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Anatomical correlation of local anesthesia in dentistry

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Anatomical correlation of local anesthesia in dnetistry

Anatomical correlation of local anesthesia in dnetistry

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    Anatomical correlation of local anesthesia in dentistry Anatomical correlation of local anesthesia in dentistry Presentation Transcript

    • Anatomical correlationAnatomical correlation ofof Local anesthesiaLocal anesthesia inin DentistryDentistry Dr.B.B.GosaiDr.B.B.Gosai
    • Pre-Lecture Quiz
    • 1 Identify technique of local anesthesia 2 Identify technique of local anesthesia
    • 3 Identify technique of local anesthesia
    • 4 Identify technique of local anesthesia
    • 5 Identify technique of local anesthesia 6 Identify technique of local anesthesia
    • 7 Identify technique of local anesthesia
    • Techniques of Maxillary Anesthesia  Supraperisoteal infiltration : for limited treatment protocol  Periodontal ligament injection as adjunct to other techniques  Intraseptal injection: for periodontal surgical techniques  Intraosseous injection: for single teeth  Posterior superior alveolar nerve block: for several molar teeth in one quadrant  Middle superior alveolar nerve block: for premolar in one quadrant  Anterior superior alveolar(Infraorbital ) nerve block: for anterior teeth in one quadrant  Maxillary (Second division) nerve block: for extensive buccal, palatal and pulpal management in one quadrant  Greater (Anterior ) palatine nerve block: for palatal soft and osseous tissue treatment distal to canine in one quadrant  Nasopalatine nerve block:for palatal soft and osseous tissue treatment from canine to canine bilaterally
    • Supraperiosteal injection Indication:  pulpal amesthesia for one or two maxillary teeth and soft tissue surrounding them Procedure:  syringe should be parallel with long axis of the tooth and inserted at the height of mucobuccal fold over the tooth
    • Supraperiosteal injectionSupraperiosteal injection Area anesthetized
    • Posterior superior alveolar nerve block  Indication:  Treatment involving two or more maxillary molars  Area anesthesised:  Pulp of maxillary 3rd , 2nd and 1st molar ( entire tooth in 72% and mesiobuccal root not anesthesised in 28 % as it may be supplied by MSAN)  Procedure:  Insert needle at height of mucobuccal fold over 2nd Molar .  Advance upward (45 degrees to occlusal plane), Inwards (medially at 45 degrees to occlusal plane) and backwards ( at 45 degrees to long axis of 2nd molar )  Advance depth of 16 mm to reach Alveolar foramina. For smaller adult and children depth of 14 mm.  Complication:  Hematoma
    • Posterior superior alveolar nerve block Area anesthetized
    • Posterior superior alveolar nerve block Insert needle at height of mucobuccal fold over 2nd Molar Advance upward (45 degrees to occlusal plane), Inwards (medially at 45 degrees to occlusal plane) and backwards ( at 45 degrees to long axis of 2nd molar )
    • Middle superior alveolar nerve block Present in 28 % of population Indication:  When infraorbital block fails Area anesthesised: Pulp of maxillary 1st and 2nd premolar and mesiobuccal root of 1st molar Procedure:  Insert needle at height of mucobuccal fold over 2nd premolar .  Advance till tip of needle reach well above the apex of 2nd premolar
    • Middle superior alveolar nerve block Needle reach well above the apex of 2nd premolar Area anesthetized
    • Anterior superior alveolar nerve block (Infraorbital nerve block)  Indication:  Treatment involving two or more maxillary teeth  Area anesthetized:  Pulp of maxillary central incisors to canine, in 72 % maxillary premolars and mesiobuccal root of 1st molar, buccal periodontium of same teeth  Procedure:  Locate infraorbital notch at infraorbital margin.  Move finger downwards>> convex feeling is roof of foramen >> further downwards concave feeling is Infraorbital foramen pulpated on face.  Insert needle at height of mucobuccal fold over 1st premolar with needle held parallel to long axis of tooth till 16 mm depth and correlated with external landmark.
