This document discusses local anesthesia for dental procedures. It covers: 1. The innervation of dental structures by nerves like the maxillary and mandibular nerves. 2. The armamentarium used for local anesthesia, including needles of various sizes, cartridges containing anesthetic drugs and vasoconstrictors, and syringes. 3. Methods for administering local anesthesia, or techniques, and accessories like topical anesthetics.

1. 1
Chapter 3
Dr/Atef fouda
Prof. Oral & Maxillofacial Surgery
Cairo University
Egypt
Innervations of dental
structures.
Armamentarium used for
local anesthesia.
Method of L.A
administration “Techniques”.

2. Atef A. Fouda.
Prof of Oral & Maxillofacial Surgery
Cairo University

3. 3
Innervations of dental structures.
Armamentarium used for local anesthesia.
Method of L.A administration “Techniques”.
Chapter III:

4. 4
Innervations of dental structures.

5. Maxillary nerve.
Posterior Superior Alveolar
Middle Superior Alveolar
Anterior Superior Alveolar
Infra orbital
Palpebral nasal labial
8 7 6
5 4
3 2 1
Trigeminal ganglion

6. Sphenopalatineganglia

7. 7

8. Accessory innervations
In some cases the left
anterior superior alveolar
nerve supplies the right
pulp & supporting
structures and labial
mucosa of anterior teeth
i.e central incisor, lateral
incisor and canine teeth.
RT LT

9. Trigeminal ganglion
Mandibular nerve
Anterior division Posterior division
Inferior alveolar
Mental Incisive
Lingual
Long buccal

10. mandibular nerve
Incisive
Mental nerve
Inferior
alveolar
nerve
1st molar
2nd molar
3rd mol ar
Central
Incisors
Lateral
incisors
Canine
Lingual mucosa from last molar to central incisor
Pulp&investst.
Mental & Lip
skin
1st premolar
2nd premolar
cheeck
Long buccal n.
Lingual
mucosamucosa

11. mandibular
Mental or
incisive
Long buccal
Sensory supply of mandibular nerve
lingual

12. Accessory innervations
Cross innervations
Cutaneous coli
Nerve to mylohyoid
Anterior region
Premolar region
Molar region
Pulp +labial mucosa
Buccal mucosa
Pulp

13. Relation between inferior alveolar & lingual and long buccal nerves.

14. Trigeminal ganglion
Mandibular nerve
Anterior divisionPosterior division
Inferior alveolar N.
Incisive N.
2 1
4
3
6 58 7
Pulp & Supporting structures of mandibular teeth
Mental N.
Lingual N.
Long buccal N.

15. Trigeminal ganglion
Mandibular nerve
Posterior division
Inferior alveolar N. Incisive N.
2 14 36 58 7
Pulp & Supporting structures of mandibular teeth

16. lingual mucoperiosteum
Trigeminal ganglion
Mandibular nerve
Anterior division Posterior division
Inferior alveolar
Incisive
Lingual
Long buccal Mental
Buccal &

17. Accessory innervations
Cutaneous coli
Branch from C2 and C3 from cervical plexus to the
buccal mucoperiosteum of premolar teeth .

18. Nerve to mylohyoid
Gives off sensory branches to the pulp of mandibular
Anterior and Molar teeth.

19. Armamentarium used for
local anesthesia.

20. 1-Needles.
2-Cartridges[Carpule].
3-Syringe.
4-Accessories.
Armamentarium for local anesthesia

21. help in tissue penetration.
Bevel
shank
determines the needle length
Hub
fixes the needle to the syringe.
cartridge end of the needle
fixes the needle inside the cartridge
Parts of the needle
1-Needles.

22. 1-Needles.
Long needle
Short needle
Ultra short needle
Shank length

23. Length:
Long = 32 mm:
Short = 20 mm:
Ultra short = 10 mm:
Shank length
1-Needles.

24. Gauge:
20 gauge 0.81 mm. diameter.
21 gauge 0.72 mm. diameter.
22 gauge 0.64 mm. diameter.
23 gauge 0.57 mm. diameter.
24 gauge 0.51 mm. diameter.
25 gauge 0.45 mm. diameter.
27 gauge 0.40 mm. diameter.
1-It is rigid enough to be guided
directly to the target area
without deviation.
2- It is less likely to penetrate
small blood vessels.
Shank Lumen diameter
1-Needles.
25 gauge long needles.
3-Aspiration is much easier and certain through the larger lumen.
4-It is safer because breakage is less likely to occur.

