Download Technic for infiltration Anaesthesia This method of injection is

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Technic for infiltration Anaesthesia
This method of injection is widely used for anaesthetizing upper teeth and lower incisiors and
canines, for removal of hypertrophied soft tissues and high muscle attachments. The success
of infiltration anaesthesia depends on diffusion of the anaesthetic solution through the minute
foramina in the cortical plate and into the cancellous bone until the nerve fibers are reached.
Because of the paucity of foramina in the cortex of the mandible, this method of injection is
unsuitable for lower premolars and molars. This method is contraindicated when there is
inflammation in the injection place.
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Insert the needle into the mucobuccal or the mucolabial fold below the vestibular
recess in the midline along the tooth prior to the one to be extracted. The needle
should be positioned with a beveled side towards the bone.
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Pass the needle through the submucous tissue until periapical region of extracted tooth
is
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encountered.
Inject ¾ of anaesthetic solution in this area slowly.
To achieve profound anaesthesia, inject the palatal tissue to anaesthetize the endings of
anterior palatine nerve
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Insert at 45° angle into the palatal tissue 1 cm away from the alveolar edge in the
periapical region of a tooth to be extracted.
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Make aspiration to check if you are not in the lumen of the vessel.
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Inject ¼ of anaesthetic solution slowly.
INTRA-ORAL TECHNIC for THE ANTERIOR and MIDDLE SUPERIOR ALVEOLAR
NERVE INJECTION
The anterior and superior alveolar nerve are branches of infraorbital nerve, which is located in
infraorbital foramen.
Technic to anaesthetize right nerve
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1. Keep the left thumb inside the mouth and the left index finger on lower infraorbital
edge to prevent injecting the solution into the orbit.
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2. Locate the infra-orbital foramen which is found 8 milimeters under the lower
infraorbital edge and 0.5 cm medially from the papil line Instruct a patient to look
straight forward.
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3. Inject between the first and second incisor. Pass the needle towards lower
infraorbital foramen.
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4. Aspirate.
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5. Deposit anaesthetic solution.
EXTRA-ORAL TECHNIC for THE ANTERIOR and MIDDLE SUPERIOR ALVEOLAR
NERVE INJECTION
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Sterilize the skin below the infra-orbital ridge.
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Locate the infra-orbital foramen with the index finger of the left hand if the right
anterior and middle superior alveolar nerves are to be anesthetized. If the left anterior
and middle superior alveolar nerves are to be anesthetized, stand on the right side
and somewhat behind the patient and locate the infra-orbital foramen with the thumb
of the left hand.
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Holding the index finger or the thumb over the infra-orbital foramen, raise and
compress the soft tissues beneath the foramen with the thumb when injecting on the
right or the index finger when injecting on the left. This stabilizes the soft tissues
while passing the needle through and into the foramen.
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Insert the needle through the skin along side the thumbnail, in the nasolabial fold.
Penetrate the soft tissue untill you reach the bone and move the needle into infraorbital
foramen.
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Insert the needle into the infra-orbital canal.
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Aspirate.
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Deposit anaesthetic solution slowly.
THE NASOPALATINE NERVE INJECTION
The nasopalatine nerve is located in the incisive foramen on the maxillary palatal surface.
The foramen is covered by the incisive papilla. Anaesthesia of this nerve produces loss of
sensation in the area between the canines.
Technic
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Insert the needle on lateral side of incisive papilla 1cm away from the alveolar ridge.
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Aspirate.
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Deposit anaesthetic solution.
ANTERIOR PALATINE NERVE INJECTION
Technic
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Approach from the opposite side of the mouth and insert the needle into palate at a
point which is midway between the apices of the palatal roots of the first and the
second molars.(0.5 cm away from the alveolar edge).
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Penetrate the tissue until bone is contacted.
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Aspirate.
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Deposit anaesthetic solution slowly.
INTRA-ORAL TECHNIC for THE POSTERIOR SUPERIOR ALVEOLAR NERVE
INJECTION
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Insert the needle below the roof of the oral vestibule in the second upper molar region.
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Pass the needle in contact with the bone backwards and upwards for 2cm.
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Aspirate.
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Deposit ¾ of anaesthetic solution.
