GITAM DENTAL COLLEGE & HOSPITAL

DEPARTMENT OF
PERIODONTICS ANDORAL IMPLANTOLOGY

Seminar
LOCAL ANESTHETIC TECHNIQUES
Presented By:
V.L.PRANEETHA
II MDS

Contents

Introduction

Basic injection techniques

Maxillary local anesthetic techniques

Mandibular local anesthetic techniques

Supplementary techniques

New advances in Local administrative techniques

Conclusion

References

Introduction
Nothing that is done by dentist is of great importance than that of a
drug which prevents pain.
LA

anxiety or pain

Patients prefer anything to shot.

Not only fear and pain emergency situation.
Matsuura 54.9%
Mostly due to stress.
Medical emergencies in North America, 4309 dentists

30,000

emergencies over 10 yrs

15,407 vasodepressor syncope

Should not be painful

Every technique is atraumatic

Several skills and techniques .empathy

Local Anesthesia definition:
Loss of sensation in a circumscribed area of the body by a depression of excitation in nerve
endings or an inhibition of the conduction process in the peripheral nerves
History of local anesthesia
Indigenous natives of Peru chewed on leaves of Eryroxylon coca, the source of cocaine, to
decrease fatigue and promote a feeling of well being. In 1860, Neimann isolates cocaine from
coca beans. In 1884, Koller introduced cocaine as a topical anesthetic for the cornea. There were
two problems with cocaine, physical dependence and toxicity. In 1905, Einhorn introduced the
prototypical ester local anesthetic, procaine. In 1943, Lofgren introduces lidocaine, the
prototypical amide local anesthetic. Development of local anesthetics, since the 1950 s, has
focused on amide local anesthetics.
Dr.Nathan Friedman

Armamentarium needed for injection procedures

Topical anesthesia , sterile cotton tip applicators, sterile gauze sponges, needle shield or
recapping device, sterile syringe, anesthetic carpules, appropriate dental needles.
Basic injection technique
Step 1: use a sterilized sharp needle
Stainless steel
Machine manufactured . Fishhook-type barb.
Disposable needles are sharp on first insertion.
Gauge of the needle should be determined by the injection to be administered.
Mollen et al ( 1981 )
23 guage and larger needles ..pain
Step 2: Check the flow of local anesthetic solution
Stoppers on the anesthetic cartridge are made of silicone rubber
Step 3: Determine whether or not to warm the anesthetic cartridge or syringe
Cold syringes cause discomfort to the patient
Brought to room temperature ( 72F , 22 C )
No devices should be used ( cartridge warmers )
Step 4: Position the patient

 Physiologically sound position

Vasodepressor syncope
Primary pathophysiological component is cerebral ischemia secondary to an inability of
heart to supply the brain.
Patient is positioned in supine position with feet elevated slightly.
Step 5 : Dry the tissue
Step 6: Apply topical antiseptic ( optional )
Betadine or Merthiolate ( thimerosal )
Alcohol containing may cause burning sensation.
Step 7A: Apply topical anesthetic
At the site of injection
2 or 3 mm
A minimum application of 1 min
Step 7B: Communicate with the patient
Positive idea on patients mind
Injection, pain, shot, hurt
Step 8: Establish a firm hand rest.
Tissue penetration may be accomplished readily, accurately, and without inadvertently
nicking of tissues
Step 9: Make the tissue taut
Step 10: Keep the syringe out of the patients line of sight.

 Behind the patient

Right handed
Step 11 A: Insert the needle into the mucosa
Bevel should be oriented towards bone
Insert the needle gently into the tissues.
Step 11 B: Watch and communicate with the patient
For evidence of discomfort during needle penetration
Furrowing of the brow or forehead, blinking of eyes
Step 12: Inject several drops of LA solu
Step 13: Slowly advance the needle toward the target
Step 14: Deposit several drops of LA before touching the periosteum
Several drops should be deposited just before contact.
Periosteum is richly innervated contact produces pain
Anesthetizing the periosteum permits atraumatic contact.
Inferior alveolar, Gow-Gates mandibular, infraorbital
By experience.
Step 15: Aspirate
Always should be carried before depositing
Minimizes IV inj
Negative pressure should be created within the catridge

