Supplemental injection techniques Dr.Soukaina Ryalat

Main types PDL injection Intraosseous Intraligamental Intra pulpal

Development of Instruments

PDL injection Localized anesthesia 74% of patients prefer PDL over the inferior alveolar anesthesia No soft tissue anesthesia ( tongue ,lip are spared)

Indications of PDL Treatment of isolated teeth. In pediatric treatment When I.D block is contra indicated (Hemophilics) Diagnosis of mandibular pain To avoid bilateral I.D block anesthesia

Contraindication Presence of infection Concerns about enamel hypoplasia Soft tissue damage,crestal bone resorption, safety of periodontium????

Equipments Extra short needle is required (30 or 27 gauge) Special needle??

Periodontal ligament injection Technique: A 27-gauge short needle Area of insertion: long axis of the tooth to be treated on its mesial or distal of the root, or on the mesial and distal roots interproximally Target area: depth of the gingival sulcus Two important items indicate the success of the injection: Significant resistance to the deposition of the solution Blanching of the soft tissues adjacent to the injection site

Intraseptal injection

Intraseptal Injection Indications: When both pain control and hemostasis are required for soft tissue and osseous periodontal treatment Contraindications: Infection at the injection site Areas anesthetized: Bone, soft tissue and root structure at the injection area

Intraseptal Injection Technique: A 27-gauge short needle Area of insertion: center of the interdental papilla adjacent to the tooth to be treated Two important items indicate the success of the injection Significant resistance during injection Blanching of soft tissues adjacent to the injection site

Intraosseous Injection Indication: pain control for dental treatment of single or multiple teeth in a quadrant Areas anesthetized: Bone, soft tissue and root structure at the injection area

Intraosseous Injection Technique: Site of injection: at a point 2 mm apical to the intersection of lines drawn horizontally along the gingival margins of the teeth and a vertical line through the interdental papilla The site should be distal to the tooth to be treated

Intra pulpal Anesthesia

Additional maxillary techniques Anterior middle superior alveolar nerve block Palatal approach – Anterior superior alveolar nerve block

AMSA- Nerve Block Developed 1n 1997 by Friedman and Hochman Area of Anesthesia; ASA nerve MSA nerve Subneural dental nerve plexus

Contraindications Patients with thin palatal mucosa Patients who cant tolerate 3-4 m administration time. Procedures requiring more than 90 minutes.

PA-ASA nerve block Nerves Anesthetised: Nasopalatine Anterior branches of ASA nerve

Maxillary nerve block High tuberosity approach Greater palatine canal approach

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