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- 1. Department of Dentistry Seminarpresentation on Anesthesia considerations in Dentistry Year III medical students Moderator:Dr Dani(MD,orthodontist) Presenters:Group 5(IDNo 031/19-036/19) Tikimt 23,2015E.C Dilla,Ethiopia
- 2. contents Overview on maxillaryand maxillary innervation Definition Methods Advantages Limitations Advances
- 3. objectives At the endof this seminar you are expected to: Define anesthesia Know the role of anesthesia in dentistry Identify different methods Limitations of anesthesia Identify advances in anesthesia
- 4. Definition 11/1/2022 4 LocalAnesthesia is the loss of sensation in circumscribed area of body caused by depression of excitation in nerve engines or inhibition of conduction process in peripheral nerves. Produces loss of sensation with out loss of consciousness
- 5. Role of LocalAnesthetics • Decrease intraoperative and postoperative pain • Decrease amount of general anesthetics used in the OR • Increase patients cooperation • Diagnostic testing/examination 11/1/2022 5
- 6. Techniques of LocalAnesthesia or methods 1. Topical anesthesia Spray Ointment Solution form Gel 2. Parentral anesthesia Infiltration Block anesthesia 11/1/2022 6
- 7. Desirable characteristics ofideal anesthesia 1. Low toxicity 2. Reduction of blood flow 3. Long duration of action 4. Rapid speed of onset 5. Good anesthetic efficacy 11/1/2022 7
- 8. Precaution to beconsidered during injection inside the mouth 11/1/2022 8 Do not inject local anesthetic into an area that is swollen. If the person has heart disease or hypertension not use an anesthetic with epinephrine(vasoconstrictor). Use lidocaine without epinephrine. Before the needle enter the mucosa, be sure its bevel is facing the mucosa.
- 9. Cont… Before thelocal anesthetic is injected, aspirat with the syringe to prevent an intravascular injection. If this happens pull the needle part way out and gently move it over to a different place. Use a sharp needle and inject the solution very slowly. Be sure the syringe is clean and sterile. 11/1/2022 9
- 10. types: 11/1/2022 10 1. amide lidocaine,mepivacaine, prilocaine, articaine, bupivacaine and etidocaine. 2. Ester procaine propoxycaine, chlorprocain and tetracaine are some common esther anesthetics.
- 11. Maxillary and mandibularinnervation 11/1/2022 11 • olfactory nerve • optic nerve • oculomotor nerve • trochlear nerve • V.trigeminal nerve－branch、 distribution • abducent nerve • VII.facial nerve－branch、distribution • vestibulocochlear nerve • IX.glossopharyngeal nerve－ distribution • vagus nerve • accessory nerve • XII.hypoglossal nerve－distribution Cranial nerves
- 13. 8 7 65 4 3 2 1 1 2 3 4 5 6 7 8 8 7 6 5 4 3 2 1 1 2 3 4 5 6 7 8 trigeminal nerve P m A Lingual n. Buccal n./ Mental n. /Inferior alveolar n. Nasopalatine n. anter. pala.n. Distribution of n. in oral region 13
- 14. Maxillary anesthesia: Infiltration Ableto be performed in the maxilla due to the thin cortical nature of the bone Involves injecting to tissue immediately around surgical site - Supraperiosteal injections -Periodontal ligament injections - intraosseous injection 11/1/2022 14
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- 19. Cont… Nerve Block Localanesthetic deposited near main nerve trunk and is usually distant from operative site Posterior superior alveolar -Infraorbital Middle superior alveolar -Greater palatine Anterior superior alveolar -Nasopalatine 11/1/2022 19
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- 21. Cont……… Posterior superior alveolarnerve block: – Used to anesthetize the pulpal tissue, corresponding alveolar bone, and buccal gingival tissue to the maxillary 1st, 2nd and 3rd molars. 11/1/2022 21
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- 23. Cont… – Technique: • Areaof insertion - height of mucobuccal fold between1st and 2nd molar • Angle at 45° superiorly and medially • No resistance should be felt (if bony contact angle it to medial, reposition laterally) • Insert about 15-20mm • Aspirate then inject if negative 11/1/2022 23
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- 25. Cont… Middle superior alveolarnerve block: - Used to anesthetize the maxillary premolars, corresponding alveolus, and buccal gingival tissue - Used if the infraorbital block fails to anesthetize premolars 11/1/2022 25
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- 27. Cont… – Technique: • Areaof insertion is height of mucobuccal fold in area of 1st & 2nd premolars • Insert around 10-15mm • Inject around 0.9-1.2cc 11/1/2022 27
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- 29. Cont… Anterior superior alveolarnerve block: - Used to anesthetize the maxillary canine, lateral incisor, central incisor, alveolus, and buccal gingiva -Technique: • Area of insertion is height of mucobuccal fold in area of lateral incisor and canine • Insert around 10-15mm • Inject around 0.9-1.2cc 11/1/2022 29
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- 31. Cont.. Infraorbital nerve block: –Used to anesthetize the maxillary1st and 2nd premolars, canine, lateral incisor, central incisor, corresponding alveolar bone, and buccal gingiva – Combines MSA and ASA blocks – Will also cause anesthesia to the lower eyelid, lateral aspect of nasal skin tissue, and skin of infraorbital region 11/1/2022 31
