Dr. William Lieberman is a pediatric dentist with extensive experience and credentials. He has owned a private pediatric dental practice in New Jersey and has held leadership positions in prominent dental organizations. The document provides an overview of Dr. Lieberman's approach to pediatric dentistry, which focuses on prevention, remineralization, and restoring teeth in a way that minimizes invasive procedures. It also details some of the technologies and techniques he utilizes, such as the computer-controlled local anesthetic delivery system, interim therapeutic restorations, and pulp therapy for primary teeth.
Local anaesthesia for children (dentistry)jhansi mutyala
When pain free reliable local anaesthesia is achieved in children confidence is gained by both the child and operator, and a sound satisfactory professional relationship is established. it includes all new tecniques of LA how to use them and their complications, composition, dosage, mechanisam of action
Definition Of The Accommodation
Mechanism Of Accommodation
Triggers Accommodation
Terms Of Accommodation
Accommodative Dysfunction
Spasm Of Accommodation
Accommodative Esotropia
Controlling Accommodation In Vision Test
Tips To Control Accommodation In Lifestyle
References
Clinical Procedures In Optometry By J.D. Bartlett, J.B. Eskridge, J.F. Amos
Theory And Practice Of Squint And Orthoptics By A.K.Khurana
Adler’s Physiology Of The Eye By L.A. Levin, S.F. Nilsson
Borish’s Clinical Refraction By W.J. Benjamin
Duke-elder’s Practice Of Refraction By David Abrams
Optics & Refraction By A.K.Khurana
Textbook Of Ophthalmology By E Ahmed
Clinical Optics By A R. Elkington, Werner L, Trindade F, Pereira F, Werner L
Physiology Of Accommodation And Presbyopia, ARQ. Bras. OFTALMOL, December 2000.
Optometry And Ophthalmology Websites
What are you preparing for dental implant treatmentskyaw tint
Myanmar Society of Oral Implantology collaborates with Dental Implant system using in Myanmar and celebrates Two days seminar. At this event, as the President of MSOI, I present this topic on preparation for dental implant treatment. It was sponsored by MDA (Naypyidaw).
What is Inspire? by Dr. Ruchir P. PatelRuchirPPatel
Dr. Ruchir P. Patel, a sleep medicine specialist at The Insomnia and Sleep Institute of Arizona in Phoenix, AZ, and a member of the Inspire Excellence Program discusses what Inspire therapy is and how it works to treat obstructive sleep apnea (OSA).
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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Local anaesthesia for children (dentistry)jhansi mutyala
When pain free reliable local anaesthesia is achieved in children confidence is gained by both the child and operator, and a sound satisfactory professional relationship is established. it includes all new tecniques of LA how to use them and their complications, composition, dosage, mechanisam of action
Definition Of The Accommodation
Mechanism Of Accommodation
Triggers Accommodation
Terms Of Accommodation
Accommodative Dysfunction
Spasm Of Accommodation
Accommodative Esotropia
Controlling Accommodation In Vision Test
Tips To Control Accommodation In Lifestyle
References
Clinical Procedures In Optometry By J.D. Bartlett, J.B. Eskridge, J.F. Amos
Theory And Practice Of Squint And Orthoptics By A.K.Khurana
Adler’s Physiology Of The Eye By L.A. Levin, S.F. Nilsson
Borish’s Clinical Refraction By W.J. Benjamin
Duke-elder’s Practice Of Refraction By David Abrams
Optics & Refraction By A.K.Khurana
Textbook Of Ophthalmology By E Ahmed
Clinical Optics By A R. Elkington, Werner L, Trindade F, Pereira F, Werner L
Physiology Of Accommodation And Presbyopia, ARQ. Bras. OFTALMOL, December 2000.
Optometry And Ophthalmology Websites
What are you preparing for dental implant treatmentskyaw tint
Myanmar Society of Oral Implantology collaborates with Dental Implant system using in Myanmar and celebrates Two days seminar. At this event, as the President of MSOI, I present this topic on preparation for dental implant treatment. It was sponsored by MDA (Naypyidaw).
What is Inspire? by Dr. Ruchir P. PatelRuchirPPatel
Dr. Ruchir P. Patel, a sleep medicine specialist at The Insomnia and Sleep Institute of Arizona in Phoenix, AZ, and a member of the Inspire Excellence Program discusses what Inspire therapy is and how it works to treat obstructive sleep apnea (OSA).
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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.
9. American Academy of Pediatrics
American Academy of Pediatric
Dentistry
Recommendation:
Dental home by age 1
10.
11. 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
15. 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
43. 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
44. 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.
48. 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
49. IPT Protocol
• Local anesthesia and rubber dam placement
• Excavation of infected dentin
• Caries detector (Sable Seek® from Ultradent) utilized
• Cavity photographed
• Placement of 2.0% chlorhexidine gluconate viscous
solution, Consepsis V® (Ultradent Products, Inc) for 60
seconds
• Placement of a resin-modified glass ionomer (Fuji II-LC®
GC America) on the preparation floor
• Final restoration placement: internal or full coverage
• Final photograph
• Recall 3, 6 and 12 months
51. Radiographic findings of primary first molar
post-treatment
6 months post-treatment
12 months post-treatment
52. 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
72. Step - 1
FRONT
• Attach Foot Control
• Tighten Securely
BACK
• Attach Power Cord
• Turn Power Switch On
• Wait 5 seconds for STA to
Self-calibrate
73. Step - 2
ANESTHETIC CARTRIDGE
• Insert cartridge into holder
• Press firmly until spike punctures the diaphragm
74. 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
75. Step - 3
Shorten length of
Wand Handpiece
• Remove tubing handpiece
• Shorten by “breaking” the length
of the handle
• Mark the bevel
76. 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
77. 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
78. • 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
80. Lesson 2: Performing the
STA-Intra-ligamentary Injection
Learn the Injection of
Your Choice
Lesson 3: Performing the
AMSA – (Palatal) Injection
81. 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)
82. 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
84. 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
85. 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
86. You need a slight bend to the needle to allow proper access.
91. 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
92. 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
93. 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
94. AMSA Injection
• A new technique that enables us to anesthetize a maxillary
quadrant in the primary dentition with one injection.
95. 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
96. 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
97. 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
98. 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
101. 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
103. 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
104. 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
106. 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
107. 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
108. 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
110. 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
111. 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
112. 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
113.
114. 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
115. 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
116.
117. 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
119. 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
120. Sound Volume Control
To Change Audible
Volume:
• Press up arrow to increase
volume
• Press down arrow to
decrease volume
121. 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
122. 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
123. 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
124. 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
126. Behavioral Management
• CCLAD technology has improved the overall acceptance of the anesthetic
injection in the pediatric population leading to less disruptive behavior.
127. 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
140. 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)
141. • 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
142. 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
143. 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)
144. •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
146. 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