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Local Anesthesia in Endodontics Michael Moreno, DMD September 15th, 2009 Local Anesthesia in Endodontics Local Anesthesia Definition pA loss of sensation to pain in a specific part of the body without loss of consciousness. Local Anesthesia in Endodontics pTypes of injections used: pInfiltration pBlocks pPDL pIntrapulpal pIntraosseous Local Anesthesia in Endodontics pInfiltration nAnesthetic injected in the mucosa nMakes contact with bone nMust diffuse through spongy bone to reach the nerve endings (cortical layer must be thin) ni.e. Maxilla in adults, both jaws of children Local Anesthesia in Endodontics pRetract lip and shake pAdvance 3-4mm, and deposit 0.5cc to start Local Anesthesia in Endodontics pThe 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 pRetract the lip pPlace thumb on the anterior border of the ramus pApproach from the opposite side (premolar area) Local Anesthesia in Endodontics pAdvance until you hit bone pWithdraw 1mm pAspirate pInject of carpule SLOWLY p25g needle is recommended Local Anesthesia in Endodontics pEven when properly administered, it can still have 15-20% failure pPositive aspiration in 10-15% of cases Local Anesthesia in Endodontics pGow Gates V3 block pInferior alveolar nerve pLingual pMylohyoid pMental pIncisive pAuriculotemporal pBuccal Local Anesthesia in Endodontics pTarget area is the neck of the condyle Local Anesthesia in Endodontics pNeedle is placed just below the MP cusp of the maxillary 2nd molar pInject slowly Local Anesthesia in Endodontics pSupplemental injections: nPDL pSyringes on the market: Peripress and Ligmaject Local Anesthesia in Endodontics pAnesthesia is achieved due to the solution diffusing through the marrow spaces in intraseptal bone pPatients may experience post op discomfort for 2- 3 days pAlthough specialized syringes are available, there is usually no need for them however, significant force is required Local Anesthesia in Endodontics pIntraosseous Injection Stabident, X-Tip, Intraflow Local Anesthesia in Endodontics Local Anesthesia in Endodontics pAdvantages of intraosseous injections pMore predictability of achieving anesthesia pLess post op discomfort pThe gingival ligaments are not affected Local Anesthesia in Endodontics Local Anesthesia in Endodontics pIntraosseous anesthesia latest news The Intraflow System by Pro-Dex Local Anesthesia in Endodontics pClaims to provide great pulpal anesthesia by itself pGreat for emergencies pGreat to anesthetize “hot teeth” pIntrapulpal anesthesia nPinpoint exposure of the pulp nThe needle tip is inserted in the exposure n Backpressure is built up into the chamber, and the pressure is causing anesthesia nWarn your patients Local Anesthesia in Endodontics pA note on anesthetics nLidocaine is the most commonly used anesthetic nAmide anesthetic, metabolized in the liver nIn conjunction with epinephrine, it provides 30 -60 mins of pulpal anesthesia, and 120-240 mins of soft tissue anesthesia Local Anesthesia in Endodontics pSeptocaine (articaine) nStudies show the same efficacy as lidocaine nNo significant difference in the achievement of analgesia Local Anesthes