 Adequate aspiration necessitates that the tip of the needle remain unmoved.
Stabilization
Positive aspiration.blood
Performed twice before LA orientation of bevel changed
Serves two functions

To slow down the rate of anesthetic administration

Preclude the deposition of large amounts anesthetic into CVS

Larger gauge needles

Step 16A: Slowly deposit the LA solution
Slow injection is important

prevents the solution from tearing the tissue into which it is deposited

rapid injection immediate discomfort prolonged soreness

Slow injection; deposition of 1ml of LA solution in not less than 60 sec. therefore a full
1.8ml cartridge requires 2min.
Malamed 84% of 200 respondents avg time to deposit 1.8ml < 20 sec.
More realistic time in clinical practice 60 sec for a full 1.8ml cartridge
Step 16B: Communicate with the patient
Step 17: Slowly withdraw the syringe
Scoop technique
McCormick and Berry etal

 Needle cap holder

Step 18: Observe the patient
Most adverse effects occur
Matsuura 54.9%
Step 19: record the injection on the patients chart
Drug, vasoconstrictor, dose (mg), needle, injection given, patient reaction.
R-IANB,2%lido+1:100,000epi,36mg,25-long, tolerated procedure well.

3 major types of local anesthetic INJs:

Local infiltration

Field block

Nerve block

Maxillary injection technique

Supraperiosteal , periodontal ligament, intracrestal, intraosseous, intraseptal, posteriorsuperior
alveolar nerve block, middlesuperior alveolar nerve block, anterior superior alveolar nerve block,
greator palatine nerve block, nasopalatine nerve block, maxillary nerve block,anterior middle
superior alveolar nerve block, palatine approach to anterior superior alveolar nerve block.

Supraperiosteal injections:

The Supraperiosteal injection, more commonly called infiltration, is the most frequently used
technique for obtaining pulpal anesthesia in maxillary teeth. Although it is a simple procedureto
accomplish successfully, there are several valid reasons for using other techniqueswhenever
more than two or three teeth are involved in treatment.
Multiple Supraperiosteal injections necessitate numerous needle penetrations of the tissues,each
with the potential to produce pain, either during the procedure or after the anesthesia effect has
resolved. In addition, and perhaps even more important, using Supraperiosteal injections for
pulpal anesthesia on multiple teeth leads to the administrations of a larger volume of local
anesthetic solution, with an attendant increase in the risk of systemic and local complications.
The Supraperiosteal injection is indicated whenever dental procedures are confined to relatively
circumscribed area in either the maxilla or mandible.
Other common names local infiltration, paraperiosteal injection
Nerves anesthetized-large branches of the dental plexus
Areas anesthetized-the entire region innervated by the large terminal branches of this plexus:
pulp and root of the teeth,buccal periosteum, connective tissue, mucous membrane
Technique:
A 25-27 gauge needle is recommended , height of the mucobuccal fold above the apex of the
tooth being anesthetized, orient needle so bevel faces bone, lift the lip,pulling the tissue taut,
hold thesyringe parallel with the long axis of the tooth,insert the needle into the height of the
micobuccal fold over the target tooth. Advance the needle until its bevel is at or above the apical
region of the tooth. In most instances the depth of penetration is only few millimeters. Because
the needle is in soft tissue, there should be no resistence to its advancement,nor should there be
any patient discomfort with this injection.deposit 0.6ml over 20 seconds.
Signs and symptoms: feeling of numbness in the area of administration and absence of pain
during treatment
Complications : pain on needle insertion with the needle tip against periosteum,
Correct: withdraw the needle and reinsert it farther from the periosteum.

