This is an opportunity to introduce yourself to the audience, describing your dental background and experience with the CompuDent and now the STA. This presentation gives you a chance to share this innovative technology in the field of local anesthesia with your colleagues. “It has made a profoundly positive impact on my patients and my practice, and I hope that someday soon it will with yours.”
Milestone Scientific introduced the first computer-controlled local anesthetic delivery system (CCLADS), the Wand, in 1997. It was the result of 12 years of development by a practicing dentist and is probably the most widely studied dental device in history with over 75 clinical studies and published articles .
This STA-Intraligamentary injection anesthetizes a single tooth with excellent patient comfort, profound long-lasting anesthesia, with almost immediate onset of anesthesia, and without unnecessary, unwanted collateral anesthesia and post-operative complications.
The STA-Intraligamentary Injection is significantly different than the traditional PDL injection administered with the syringe, Ligmaject, or PeriPress. In the traditional PDL injection, a small amount of anesthetic is delivered into the PLD space under excessive pressure. With the STA-Intraligamentary Injection, a much larger volume is delivered under minimal pressure. By using the STA system to administer a STA-Intraligamentary Injection instead of a Mandibular Block, the benefits to you, to your patients, and to your practice are remarkable.
The Hollow needle syringe was developed in 1853 by a French surgeon, Dr. Charles Pravaz. The design of today’s dental syringe has not significantly changed in over 150 years. The STA produces three different flow rates so that every injection delivered with a syringe can be better delivered using computer-controlled technology. The precise, consistent flow of anesthetic is now controlled by a CCLADS rather than by manual pressure.
The STA system is a significant improvement over previous versions of CCLADS. The new design focused on making it much more user-friendly. They even created an innovative built-in Training Mode that teaches the clinician how to use the system. It has many other improved features making the experience truly easy to use, such as an automatic purge cycle, a shorter cruise-control time, user adjustable sound controls, etc. In addition, they have taken the concept of CCLADS to a whole new level with the development of a revolutionary feature called DPS (Dynamic Pressure Sensing). This technology actually provides real-time feedback and therefore guides the clinician to performing a highly predictable STA Intraligamentary injection. For the first time in dentistry the STA System using DPS technology enables a technique friendly, highly predictable with immediate onset of profound single tooth anesthesia technique to be performed. And all of this can be performed using a virtually painlessly technique to any tooth for any procedure. That’s a true advancement.
The STA-Intraligamentary Injection should be considered as a primary injection for anesthesia on all teeth, not just when the Mandibular Block or any other injection has failed. This injection uses the PDL space as the injection site. Using the ControlFlo rate, anesthetic solution travels via the periodontal ligament and associated “space” through the cribriform plate into the medullary bone surrounding the apical region of the tooth achieving predictably successful anesthesia with almost immediate onset and significantly longer duration of anesthesia.
The STA-Intraligamentary Injection provides many benefits to the patient. The STA system can deliver a greater volume of anesthetic under less pressure than a traditional PDL injection into the surrounding bone. The STA-II is a significant improvement over similar injection techniques. Actually, the STA-II is a non-trephinating intra-osseous injection. It is less invasive compared to those techniques that require you to drill through bone such like the Stabident or X-Tip techniques.
The productivity benefits of being able to anesthetize and provide treatment to teeth on both lower quadrants during the same appointment are powerful and self evident. The STA Systems unique solution to the problem and risks of administration of a bilateral Mandibular Block on a patient are profound. In addition, greater efficiency and utilization of time is gained by eliminating the patient’s need to return for a subsequent appointment. This a significant benefit to you and your patients.
Numerous clinical studies conducted all around the world have clearly demonstrated this technology’s ability to substantially reduce pain disruptive behavior in children. In 2005, one such study was recently published in JADA by Professor Ashkenazi and her colleagues from Israel. Another clinical study from the University of Nebraska, Department of Pediatric Dentistry showed that pediatric patients were 5 times less disruptive when the Wand Handpiece was used as compared with the traditional dental syringe. With proper technique the pediatric patient often does not realize that an anesthetic has been delivered until after the injection.
The STA System allows one to perform an exciting new injection technique for the maxilla that has been recently reported in the dental literature, the Anterior Middle Superior Alveolar nerve block or AMSA for short. It is an alternative to the supraperiosteal infiltration injection performed into the mucobuccal fold. An infiltration will produce unwanted collateral anesthesia to the patient’s lip, face, and muscles of facial expression. This unintentional side effect is inconvenient and uncomfortable to the patient and distorts their smile line, which is undesirable especially when performing esthetic dentistry. The AMSA can anesthetize 5 teeth using a palatal approach without anesthetizing the patient’s lip and face. The pulpal anesthesia is profound and extends from the central incisor through the mesial-buccal root of the maxillary 1 st molar. Anesthesia on the buccal/facial attached gingiva my not be profound, but it is usually sufficient to perform most procedures such as scaling and root planning, placing a rubber dam clamp, placing retraction cord for impressions, and placing buccal-gingival restorations. The profound palatal anesthesia extends form the central incisor posteriorly to the area of the second molar. This AMSA can be performed virtually painlessly using the ControlFlo rate of the STA system.
