William Lieberman D.D.S., M.B.A
Pediatric Dentist
Dr. William H. Lieberman D.D.S., M.B.A.
• Private pediatric practice in New Jersey
• Past-President American Society of De...
Shore Pediatric Dental Group
Hygiene Room
Prevention
Restoration
Remineralization
Prevention
American Academy of Pediatrics
American Academy of Pediatric
Dentistry
Recommendation:
Dental home by age 1
ANTICIPATORY GUIDANCE –
What is it?
It is the process of providing practical, developmentally
appropriate health informati...
Infant Exam
Counseling
Diet & Nutrition
Oral Hygiene
Habits
Airway Space
• The pediatric dentist can be the first to identify
airway structure issues.
• Learn how to incorporate this...
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances :
eg. “W-loop”
Periodic exam
Why every 6 months?
Remineralization
White Spot Demineralization
Mila
Cumulative Fluoride
Release
Oxman et .al. 2008 AADR Abstract #987
0
500
1000
1500
2000
2500
3000
3500
1 7 14 28 120 180 36...
Recaldent
Novamin
Pro-Argin
Remineralizing
Agents
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary
Teeth
Successful Pulp Therapy requires:
• Correct Diagnosis
• Vital
• Non-vital
• Restoration
• Microleakage
Characteristics of Reported Pain
Provoked : thermal, chemical, mechanical
• indicates dentin sensitivity, pulp in transiti...
Radiographic Examination
Internal resorption
• once internal resorption has become advanced to
be seen radiographically th...
Medicaments for Pulpotomy
Formocresol
Ferric
Sulfate
Mineral Trioxide
Aggregate (MTA)
Pulpectomy
IPT Technique
• Gross caries removal
• Walls extended to sound tooth structure
• Infected dentin removed
• Affected dentin...
IPT Protocol
• Local anesthesia and rubber dam placement
• Excavation of infected dentin
• Caries detector utilized
• Cavi...
Clinical Procedure
Radiographic findings of primary first molar
post-treatment
6 months post-treatment
12 months post-treatment
Findings:
• 3 month recall 100% teeth were WNL
• 6 month follow-up 93% teeth were WNL
• Failure of Class II composite and ...
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Zirconium Crowns
Sectional Matrix
Local Anesthesia for
Patients
Dr. William H. Lieberman D.D.S., M.B.A.
Pediatric
1975-2013
Then & Now
• Paper Charts • Electronic Charts
1975-2013
Then & Now
• X-Ray Film • X-Ray Sensors
1975-2013
Then & Now
• Amalgam Restorations • Composite (RMGI) Restorations
1975-2013
Then & Now
• Curing Light • LED Light
1975-2013
Then & Now
• Syringes • The Wand / STA - Single Tooth Anesthesia
System Instrument
Drug choice and Volume
4% Articaine HCL
• Adult: ½ cartridge
• Child: ¼ cartridge
• Preferred Vasoconstrictor Concentratio...
What do you see ?
Prevalence of Dental Fear?
Agras, et al. 1979
20%
Technology ?1853 1904 2010
150+ years
Computer-Controlled
Local Anesthetic
Delivery System
“New Innovation”
“C-CLAD”
1997
1997 – 1st
Generation
2007 – 3rd
Generation
Computer Controlled Local
Anesthetic Delivery System
Disruptive Technology
•An innovation that alters a product or
service in ways the market does not
expect
Allows you to
do something you
can’t do any other way!
Simple mechanical system
Dynamic Pressure Sensing
Technology - DPS™
• Monitors “Exit-Pressure”
• Real-Time, continuous
information
• Visual and aud...
No
Feedback
FPO
Total
Feedback
Lesson 1
Set Up and Basic
Operation
Step - 1
FRONT
• Attach Foot Control
• Tighten Securely
BACK
• Attach Power Cord
• Turn Power Switch On
• Wait 5 seconds f...
Step - 2
ANESTHETIC CARTRIDGE
• Insert cartridge into holder
• Press firmly until spike punctures the diaphragm
Step - 3
Wand Handpiece & Needle
• Attach Luer-Lock needle to
handpiece, if necessary
• Tighten securely
• Place needle an...