Posterior superior alveolar nerve block:

The posterior superior alveolar nerve block is a commonly used dental nerve block. Although it
is highly successful technique (>95%), there are several issues to weigh when cosidering its use.
These include the extent of anesthesia produced and the potential for hematoma formation.
Other common names: tuberosity block,zygomatic block
Nerves Anesthetized: posterior superior alveolar and branches
Areas

anesthetized:

pulps

of

the

maxillary

third,

second,

and

firstmolars(entire

tooth=72%;mesiobuccal root of the maxillary first molar not anesthetized=28%), buccal

periodontium and bone overlying these teeth
Technique :
A 25-guage short needle recommended,height of the mucobuccal fold above maxillary second
molar,maxillary tuberosity ,zygomatic process of the maxilla. Advance the needle slowly in an
upward,inward and backward direction in one movement, inward medially toward the midlne at
a degree angle to the occlusal plane, backward- posteriorly at a 45-degree angle to the long axis
of the second molar,slowly advance the needle through soft tissue. The goal is to deposit local
anesthetic close to the PSA nerves, located poteriorsuperior and medial to the maxillary
tuberosity. Aspirate in two planes, rotate the syringe barrel (needle bevel) one fourthturn and
reaspirate. If both aspirations are negative: slowly, over 30-60 seconds, deposit 0.9ml to 1.8ml
anesthetic solution.
Signs and symptoms:
Subjective symptoms usully none, objective- absence of pain during the injection

Complcations:

Hematoma : this is commonly produced by inserting the needle too far posteriorly into pterygoid
plexus of veins. In addition, the maxillary artery may be perforated., use of short needle
minimizes the risk of pterygoid plexus puncture.
Mandibular anesthesia is often produced as it is located lateral to the PSA nerves.
Middle superior alveolar nerve block:
MSA nerve is preseent in only about 28% of the population,there by limiting the clinical
usefulness of this block.
Nerves anesthetized: middle superior alveolar and terminal branches
Areas anesthetized: pulps of maxillary second premolars, mesiobuccal root of the first
molar,buccal periodontal tissues and bone over the same teeth.
Technique :
A 25-guage short needle is recommended, height of mucobuccal fold above the maxillary second
premolar, slowly deposit 0.9ml 1.2ml over 20-30 seconds.
Signs and symptoms : absence of pain during procedure
Complications are rare
Amterior superior alveolar nerve block:
ASA nerve block provides profound pulpal and buccal soft tissue anesthesia from maxillary
central incisor through the premolars in about 72% of patient.
Other common names: infraorbital nerve block
Nerves anesthetized: ASA, MSA, infraorbital nerves
Areas anesthetized: pulps of the maxillary central incisor through the canine on the injected
side.,buccal periodontium and bone of the same teeth,lower eyelid,lateral aspect of the
nose,upper lip.
Technique :

A 25 guage needle is recommended, mucobuccal fold directly over first prmolar, feel the
infraorbital notch, move your finger downward from the notch,applying gentle pressure on
tissues, the bone immediately inferior to the notch is convex, this represents the lower border of
the orbit and the roof of the infraorbital foramen.as the finger continues inferiorly, a concavity is
felt; this is infraorbital foramen.insert the needle into the height of the mucobuccal fold over he
first premolar with a bevel facing bone ,aspirate and slowly deposit 0.9ml-1.2 ml over 30-40
seconds. The administrator is able to feel the anesthetic solution as it is deposite beneath the
finger on the foramen if the needle tip is in the correct positon.
Signs and symptoms:
Tingling and numbness of the lower eyelid ,side of the nose and upper lip indicate anesthesia of
the infraorbital nerve, numbness in the teeth and soft tissues along the direction of the ASA and
MSA nerves.and no pain during dental therapy.
Complications : Rare complications

Palatal anesthesia
Anesthesia of hard palate is necessary for dental procedures involving manipulation of palatl soft
or hard tissues. For many sental patients, palatal injections prove to be a very traumatic
experience. For many dentists the administration of palatal anesthesia is one of the most
traumatic procedures they perform in dentistry. The steps in the atraumatic administration of
palatal anesthesia are as follows:
1. Provide adequate topical anesthesia at the site of needle penetration
2. Use pressure anesthesia at the site before and during needle insertion and the deposition
of solution.
3. Maintain control over the needle.
4. Deposit the anesthetic solution slowly
Control over the needle is probably of greater importance in palatal anesthesia than in other
intraoral injections.
Greator palatine nerve block:

