ARMAMENT

ARIU

M- Vishal gohil- Nancy hirpara- Bhakti jivani

The equipment necessary for the administration of local anesthetics and for the extraction of the tooth introduced in armamentarium

Armamentaria have evolved to ease surgery ,shortening on table time, widening the surgical field, increasing visibility,mimimizing trauma to surgical areas etc

OBJECTIVES To provide an optimal surgical field For optimum visibility To decrease physical strain of the surgeon To enable patient comfort To protect vital structures

EQUIPMENTI. SyringeII. NeedleIII. Cartridge

ADA CRITERIA FOR ACCEPTANCE OF LOCAL ANESTHETIC SYRINGE 1. they must be durable and able to

withstand repeated sterilization without damage

2. they should be capable of accepting a wide variety of cartridge and needles of different manufacture and should permit repeated use

3. inexpensive , self-contained , lightweight and simple to use with one hand

4. they should provide for effective aspiration and be constructed so that blood may be easily observed in the cartridge

I. SYRINGE It is the vehicle whereby the contents of the anesthetic

cartridge are delivered through the needle to the patient. Four types: 1. Nondisposable syringes: a. Breech-loading , metallic , cartridge-type , aspirating b. Breech-loading , plastic , cartridge-type , aspirating c. Breech-loading , metallic , cartridge-type , self-aspirating d. Pressure syringe for periodontal ligament injection e. Jet injector (needle-less syringe) 2. Disposable syringe 3. Safety syringes 4. Computer-controlled local anesthetic delivery systems

1. NONDISPOSABLE SYRINGESo A. Breech-loading metallic cartridge type aspirating syringe - most commonly used in dentistry - breech loading implies that the cartridge is inserted into the syringe from the side of the barrel of the syringe - the needle is attached to barrel of the syringe at the needle adaptor - the needle than passes into the barrel, where it penetrates the diaphragm of local anesthetic cartridge - the needle adaptor is removable and sometimes is discarded inadvertently along with disposable needle

METALLIC BREECH-LOADING , ASPIRATING SYRINGE........Advantages - visible cartridge - aspiration with one

hand - autoclavable - rust resistant - long lasting with

proper maintenance

Disadvantages - weight(heavier than

plastic syringe) - syringe may be too

big for small operators

- possibility of infection with improper care

B. Breech-loading , plastic , cartridge-type aspirating syringe - a plastic, reusable, dental aspirating

syringe is available that is both autoclavable and chemically sterlizable - with proper handling, this syringe may be used for multiple anesthetic

administrations before it is discarded

PLASTIC, REUSABLE, ASPIRATING SYRINGE......... Advantages - plastic eliminates

metallic,clinical look - lightweight: provide

better feel during injection

- cartridge is visible - aspiration with one

hand - rust resistant - long lasting with proper

maintenance - low cost

Disadvantages - size(may be too big

for small operators) - possibility of

infection with improper care

- deterioration of plastic with repeated autoclaving

C. Breech-loading , metallic , cartridge-type , self- aspirating syringe - to increase ease of aspiration , self-aspirating syringes have been developed - these syringes use the elasticity of the rubber diaphragm in the anesthetic cartridge to obtain the necessary negative pressure for aspiration - the use of a self-aspirating dental syringe permits easy performance of multiple aspirations throughout the period of local anesthetic deposition

METALLIC , SELF-ASPIRATING SYRINGES....... Advantages - cartridge visible - easier to aspirate with

small hands - autoclavable - rust resistant - long lasting with proper

maintenance - piston is

scored(indicates volume of local anesthetic administered)

Disadvantages - weight - feeling of insecurity

for doctors accustomed to harpoon-type syringe

- finger must be moved from thumb ring to thumb disc to aspirate

- possibility of infection with improper care

D. Pressure syringes - it is brought about a renewed interest in the

periodontal ligament injection - it is also known as intraligamentary injection - it is more reliable to achieve pulpal

anesthesia of one isolated tooth in mandible

PRESSURE SYRINGES........ Advantages - measured dose - overcomes tissue

resistance -

nonthreatening(new devices)

- cartridges protected

Disadvantages - cost - easy to inject too

rapidly - threatening(original

devices)

E. Jet injector - jet injection is based on the principle that liquids forced through very small openings , called jets , at very high pressure can penetrate intact skin or mucous membrane - the most frequently used jet injectors in dentistry are syriJet Mark II and MadaJet - the primary purpose of the jet injector is

obtain topical anesthesia before insertion of a needle

JET INJECTORS....... Advantages - does not require

use of needle - delivers very small

volumes of local anesthetics

- used in instead of topical anesthetics

Disadvantages - inadequate for

pulpal anesthesia or for regional block

- some patients are disturbed by the jolt of the injection

- cost - may damage

periodontal tissue

2. DISPOSABLE SYRINGES Most often they are used for intramuscular or

intravenous drug administration, but they also may be used for intraoral injection.

