Local Anesthesia in Endodontics

Michael Moreno, DMD September 15th, 2009

Local Anesthesia in Endodontics

Local Anesthesia Definition A loss of sensation to pain in a specific part of the body without loss of consciousness.

Local Anesthesia in Endodontics

Types of injections used:
Infiltration Blocks PDL Intrapulpal Intraosseous

Local Anesthesia in Endodontics

Infiltration
  

Anesthetic injected in the mucosa Makes contact with bone Must diffuse through spongy bone to reach the nerve endings (cortical layer must be thin) i.e. Maxilla in adults, both jaws of children

Local Anesthesia in Endodontics

Retract lip and shake Advance 3-4mm, and deposit 0.5cc to start

Local Anesthesia in Endodontics

The 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

Retract the lip Place thumb on the anterior border of the ramus Approach from the opposite side (premolar area)

Local Anesthesia in Endodontics

Advance until you hit bone Withdraw 1mm Aspirate Inject of carpule SLOWLY 25g needle is recommended

Local Anesthesia in Endodontics

Even when properly administered, it can still have 15-20% failure Positive aspiration in 10-15% of cases

Local Anesthesia in Endodontics

Gow Gates V3 block
Inferior alveolar nerve Lingual Mylohyoid Mental Incisive Auriculotemporal Buccal

Local Anesthesia in Endodontics

Target area is the neck of the condyle

Local Anesthesia in Endodontics

Needle is placed just below the MP cusp of the maxillary 2nd molar Inject slowly

Local Anesthesia in Endodontics

Supplemental injections:


PDL
Syringes on the market: Peripress and Ligmaject

Local Anesthesia in Endodontics

Anesthesia is achieved due to the solution diffusing through the marrow spaces in intraseptal bone Patients may experience post op discomfort for 2-3 days Although specialized syringes are available, there is usually no need for them however, significant force is required

Local Anesthesia in Endodontics

Intraosseous Injection Stabident, X-Tip, Intraflow

Local Anesthesia in Endodontics

Local Anesthesia in Endodontics

Local Anesthesia in Endodontics

Advantages of intraosseous injections
More predictability of achieving anesthesia Less post op discomfort The gingival ligaments are not affected

Local Anesthesia in Endodontics

Intraosseous anesthesia latest news The Intraflow System by Pro-Dex

Local Anesthesia in Endodontics

Claims to provide great pulpal anesthesia by itself Great for emergencies Great to anesthetize hot teeth

Local Anesthesia in Endodontics

Intrapulpal anesthesia
   

Pinpoint exposure of the pulp The needle tip is inserted in the exposure Backpressure is built up into the chamber, and the pressure is causing anesthesia Warn your patients

Local Anesthesia in Endodontics

A note on anesthetics


Lidocaine is the most commonly used anesthetic Amide anesthetic, metabolized in the liver In conjunction with epinephrine, it provides 30-60 mins of pulpal anesthesia, and 120-240 mins of soft tissue anesthesia

Local Anesthesia in Endodontics

Septocaine (articaine)


Studies show the same efficacy as lidocaine

No significant difference in the achievement of analgesia

Oraverse
Phentolamine Mesylate For use in patients ages 6 and up 33lbs and up Reverses effects of local anesthetic in approx. half the time

Questions?