Supplemental injection techniques Dr Soukaina Ryalat Main types

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. 1 Area of insertion: long axis of the tooth to be treated on. 2 its mesial or distal of the root, or on the mesial and distal roots interproximally Target area: depth of the gingival sulcus. 3 Two important items indicate the success of the. 4 injection: Significant resistance to the deposition of the solution. a Blanching of the soft tissues adjacent to the injection. b 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. 1 Area of insertion: center of the interdental. 2 papilla adjacent to the tooth to be treated Two important items indicate the success of. 3 the injection Significant resistance during injection. a Blanching of soft tissues adjacent to the. b 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 1 n 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 •

Thank you Good luck •