Step - 3
Shorten length of
Wand Handpiece
• Remove tubing handpiece
• Shorten by “breaking” the length
of the handle
• Mar...
Step - 4
• Insert wings of holder
into top of STA
• Turn counter-clockwise
¼ turn
• STA activates and purges
handpiece of ...
Step - 4b
• Turn clockwise ¼ turn • Push cartridge out using
finger slots at top of cartridge
holder
• Remove cartridge an...
• The Training Mode provides
an audible explanation of the
various functions of the STA
• Allows one to become familiar
wi...
Step – 6 System is Ready
Lesson 2: Performing the
STA-Intra-ligamentary Injection
Learn the Injection of
Your Choice
Lesson 3: Performing the
AMSA ...
Lesson 2
Tools needed to perform
STA-IL Injection
• What you need to perform this injection:
• Bonded - 30-g ½ inch STA-Wa...
Lesson 2
Performing STA-IL
Injection
• What you need to learn:
• How to use Cruise-control feature
• Understand how DPS® w...
Performing
STA-Intra-ligamentary
Injection
Easy Learn: Cruise Control
• What is the Cruise Control
feature:
• The feature allows you to deliver anesthetic
solution w...
Easy Learn: STA-IL Insertion Site
• Area effected:
• Single Tooth Anesthesia
• Injection site:
1. Start on distal
2. Bend ...
You need a slight bend to the needle to allow proper access.
NOTE:Youcannotaccessthedistalofthelowermolars
properlywithoutbendingtheneedleslightly.
Incorrect Correct
Unbent needle Ben...
• Importanttomaintaindirectvisionofproperneedleangle
andneedleentranceintothesulcuswhenusingeither
approach
• Distal-bucca...
Mesial Approach
Incorrect needle
angle and entrance
Correct
• Proper angle and entrance can be achieved with bent or strai...
 Objective of Insertion:
1. Needle tip to entrance of PDL
 Angle of Insertion:
1. 30 to 45 degrees
2. Bend needle, if ne...
Easy Learn: Dynamic Pressure Sensing
• What is the DPS feature:
• This feature provides real-time audible and visual
feedb...
Easy Learn: DPS®
technology
Trouble Shooting:
• Problem:
Pressure not building:
1. Insufficient hand pressure on
STA/Wand ...
AMSA Injection
• A new technique that enables us to anesthetize a maxillary
quadrant in the primary dentition with one inj...
Lesson 3
Tools needed to perform
AMSA - Injection
• What you need to perform this injection:
• 30-g ½ inch – Bonded STA-Wa...
Lesson 3
How to Perform AMSA-
Injection
• What you need to Learn:
• How to use Cruise-control feature
• How to perform Pre...
Easy Learn: AMSA Insertion Site
• Area effected:
• The AMSA can produce pulpal anesthesia
from the Central Incisor to the ...
Easy Learn: AMSA Insertion Site
• Injection site:
1. Imagine a line located between
the 1st and 2nd Premolar
2. Mid-way al...
Clinical Technique: AMSA
Injection
Lesson 4
Performing P-ASA Injection
• What you need to Learn:
• How to use Cruise-control feature
• How to perform Pre-Pun...
Clinical Technique: P-ASA Injection
Easy Learn: P-ASA Insertion Site
• Area effected:
• The P-ASA can produce pulpal
anesthesia of the Central and
Lateral Inc...
Easy Learn: Anesthetic Pathway
• What is the Pre-Puncture
technique:
• The technique allows you to penetrate and
advance t...
Clinical Technique: P-ASA
Injection
Lesson 5
Tools needed to perform IA
Block Injection
• What you need to perform this injection:
• Smaller Children: 30-g 1 ...
Lesson 5
Performing IA Block
Injection
• What you need to Learn:
• How to change to Normal Mode
• How to use Cruise-contro...
Easy Learn: Bi-rotation Insertion
• Bi-rotation Insertion technique:
• This technique allows you to minimize needle
deflec...
