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Local anesthesia

  1. 1. Local anesthesia anatomy review & injection technique Dr. Haydar Muneer Salih B.D.S., F.I.B.M.S
  2. 2. Nothing that is done by a dentist for patient is of greater importance than the administration of a drug for prevention of pain during dental treatment yet the act of administration of local anesthesia frequently associated with great anxiety and pain
  3. 3. Local Anesthetics • Role: • Decrease intraoperative and postoperative pain • Increase patients cooperation • Diagnostic testing/examination
  4. 4. Anatomical considerations: • Trigeminal nerve: – Sensory divisions: • Ophthalmic division V1 • Maxillary division V2 • Mandibular division V3 – Motor division: • Muscles of mastication- masseter, temporalis, medial and lateral pterygoids • Mylohyoid, Anterior belly of the digastric , Tensor tympani, Tensor veli palatini
  5. 5. Maxillary division of trigeminal nerve
  6. 6. Mandibular division of trigeminal nerve
  7. 7. Local anesthetic instruments: • Anesthetic carpule • Syringe • Needle
  8. 8. Anesthetic carpule 1. Local anesthetic agent 2. Vasoconstrictor agent 3. Preservation for vasoconstrictor (anti-oxidant) 4. Vehicle to make solution isotonic NaCl 0.9%
  9. 9. Anesthetic syringe
  10. 10. Anesthetic needle
  11. 11. Injection technique 1. Use sterile sharp needle 2. Check the follow of the solution 3. Warm the anesthetic carpule and syringe to the room temperature 4. Position the patient 5. Dry the tissue 6. Apply topical anesthesia 7. Communicate with the patient
  12. 12. 8. Establish a firm hand rest 9. Make the tissue taut 10. Keep the syringe out of patient line of sight 11. Insert the needle to the mucosa 12. Watch and communicate with patient 13. Slowly advance and withdraw 14. Observe the patient after injection
  13. 13. Maxillary anesthesia: • Infiltration: Able to be performed in the maxilla due to the thin cortical nature of the bone • Target area: apical region of the tooth to be anesthetize • Land marks: a. Mucosal fold b. Crown of the tooth c. Root contour of the tooth • Orientation of the needle bevel so it faces the bone
  14. 14. Maxillary anesthesia:
  15. 15. • Anesthesia of the hard palate is necessary for dental extraction of maxillary teeth • For many patient palatal injection proved to be very traumatic and for many dentist is the one of the most traumatic procedures
  16. 16. 1. Inform the patient that this procedure is little uncomfortable so he will be psychological prepared 2. Provide adequate topical anesthesia 3. Maintain control over the needle 4. Deposit the anesthesia slowly 5. Trust yourself
  17. 17. Anesthesia for greater palatine
  18. 18. Naso palatine nerve block:
  19. 19. Mandibular anesthesia: • Infiltration techniques do not work in the adult mandible due to the dense cortical bone • Nerve blocks are utilized to anesthetize the inferior alveolar, lingual, and buccal nerves • Provides anesthesia to the pulpal, alveolar, lingual and buccal gingival tissue, and skin of lower lip and medial aspect of chin on side injected
  20. 20. Inferior alveolar nerve block (IAN) Technique involves blocking the inferior alveolar nerve prior to entry into the mandibular lingula on the medial aspect of the mandibular ramus. Technique: • Area of insertion is the mucous membrane on the medial border of the mandibular ramus • Height of injection injection- 6-10 mm above the occlusal table of the mandibular teeth • Mouth must be open for this technique
  21. 21. Inferior alveolar nerve block (IAN) • Depth of injection: 25mm • Approach area of injection from contralateral premolar region • Use the non-dominant hand to retract the buccal soft tissue (thumb in coronoid notch of mandible; index finger on posterior border of extraoral mandible • Inject ~0.5 0.5-1.0cc of local anesthetic • Continue to inject ~0.5cc on removal from injection site to anesthetize the lingual branch
  22. 22. Mental nerve block • Mental and incisive nerves are the terminal branches for the inferior alveolar nerve • Provides sensory input for the lower lip skin, mucous membrane, pulpal/alveolar tissue for the premolars, canine, and incisors on side blocked
  23. 23. Mental nerve block Technique: • Area of injection mucobuccal fold at or anterior to the mental foramen. This lies between the mandibular premolars • Depth of injection ~5 5-6mm • Inject 0.5 0.5-1.0cc of local anesthesia • Message local anesthesia into tissue to manipulate into mental foramen to anesthetize the incisive branch

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