The greator palatine nerve block is useful for dental procedures involving the palatal soft tissues
distal to the canine. Minimum volumes of solution (0.45 to0.6 ml) provide profound hard and
soft tissue anesthesia. Although potentially traumatic, the greator palatine nerve block is less so
than the nasopalatine nerve block because the tissues surrounding the greator palatine foramen
are better able to accommodate the volume of solution deposited.
Nerves anesthetized: greator palatine nerves
Areas anesthetized: the posterior portion of the hard palate and its overlying soft
tissues,anteriorly as far as the first premolar and medially to the midline.
Technique :
A 25 guage needle is recommended,soft tissues slightly anterior to the greator palatine foramen,,
(the foramen is most frequently located distal to the maxillary second molar, but it may be either
anterior or posterior to its usual position),direct the syringe into the mouth from the opposite
side,deposit a small volume of anesthetic, the solution is forced against the mucous membrane,
and a droplet forms.

Nasopalatine nerve block

The nasopalatine nerve block is an invaluable technique for palatal pain control in that,with the
administration of a minimum volume of anesthetic solution (maximally,one quarter of a
cartridge), a wide area of palatal soft tissue anesthesia is achieved,thereby minimizing the need
for multiple palatal injections.
Other common names: incisive nerve block, speopalatine nerve block
Nerves anesthetized: nasopalatine nerves bilaterally
Areas anesthetized: anterior portion of the hard palate (soft and hard palate)from the mesial of
the right premolar to the mesial of the left first premolar.
Technique :

A 27 guage needle is recmmended, labial frenum in the midline between the maxillary central
incisors, interdental papilla between the maxillary central incisor,if needed palatal soft tissues
lateral to the incisive papilla.
Multiple needle penetrations :
Areas of insertion: labial frenum in the midline between the maxillary central incisors,
interdental papilla between the maxillary central incisors , if needed , palatal soft tissues lateral
to the incisive papila.

Anterior middle superior alveolar nerve block:

AMSAinjection represents a newly described maxillary nerve block injection, it was first
reported by Friedman and Houchman in 1997 during development of a CCLD system. This
technique provides pulpal anesthesia on multiple maxillary teeth from a single injection site. The
injection site is on the hard palate about halfway along an imaginary line connecting the
midpalatal suture to the free gingival margin. The location of the line is at contact point between
the first and second premolars. Two anatomical structures , the nasal aperture and maxillary sinus
cause the convergence of branches of the anterior and middle superior alveolar nerves and
associated subneural dental plexus in the region of the apices of the premolars
Areas anesthetized: pulpal anesthesia of the maxillary incisors, canine,and premolars, buccal
attached gingiva of these same teeth,attached palatal tissues from midlie to free gingival margin
on the associated teeth. A prepuncture technique can be utilized.Apply the bevel of the needle
toward the palatal tissue ,cotine the slow insertion technique into the palatal tisue. Orientation of
the handpiece should be from the contralateral premolars . The needle is advanced until contact
with bone occurs.

Palatine approach- Anterior superior alveolar:

The palatal approach-anterior sperior alveolar(P-ASA) injection,as with the AMSA injection,was
defined by Friedman and Hochman in conjunction with the clinical use and development of

CCLAD systemin the mid 1990. The P-ASA injection shares several common elements with the
nasopalatine nerve block,but differs sufficiently to be considered a distict identity. The P-ASA
uses a similar tissue point of entry to the nasopalatine but differs in its final target;that is needle
position within the incisive canal. The volume of anesthetic recommended for the P-ASA is 1.41.8ml, administered at a rate of 0.5ml per minute.
Other common names: palatal approach ASA or palatal approach maxillary anterior field block
Nerves anesthetized:nasopalatine, anterior banches of ASA
Areas anestehetized: pulps of maxillary central incisors, lateral incisors and the canines, facial
periodontal tissues associated with these same teeth, palatal periodontal tissues associated with
the same teeth
Area of insertion: just lateral to the incisive papilla in the papillary groove , continue the slow
insertion tecnique into the nasopalatine canal.orientation of the needle sould be parallel to the
long axis of the central incisors.the needle is advanced to a depth of 6-10mm.

