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Dental Anesthesia Dental Anaesthesia Techniques & Complications

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Dental Anesthesia Dental Anaesthesia Techniques & Complications

  1. 1. Dental Anesthesia Dental Anaesthesia Techniques & Complications Lecturer Hamed lbrahim Mohammed B.D.S,MSc Oral and Maxillofacial
  2. 2. Specific Local Anesthetic Agents Esters & Amides
  3. 3. • The ester linkage is primarily hydrolyzed by plasma cholinesterases before going through further metabolism by the liver. The esters are excreted by the kidneys, nearly all as metabolites.
  4. 4. INFERIOR ALVEOLAR NERVE BLOCK The inferior alveolar nerve block (IANB), commonly (but inaccurately) referred to as the mandibular nerve block, is the most frequently used and possibly the most important injection technique in dentistry
  5. 5. Areas Anesthetized
  6. 6. Area of insertion mucous membrane on the medial side of the mandibular ramus, at the intersection of two lines: one horizontal, representing the height of injection, and the other vertical, representing the anteroposterior plane of injection
  7. 7. BUCCAL NERVE BLOCK Nerve Anesthetized. Buccal (a branch of the anterior division of the mandibular) Area Anesthetized. Soft tissues and periosteum buccal to the mandibular molar teeth
  8. 8. THE GOW-GATES TECHNIQUE
  9. 9. VAZIRANI-AKINOSI CLOSED- MOUTH
  10. 10. MENTAL NERVE BLOCK
  11. 11. INCISIVE NERVE BLOCK
  12. 12. Local infiltration Small terminal nerve endings in the area of the dental treatment are flooded with local anesthetic solution. Field block Local anesthetic solution is deposited near the larger terminal nerve branches so the anesthetized area will be circumscribed, preventing the passage of impulses from the tooth to the central nervous system Nerve block Local anesthetic is deposited close to a main nerve trunk, usually at a distance from the site of operative intervention. Posterior superior alveolar, inferior alveolar, and nasopalatine injections are examples of nerve blocks.
  13. 13. Supraperiosteal Injection Other Common Name: Local infiltration, paraperiosteal injection Nerves Anesthetized: Large terminal branches of the dental plexus Areas Anesthetized: The entire region innervated by the large terminal branches of this plexus: pulp and root area of the tooth, buccal periosteum, connective tissue, mucous membrane.
  14. 14. Local Palatal Infiltration The administration of local anesthetic for the palatal anesthesia of just one or two teeth is common in clinical practice. When a block is undesirable, local infiltration provides effective palatal anesthesia of the individual teeth to be treated. Contraindications include acute inflammation and infection over the area to be anesthetized. A 25- or 27- gauge short needle is preferred for this technique.
  15. 15. Posterior Superior Alveolar Nerve Block Other Common Names: Tuberosity block, zygomatic block Nerves Anesthetized. Posterior superior alveolar and branches Areas Anesthetized 1. Pulps of the maxillary third, second, distobuccal and palatal roots of first molars 2. Buccal periodontium and bone overlying these teeth Indications 1. When treatment involves two or more maxillary molars 2. When supraperiosteal injection is contraindicated 3. When supraperiosteal injection has proved ineffective
  16. 16. Middle Superior Alveolar Nerve Block Nerves Anesthetized. Middle superior alveolar and terminal branches Areas Anesthetized 1. Pulps of the maxillary first and second premolars, mesiobuccal root of the first molar 2. Buccal periodontal tissues and bone over these same teeth
  17. 17. Anterior Superior Alveolar Nerve Block The anterior superior alveolar (ASA) nerve block is a local anesthesia that anesthetizes the maxillary canine, the central and lateral incisors, and the mucosa above these teeth, with occasional crossover to the contralateral maxillary incisors
  18. 18. Infraorbital nerve block Infraorbital nerve is a branch of the maxillary nerve, which is a branch off the trigeminal nerve (CN V2). Travels through the orbit and enters the infraorbital canal to exit onto the face through the infraorbital foramen. Infraorbital nerve innervates the ipsilateral lower eyelid, side of the nose, and upper lip .Regional blocks provide anesthesia without distorting soft tissues as in local infiltration
  19. 19. Nasopalatine Nerve Block The nasopalatine nerve block, otherwise known as the incisive nerve block or sphenopalatine nerve block, anesthetizes the nasopalatine nerves bilaterally. In this technique, the anesthetic solution is deposited in the area of the incisive foramen. This technique is indicated when treatment requires anesthesia of the lingual aspect of multiple anterior teeth. A 25- or 27-gauge short needle is preferred for this technique.
  20. 20. Greater Palatine Nerve Block The greater palatine nerve block is useful when treatment is necessary on the palatal aspect of the maxillary premolar and molar dentition. This technique targets the area just anterior to the greater palatine canal. The greater palatine nerve exits the canal and travels forward between the bone and soft tissue of the palate. Contraindications to this technique are acute inflammation and infection at the injection site. A 25- or 27-gauge long needle is preferred for this technique
  21. 21. review
  22. 22. complications of local anaesthetics
  23. 23. hematoma
  24. 24. failure to obtain anesthesia causes a)operator dependent i)LA agent(type, dose) ii)improper surgical tech. iii)injection of wrong solution. b)patient dependent i)anatomical-additional innervation ii)psychological –uncooprative,movement iii)pathological-infection
  25. 25. trismus primary cause-trauma to muscle ,blood vessels in infratemporal fossa secondary causes injection of LA containing irritating soln.(alcohol,cold sterilising soln.) LA have mild myotoxic properties (aids to progressive necrosis of exposed muscle fibers) hematoma –(leads to irritation of muscle fibers low grade infection excessive deposition of LA-distension of tissues-post inj trismus

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