Rotational
Insertion
Linear
Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn: 2-Speed Operation
Step - 1
1
2
• Using “Normal” mode 2-
speed operation:
• You can more effectively and effici...
Easy Learn: Aspiration
Step - 2
1
2
3
• Using Aspiration to prevent
intravascular needle
placement:
• You can prevent need...
Easy Learn: Anesthetic Pathway
• Anesthetic Pathway
technique:
• This technique allows you to penetrate and
advance the ne...
Lesson 7
Tools needed to Perform
Supraperiosteal/Buccal
Infiltration Injection
• What you need to perform this injection:
...
Lesson 7
Performing Supraperiosteal/
Buccal Infiltration Injection
• What you need to Learn:
• How to change to Normal Mod...
Easy Learn: Anesthetic Pathway
• Anesthetic Pathway
technique:
• The technique allows you to penetrate and
advance the nee...
Aspiration
After purging, STA
defaults to Aspiration
ON
If not needed, Aspiration can
be turned OFF, by pressing
Aspirate ...
Cartridge Volume
• LED lights indicate
amount of anesthetic
solution remaining
• STA “bongs” once when
¼ cartridge is expr...
Sound Volume Control
To Change Audible
Volume:
• Press up arrow to increase
volume
• Press down arrow to
decrease volume
Modes of operation:
STA, Normal, Turbo
“Select” button change
• A - STA Mode – 1 speed
ControlFlo only
DPS® (Dynamic Press...
Foot Control and Mode Selections:
• Depress Pedal Slightly
• ControlFlo Speed
• Used for Palatal and PDL injections
exclus...
DPS® - Dynamic Pressure Sensing
• Informs the Dentist of Correct Injection Site (PDL Space) with
Ascending Lights and Soun...
STA-IntraligamentaryInjection
Technique: DPS - Dynamic Pressure
Sensing
• Hold needle steadily in place with minimal
press...
THE ROLE OF
CCLAD
IN
Pediatric dentistry
Behavioral Management
• CCLAD technology has improved the overall acceptance of the anesthetic
injection in the pediatric ...
References
• Lieberman, William H. Clinical Session: The Wand. Pediatric
Dent. 1999;21:2
• Allen KD, Kotil D, Larzelere RE...
Pediatric
Restorative Dentistry
Painless & Predictable
Bi-Lateral
Restorative Dentistry
Efficient
No Soft Tissue
Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent “Dripping”
HAPPY PATIENTS
Cooperative Patients
Dr. Bill’s Helpful Tips
•Needle choice
o 30 gauge for all
o1” for older children mandibular blocks
o ¾” for infiltration a...
• Break the Wand for any injection to better
“cup” the needle
• Mark the bevel with a permanent marker
• Bend the needle w...
Dr. Bill’s Helpful Tips
• Instrument location - LED’s should be clearly
visible to operator & within reach
• Start instrum...
Dr. Bill’s Helpful Tips
• Avoid dripping the anesthetic in the mouth - the
bitter taste is the easiest way to lose a compl...
•Rule of 2’s for STA:
o20 seconds MAXIMUM time to be in one
location
o2 minute window to begin procedure
o20 minutes to co...
Timeliness
Summary
 Audible & visible assurance of pulpal anesthesia
 Painless- minimizes disruptive behavior
 Immediate onset of ...
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
Edit version prevention remineralization resoration 2013
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Edit version prevention remineralization resoration 2013

  1. 1. William Lieberman D.D.S., M.B.A Pediatric Dentist
  2. 2. Dr. William H. Lieberman D.D.S., M.B.A. • Private pediatric practice in New Jersey • Past-President American Society of Dentistry for Children • Past Trustee, American Academy of Pediatric Dentistry • MBA, Healthcare • Coordinator Dental Continuing Education, Monmouth Medical Center • Associate Clinical Professor at New York University Brief Bio.
