Selection of dental anesthetic technique

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Selection of dental anesthetic technique

  1. 1. Selection of Anesthetic Technique Hesham El-Hawary Selec%on  of     Dental  Anesthe%c   Technique   Dr  Hesham  El-­‐Hawary   Assistant  professor  OMFS      
  2. 2. Selection of Anesthetic Technique Hesham El-Hawary O mankind! Be afraid of your Lord (by keeping your duty to Him and avoiding all evil), and fear a Day when no father can avail aught for his son, nor a son avail aught for his father. Verily, the Promise of Allah is true, let not then this (worldly) present life deceive you, nor let the chief deceiver (Satan) deceive you about Allah. Luqmān 33 In the Name of Allah, the Most Beneficent, the Most Merciful.
  3. 3. Selection of Anesthetic Technique Hesham El-Hawary        The  main  factors  to  be  concirened  are:               1.  SelecAon  of  a  suitable  syringe  and  needle     (  see  the  armamentarium  lecture  –  click  to  open)   2.   UAlizaAon  of  the  proper  L.A.  drug      (see  the  pharmacology  lecture  –  click  to  open)     3.  InserAon   of   the   needle   in   the   correct   site   for   injecAon    
  4. 4. Selection of Anesthetic Technique Hesham El-Hawary
  5. 5. Selection of Anesthetic Technique Hesham El-Hawary TYPES  OF  LOCAL  ANESTHETIC  TECHNIQUES   Selec%on  of  Anesthe%c  Technique  
  6. 6. Selection of Anesthetic Technique Hesham El-Hawary Local  Anesthe%c  Techniques   1.  Topical  anesthesia   2.  Local  infiltraAon   3.  Field  block   4.  Nerve  block  
  7. 7. Selection of Anesthetic Technique Hesham El-Hawary Topical  Anesthesia   •  Ointments,  gels,  sprays  and  pastes  on  mucous   membrane  or  skin   •  ApplicaAon   of   a   topical   anestheAc   agent   on   the   mucosa   allows   for   the   easy   and   painless   inserAon  of  the  sharp  needle   •  Affects  free  nerve  endings  
  8. 8. Selection of Anesthetic Technique Hesham El-Hawary Local  Infiltra%on  Anesthesia   •  Flooding  of  the  small  terminal  nerve  endings   with  local  anestheAc  soluAon  
  9. 9. Selection of Anesthetic Technique Hesham El-Hawary Field  Block  Anesthesia   •  Referred  to  as  local  infiltraAon   •  local   anestheAc   soluAon   is   deposited   in   the   vicinity  of  larger  terminal  nerve  fiber   •  so  a  circumscribed  area  is  anestheAzed   •  Local  anesthesia  injecAon  above  a  tooth  apex   is  an  example  of  a  field  block,  in  spite  of  being   r e f e r r e d   t o   a s   p a r a p e r i o s t e a l   o r   supraperiosteal  infiltraAon  anesthesia  
  10. 10. Selection of Anesthetic Technique Hesham El-Hawary •  Subperiosteal  injecAon     – Not  be  aWempted     – Because  of   •  Liability  of  needle  breakage     •  Difficulty   of   forcing   the   anestheAc   agent   between   periosteum  and  bone  
  11. 11. Selection of Anesthetic Technique Hesham El-Hawary Nerve  Block  Anesthesia   •  The  anestheAc  soluAon  is  deposited  close  to  a   main  nerve  trunk     •  Usually  at  a  distance  from  the  operaAve  site   before   the   nerve   divided   into   terminal   branches  
  12. 12. Selection of Anesthetic Technique Hesham El-Hawary FACTORS  AFFECTING  SELECTION  OF  ANESTHETIC   TECHNIQUE   Selec%on  of  Anesthe%c  Technique    
  13. 13. Selection of Anesthetic Technique Hesham El-Hawary 1.  Area  to  be  anestheAzed    Depending  on  the  type  of  bone  (density  of  bone)   –  Maxilla  and  anterior  mandibular  region     •  Cancellous  bone  with  thin  corAcal  layer     •  InfiltraAon  anesthesia  or  field  block  anesthesia  reaches  the  nerve   filaments  inside  the  cancellous  bone   –  Posterior  mandible     •  Thick  and  dense  corAcal  bone   •  Nerve  block  anesthesia  
  14. 14. Selection of Anesthetic Technique Hesham El-Hawary 1.  Area  to  be  anestheAzed    Depending  on  the  type  of  bone  (density  of  bone)   –  Maxilla  and  anterior  mandibular  region     •  Cancellous  bone  with  thin  corAcal  layer     •  InfiltraAon  anesthesia  or  field  block  anesthesia  reaches  the  nerve   filaments  inside  the  cancellous  bone   –  Posterior  mandible     •  Thick  and  dense  corAcal  bone   •  Nerve  block  anesthesia  
  15. 15. Selection of Anesthetic Technique Hesham El-Hawary 2.  Extent  of  surgical  procedure   –  MulAple   extracAons,   nerve   block   anesthesia   is   preferable   •  Allow  anesthesia  of  the  enAre  operaAve  area     •  Prevent  mulAple  needle  punctures  
  16. 16. Selection of Anesthetic Technique Hesham El-Hawary 2.  Extent  of  surgical  procedure   –  MulAple   extracAons,   nerve   block   anesthesia   is   preferable   •  Allow  anesthesia  of  the  enAre  operaAve  area     •  Prevent  mulAple  needle  punctures  
  17. 17. Selection of Anesthetic Technique Hesham El-Hawary 2.  Extent  of  surgical  procedure   –  MulAple   extracAons,   nerve   block   anesthesia   is   preferable   •  Allow  anesthesia  of  the  enAre  operaAve  area     •  Prevent  mulAple  needle  punctures  