These syringes contain a luer-lock screw on needle attachment with no aspirating tip.

Because there is no thumb ring aspiration ,it requires both hands.

In addition this syringes do not accept dental cartridges.

DISPOSABLE SYRINGE........ Advantages - disposable, single

use - sterile until opened - lightweight

Disadvantages - does not accept prefilled dental cartridges - aspiration difficult

3. SAFETY SYRINGES Safety syringes minimize the risk of an

accidental needle-stick injury occurring to a dental health provider with a contaminated needle after administration of a local anesthetics

These syringes possess a sheath that “locks” over the needle when it is removed from the patient’s tissues , preventing accidental needle-stick

These are designed as single-use items , although they permit reinjection

SAFETY SYRINGES...... Advantages - disposable , single

use - sterile until opened - lightweight

Disadvantages - cost: more

expensive than reusable syringe

- may feel awkward to a first-time user

4. COMPUTER-CONTROLLED LOCAL ANESTHETIC DELIVERY(C-CLAD) SYSTEMS This system enables a dentist or hygienist to

accurately manipulate needle placement with finger-tip accuracy and deliver the local anesthetic with a foot-activated control

RECOMMENDATIONS1. A safety syringe, minimizing the risk of

accidental needle-stick injury, is recommended for use during all local anesthetic injections

2. A self-aspirating syringe is recommended for practitioners with small hands

3. All reusable syringes must be capable of being sterilized

4. Nonreusable syringes must be disposed of properly

5. Non-aspirating syringes should never be used for local anesthetics

II. NEEDLE Needle is a vehicle that permits local

anesthetic solution to travel from the dental cartridge into the tissues surrounding the needle tip

Most needles used in dentistry are stainless-steel and disposable

PARTS OF NEEDLE Bevel Shaft Hub Syringe adaptor Cartridge penetration end

GAUGE Gauge refers to the diameter of the lumen of

the needle: the smaller the number , the greater the diameter of the lumen

A 30-gauge needle has a smaller internal diameter than 25-gauge needle

There is a growing trend toward the use of smaller diameter needles based on the assumption that they are less traumatic to the patient than needles with larger diameter

The most commonly used needles in dentistry are 30-gauge short and 27-gauge long

ADVANTAGES OF LARGER NEEDLE OVER SMALLER GAUGE NEEDLE1. Less deflection , as needle advances

through tissues2. Greater accuracy of injection3. Less chance of needle breakage4. Easier aspiration5. No perceptual difference in patient comfort

LENGTH Dental needles are available in three lengths:

Long : 30-35mm

Short : 20-25mm

Ultra-short : <20mm

RECOMMENDATIONS1. Sterile disposable needles should be used2. If multiple injections are to be administered,

needles should be changed after three or four insertions in a single patient

3. A needle should never be forced against resistance

4. Needles should remain capped until used and should be made safe immediately when withdrawn

5. The direction of a needle should not be changed while it is still in tissue

III. CARTRIDGE The dental cartridge is a glass cylinder

containing the local anesthetic drug , among other ingredients

Cyli

ndri

cal

gl

ass t

ube

Stoppers(plunger,burg)

Aluminium cap

diaphragm

components

PROBLEMS1. Bubble in cartridge2. Extruded stopper3. Burning on injection4. Sticky stopper5. Corroded cap6. Rust on the cap7. Leakage during injection8. Broken cartridge

RECOMMENDATIONS1. Dental cartridges must never be used on

more than one patient2. Cartridges should be stored at room

temperature3. It is not necessary to warm cartridge before

use4. Cartridges should not be used beyond their

expiration date5. Cartridges should be checked carefully for

cracks, chips, and the integrity of the stopper and cap before use