- 32. Cont… Technique: • Palpate infraorbitalforamen extra-orally and place thumb or index finger on region • Retract the upper lip and buccal mucosa • Area of insertion is the mucobuccal fold of the1st premolar/canine area • Contact bone in infraorbital region • Inject 0.9-1.2cc of local anesthetic 11/1/2022 32
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- 34. Cont… Greater palatine nerveblock: - Can be used to anesthetize the palatal soft tissue of the teeth posterior to the maxillary canine and corresponding alveolus/hard palate 11/1/2022 34
- 35. Cont…… Technique: • Area ofinsertion is ~1cm medial from 2nd maxillary molar on the hard palate • Palpate with needle to find greater palatine foramen • Depth is usually less than 10mm • Utilize pressure with elevator/mirror handle to desensitize region at time of injection • Inject 0.3-0.5cc of local anesthetic 11/1/2022 35
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- 37. Cont… Nasopalatine nerve block: -Can be used to anesthetize the soft and hard tissue of the maxillary anterior palate from canine to canine – Technique: • Area of insertion is incisive papilla into incisive foramen • Depth of penetration is less than 10mm • Inject 0.3-0.5cc of local anesthetic • Can use pressure over area at time of injection to decrease pain 11/1/2022 37
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- 39. Mandibular anesthesia • Infiltrationtechniques do not work in the adult mandible due to the dense cortical bone • Nerve blocks are utilized to anesthetize the inferior alveolar, lingual, and buccal nerves • Provides anesthesia to the pulpal, alveolar, lingual and buccal gingival tissue, and skin of lower lip and medial aspect of chin on side injected 11/1/2022 39
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- 41. Cont… Inferior alveolar nerveblock (IAN): – Technique involves blocking the inferior alveolar nerve prior to entry into the mandibular lingula on the medial aspect of the mandibular ramus – Multiple techniques can be used for the IAN nerve block • IAN • Akinosi 11/1/2022 41
- 42. Cont…. Technique: • Area ofinsertion is the mucous membrane on the medial border of the mandibular ramus at the intersection of a horizontal line (height of injection) and vertical line (anteroposterior plane) • Height of injection injection- 6-10 mm above the occlusal table of the mandibular teeth • Anteroposterior plane-just lateral to the pterygomandibular raphe 11/1/2022 42
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- 44. cont… – Mouth mustbe open for this technique, best to utilize mouth prop – Depth of injection: 25mm – Approach area of injection from contralateral premolar region – Use the non-dominant hand to retract the buccal soft tissue (thumb in coronoid notch of mandible; index finger on posterior border of extraoral mandible) 11/1/2022 44
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- 47. cont… – Inject ~0.5-1.0ccof local anesthetic – Continue to inject ~0.5cc on removal from injection site to anesthetize the lingual branch – Inject remaining anesthetic into coronoid notch region of the mandible in the mucous membrane distal and buccal to most distal molar to perform a long buccal nerve block 11/1/2022 47
- 48. cont… Akinosi closed-mouth mandibularblock: – Useful technique for infected patients with trismus, fractured mandibles, mentally handicapped individuals, children – Provides same areas of anesthesia as the IAN nerve block 11/1/2022 48
- 49. Cont… Area of insertion soft tissue overlying the medial border of the mandibular ramus directly adjacent to maxillary tuberosity Inject to depth of 25mm Inject ~1.0-1.5cc of local anesthetic as in the IAN Inject remaining anesthetic in area of long buccal nerve 11/1/2022 49
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- 51. Cont…. Mental nerve block: -Mental and incisive nerves are the terminal branches for the inferior alveolar nerve - Provides sensory input for the lower lip skin, mucous membrane, pulpal/alveolar tissue for the premolars, canine, and incisors on side blocked 11/1/2022 51
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- 53. cont… – Technique: • Areaof injection mucobuccal fold at or anterior to the mental foramen. This lies between the mandibular premolars • Depth of injection ~5 5-6mm • Inject 0.5 0.5-1.0cc of local anesthesia • Message local anesthesia into tissue to manipulate into mental foramen to anesthetize the incisive branch 11/1/2022 53
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- 55. Complication of anesthesia •Trauma to the nerve • Trauma to the blood vessels • Injection directly to the blood vessel dropping of the anesthetic solution to the blood vessel. • Hematoma –the damage of bv by the tip of a needle may lead to bleeding into the tissue 11/1/2022 55
- 56. Prevention of complications •Use of proper technique • Use of proper syringe and needle • Good knowledge of the innervations and blood supply of the face and teeth • Aspiration before the release of the anesthetic solution. 11/1/2022 56
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