  18. 18. Selection of Anesthetic Technique Hesham El-Hawary 3.  DuraAon  and  profoundness  of  anesthesia    Nerve  block  anesthesia  produces  a  more  profound   and  longer  duraAon  than  infiltraAon  anesthesia   4.  Age  of  the  paAent    Older  individuals  have  dense  bone,  thus  it  is  more   difficult  for    infiltraAon  anesthesia  to  penetrate  into   the  bone  
  19. 19. Selection of Anesthetic Technique Hesham El-Hawary 3.  DuraAon  and  profoundness  of  anesthesia    Nerve  block  anesthesia  produces  a  more  profound   and  longer  duraAon  than  infiltraAon  anesthesia   4.  Age  of  the  paAent    Older  individuals  have  dense  bone,  thus  it  is  more   difficult  for    infiltraAon  anesthesia  to  penetrate  into   the  bone  
  20. 20. Selection of Anesthetic Technique Hesham El-Hawary 4.  Age  of  the  paAent    Older  individuals  have  dense  bone,  thus  it  is  more   difficult  for    infiltraAon  anesthesia  to  penetrate  into   the  bone  
  21. 21. Selection of Anesthetic Technique Hesham El-Hawary 5.  Homeostasis    When  required  for  the  procedure,  infiltraAon   anesthesia   is   recommended   to   allow   the   vasoconstrictor   present   with   the   local   anestheAc  to  act  directly  on  the  blood  vessels   and  reduce  bleeding  
  22. 22. Selection of Anesthetic Technique Hesham El-Hawary 5.  Homeostasis    When  required  for  the  procedure,  infiltraAon   anesthesia   is   recommended   to   allow   the   vasoconstrictor   present   with   the   local   anestheAc  to  act  directly  on  the  blood  vessels   and  reduce  bleeding  
  23. 23. Selection of Anesthetic Technique Hesham El-Hawary 6.  Presence  of  infecAon     InfiltraAon   anesthesia   should   be   avoided   to   prevent  injecAon  into  an  infected  area  which   can  spread  the  infecAon  
  24. 24. Selection of Anesthetic Technique Hesham El-Hawary 6.  Presence  of  infecAon     InfiltraAon   anesthesia   should   be   avoided   to   prevent  injecAon  into  an  infected  area  which   can  spread  the  infecAon  
  25. 25. Selection of Anesthetic Technique Hesham El-Hawary 7.  Skill  of  the  operator  
  26. 26. Selection of Anesthetic Technique Hesham El-Hawary INFILTRATION  ANESTHESIA   Maxillary  Anesthe%c  Techniques  
  27. 27. Selection of Anesthetic Technique Hesham El-Hawary §  The  most  commonly  used  technique     §  It  is  divided  into     §  SoM  %ssue  infiltra%on   § Submucosal   § Paraperiosteal   §  Bony  infiltra%on  
  28. 28. Selection of Anesthetic Technique Hesham El-Hawary SoM  %ssue  infiltra%on  anesthesia    In  this  technique  anesthesia  is  deposited  into   the   soa   Assue   in   close   proximity   to   bone   which  is  then  absorbed  via  pores  in  the  bone   surface   All   it   reaches   the   nerve   filaments   inside  the  cancellous  bone  
  29. 29. Selection of Anesthetic Technique Hesham El-Hawary SoM  %ssue  infiltra%on  anesthesia    In  this  technique  anesthesia  is  deposited  into   the   soa   Assue   in   close   proximity   to   bone   which  is  then  absorbed  via  pores  in  the  bone   surface   All   it   reaches   the   nerve   filaments   inside  the  cancellous  bone  
  30. 30. Selection of Anesthetic Technique Hesham El-Hawary Soa  Tissue  InfiltraAon   Submucosal  anesthesia   §  Needle  is  inserted  at  a  slight   depth   just   below   the   mucous  membrane   §  In   cases   just     need   superficial  anesthesia     §  Hypertrophied  Assue     §  High  muscle  aWachment  
  31. 31. Selection of Anesthetic Technique Hesham El-Hawary Soa  Tissue  InfiltraAon   Submucosal  anesthesia   §  Needle  is  inserted  at  a  slight   depth   just   below   the   mucous  membrane   §  In   cases   just     need   superficial  anesthesia     §  Hypertrophied  Assue     §  High  muscle  aWachment   Paraperiosteal  Anesthesia   §  Called  local  infiltraAon     §  Mostly  used  for  anestheAzing     §  All  maxillary    teeth     §  Lower  anterior  mandibular  teeth   §       It’s  acAon  depends  on  the   diffusion   of   the   L.A.   soluAon   through   the   periosteum   and   the   minute   foramina   in   the   corAcal  bone  
  32. 32. Selection of Anesthetic Technique Hesham El-Hawary Paraperiosteal  Anesthesia   Advantages     1.  High  success  rate   2.  Technically   it   is   an   easy   injecAon   3.  Usually   it   is   enArely   atraumaAc  
  33. 33. Selection of Anesthetic Technique Hesham El-Hawary Paraperiosteal  Anesthesia   Advantages     1.  High  success  rate   2.  Technically   it   is   an   easy   injecAon   3.  Usually   it   is   enArely   atraumaAc   Disadvantages     •  Not  suitable  for  large  areas   –  Needs  mulAple    punctures     –  AdministeraAon   of   large   amount  of  L.A.  soluAon  
  34. 34. Selection of Anesthetic Technique Hesham El-Hawary Author: Hesham El-Hawary Email: hesham@elhawarydentalclinic.com Website: www.elhawarydentalclinic.com Twitter: Facebook: /elhawaryclinic

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