The injection site is an area, not an exact point. The location of the intended needle placement is ½ way along an imaginary line between the free gingival margin and the mid-palatal suture that bisects the contact point between the first and second pre-molars. Another way to find the injection site is to locate the junction of the horizontal and vertical parts of the palate that bisect the contact point between the pre-molars. As you can see on the dry skull slide, the palatal bone is very porous and has many nutrient canals that will allow the anesthetic to profuse through to anesthetize the tooth from the palatal approach rather than from the buccal aspect.
The AMSA in conjunction with the traditional PSA (Posterior Superior Alveolar) injection behind the maxillary second molar takes the place of multiple infiltrations and palatal injections to anesthetize a maxillary quadrant. This injection technique is very valuable for scaling and root planing. This injection was first described by Drs. Hochman and Friedman in 1997, is now considered a “State of the Art” injection, is being taught in many dental schools, and is being used successfully by most of the world’s most prominent esthetic dentists, such as Drs. Goldstein, Hornbrook, Dorfman, Dickerson, Sheets, and Crispin. Dr. Stanley Malamed includes this important injection in his textbook and lectures on local anesthesia.
The P-ASA is similar to the AMSA in that it is a single site palatal injection that anesthetizes multiple teeth (6 anteriors) and related gingival tissue without collateral numbness to the lips and face, and was also first described by Drs. Friedman and Hochman. In this injection, the needle is placed into the nasal-palatine canal where anesthetic is delivered in a dosage necessary to anesthetize the teeth. The pulpal and palatal anesthesia is profound and extends from cuspid to cuspid. The anesthetic effect may not be completed on the cuspids if they are unusually long. The transitory labial anesthesia extends from cuspid to cuspid, but is often not as profound. It is usually sufficient to perform most procedures such as scaling and root planing, placing a rubber dam clamp, placing retraction cord for impressions, and placing buccal gingival restorations.
The P-ASA injection site is just lateral to the incisive papilla. The needle usually contacts the internal wall of the nasal-palatine canal at which time aspiration is tested and a volume of anesthetic is delivered. When the needle has been placed into the tissue and incisive canal there will be approximately 4-5 mm of remaining needle from the hub (this is deep enough), the anesthetic is then delivered. The dose is about ¾ to 1 full cartridge of a 2% drug and about ½ cartridge of a 4% drug. Expect to see significant blanching of the tissue with a duration of anesthesia of 1 to 1 ½ hours.
Speaker can poll the audience about the incidence of missed Mandibular Blocks for discussion below. One of the reasons for missed blocks may be needle deflection. All needles deflect due to the mono bevel on the needle tip. This deviation can be up to 7mm. The dental syringe is used with a straight linear injection technique, and it is almost impossible to re-orient the bevel of the needle. The Wand Handpiece can be rotated back and forth 180 degrees to re-orient the needle’s bevel and cancel needle deflection. This is described as the Bi-Rotational Insertion Technique (BRIT) in Dr. Stanley Malamed’s “Handbook of Local Anesthesia” textbook. This results in better success and a more rapid onset of anesthesia.
All traditional and newly discovered injections can be delivered more comfortably with the computer-controlled technology of the STA, according to many clinical studies. The patented ControlFlo of a drop of anesthetic every two seconds is precise, constant, and consistent and is below the patient’s pain threshold. This technology, along with greater needle control, allows the newly discovered injections to be delivered more comfortably, more successfully, and with greater ease than with a syringe. This is 21 st Century Anesthesia.
There have been over 25 clinical studies and over 50 published articles about the CCLADS technology. All of these studies validate the efficacy and multiple benefits of the STA System as it represents the next generation of Computer controlled local anesthesia delivery systems. The original Wand System has been used in dentistry for a decade now. There are many references to the original Wand in the dental literature and in textbooks written on dental local anesthesia. It is no wonder that it has established a new standard of care for pain control. The STA System represents the next innovation in CCLADS technology.
Using the STA to deliver both the traditional and newly described injections we have discussed will provide valuable options and alternatives to the delivery of local anesthesia being used by thousands of dentists around the world. Millions of injections have now been performed using the predicate device of this technology. Patients will undoubtedly appreciate the fact that you have gone out of your way to make the most difficult, fearful, and anxiety ridden component of the dental experience as comfortable and positive as possible.
There are many more professional references and evaluations available than can be described here. I can provide clinical studies and articles to you on request. But, I think the most positive reference you can get is the one from one of your colleagues who is using the STA system, replacing the dreaded syringe, on an every day basis. I am that reference for you. I hope that I have given you many reasons why you should at least try this system to provide your patients with a more positive experience. This state of the art technology is a great source of patient referral and a tremendous practice builder. Your patients deserve the very best and will appreciate you for providing it to them.
Thank You for your Attention. I would be pleased to answer any questions.
