in the achievement of analgesia
Local Anesthesia in Endodontics
Oraverse Phentolamine
Mesylate
For use in patients ages 6 and up 33lbs and up
Reverses effects of local anesthetic in approx. half the time
Questions?
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