Maxillary nerve block:

The maxillary nerve block is a an effective method of achieving profound anesthesia of a
hemimaxilla .it is useful in procedures invoving quadrant dentistry or in extensive surgical
procedures.the major difficulties in the greator palatine canal approach occur in locating the
canal and negotiating it successfully. The major difficulty in the high tuberosity approach is the
higher incidence of hematoma.
Other common names: second division block
Nerves anesthetized : maxillary division of the trigeminal nerve.
Areas anesthetized: pulpal anesthesia of the maxillary teeth on the side of the block,buccal
periodontium and bone overlying these teeth, soft tissues and bone of the hard palate and part of
the soft palate, medially to the midline.,skin of the lower eyelid,ide of the ose,cheek,and upper
lip

Technique :
Height of the mucobuccal fold above the distal aspect of the maxillary second molar, target areamaxillary nerve as it passes the pterygopalatine fossa, superior andmedial to the target area of the
PSA nerve block direct the syringe to the opposite side with the needle approaching the
injectonsite at a right angle .

Techniques of madibular anesthesia

Inferior alveolar nerve block:
The inferior alveolar nerve block ,commonly referrred to as the mandibular nerve block,is the
most frequently used and possibly the most important injection techniques in dentistry.
Nerves anesthetized:inferior alveolar nerve , incisive ,mental and lingual( commonly)
Areas anesthetized: mandibular teeth to the midline,body of the mandible, inferior portion of the
ramus,buccal mucoperiosteum,mucous membrane anterior to the mandibular first molar,anterior
two thirds of the tongue and floor of the oral cavity,lingual soft tissues and periosteum
Target area: inferior alveolar nerve as it passes downward toward the mandibular foramen but
before it enters into the foramen.the needle insertion point lies three fourths of the
anteroposterior distance from the coronoid notch back to the deepest part of the pterygomandibular raphae,the posterior border of the mandibular ramus can be approximated intraorally
by using the pterygomandibular raphae as it bends vertically upward toward the maxilla., place
the barrel of the syringe in the corner of the mouth on the contralateral side. The average depth of
penetration to bony contact will be 20-25 mm,approximately two thirds to three fourths of a long
dental needle, if the bone is contacted too soon ,-withdraw it slightly in tissues and reposition the
syringe barrel more posteriorly ,continue the insertion until contact with bone is made at an
appropriate depth(20-25mm)
Buccal nerve block:

Areas anesthetized: soft tissues and periosteum buccal to the mandibular teeth direct the syringe
toward the injection site with the bevel facing down toward bone and the syringe aligned parallel
with the occlusal plane on the side of injection but buccal to the teeth. Penetrate mucous
membrane at the injection site, distal and buccal to the last molar.
Mandibular nerve block:
Areas anesthetized: mandibuar teeth to the midline, buccal mucoperiosteum and mucous
membrane on the side of injection, anterior two thirds of the tongue and floor of the mouth,
lingual soft tissues and periosteum, body of the mandible, inferior portion of the ramus,skin over
the zygoma and posterior portions of the cheek and temporal regions.
Technique :
A 25 guage needle is recommended , mucous membrane on the mesial of the mandibular ramus,
on a line from the intertragic notch to the corner of the mouth,just distal to the maxillary second
molar,target area is lateral side of the condylar neck, just below the insertion of the lateral
pterygoid muscle.height of the inection established by placement of the needle tip just below the
mesiolingual cusp of the maxillary second molar,there are three positions used for a right and left
IAN, align the needle with the plane extending from the corner of the mouth to the intertragic
notch on the side of injectio. It should be parallel with the angle between the ear and the face.the
syringe barrel lies in the corner of the mouth over the premolars, but its position may vary from
molars to incisors, depending on the divergence of the ramus as assessed by the angle of the ear
to the side of the face.