The Dental Anesthesia Revolution Starts Now !
Recognized global leader in advanced injection technologies ◦ Milestone’s revolutionary injection systems are currently sold through the Company’s global distributor network to dental professionals worldwide. ◦ Customer base spans over 25 countries ◦ Responsible for over 30 million computer controlled injections worldwide. ◦ Supported by an unmatched number of clinical studies
Avoid the Block by incorporating the STA-System into your practice. One or two minute injection with immediate onset of profound anesthesia. A precise tool in your hand allows you to consistently and accurately delivery single tooth anesthesia every time. Eliminates the collateral numbing of cheek, lip and tongue.
Not have to wait 8 to 12 minutes to find out if your syringe missed the Block. Use the Intraligamentary (PDL) injection as your primary and only injection and have it last as long as the Block. Obtain profound anesthesia instantly and painlessly. Perform dentistry on the mandibular right and left (bi-lateral) during the same visit without the Block. Convert your most difficult patient within your practice into your most pleasant patient using a magic wand in your armentarium.
Replace 150-year old hypodermic syringe technology
• The STA™ Delivery System – What is It? Based on Milestone’s patented Dynamic Pressure Sensing (DPS ™) technology Computer-controlled drive unit Ergonomically designed, single-use disposable handpiece Real-time visual and audible feedback that ensures a successful, STA intraligamentary (PDL) injection Proven through university studies to be painless and produce no histological damage.
Uses DPS – Dynamic Pressure Sensing technology Site-specific injection Used as primary anesthesia Dosage* of ¼ cartridge per root Delivery time 1 or 2 minutes* Duration approximately 40-60 minutes of profound anesthesia*Using 4% Articaine Hydrochloride 1:200,000 local anesthetic solution.1 minute injection for single rooted tooth, 2 minute injection for multi-rooted tooth. § Hochman M. Compendium, April 2007
Increased predictability with DPS technology Simple to administer Immediate onset No collateral anesthesia of cheek, lip and tongue. No risk of intravascular or trismus. No risk of tachycardia Increased productivity and efficiency
For Pediatric Dentistry… Clinically proven to significantly reduces Disruptive Pain Behavior in multiple independent university trials. Non-threatening handpiece reduces a child’s fear and anxiety and ensures a more manageable patient. STA Intraligamentary (PDL) injection eliminates the difficulties and risks of performing a mandibular block on the pediatric patient. Collateral anesthesia of cheek, lip and tongue are eliminated.
Anterior Middle Superior Alveolar Injection* Single injection for multiple maxillary teeth – Central incisor thru mesial of 1 st molar. No collateral anesthesia to facial tissues and lip. Reduced dosage of anesthetic Improved clinical efficiency No risk of intravascular injection Accurate smile-line assessment *Friedman M, Hochman M Compendium Cont. Ed. Oct 1997 *Friedman M, Hochman M Quintessence Int May 1998
Avoids the annoying droopy lip syndrome. AMSA allows accurate smile line assessment. Single palatal injection approach. Use ControFlo Rate exclusively. Pre-puncture technique using needle bevel for palate.
Palatal - Anterior Superior Alveolar Injection* Single site injection for multiple maxillary teeth – All maxillary incisors and canine teeth. No collateral anesthesia to face and lip. Reduced dosage of anesthetic Improved clinical efficiency No risk of intravascular injection *Friedman MJ, Hochman MN, J Esthetic Dent, April 1999
Only technique - crossing midline Single site injection for multiple teeth Reduced dosage of anesthetic Improved clinical efficiency No collateral anesthesia to face and lip Accurate smile-line assessment
For Esthetic & Restorative Dentistry… AMSA: ◦ Allows accurate smile line assessment ◦ Single site injection to anesthetize multiple maxillary teeth. ◦ Bi-lateral AMSA’s give you anesthesia of 8 maxillary teeth to perform esthetic dentistry without the droopy lip syndrome. P-ASA: ◦ Anesthetize all 4 maxillary incisors from a single site palatal injection. ◦ Perform esthetic dentistry without the droopy lip syndrome. STA Intraligamentary (PDL) ◦ Single tooth anesthesia advantages
Handbook of Local anesthesia 5th edition – Dr. Stanly Malamed “CCLADS systems have increased the ability of doctors to guarantee the pain-free delivery of local anesthesia to their patients. In my experience CCLADs make it easier to more comfortably deliver those injections that are ‘difficult’ to administer painlessly. These include all palatal injections and the periodontal ligament (PDL) techniques.” CRA – Clinical Research Associates – Dr. Gordon Christensen 400+ CRA evaluating dental teams were asked to list “products they can’t live without”. CompuDent is proudly listed as a: Product CRA Evaluators “Can’t Live Without” CRA Volume 28 Issue 7 Dr. Gary Rainwater, DDS, President ADA 1996-97 “I don’t know why everyone isn’t using it? I use it every day.” John Yagiela, DDS, PhD, Professor of Anesthesiology, UCLA School of Medicine “The Wand” expands the types of injections that can be administered”