LA part 6

1
Chapter 6
Dr/Atef fouda
Prof. Oral & Maxillofacial Surgery
Cairo University
Egypt
New trends in
dental local
anesthesia

Atef A. Fouda.
Prof of Oral & Maxillofacial Surgery
Cairo University

3
Chapter V
New trends in dental local anesthesia

Goals
Decrease pain during injection.
Increase efficiency of LA agent.
Decrease post-op discomfort.
22 February 2017 Atef Fouda, Prof. of Oral and maxillofac.Surg. & Local Anesthesia.
Modification of the techniques.
Increase safety.

Decrease pain during injection.
22 February 2017 Atef Fouda, Prof. of Oral and maxillofacial Surg. New trends on Local Anesthesia.
Physical means during injection
Cold application at injection site.
Apply pressure while injection.
Warm the anesthetic solution.
Pharmaceutical:
Use of topical anesthesia

BRAIN
Apply pressure
Or
Cold
Gate control
theory

VIBRO TACTILE:
VIBRATION AT THE INJECTION SITE.

VibraJect:
Vibration of the needle.

Needle free injection

Syrijet holds any 1.8 ml cartridge of
local anesthetic
liquids forced through very small
openings, called jets at very high
pressure [2000 psi] can penetrate
skin or intact mucous membrane.
This technique is particularly effective
for palatal injections.
needle-less injection
Syringe modification:
Jet syringe

Reduced doses of LA.
Less unwanted numbness.
Light in weight.
Easy to use.
Less fear from patient side.
No infected sharp materials “environment friendly”
long life
Needle free injection

Syrijet
*Jet Syringes ($1,600)

Centbucridine:
It is a quinolone derivative with local anesthetic action. It has
vasoconstricting and anti-histaminic properties.
Centbucridine
in a concentration of 0.5% can be used effectively for infiltration
and nerve blocks with an anesthetic potency 4-5 times greater
than that of 2% lignocaine with longer duration of anesthesia that
last up to 2 hours.
It produced no side effects or toxic reactions and confirmed its
safety for use in medically compromised patients where Lignocaine
or adrenaline is contraindicated.
Local anesthetic drugs

Dentipatch:
a patch that contains 10-20% lidocaine is placed on the dried
mucosa for 15 minutes.
Recommended for use in achieving topical anesthesia for both
maxilla and mandible.

Phentolamine: “under investigation”
Drug used for Reversal of effects of local anesthetic solutions. It is
available as a cartridge, It is administered following dental
procedure using the same location and techniques (infiltration /
block injection) employed for the administration of local
anesthetic solution.
This novel molecule is a recent innovation in reversal of local
anesthesia that will immensely benefit child patients and others
with special needs to prevent post-operative anesthesia induced
injuries.

INCREASE SAFETY.

Ultrasafe Syringe

2/22/2017 7:17 PM Atef Fouda, Prof. of Oral and maxillofac.Surg. & Local Anesthesia.

Local anesthetic techniques
Branches from IAN
IAN

Site of injection
IANB

Site of Gow-
gates
technique

IA nerve
Mylohyoid nerve
Lingual nerve
Long buccal nerve
Gow-Gates T

2002

2011

2013

Success rate 95% compared to 80% IA block.
Positive aspiration 2% compared with 10-15% IA NB.
Anesthesia extended to accessory innervations.
In most of cases no need for separate Long buccal
anesthesia.
Gow-Gates mandibular nerve block

Anterior, Middle superior alveolar NB.
Infra-orbital NB.

A
S
A
M
S
A
A
M
S
A
P
S
A
M

Technique:
•Area of insertion in
mucobuccal fold
higher than root
length at the area of
lateral incisor and
canine.
•Inject about 1.2ml
Anterior superior Alv. N.

Technique:
•Area of insertion
in mucobuccal fold
higher than root
length at the area
of premolar
region.
•Inject about
1.2ml

27-Nov-16 Atef Fouda, Prof. of Oral and maxillofac.Surg. & Local Anesthesia.