    • Anterior superior alveolar nerve block (Infraorbital nerve block) Area anesthetized Locate infraorbital notch at infraorbital margin and palpate downwards to located foramen
    • Mucobuccal fold over 1st premolar with needle held parallel to long axis of tooth
    • Palatal anesthesia Traumatic experience for patient with complains of extreme pain while performing anesthesia.  This can be reduced by applying topical anesthesia pressure anesthesia control over needle slow deposition of anesthetic
    • Greater palatine nerve block  Indication:  Dental procedures involving palatal soft tissues distal to canine.  Area anesthesised:  Posterior part of hard palate and overlying soft tissue till 1st premolar anteriorly and medially midline.  Procedure:  Path of insertion from opposite aside of the mouth at a right angle to target area.  Locate greater palatine foramen by placing cotton swab at junction of maxillary alveolar process and hard palate in the groove. Press firmly posteriorly from first maxillary molar. Swab will fall in the “Depression” created by greater palatine foramen which is located usually distal to maxillary 2nd Molar .  Complication:  Ischemia and necrosis due to concentrated vasocontrictor solution used for hemostasis.
    • Greater palatine nerve block
    • Locate greater palatine foramen by placing cotton swab at junction of maxillary alveolar process and hard palate in the groove. Press firmly posteriorly from first maxillary molar. Swab will fall in the “Depression” created by greater palatine foramen which is located usually distal to maxillary 2nd Molar .
    • Nasopalatine nerve block  Indication:  Restorative therapy for more than two teeth.  Area anesthetized:  Anterior portion of the hard palate and overlying soft tissue from mesial of right 1st premolar to mesial of left 1st premolar.  Procedure:  Single needle penetration  Insert needle at incisive papilla and advance towards incisive foramen till the depth of 6-10 mm.  Multiple needle penetration  First injection at labial frenulum  Second injection labial aspect of papilla between central incisors  Third injection if second injection has failed then to lateral aspect of insicive papilla.
    • Nasopalatine nerve block
    • Nasopalatine nerve block Area anesthetized Single needle penetration at incisive papilla
    • Nasopalatine nerve block Multiple Needle Penetration First injection at labial frenulum
    • Nasopalatine nerve block Multiple Needle Penetration Second injection labial aspect of papilla between central incisors Third injection if second injection has failed then to lateral aspect of insicive papilla.
    • Maxillary nerve block  Indication:  Extensive oral surgical, periodontal or restorative procedures requiring anesthesia of whole maxillary division.  Area anesthetized:  Hemimaxilla including soft and hard tissues.  Procedure:  High tuberosity approach:  Insert needle at height of mucobuccal fold over maxillary 2nd molar tooth.  Advance needle like PSAN block but depth should be 30 mm. At this depth needle tip is in proximity to maxillary nerve in pterygopalatine fossa.  Greater palatine approach:  Locate greater palatine foramen  Advance needle into canal to a depth of 30 mm.  Complication:  Maxillary artery injury with hematoma  Penetration into the orbit with ophthalmoplegia.  Due to septa in greater palatine canal procedure may not be successful.
    • Maxillary nerve block Area anesthetized Needle at height of mucobuccal fold over maxillary 2nd molar tooth
    • Inferior alveolar nerve block  Also known as Mandibular block  Indication:  Procedures on multiple mandibular teeth in one quadrant.  Area anesthetized:  Mandibular teeth, body and ramus of mandible, buccal mucoperiosteum and anterior two third of tongue(lingual nerve).  Procedure:  Height of injection determined by imaginary line extend posteriorly from coronoid notch to pterygomandibular raphe as it turns upwards towards maxilla.  Anteroposterior site on injection: about three fourths the distance from anterior border of ramus  Penetration depth: till bone is touched usually 20-25 mm.  Complication:  Trismus  Transient facial palsy.  Hematoma.
    • Mandibular landmarks 1. Lingula 2. Posterior border of ramus 3. Coronoid notch 4. Coronoid process 5. Masseteric notch 6. Condylar process
    • Inferior alveolar nerve block Area anesthetized
    • Inferior alveolar nerve block Height of injection determined by imaginary line extend posteriorly from coronoid notch to pterygomandibular raphe as it turns upwards towards maxilla.
