1. Intraosseous Anesthesia as a Primary Technique for Local Anesthesia in Dentistry
Kaitlyn Tom1– Johan Aps2
1(Undergraduate, Department of Biological Sciences) - 2(DDS, MSc, MSc, PhD – Dept. of Oral Medicine)
Introduction
What is Local Anesthesia in Dentistry?
Local anesthesia in dentistry offers increased patient comfort by providing regional as well as reversible pain loss. By interfering with calcium binding and sodium channel opening in nerve cell membranes, local anesthesia disrupts the generation of action potentials and pain stimuli.
What Products Are Used?
Common injectable products used within clinical dentistry include: bupivacaine, articaine, lidocaine, prilocaine, and mepivacaine.
What Issues Are Encountered?
The biggest issues encountered in dental local anesthesia include: failed technique due to complex oral anatomy especially in the mandible, long onset times, and post-operative discomfort, pain.
Local Anesthesia in the Maxilla
Results
PubMed Studies:
“A brief summary of found conclusions”
1. Intraosseous anesthesia causes less discomfort during administration, shorter latency periods, shorter duration times, but long enough for treatment, majority of subjects preferred intraosseous anesthesia.
2. The intraligamentary and intraosseous injections are effective anesthetic techniques for managing nerve block failures and for providing localized anesthesia in the mandible.
3. Intraosseous injection has a higher success rate than inferior alveolar nerve block.
4. Computerized intraosseous injection causes little to no pain in children.
5. Compared to conventional techniques, intraosseous anesthesia should be considered for conservative and endodontic treatments.
References: Please contact Kaitlyn Tom at
Technique
Description
1. Supraperiosteal (Local Infiltration)
Local anesthetic deposited into small terminal nerve endings
2. Nerve Block:
Posterior Superior Alveolar (PSA), Middle Superior (MSA), Anterior Superior (ASA), Maxillary, Greater Palatine, Nasopalatine Nerves
Local anesthetic deposited close to the main trunk of the target nerve
3. Traditional Intraosseous (IO)
Used after supraperiosteal failure, local anesthetic deposited directly into the interproximal bone between two teeth
4. Intraligamentary (PDL, IO)
Used after supraperiosteal failure, local anesthetic deposited directly into periodontal tissues surrounding the root
5. Intraseptal (IO)
Used when inflammation or infection precludes use of PDL, local anesthetic deposited interdentally into papilla adjacent to the tooth
Intraosseous devices
Computer controlled
Hand controlled
Quicksleeper®
X-Tip®
SleeperOne®
Stabident®
The Wand® & STA®
Intraflow®
Compu-dent®
Comfort Control Syringe®
Other devices
Computer Controlled
Jet / Pressure controlled
Anaeject®
Syrijet®
Orastar®
Med-Jet H III®
Local Anesthesia in the Mandible
Technique
Description
1. Inferior Alveolar Nerve Block (IANB)
Blocks the inferior alveolar, incisive, mental, and lingual nerves, has however, the highest percentage of clinical failures
2. Gow-Gates Mandibular Block
Blocks the IAN, lingual, mylohyoid, mental, incisive, auriculotemporal, and buccal nerves.
3. Vazirani-Akinosi closed-mouth mandibular block
Used in limited mandibular opening, blocks IAN, incisive, mental, lingual, mylohyoid nerves
4. Nerve Block for Mental, Buccal, Incisive Nerves
Local anesthetic deposited close to the main trunk of the target nerves
5. Intraosseous, Intraligamentary, Intraseptal Injection
Identical to maxillary equivalents
Aim of the Study
To conduct a literature review to determine the reasons for which local anesthesia in dentistry can fail, and to assess solutions to these failures.
Conclusion
The results of this study support the use of computer controlled injection devices and intraosseous anesthesia for procedures involving one or two teeth in the mandible. Compared to traditional local anesthesia injection techniques, intraosseous injection shows high success rates, easy administration, fast onset times, long duration, and significant patient comfort.
Materials and Methods
Techniques, products, devices were searched manually and through internet sources.
Studies were searched using the PubMed database