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Pass the rest of anaesthetic solution to anaesthetize the endings of the anterior palatal
nerve in an extracted tooth area.
EXTRA-ORAL TECHNIC for THE POSTERIOR SUPERIOR ALVEOLAR NERVE
INJECTION
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Sterilize the skin in injection side.
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Penetrate the skin in the angle between anterior border of masseter and lower border
of zygomatic arch.
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Penetrate the tissue until you reach 1-2cm.
• Aspirate.
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Deposit anaesthetic solution.
INTRA-ORAL TECHNICS for INFERIOR ALVEOLAR NERVE BLOCK ANAESTHESIA
1.Direct method
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Ask patient to open his mouth as wide as possible.
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Place the thumb of the left hand in the mucobuccal fold opposite the bicuspids or the
bicuspid area if the mandible is edentulous. Move the finger posteriorly until the
anterior border of the mandible ramus is reached. The index finger places on the
posterior border of the ramus outside the mouth
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Keep the syringe on the premolars in opposite side of the mouth and parallel to
occlusal plane of the mandibular teeth
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Inject the lateral border of the pterygomandibular fold in the middle of the distance
between maxilla and mandible
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Penetrate the tissue until you reach the bone.
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Aspirate and deposit ¾ anaesthetic solution (to anaethetize alveolar and lingual nerve)
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The rest of anaesthetic solution you should deposit in the recess of vestibule in region
of extracted teeth( to anaesthetize buccal nerve).
2. Weissbrem injection for Inferior alveolar nerve block anaesthesia
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Ask patient to open his mouth as wide as possible.
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Keep the syringe on the premolars in opposite side of the mouth and parallel to
occlusal plane of the mandibular teeth
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Inject the anterior border of the pterygomandibular fold 0.5 cm beneath occlusal plane
of maxillary teeth( 1.5 cm if the patient is edentulous )
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Penetrate the tissue until you reach the bone.
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Aspirate by drawing back the plunger to check if you are not in the lumen of a vessel.
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Deposit 3/4 of the anaesthetic solution slowly
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The rest of the solution deposit withdraw the the needle slowly until it’s still
embedded in the tissue.
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The adventage of this method is that we anaesthtize all three nerves(alveolar inferior,
lingual and buccal) useing only one injection
LINGUAL NERVE ANAESTHESIA alone.
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If you want to anaesthetize the trunk of the lingual nerve only, you should deposit
anaesthetic solution in soft tissue on the lingual surface of the alveolar process in the
last molar area.
INTRA-ORAL TECHNIC for MENTAL NERVE BLOCK ANESTHESIA
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Locate the mental foramen. The mental foramen is under lower second premolar in the
middle between lower and upper border of mandible corpus. If the patient is
edentulous the mental foramen is in the middle between anterior border of masseter
and middle line of the mandible.
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Penetrate the tissue from posterior upper area to anterior lower area.
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Aspirate.
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Deposit the anaesthetic solution.
EXTRA-ORAL TECHNIC for MENTAL NERVE BLOCK ANESTHESIA
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The mental foramen is in the middle between anterior border of masseter and middle
line of the mandible.
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Sterilize the skin in injection side.
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Penetrate the skin from posterior upper area to anterior lower area.
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Aspirate.
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Deposit the anaesthetic solution.
EXTRA-ORAL TECHNICS for INFERIOR ALVEOLAR NERVE-BLOCK ANESTHESIA
Indications
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Trismus or ankylosis which prevents intra-oral nerve-block technics
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When to obtain nerve-block anaesthesia the needle would have to traverse
infected tissue
EXTRA-ORAL TECHNICS for INFERIOR ALVEOLAR NERVE BLOCK ANAESTHESIA
1. Cieszyński method
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Sterilize the skin in injection side.
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Put the index finger at posterior ramus and the thumb at the angle of mandible.
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Inject the needle at the front of the thumb.
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Pass the needle parallel to the inner surface of the ramus upward and backward,
parallel to the posterior border of the ramus, 4-5 cm deep.
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Aspirate and deposit anaesthetic solution.
2. Jarząb method /this method is used in case of inflammation of the mandibular angle with
trissmus/.
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Sterilize the skin in injection side.
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Penetrate the skin from posterior border of mandible ramus in the middle between
condylar process and mandibular angle. Penetrate the tissue until you reach 2 cm.