  3. 3. Shore Pediatric Dental Group
  4. 4. Hygiene Room
  5. 5. Prevention Restoration Remineralization
  6. 6. Prevention
  7. 7. American Academy of Pediatrics American Academy of Pediatric Dentistry Recommendation: Dental home by age 1
  8. 8. ANTICIPATORY GUIDANCE – What is it? It is the process of providing practical, developmentally appropriate health information about children to their parents in anticipation of significant physical, emotional and psychological milestones. -Nowak and Casamassimo 1995
  9. 9. Infant Exam
  10. 10. Counseling Diet & Nutrition Oral Hygiene Habits
  11. 11. Airway Space • The pediatric dentist can be the first to identify airway structure issues. • Learn how to incorporate this knowledge and develop a medical/dental team approach for the developing child
  12. 12. Sleep Apnea
  13. 13. Brodsky Tonsil Scale
  14. 14. W-Loop Dental Equilibration Appliances : eg. “W-loop”
  15. 15. Periodic exam Why every 6 months?
  16. 16. Remineralization
  17. 17. White Spot Demineralization
  18. 18. Mila
  19. 19. Cumulative Fluoride Release Oxman et .al. 2008 AADR Abstract #987 0 500 1000 1500 2000 2500 3000 3500 1 7 14 28 120 180 360 days FluorideReleaseppmf/g Ketac Nano Fuji II LC Vitremer Fuji IX
  20. 20. Recaldent Novamin Pro-Argin Remineralizing Agents
  21. 21. NYU 3 visit protocol
  22. 22. First Visit Exam Counseling Varnish
  23. 23. Second Visit ITR (Interim Therapuetic Resortation) Fluoride Varnish Tooth Mousse
  24. 24. Third Visit Fluoride Varnish Counsel Repair
  25. 25. ITS Interim Therapeutic Strip Crowns
  26. 26. Restoration
  27. 27. Pulp Therapy for Primary Teeth
  28. 28. Successful Pulp Therapy requires: • Correct Diagnosis • Vital • Non-vital • Restoration • Microleakage
  29. 29. Characteristics of Reported Pain Provoked : thermal, chemical, mechanical • indicates dentin sensitivity, pulp in transitional stage • usually acute inflammation and reversible Spontaneous • throbbing, constant • indicates advanced pulp damage • pulp usually non-treatable • irreversible pulpitis or necrosis • often nocturnal
  30. 30. Radiographic Examination Internal resorption • once internal resorption has become advanced to be seen radiographically there is usually a perforation of the root by the resorptive process Pathologic bone and root resorption • Indicative of advanced pulp degeneration. The pulp tissue may remain vital even with such advanced degenerative changes.
  31. 31. Medicaments for Pulpotomy Formocresol Ferric Sulfate Mineral Trioxide Aggregate (MTA)
  32. 32. Pulpectomy
  33. 33. IPT Technique • Gross caries removal • Walls extended to sound tooth structure • Infected dentin removed • Affected dentin remaining • Should have 1mm sound dentin over remaining pulp • Base over remaining dentin • Final restoration • Must have good marginal integrity • Recall for evaluation
  34. 34. IPT Protocol • Local anesthesia and rubber dam placement • Excavation of infected dentin • Caries detector utilized • Cavity photographed • Placement of 2.0% chlorhexidine gluconate viscous solution for 60 seconds • Placement of a resin-modified glass ionomer on the preparation floor • Final restoration placement: internal or full coverage • Final photograph • Recall 3, 6 and 12 months
  35. 35. Clinical Procedure
  36. 36. Radiographic findings of primary first molar post-treatment 6 months post-treatment 12 months post-treatment
  37. 37. Findings: • 3 month recall 100% teeth were WNL • 6 month follow-up 93% teeth were WNL • Failure of Class II composite and one SSC restoration • 12 month recall all remaining teeth were WNL ProspectiveIPTinPrimaryMolarsusingRMGIand2% CHX:A 12monthfollow-up
  38. 38. Restorative Materials Composites Flowable RMGI Giomers Crowns
  39. 39. Zirconium Crowns
  40. 40. Sectional Matrix
  41. 41. Local Anesthesia for Patients Dr. William H. Lieberman D.D.S., M.B.A. Pediatric
  42. 42. 1975-2013 Then & Now • Paper Charts • Electronic Charts
  43. 43. 1975-2013 Then & Now • X-Ray Film • X-Ray Sensors
  44. 44. 1975-2013 Then & Now • Amalgam Restorations • Composite (RMGI) Restorations
  45. 45. 1975-2013 Then & Now • Curing Light • LED Light
  46. 46. 1975-2013 Then & Now • Syringes • The Wand / STA - Single Tooth Anesthesia System Instrument
  47. 47. Drug choice and Volume 4% Articaine HCL • Adult: ½ cartridge • Child: ¼ cartridge • Preferred Vasoconstrictor Concentration • 1:100,000 epinephrine 2% Lidocaine HCL • Adult: ¾ cartridge • Child: ½ cartridge • Preferred vasoconstrictor concentration • 1:100,000 epinephrine
  48. 48. What do you see ?
