Local Anesthesia in Endodontics

Michael Moreno, DMDSeptember 15th, 2009

Local Anesthesia in Endodontics

Local Anesthesia – Definition

A loss of sensation to pain in a specific part of the body without loss of consciousness.

Local Anesthesia in Endodontics Types of injections used:

Infiltration Blocks PDL Intrapulpal Intraosseous

Local Anesthesia in Endodontics Infiltration

Anesthetic injected in the mucosa

Makes contact with bone

Must diffuse through spongy bone to reach the nerve endings (cortical layer must be thin)

i.e. Maxilla in adults, both jaws of children

Local Anesthesia in Endodontics

Retract lip and shake Advance 3-4mm, and deposit 0.5cc to start

Local Anesthesia in Endodontics The Mandibular Nerve

When correctly positioned, the local anesthetic is deposited above the lingula and the mandibular foramen

Inferior alveolar nerve

Lingual n.

Local Anesthesia in Endodontics Retract the lip Place thumb on the

anterior border of the ramus

Approach from the opposite side (premolar area)

Local Anesthesia in Endodontics Advance until you hit

bone Withdraw 1mm Aspirate Inject ¾ of carpule

SLOWLY 25g needle is

recommended

Local Anesthesia in Endodontics Even when properly administered, it can

still have 15-20% failure Positive aspiration in 10-15% of cases

Local Anesthesia in Endodontics Gow Gates – V3 block

Inferior alveolar nerve Lingual Mylohyoid Mental Incisive Auriculotemporal Buccal

Local Anesthesia in Endodontics

Target area is the neck of the condyle

Local Anesthesia in Endodontics

Needle is placed just below the MP cusp of the maxillary 2nd molar

Inject slowly

Local Anesthesia in Endodontics Supplemental injections:

PDL Syringes on the market: Peripress and Ligmaject

Local Anesthesia in Endodontics Anesthesia is achieved due to the solution

diffusing through the marrow spaces in intraseptal bone

Patients may experience post op discomfort for 2-3 days

Although specialized syringes are available, there is usually no need for them – however, significant force is required

Local Anesthesia in Endodontics

Intraosseous Injection – Stabident, X-Tip, Intraflow

Local Anesthesia in Endodontics

Local Anesthesia in Endodontics

Advantages of intraosseous injections

More predictability of achieving anesthesia

Less post op discomfort

The gingival ligaments are not affected

Local Anesthesia in Endodontics

Local Anesthesia in Endodontics

Intraosseous anesthesia – latest news

The Intraflow System by Pro-Dex

Local Anesthesia in Endodontics Claims to provide great pulpal anesthesia by itself Great for emergencies Great to anesthetize “hot teeth”

Intrapulpal anesthesia

Pinpoint exposure of the pulp The needle tip is inserted in the exposure Backpressure is built up into the chamber, and

the pressure is causing anesthesia Warn your patients

Local Anesthesia in Endodontics

A note on anesthetics

Lidocaine is the most commonly used anesthetic

Amide anesthetic, metabolized in the liver

In conjunction with epinephrine, it provides 30-60 mins of pulpal anesthesia, and 120-240 mins of soft tissue anesthesia

Local Anesthesia in Endodontics

Septocaine (articaine)

Studies show the same efficacy as lidocaine

No significant difference in the achievement of analgesia

Local Anesthesia in Endodontics

Oraverse Phentolamine

Mesylate

For use in patients ages 6 and up 33lbs and up

Reverses effects of local anesthetic in approx. half the time

Questions?