Periodontal Ligament Injection Indications Anesthesia for 1-2 teeth Anesthesia for 1-2 teeth...

Periodontal Ligament InjectionPeriodontal Ligament Injection

IndicationsIndications

Anesthesia for 1-2 teethAnesthesia for 1-2 teeth

Bilateral mandibular treatment neededBilateral mandibular treatment needed

Isolated treatment in childrenIsolated treatment in children

Nerve blocks contraindicated Nerve blocks contraindicated (hemophiliacs)(hemophiliacs)

Aid diagnosis of mandibular painAid diagnosis of mandibular pain


ContraindicationsContraindications

Primary teethPrimary teeth

Infection/inflammationInfection/inflammation

Psychological need for “feeling numb”Psychological need for “feeling numb”


AdvantagesAdvantages

Avoid unecessary areas of anesthesiaAvoid unecessary areas of anesthesia

Minimizes dosage of anestheticMinimizes dosage of anesthetic

Supplements partially effective blockSupplements partially effective block


DisadvantagesDisadvantages

Administration difficult in some areasAdministration difficult in some areas

May cause post-op discomfort, tooth May cause post-op discomfort, tooth extrusion, &/or tissue necrosisextrusion, &/or tissue necrosis

Excess pressure may break cartridgeExcess pressure may break cartridge


TechniqueTechnique

Insert needle on long axis of toothInsert needle on long axis of tooth

Deposit 0.2 ml slowly (30 secs)Deposit 0.2 ml slowly (30 secs)

Should feel resistance to depositionShould feel resistance to deposition

Intraosseous InfiltrationIntraosseous Infiltration


Local factors preclude adequate anesthesiaLocal factors preclude adequate anesthesia

dense cortical platedense cortical plate

infection / inflammationinfection / inflammation

severe pulpal irritationsevere pulpal irritation

Intraosseous InfiltrationIntraosseous Infiltration

Injection siteInjection site

Lateral - distil to tooth treatedLateral - distil to tooth treated

avoid mental foramen areaavoid mental foramen area

Vertical - for edentulous areaVertical - for edentulous area

on alveolar crest, mesial or distilon alveolar crest, mesial or distil

to treatment areato treatment area

Intraosseous Infiltration Intraosseous Infiltration Stabident SystemStabident System

TechniqueTechnique

Apply topical, consider local infiltrationApply topical, consider local infiltration

Push perforator through tissue to bonePush perforator through tissue to bone

Activate in short spurts until resistance is Activate in short spurts until resistance is lost ( approx. 2 secs)lost ( approx. 2 secs)

Hold syringe in pen grip, into perforationHold syringe in pen grip, into perforation

Inject “plain” anesthetic (0.6 ml-1-2 teeth)Inject “plain” anesthetic (0.6 ml-1-2 teeth)

Mylohyoid Nerve InfiltrationMylohyoid Nerve Infiltration

Mylohyoid nerve may provide sensation to Mylohyoid nerve may provide sensation to molar teethmolar teeth

May be used as a supplement to IAN blockMay be used as a supplement to IAN block

Supplements lingual anesthesiaSupplements lingual anesthesia

Mylohyoid Nerve InfiltrationMylohyoid Nerve Infiltration

TechniqueTechnique

Retract tongue mediallyRetract tongue medially

Penetrate mucosa of floor of mouth by Penetrate mucosa of floor of mouth by alveolusalveolus

Aspirate, deposit 0.5 ml solutionAspirate, deposit 0.5 ml solution

Extraoral Nerve BlocksExtraoral Nerve Blocks

MaxillaryMaxillary

InfraorbitalInfraorbital

MandibularMandibular

Extraoral Nerve BlocksExtraoral Nerve Blocks


InfectionInfection

Inability to open mouthInability to open mouth

Presence of pathologyPresence of pathology

TraumaTrauma

Diagnostic or Theraputic reasonsDiagnostic or Theraputic reasons

Extraoral Maxillary/Mandibular Extraoral Maxillary/Mandibular Nerve BlockNerve Block

Target areaTarget area

Foramen Rotundum / Foramen OvaleForamen Rotundum / Foramen Ovale

Penetration PointPenetration Point

Skin overlying sigmoid notchSkin overlying sigmoid notch

LandmarksLandmarks

Pterygoid platesPterygoid plates

Extraoral Maxillary/Mandibular Extraoral Maxillary/Mandibular Nerve BlocksNerve Blocks

ArmamentariumArmamentarium

20-22 gauge spinal needle (3-5 inch)20-22 gauge spinal needle (3-5 inch)

3 ml syringe3 ml syringe

Alcohol skin prepAlcohol skin prep


TechniqueTechnique

Prep skin overlying sigmoid notch,Prep skin overlying sigmoid notch,

Anesthetize skin and masseter muscleAnesthetize skin and masseter muscle

Pass spinal needle through sigmoid notch until Pass spinal needle through sigmoid notch until the pterygoid plate is contactedthe pterygoid plate is contacted


TechniqueTechnique

Withdraw, then re-direct anterior/superior to Withdraw, then re-direct anterior/superior to 4.5 cm for maxillary block4.5 cm for maxillary block

Re-direct posterior/superior toward Re-direct posterior/superior toward Foramen Ovale for mandibular blockForamen Ovale for mandibular block


TechniqueTechnique

Remove styletteRemove stylette

Place filled syringe on spinal needlePlace filled syringe on spinal needle

Aspirate and deposit 3 ml of anesthetic Aspirate and deposit 3 ml of anesthetic solutionsolution

Extraoral Infraorbital Nerve Extraoral Infraorbital Nerve BlockBlock

LandmarksLandmarks

Infraorbital rimInfraorbital rim

Infraorbital foramenInfraorbital foramen

PupilPupil

Extraoral Infraorbital Nerve Extraoral Infraorbital Nerve BlockBlock

TechniqueTechnique

Palpate foramen- 6 mm below rim on Palpate foramen- 6 mm below rim on pupillary linepupillary line

Prep skinPrep skin

Penetrate skin and contact bonePenetrate skin and contact bone

Redirect until foramen enteredRedirect until foramen entered

Advance 2-3 mm and deposit solutionAdvance 2-3 mm and deposit solution

Periodontal Ligament Injection Indications Anesthesia for 1-2 teeth Anesthesia for 1-2 teeth...

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