  49. 49. Prevalence of Dental Fear? Agras, et al. 1979 20%
  50. 50. Technology ?1853 1904 2010 150+ years
  51. 51. Computer-Controlled Local Anesthetic Delivery System “New Innovation” “C-CLAD” 1997
  52. 52. 1997 – 1st Generation 2007 – 3rd Generation Computer Controlled Local Anesthetic Delivery System
  53. 53. Disruptive Technology •An innovation that alters a product or service in ways the market does not expect
  54. 54. Allows you to do something you can’t do any other way!
  55. 55. Simple mechanical system
  56. 56. Dynamic Pressure Sensing Technology - DPS™ • Monitors “Exit-Pressure” • Real-Time, continuous information • Visual and audible feedback • System control: “Exit-Pressure”
  57. 57. No Feedback FPO Total Feedback
  58. 58. Lesson 1 Set Up and Basic Operation
  59. 59. Step - 1 FRONT • Attach Foot Control • Tighten Securely BACK • Attach Power Cord • Turn Power Switch On • Wait 5 seconds for STA to Self-calibrate
  60. 60. Step - 2 ANESTHETIC CARTRIDGE • Insert cartridge into holder • Press firmly until spike punctures the diaphragm
  61. 61. Step - 3 Wand Handpiece & Needle • Attach Luer-Lock needle to handpiece, if necessary • Tighten securely • Place needle and cap into holder on either side of STA
  62. 62. Step - 3 Shorten length of Wand Handpiece • Remove tubing handpiece • Shorten by “breaking” the length of the handle • Mark the bevel
  63. 63. Step - 4 • Insert wings of holder into top of STA • Turn counter-clockwise ¼ turn • STA activates and purges handpiece of air • Lights are activated Insertion of Cartridge Holder
  64. 64. Step - 4b • Turn clockwise ¼ turn • Push cartridge out using finger slots at top of cartridge holder • Remove cartridge and continue Removal of Cartridge Holder
  65. 65. • The Training Mode provides an audible explanation of the various functions of the STA • Allows one to become familiar with operating the STA • Enable Training Mode by pressing and holding the “Hold to Train” button for 4 seconds Easy Learn: Training Mode Step - 5
  66. 66. Step – 6 System is Ready
  67. 67. Lesson 2: Performing the STA-Intra-ligamentary Injection Learn the Injection of Your Choice Lesson 3: Performing the AMSA – (Palatal) Injection
  68. 68. Lesson 2 Tools needed to perform STA-IL Injection • What you need to perform this injection: • Bonded - 30-g ½ inch STA-Wand® Handpiece • The STA drive-unit set to “STA” mode • Activate Training Mode feature (optional)
  69. 69. Lesson 2 Performing STA-IL Injection • What you need to learn: • How to use Cruise-control feature • Understand how DPS® works • How to use STA aspiration to prevent back-spray of anesthetic into patients mouth
  70. 70. Performing STA-Intra-ligamentary Injection
  71. 71. Easy Learn: Cruise Control • What is the Cruise Control feature: • The feature allows you to deliver anesthetic solution without the need of continuously depressing the foot pedal, it’s analogous to cruise-control in your car in which you release the accelerator and continue to drive. • How do you activate: 1. Start injection by depressing pedal 2. After 3 seconds voice prompt will say “Cruise” 3. Immediately release foot off pedal to remain in cruise mode • How do you de-activate: • Tap foot-control pedal to stop Step - 1
  72. 72. Easy Learn: STA-IL Insertion Site • Area effected: • Single Tooth Anesthesia • Injection site: 1. Start on distal 2. Bend needle, if necessary, to gain access 3. It is best to maintain a direct view of the needle and it’s entrance to the sulcus at all times 4. It is important for the shaft of the needle to be parallel with the surface of the root Step - 2
  73. 73. You need a slight bend to the needle to allow proper access.