25. 1-Needles.
Needle label
Certified
2 Not to be used twice.
Sterile EO Sterile and sterilized with Ethylene Oxide Gas sterilization
27Gauge & 35mm Represents the lumen diameter and length in mm.

26. 1-Needles.
Needle Capping.
By introducing the needle with the syringe inside the cover that
was on the bracket table.

27. By applying angle between the cover and the needle while capping.
1-Needles.
Needle Capping.

28. By fixing the needle to cartoon barrier and covering the needle
using the other hand.
1-Needles.
Needle Capping.

29. 1-Needles.
Needle Capping.
By using needle capper

30. 4-The vasoconstrictor.
5-A preservative for the vasoconstrictor ”sodium bisulfite”.
Contents of the anesthetic carpule:
2-Cartridges.
1-The anesthetic drug.
2- Sodium chloride to make the solution isotonic.
3-Distilled water to complete the desired volume of the carpule.
Plain anesthetic carpule:
Anesthetic carpule with vasoconstrictor

31. 2-Cartridges.
Anesthetic drug concentration
4% LA = 40 mg of LA/ml
Carpule = 1.8 carpule = 40 X 1.8 = 72 mg of LA.
Anesthetic drug concentration measured by percentage
concentration of the drug in the solution
2% concentration = 20 mg of LA/ml
Carpule = 1.8 carpule = 20 X 1.8 = 36 mg of LA.
3% LA = 30 mg of LA/ml
Carpule = 1.8 carpule = 30 X 1.8 = 54 mg of LA.
Carpule volume: 1.8 ml

32. 2-Cartridges.
Vasoconstrictor concentration
Represented as ratio
1:20 000 = 50 µg/ml Carpule = 90 µg/ml
1:50 000 = 20 µg/ml Carpule = 36 µg/ml
1:100 000 = 10µg/ml Carpule = 18 µg/ml

33. 2-Cartridges.
Anesthetic drug package

34. Parts of the carpule
2-Cartridges.

35. 2-Cartridges.
Color coding of the carpule

36. Reusable Disposable.
3-Syringe:

37. 3-Syringe:
which carry the anesthetic carpule.
2-Syringe barrel
Components of dental syringe:
1-Hub
for receiving the dental needle.
3-Fingers rest
syringe support during injection.

38. 4-Piston of the syringe
Piston either end with flat metallic
disc to push the cartridge rubber
stopper and subsequently the
anesthetic solution to be finally
extruded from the needle at the other
end or end with harpoon that could be
fixed to the rubber stopper of the
carpule to help in its retraction and
aspiration through the needle.
3-Syringe:
5-Thumb rest [Ring]
Pushing the piston using the operator’s thumb.

39. 3-Syringe:
Aspirating
Non Aspirating
Self Aspirating

40. 3-Syringe:
Lateral loading
Apical “Breach” loading

41. 3-Syringe:
Cyto-ject
Intra-ligamentary injection.
Periodontal ligament injection.

42. liquids forced through very small
openings, called
jets at very high pressure [2000 psi]
can penetrate
skin or intact mucous membrane
Syrijet holds any 1.8 ml cartridge of
local anesthetic
*Jet Syringes ($1,600)
needle-less injection
3-Syringe:
Jet syringe

43. Computer Controlled Local
Anesthetic Delivery.
3-Syringe:
Highly effective.
Higher Patient Comfort.
Reduced Patient Anxiety
Faster numbing onset.

44. 4-Accessories
Topical anesthetic
Available in the form of gel, spray and cream
Concentration between 4% to 20%.

45. TOPICAL ANESTHESIA
Used before injection to decrease pain from needle
puncture. It may be in form of jel or spray.
Be carful from toxicity if the area of application is
injured.

46. 4-Accessories
Cotton sticksAntiseptic solution Needle burner