1. Supplemental injection techniques
Dr.Soukaina Ryalat

2. Main types
PDL injection
Intraosseous
Intraligamental
Intra pulpal

3. Development of Instruments

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

5. 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

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

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

8. 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

12. Intraseptal injection

13. 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

14. 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

16. 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

17. 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

20. Intra pulpal Anesthesia

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

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

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

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

25. Maxillary nerve block High tuberosity approach
Greater palatine canal approach

26. Thank you
Good luck