  74. 74. NOTE:Youcannotaccessthedistalofthelowermolars properlywithoutbendingtheneedleslightly. Incorrect Correct Unbent needle Bent needle (allows proper angle and access to PDL)
  75. 75. • Importanttomaintaindirectvisionofproperneedleangle andneedleentranceintothesulcuswhenusingeither approach • Distal-buccal requires needle to be bent as well Buccal Approach
  76. 76. Mesial Approach Incorrect needle angle and entrance Correct • Proper angle and entrance can be achieved with bent or straight needle Incorrect
  77. 77.  Objective of Insertion: 1. Needle tip to entrance of PDL  Angle of Insertion: 1. 30 to 45 degrees 2. Bend needle, if necessary 3. Direct vision of needle 4. Needle shaft parallel to root  Movement of Insertion: 1. Very SLOWLY advance needle producing Anesthetic Pathway 2. Needle is inserted like a “Periodontal Probe”, gently Easy Learn: Needle Insertion Step - 3 30º
  78. 78. Easy Learn: Dynamic Pressure Sensing • What is the DPS feature: • This feature provides real-time audible and visual feedback to indicate when the needle is properly positioned when performing the STA-Intra- ligamentary (PDL) injection. • How to use: 1. In STA-Mode only 2. Start injection 3. Insert needle into “assumed” correct PDL injection location 4. Wait approximately 10-15 seconds in “assumed” correct location 5. Listen & Watch, “ascending tone” & Increase of Pressure Scale through “orange” LED zone 6. Maintaining the High “orange” or the “green” LED zone throughout confirms proper needle location Step - 4
  79. 79. Easy Learn: DPS® technology Trouble Shooting: • Problem: Pressure not building: 1. Insufficient hand pressure on STA/Wand handpiece 2. Did not wait 10 -15 seconds to allow pressure to build 3. Incorrect needle position Over-Pressure Alert: 1. Excessive hand pressure on STA/Wand handpiece 2. Blocked needle tip with excessive hand pressure into PDL tissue 3. Incorrect needle position Step - 5
  80. 80. AMSA Injection • A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection.
  81. 81. Lesson 3 Tools needed to perform AMSA - Injection • What you need to perform this injection: • 30-g ½ inch – Bonded STA-Wand® Handpiece • Cotton-applicator with wooden-handle required • The STA drive-unit set to “STA” mode
  82. 82. Lesson 3 How to Perform AMSA- Injection • What you need to Learn: • How to use Cruise-control feature • How to perform Pre-Puncture Technique • How to perform Anesthetic Pathway Technique • How to use STA-aspiration to prevent back-spray of anesthetic into patients mouth
  83. 83. Easy Learn: AMSA Insertion Site • Area effected: • The AMSA can produce pulpal anesthesia from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues. • Injection site: 1. Imagine a line located between the 1st and 2nd Premolar 2. Mid-way along an imaginary line from the palatal suture to the free gingival margin 3. Approach this site with the hand- piece from the contra-lateral premolars  Bisect premolars  Midway between the free gingival margin and mid-palatine suture Step - 1
  84. 84. Easy Learn: AMSA Insertion Site • Injection site: 1. Imagine a line located between the 1st and 2nd Premolar 2. Mid-way along an imaginary line from the palatal suture to the free gingival margin 3. Approach this site with the hand- piece from the contra-lateral premolars Step - 1
  85. 85. Clinical Technique: AMSA Injection
  86. 86. Lesson 4 Performing P-ASA Injection • What you need to Learn: • How to use Cruise-control feature • How to perform Pre-Puncture Technique • How to perform Anesthetic Pathway Technique • How to use STA-aspiration to prevent back-spray of anesthetic into patients mouth
  87. 87. Clinical Technique: P-ASA Injection
  88. 88. Easy Learn: P-ASA Insertion Site • Area effected: • The P-ASA can produce pulpal anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues • Injection site: 1. Entry point is the incisive groove surrounding the incisive papilla 2. Final needle tip position is within the incisive canal Step - 1