Technique:
1-Palpate infra-orbital notch
extra-orally.
2-place thumb or index finger on
that region.
3-Retract the upper lip and buccal
mucosa.
4-Area of insertion is 4-5 mm
from mucobuccal fold of the 1st
premolar/canine area.
5-Contact bone at infra-orbital
region.
6-Inject 0.9-1.2cc of local
anesthetic solution.
Infra-orbital NB.
Anterior, Middle superior alveolar NB. [ASMA].

[MSA]
[AMSA]

Success rate of pulpal anesthesia after AMSA :
17% central incisors.
23% lateral incisors.
60% canine.
40% first premolar.
66% second premolar.
Inactivation of muscles of facial expression.
Lip numbness.[Trauma-inability for eating & drinking].
Disadvantages of infra orbital NB:
Anterior, Middle superior alveolar NB.Infra-orbital NB.

Proximal
Distal
MOLARS
PRE-MOLARS
Anterior
Terminal branches
Maxillary N.
Posterior S.A.
MSA
ASA

2010

2012

Success rate of pulpal anesthesia after AMSA :
17% central incisors.
23% lateral incisors.
60% canine.
40% first premolar.
66% second premolar.
In activation of muscles of facial expression.
Lip numbness.[Trauma-inability for eating & drinking].
Disadvantages of infra orbital NB:

Central incisor
Lateral incisor
Premolars
canine

Computer Controlled Local Anesthetic Delivery Devices – CCLAD.

Base unit consists of a microprocessor and connects to the foot
pedal and Hand piece assembly that accepts the LA cartridge. LA
solution from the cartridge passes through the micro bore tubing in
the Hand piece assembly and attached needle into the target tissue.
Base unit,
Foot pedal and
Disposable Hand piece.
The system has 3 components:

foot pedal controls the rate of injection and if aspiration feature is
enabled, it prevents inadvertent intravascular injections.
Slow: 0.005ml/s – needle insertion, PDL injection, Palatal
administration.
Fast: 0.03ml/s – buccal infiltrations, nerve block
Rate of Injection:

1-Painless injection:
Ability to administer small quantities of LA solution continuously during
needle insertion, which anesthetizes the tissue immediately ahead of the
advancing needle.
2-Less fear of injection.
Pressure anesthesia was more accepted and preferred by 70% of the patients
than traditional needle anesthesia (20%). Both needle and pressure anesthesia
was equally effective for carrying out the dental procedures.
3- Ability to perform newer techniques
such as palatal approach to anterior superior alveolar block.
Advantages of CCLADs: The benefits of these devices is
attributed to

Intra-oral techniques
Extra-oral technique

2/22/2017 7:17 PM
Atef Fouda, Prof. of Oral and
maxillofac.Surg. & Local Anesthesia.

Ultrasound-guided
nerve block

Proper nerve visualization:
"Ultrasound guidance enables us to see the nerve and to
direct the needle to the nerve and avoid other structures
the needle as it is being advanced in real-time.
Ultrasound Guidance Improves Anesthesia
" Such visualization also
reduces the likelihood of the
needle hitting another
anatomical structure such as
blood vessels.

Ability to see anesthetic spread:
With ultrasound guidance, the anesthesiologist can see the spread
of the local anesthetic as it is occurring. "You get instant feedback
showing that you are surrounding the specific nerve with local
anesthetic.
Proper directioning of the needle:
This benefit also allows the
anesthesiologist to withdraw and reinsert
the needle as necessary to reach nerve
roots that may not have been bathed in
anesthetic during the first application.

Faster onset and longer duration: of anesthetic effect:
Because the anesthesiologist can direct the anesthetic to the target
nerve, the desired anesthetic effect begins sooner and lasts longer.
Use of less anesthetic
solution:
Because the target nerve can be
accessed more quickly and
specifically, the anesthesiologist
can achieve sufficient blockage of a
nerve using less local anesthetic.

SUMMARY
The three main nerves of the face – Trigeminal– can easily be
blocked.
Using ultrasound-guidance is recommended.
Circling the nerve with local anaesthetic gives the greatest chance
of block success.

LA part 6

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LA part 6

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