Vazirani-akinosi closed-mouth mandibular block:

If it is necessary to continue dental care in the patient with significant trismus,the options for
providing mandibular anesthesia are extremely limited. The inferior alveolar and Gow-Gates
mandibular nerve blocks cannot be attempted and , indeed,possess a significantly high rate in
experienced hands. Extraoral mandibular blocks can be administered through the sigmoid notch
or inferiorly from the chin

Areas anesthetized: mandibular teeth to the midline,body of the mandible and inferior portion of
the ramus ,buccal mucoperiosteum and mucous membrane in front of the mental foramen,
anterior two thirds of the tongue and floor of the oral cavity,lingual soft tissues and
mucoperiosteum
Technique :
A 25 gauge needle is recommended ,area of insertion is soft tissues overlying the medial border
of the mandibular ramus directly adjacent to the maxillary tuberosity at the height of the
mucogingival junction adjacent to the maxillary third molar , the barrel of the syringe is held
parallel with the maxillary occlusal plane, the needle at the level of the mucogingival junction of
the maxillary third molar. Orient the bevel away from the maandibular ramus; thus as the needle
advances through tissues,needle deflection occurs toward the ramus and the needle rmains in
close proximity to the inferior alveolar nerve.,advance the needle 25mm into tissue ,this distance
is measured from the maxillary tuberosity. The tip of the needle should lie in the mid portion of
the pterygomandibular space,close to the branches of V3.
Mental nerve block
Areas anesthetized: buccal mucous membrane anterior to the mental foramen to the midline and
skin of the lower lipand chin.move your finger slowly anteriorly until the bone beneath your
finger feels irregular and some what concave ,I radiograph is available mental foramen , can be
located easily.
Technique :
Penetrate the mucous membrane at the injection site, at the canine first premolar, directing the
syringe toward the mental foramen. Advance the needle slowly until the foramen is reached. The
depth of penetration is 5-6mm.for the mental foramen to be successful there is no need to enter
the mental foramen.aspirate,if negative slowly deposit 0.6ml over 20 sec.
Signs and symptoms:
Subjective symptoms are tingling and numbness of the lower lip , objective symptoms are no
pain during the treatment.

Complcations:
Hematoma , blood may exit the needle puncture point into the buccal fold. To treat: apply
pressure with gauze directly to the area of bleeding for at least 2 minutes.
Incisive nerve block:
The incisive nerve is a terminal branch of the inferior alveolar nerve . originating as a drect
communcation of the inferior alveolar nerve at the mental foramen, the incisive nerve continues
anteriorly in the incisive canal, providing sensory innervation to these teeth located anterior to
the mental foramen.
Areas anesthetized: buccal mucous membrane anterior to the mental foramen, usually from the
second premolar to the midline, lower lip and skin of the chin,pulp nerve fibres to the premolars,
canine, and incisors.
Technique :
A 25 guaze needle is recommended, mucobuccal fold at or just anterior to the mental
foramen,advance the needle until the mental foramen is reached. The depth of penetraton is 56mm. there is no need to enter the mental foramen for the incisive nerve block to be successful.
Aspirate ,if negative , slowly deposit 0.6ml over 20 seconds. During the injection, maintain
gentel finger pressure directly over the injection site to increse the volume of solution entering
into the mental foramen.
Signs and symptoms:
Tinglng or numbness of the lower lip, and no pain during dental therapy.
Comlications: few of any consequences, hematoma formation.

Suppliment injection techniques:

Used as the sole technique for pain control for certain types of dental treatment. For example, the
periodontal ligamet injection,intraseptal, and intraosseous techniques provide effective pulpal
anesthesia without the need for other injections.
Interaosseous anesthesia
Periodontal ligament injection
It was not until the early 1980s that the intraligamentary or PDL injection regained popularity.
Credit for its increased interest must go to the manufactures of syringe devices designed to make
the injection easier to administer. These original devices, the peripress and Ligmaject, provide a
mechanical advantage that allows the adinstrator to deposit the anesthetic more easily.therefore
the PDL injection appears to produce anesthesia in much the same way as the IO and intraseptal
injection, by diffusion of anesthetic solution apically through marrow spaces in the intraseptal
bone
Areas anesthetized: Bone,soft tissue, and apical and pulpal tissues in the area of injection
Technique:
A 27 guage needle is recommended, long axis of the tooth to be treated on its mesial or distal of
the root.target area is depth of the gingival sulcus,landmarks are root(s) of the tooth, periodontal
tissues
Intra septal injection
Areas anesthetized: Bone,soft tissues, root structure in the area of injection.
Technique:
A 27 guage needle is recommended, area of insertion center of the interdental papila adjacent to
the tooth to be treated. Landmark of this technique is papillary triangle, about 2mm below the
tip, equidistant from adjacent teeth.
The stabident system consists of two parts: a perforator, a solid needle that perforates the cortical
plate of bone with a conventional slow-speed contra-angle handpiece, and an 8mm, 27-guage
needle that is inserted into this predrilled hole for anesthetic administration ,the 27 guage

ultrashort needle could then be easily placed into the hole. Cotton pliers leave a slight dimple.
Mark the perforation site. Activate the handpiece, using a gentle pecking motion on the
perforator until a sudden loss of resistance is left. Cortical bone will be perforated within 2
seconds. Hold the guide sleeve in place as the drill is withdrawn. It is easy to insert the needle
into the hole using an ultrashort needle. Perforation of linual plate of bone. Prevented by proper
technique. Bend the needle, if necessary, to gain to the canal.

The stabident system

a perforator
27-guage needle
X-Tip
IntraFlow IO system
Needle
Transfuser
Latch tip
Motor or infusion drive
VIBROTACTILE DEVICES
Inui etal have shown, however, that pain reduction due to non-noxious touch or vibration
can result from tactile-induced pain inhibition within the cerebral cortex itself and that
the inhibition occurs without any contribution at the spinal level, including descending
inhibitory actions on spinal neurons.
VibraJect
Nanitsos et al

 DentalVibe
Stimulates the sensory receptors at the injection site, effectively closing the neural pain
gate, blocking the painful sensation of injections.
Accupal
Accupal provides pressure and vibrates the injection site 360 proximal to the needle
penetration, which shuts the pain gate,
COMPUTER-CONTROLLED LOCAL ANESTHETIC DELIVERY SYSTEMS
Wand/Compudent system
Accurately manipulate needle placement with fingertip accuracy and deliver the LA with
a foot-activated control.
Flow rates of LA delivery are controlled by a computer
Comfort control syringe
Five pre-programmed speeds for different injection techniques and can be used for all
injection techniques.
JET INJECTORS
Syrijet
MED-JET H III
Small orifice 7 times smaller than the smallest available needle in the world.
The system's uniqueness is its ability to utilize low pressure delivery methods without
compromising accuracy, convenience and ease of use.

SAFETY DENTAL SYRINGES

 Ultra Safety Plus XL syringe

UltraSafe Syringe
SafetyWand
RevVac safety syringe
Reversing local anesthesia
In May 2009, The FDA approved OraVerse (phentolamine mesylate)
Kovacaine Nasal Spraymaxillary anterior six teeth is set to be tested in an FDA Phase
3 trial
Syringe micro vibrator

References:

Hand book of local anesthesia Stanley F. Malamaid, 5th edition

Local anesthesia in dentistry AnesthProg 51: 138-142:2004

Review of local anesthetic agents MINERVA ANESTESIOL 2005 ; 71: 59-74

Local anesthesia in todays dental practice Margaret I. Scarlett

An update on Anesthetics in dentistry J Can Dent Assoc 2002; 68(9):546-51

Heavner, J.E. (2008). Pharmacology of local anesthetics. In D.E. Longnecker et al

(eds) Anesthesiology. New York: McGraw-Hill Medical.

Strichartz, G.R. &Berde, C.B. (2005). Local Anesthetics. In R.D. Miller Millers
Anesthesia, 6th edition. Philadelphia: Elsevier Churchill Livingstone.