  89. 89. Easy Learn: Anesthetic Pathway • What is the Pre-Puncture technique: • The technique allows you to penetrate and advance the needle through the palatal gingiva with minimal discomfort to the patient • How to perform: 1. Place bevel against surface with cotton-applicator on-top 2. Wait 8 seconds- then rotate and penetrate surface 1 - 2 mm 3. Advancement Pace: 1 - 2 mm then wait 4 seconds to allow anesthetic to proceed needle 4. Advance needle until bevel contacts surface of bone Step - 2
  90. 90. Clinical Technique: P-ASA Injection
  91. 91. Lesson 5 Tools needed to perform IA Block Injection • What you need to perform this injection: • Smaller Children: 30-g 1 inch – Bonded STA-Wand® Handpiece • Adolescents : 27-g 1 ¼ inch – Bonded STA-Wand® Handpiece • Normal Mode
  92. 92. Lesson 5 Performing IA Block Injection • What you need to Learn: • How to change to Normal Mode • How to use Cruise-control feature • How to perform Anesthetic Pathway Technique • How to use Bi-Rotational Insertion Technique • How to use STA-aspiration • How to use 2 speed operation
  93. 93. Easy Learn: Bi-rotation Insertion • Bi-rotation Insertion technique: • This technique allows you to minimize needle deflection during insertion. • How to perform: • Rotate needle in a back-n-forth fashion
  94. 94. Rotational Insertion Linear Insertion Deflection X X Linear Rotational Insertion Techniques
  95. 95. Easy Learn: 2-Speed Operation Step - 1 1 2 • Using “Normal” mode 2- speed operation: • You can more effectively and efficiently perform the IA Block using the 2-speeds How to use: 1. Depressing the foot control lightly allows you to start the injection using the ControFlo (slower) flow rate – Use for the first ¼ cartridge of IA Block 2. Depressing the foot control all the way down allows the second, more rapid rate to administer the remaining volume of anesthetic
  96. 96. Easy Learn: Aspiration Step - 2 1 2 3 • Using Aspiration to prevent intravascular needle placement: • You can prevent needle placement into a vessel by use of aspiration How to use: • After completion of needle placement: 1. Press and then release foot-control pedal to activate aspiration, which is six beeps for the complete cycle 2. If you see blood in the needle hub, re- position needle and re-aspirate until negative observation
  97. 97. Easy Learn: Anesthetic Pathway • Anesthetic Pathway technique: • This technique allows you to penetrate and advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient. • How to perform: 1. Penetrate mucosa 2. Advancement Pace: 1- 2 mm then wait 4 seconds to allow anesthetic to proceed needle 3. Advance needle until contact against surface of bone
  98. 98. Lesson 7 Tools needed to Perform Supraperiosteal/Buccal Infiltration Injection • What you need to perform this injection: • 30-g 1-inch Bonded STA-Wand® Handpiece • Normal Mode
  99. 99. Lesson 7 Performing Supraperiosteal/ Buccal Infiltration Injection • What you need to Learn: • How to change to Normal Mode • How to use Cruise-control feature • How to perform Anesthetic Pathway Technique • How to use STA-aspiration • How to use 2 speed operation
  100. 100. Easy Learn: Anesthetic Pathway • Anesthetic Pathway technique: • The technique allows you to penetrate and advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient. • How to perform: 1. Penetrate mucosa 2. Advancement Pace: 1 - 2 mm then wait 4 seconds to allow anesthetic to proceed needle 3. Advance needle until contact against surface of bone
  101. 101. Aspiration After purging, STA defaults to Aspiration ON If not needed, Aspiration can be turned OFF, by pressing Aspirate button
  102. 102. Cartridge Volume • LED lights indicate amount of anesthetic solution remaining • STA “bongs” once when ¼ cartridge is expressed, twice when ½ is expressed, and three times when ¾ is used