    • Buccal nerve block Indication:  When buccal soft tissue anesthesia is required for dental procedures in the mandibular molar region. Area anesthetized: Soft tissues and periosteum buccal to mandibular molar teeth. Procedure:  Injection at distal and buccal to last molar near anterior border of ramus of mandible.  Depth usually 1-2 mm rarely above 2-4 mm. Complication:  Hematoma - bluish discolouration at the injection site..
    • Buccal nerve block Area anesthetized
    • Buccal nerve block Injection at distal and buccal to last molar near anterior border of ramus of mandible
    • Mental nerve block Indication:  Dental procedures requiring pulpal anesthesia on mandibular teeth anterior to mental foramen. Area anesthetized:  Pulpal nerve fibres supplying premolars, canine and incisors.  Buccal mucous membrane anterior to mental foramen to the midline and skin of lower lip and chin. Procedure:  Injection at mucobuccal fold at mental foramen located between apices of two premolars or canine and deposit the content at the foramen.
    • Mental nerve block Area anesthetized
    • Incisive nerve block Indication:  When buccal soft tissue anesthesia is required for procedures in the mandible anterior to the mental foramen like biopsy and suturing of tissue. Area anesthetized: Buccal mucous membrane anterior to mental foramen to the midline and skin of lower lip and chin. Procedure:  Injection at mucobuccal fold at mental foramen located between apices of two premolars. Complication:  Hematoma - bluish discolouration at the injection site..
    • Incisive nerve block Area anesthetized between apices of two premolars
    • Mandibular nerve block: The Gow-Gates Technique  Higher success rate  Indication:  Procedures on multiple mandibular teeth in one quadrant and inferior alveolar nerve block fails.  Area anesthetized:  Mandibular teeth to midline, body and ramus of mandible, buccal mucoperiosteum and anterior two third of tongue(lingual nerve).  Landmarks and procedure:  Extraoral: lower border of tragus and corner of mouth (Imaginary line joining these two points)  Intraoral: Height of injection determined by tip of needle just below the mesiolingual (mesiopalatal) cusp of maxillary second molar.  Penetration just distal to maxillary second molar tooth aligning needle to line mentioned in Extraoral landmark with average depth about 25 mm.  Complication:  Trismus  Temporary paralysis of III, IV and VI.  Hematoma.
    • Mandibular nerve block: The Gow-Gates Technique Area anesthetized
    • Mandibular nerve block: The Gow-Gates Technique Extraoral landmark: lower border of tragus and corner of mouth (Imaginary line joining these two points)
    • Direction of needle in Gow-Gates Technique
    • Vazirani-Akinosi Mouth Mandibular nerve block:  Indication:  Limited mandibular opening.  Area anesthetized:  Mandibular teeth to midline, body and ramus of mandible, buccal mucoperiosteum and anterior two third of tongue(lingual nerve).  Landmarks and procedure:  Insert needle at mucogingival junction of maxillary third molar.  Advance needle slightly laterally and posteriorly with average depth about 25 mm.  Complication:  Temporary paralysis of VII.  Trismus (rare)  Hematoma.
    • Vazirani-Akinosi Mouth Mandibular nerve block: Area anesthetized
    • Vazirani-Akinosi Mouth Mandibular nerve block:
    • Vazirani-Akinosi Mouth Mandibular nerve block:
    • Post-lecture QUIZ!!!!!
    • 1 Identify technique of local anesthesia 2 Identify technique of local anesthesia
    • 3 Identify technique of local anesthesia
    • 4 Identify technique of local anesthesia
    • 5: Identify technique of local anesthesia 6: Identify technique of local anesthesia
    • 7 Identify technique of local anesthesia
    • 8 Identify technique of local anesthesia
    • 9 Identify landmarks at 1 and 3
    • 10 Identify technique of local anesthesia 11 Identify technique of local anesthesia
    • 12 Identify technique of local anesthesia 13 Identify technique of local anesthesia
    • …..Thanks…..