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Selection of dental anesthetic technique
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Selection of dental anesthetic technique

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  • 1. Selection of Anesthetic Technique In the Name of Allah, the Most Beneficent, the Most Merciful.O mankind! Be afraid of your Lord (bykeeping your duty to Him and avoiding allevil), and fear a Day when no father canavail aught for his son, nor a son availaught for his father. Verily, the Promise ofAllah is true, let not then this (worldly)present life deceive you, nor let the chiefdeceiver (Satan) deceive you about Allah. Luqmān 33 Hesham El-Hawary
  • 2. Selection of Anesthetic Technique Selection ofDental Anesthetic Technique Dr Hesham El-Hawary Assistant professor OMFS Hesham El-Hawary
  • 3. Selection of Anesthetic TechniqueThe main factors to be concirened are:1. Selection of a suitable syringe and needle ( see the armamentarium lecture – click to open)2. Utilization of the proper L.A. drug (see the pharmacology lecture – click to open)3. Insertion of the needle in the correct site for injection Hesham El-Hawary
  • 4. Selection of Anesthetic Technique Hesham El-Hawary
  • 5. Selection of Anesthetic TechniqueSelection of Anesthetic TechniqueTYPES OF LOCAL ANESTHETIC TECHNIQUES Hesham El-Hawary
  • 6. Selection of Anesthetic TechniqueLocal Anesthetic Techniques 1. Topical anesthesia 2. Local infiltration 3. Field block 4. Nerve block Hesham El-Hawary
  • 7. Selection of Anesthetic Technique Topical Anesthesia• Ointments, gels, sprays and pastes on mucous membrane or skin• Application of a topical anesthetic agent on the mucosa allows for the easy and painless insertion of the sharp needle• Affects free nerve endings Hesham El-Hawary
  • 8. Selection of Anesthetic Technique Local Infiltration Anesthesia• Flooding of the small terminal nerve endings with local anesthetic solution Hesham El-Hawary
  • 9. Selection of Anesthetic Technique Field Block Anesthesia• Referred to as local infiltration• local anesthetic solution is deposited in the vicinity of larger terminal nerve fiber• so a circumscribed area is anesthetized• Local anesthesia injection above a tooth apex is an example of a field block, in spite of being referred to as paraperiosteal or supraperiosteal infiltration anesthesia Hesham El-Hawary
  • 10. Selection of Anesthetic Technique• Subperiosteal injection – Not be attempted – Because of • Liability of needle breakage • Difficulty of forcing the anesthetic agent between periosteum and bone Hesham El-Hawary
  • 11. Selection of Anesthetic Technique Nerve Block Anesthesia• The anesthetic solution is deposited close to a main nerve trunk• Usually at a distance from the operative site before the nerve divided into terminal branches Hesham El-Hawary
  • 12. Selection of Anesthetic TechniqueSelection of Anesthetic TechniqueFACTORS AFFECTING SELECTION OF ANESTHETICTECHNIQUE Hesham El-Hawary
  • 13. Selection of Anesthetic Technique1. Area to be anesthetized Depending on the type of bone (density of bone) – Maxilla and anterior mandibular region • Cancellous bone with thin cortical layer • Infiltration anesthesia or field block anesthesia reaches the nerve filaments inside the cancellous bone – Posterior mandible • Thick and dense cortical bone • Nerve block anesthesia Hesham El-Hawary
  • 14. Selection of Anesthetic Technique1. Area to be anesthetized Depending on the type of bone (density of bone) – Maxilla and anterior mandibular region • Cancellous bone with thin cortical layer • Infiltration anesthesia or field block anesthesia reaches the nerve filaments inside the cancellous bone – Posterior mandible • Thick and dense cortical bone • Nerve block anesthesia Hesham El-Hawary
  • 15. Selection of Anesthetic Technique2. Extent of surgical procedure – Multiple extractions, nerve block anesthesia is preferable • Allow anesthesia of the entire operative area • Prevent multiple needle punctures Hesham El-Hawary
  • 16. Selection of Anesthetic Technique2. Extent of surgical procedure – Multiple extractions, nerve block anesthesia is preferable • Allow anesthesia of the entire operative area • Prevent multiple needle punctures Hesham El-Hawary