  103. 103. Sound Volume Control To Change Audible Volume: • Press up arrow to increase volume • Press down arrow to decrease volume
  104. 104. Modes of operation: STA, Normal, Turbo “Select” button change • A - STA Mode – 1 speed ControlFlo only DPS® (Dynamic Pressure Sensing) • B - Normal Mode – 2 speed ControlFlo and RapidFlo • C - Turbo Mode - 3 speed ControlFlo, RapidFlo, and TurboFlo A B C
  105. 105. Foot Control and Mode Selections: • Depress Pedal Slightly • ControlFlo Speed • Used for Palatal and PDL injections exclusively • Start of all injections during the first ¼ cartridge • Depress Pedal Moderately • RapidFlo Speed • Infiltration & Mandibular Block • After first ¼ cartridge only • Depress Pedal Firmly • TurboFlo Speed • After first ½ cartridge only
  106. 106. DPS® - Dynamic Pressure Sensing • Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Sounds • Informs the Dentist if the Needle has Left the Correct Site • Informs the Dentist if the Needle has been Blocked • All Feedback Information in Real Time
  107. 107. STA-IntraligamentaryInjection Technique: DPS - Dynamic Pressure Sensing • Hold needle steadily in place with minimal pressure for approximately 15 seconds • Ascending tones and lights will indicate the needle is in the correct injection site, the periodontal ligament space • If ascending tones and lights are not initiated after 15 seconds, move needle slightly until the correct position is attained and lights and tones are seen and heard
  108. 108. THE ROLE OF CCLAD IN Pediatric dentistry
  109. 109. Behavioral Management • CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior.
  110. 110. References • Lieberman, William H. Clinical Session: The Wand. Pediatric Dent. 1999;21:2 • Allen KD, Kotil D, Larzelere RE, Hutfless S, Beiraghi S. Comparison of a computerized anesthesia device with a traditional syringe in preschool children. Pediatric Dent. 2002 Jul-Aug;24(4): 315-20
  111. 111. Pediatric Restorative Dentistry
  112. 112. Painless & Predictable
  113. 113. Bi-Lateral Restorative Dentistry Efficient
  114. 114. No Soft Tissue Numbness
  115. 115. STA-IL Anterior Teeth
  116. 116. Bevel orientation
  117. 117. Mark the Bevel
  118. 118. Patient Compliance
  119. 119. Lack of Disruptive Behavior
  120. 120. Prevent “Dripping”
  121. 121. HAPPY PATIENTS
  122. 122. Cooperative Patients
  123. 123. Dr. Bill’s Helpful Tips •Needle choice o 30 gauge for all o1” for older children mandibular blocks o ¾” for infiltration and blocks in younger children o ½” for STA (periodontal ligament injection)
  124. 124. • Break the Wand for any injection to better “cup” the needle • Mark the bevel with a permanent marker • Bend the needle with caution, as needed, for a better angle Dr. Bill’s Helpful Tips
  125. 125. Dr. Bill’s Helpful Tips • Instrument location - LED’s should be clearly visible to operator & within reach • Start instrument prior to injection to avoid startling the patient • Use cruise control- NEVER turbo w/ pediatric patient
  126. 126. Dr. Bill’s Helpful Tips • Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient • Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
  127. 127. •Rule of 2’s for STA: o20 seconds MAXIMUM time to be in one location o2 minute window to begin procedure o20 minutes to complete treatment • Watch the videos on the website…very helpful! www.STAis4U.com Dr. Bill’s Helpful Tips
  128. 128. Timeliness
  129. 129. Summary  Audible & visible assurance of pulpal anesthesia  Painless- minimizes disruptive behavior  Immediate onset of anesthesia o no delay is important for a child’s short attention span o saves chair time  Multiple quadrants at the same visit  No soft tissue numbness - no risk of lip biting

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