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Aspirate.
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Deposit anaesthetic solution.
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Penetrate the tissue deeper for linqual nerve anaethesia.
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Indications for Use of Antibiotics
1. Rapidly progressive swelling
2. Diffuse swelling
3. Involvement of facial spaces
4. Severe pericoronitis
5. Osteomyelitis
6. Compromised host defenses:
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Uncontrolled metabolit diseases
- uremia
- alkoholizm
- malnutrition
- severe diabetes
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Suppressing diseases
- leukemia
- lymphoma
- malignant tumors
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Suppressing drugs
- cancer chemotherapeutic agents
- immunosuppressive agents
7. Focus diseases
8. Congenital and Acquired Heart defects
Situations in Which Use of Antibiotics Is Not Necessary
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Chronic well-localized abscess
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Minor vestibular abscess
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Dry socket
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Mild pericoronitis
Effective Orally Administered Antibiotics Useful for Odontogenic Infections
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Penicillin /The antibacterial spectrum includes the gram-positive cocci (except
staphylococci) and oral anaerobes/
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Cefadroxil /effective against gram-positive cocci and many gram-negative rods/
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Clindamycin /The antibacterial spectrum includes the gram-positive cocci and almost
all anaerobic bacteria/
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Erythromycin /effective against gram-positive cocci and anaerobic bacteria/
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Tetracycline /useful only against anaerobic bacteria/
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Metronidazole (chemotherapeutic agent)/effective only for anaerobic bacteria/
Indications for Culture and Antibiotic Sensitivity Testing
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Rapidly spreading infection
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Postoperative infection
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Nonresponsive infection
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Recurrent infection
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Compromised host defenses
Use narrowest spectrum antibiotic!
Antibiotics that have narrow-spectrum activity against the causative organisms are just as
effective as antibiotics that have broad-spectrum activity, without the problems of upsetting
normal host microflora populations and increasing the chance of bacterial resistance.
Reasons for Treatment Failure
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Inadequate surgery
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Depressed host defenses
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Foreign body
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Patient noncompliance
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Drug not reaching site
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Drug dose too low
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Wrong bacterial diagnosis
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Wrong antibiotic
Cardiac Conditions Associated With Endocarditis
High-Risk Category—Prophylaxis Recommended
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Prosthetic cardiac valve
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Previous bacterial endocarditis
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Complex cyanotic congenital heart disease
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Surgically constructed systemic pulmonary heart
Moderate-Risk Category—Prophylaxis Recommended
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Most other congenital malformations
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Acquired valvar dysfunction
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Hypertropic cardiomyopathy
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Mitral valve prolapse with valvar regurgitation
Negligible-Risk Category—Prophylaxis NOT Recommended
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Isolated secundum atrial septal defect
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Surgical repair of atrial septal defect; patient ductus arteriosus
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Coronary artery bypass graft
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Mitral valve prolapse without regurgitation
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Physiologic, functional, or innocent heart murmur
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Previous rheumatic fever with valvar dysfunction
Dental Procedures in Which Prophylaxis Is Recommended
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Dental extractions
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Periodontal procedures
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Dental implant placement
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Periapical endodontic procedures
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Initial placement of orthodontic bands but not brackets
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Intraligamentary local anesthetic injections
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Dental prophylaxis when bleeding is expected
Dental Procedures in Which Prophylaxis Is NOT Recommended
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Restorative dentistry
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Routine local anesthetic injection
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Intracanal endodontic therapy
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Suture removal
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Placement of removable appliances
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Making impressions
Antibiotic Regimen for Prophylaxis of Bacterial Endocarditis
In case when antibiotic prophylaxis can be applied orally:
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Antibiotic
Regimen
Standard
amoxicillin
Adults: 2 G orally 1 hr before procedure
Children: 50 mg/kg orally 1 hr before procedure
In case of allergy to penicillin:
clindamycin
Adults: 600 mg orally 1 hr before procedure
Children: 20 mg/kg orally 1 hr before procedure
Sometimes there are some indications for another dose of antibiotic 6-8 hours after surgery.
These doses are reduced. Sometimes application of antibiotic prophylaxis is prolonged for
three days.
In case of high risk of endocarditis application of antibiotic prophylaxis is intraveniously.