  • 17. Selection of Anesthetic Technique2. Extent of surgical procedure – Multiple extractions, nerve block anesthesia is preferable • Allow anesthesia of the entire operative area • Prevent multiple needle punctures Hesham El-Hawary
  • 18. Selection of Anesthetic Technique3. Duration and profoundness of anesthesia Nerve block anesthesia produces a more profound and longer duration than infiltration anesthesia4. Age of the patient Older individuals have dense bone, thus it is more difficult for infiltration anesthesia to penetrate into the bone Hesham El-Hawary
  • 19. Selection of Anesthetic Technique3. Duration and profoundness of anesthesia Nerve block anesthesia produces a more profound and longer duration than infiltration anesthesia4. Age of the patient Older individuals have dense bone, thus it is more difficult for infiltration anesthesia to penetrate into the bone Hesham El-Hawary
  • 20. Selection of Anesthetic Technique4. Age of the patient Older individuals have dense bone, thus it is more difficult for infiltration anesthesia to penetrate into the bone Hesham El-Hawary
  • 21. Selection of Anesthetic Technique5. Homeostasis When required for the procedure, infiltration anesthesia is recommended to allow the vasoconstrictor present with the local anesthetic to act directly on the blood vessels and reduce bleeding Hesham El-Hawary
  • 22. Selection of Anesthetic Technique5. Homeostasis When required for the procedure, infiltration anesthesia is recommended to allow the vasoconstrictor present with the local anesthetic to act directly on the blood vessels and reduce bleeding Hesham El-Hawary
  • 23. Selection of Anesthetic Technique6. Presence of infection Infiltration anesthesia should be avoided to prevent injection into an infected area which can spread the infection Hesham El-Hawary
  • 24. Selection of Anesthetic Technique6. Presence of infection Infiltration anesthesia should be avoided to prevent injection into an infected area which can spread the infection Hesham El-Hawary
  • 25. Selection of Anesthetic Technique7. Skill of the operator Hesham El-Hawary
  • 26. Selection of Anesthetic TechniqueMaxillary Anesthetic TechniquesINFILTRATION ANESTHESIA Hesham El-Hawary
  • 27. Selection of Anesthetic Technique The most commonly used technique It is divided into  Soft tissue infiltration  Submucosal  Paraperiosteal  Bony infiltration Hesham El-Hawary
  • 28. Selection of Anesthetic TechniqueSoft tissue infiltration anesthesiaIn this technique anesthesia is deposited intothe soft tissue in close proximity to bonewhich is then absorbed via pores in the bonesurface till it reaches the nerve filamentsinside the cancellous bone Hesham El-Hawary
  • 29. Selection of Anesthetic TechniqueSoft tissue infiltration anesthesiaIn this technique anesthesia is deposited intothe soft tissue in close proximity to bonewhich is then absorbed via pores in the bonesurface till it reaches the nerve filamentsinside the cancellous bone Hesham El-Hawary
  • 30. Selection of Anesthetic Technique Soft Tissue InfiltrationSubmucosal anesthesia Needle is inserted at a slight depth just below the mucous membrane In cases just need superficial anesthesia  Hypertrophied tissue  High muscle attachment Hesham El-Hawary
  • 31. Selection of Anesthetic Technique Soft Tissue InfiltrationSubmucosal anesthesia Paraperiosteal Anesthesia Needle is inserted at a slight  Called local infiltration depth just below the  Mostly used for anesthetizing mucous membrane  All maxillary teeth In cases just need  Lower anterior mandibular teeth superficial anesthesia  It’s action depends on the  Hypertrophied tissue diffusion of the L.A. solution  High muscle attachment through the periosteum and the minute foramina in the cortical bone Hesham El-Hawary
  • 32. Selection of Anesthetic Technique Paraperiosteal AnesthesiaAdvantages1. High success rate2. Technically it is an easy injection3. Usually it is entirely atraumatic Hesham El-Hawary
  • 33. Selection of Anesthetic Technique Paraperiosteal AnesthesiaAdvantages Disadvantages1. High success rate • Not suitable for large areas2. Technically it is an easy – Needs multiple punctures injection – Administeration of large3. Usually it is entirely amount of L.A. solution atraumatic Hesham El-Hawary
  • 34. Selection of Anesthetic TechniqueAuthor: Hesham El-HawaryEmail: hesham@elhawarydentalclinic.comWebsite: www.elhawarydentalclinic.comTwitter: @elhawary_heshamFacebook: Hesham El-Hawary Hesham El-Hawary