เทคนิ�คการฉีดยาชาเฉีพาะท�

ทางท�นิตกรรมLocal anesthetic injection techniques

in DentistryUdomrat Khemaleelakul

Department of Oral and Maxillofacial SurgeryFaculty of Dentistry, Chiangmai University

Dental Treatments

•Fear•Anxiety•Pain

Techniques• Iatrosedation• Hypnotism• Acupuncture• Electroanalgesia• Audioanalgesia

Techniques

•Local analgesia• Sedation• General anesthesia

Spectrum of pain anxiety control

หั�วข้�อการบรรยาย

• Local anesthetics in dentistry• Maxillary injection techniques• Mandibular injection techniques• Complications (injection techniques)

Local Anesthetics in

Dentistry

Development in LA for Dentistry

• 1859 Niemann Isolation of cocaine• 1884 Koller Clinical used (topical)• 1884 Halsted Clinical used (regional) • 1885 Corning Tourniquet to retard absorb. • 1903 Braun Chemical tourniquet:

Epinephrine

Development in LA for Dentistry

• 1904 Einhorn Synthesis of ‘procaine’• 1905 Braun Clinical use of procaine• 1943 Lofgren Synthesis of ‘lidocaine’• 1957 ‘mepivacaine’• 1960 ‘prilocaine’• 1963 ‘bupivacaine’• 1969 ‘articaine’

Local anesthetic

agents

Local anesthetic agents

• Chemical structure;oEsters

cocaine, benzocaine, procaine, tetracaine, propoxycaine, chloroprocaine

oAmides mepivacaine, etidocaine, lidocaine,

prilocaine, bupivacaine, articaine?

Common Used of Local Anesthetics in Dentistry

• Lidocaine• Mepivacaine• Prilocaine• Bupivacaine• Etidocaine• Articaine

ส่�วนิประกอบข้องยาชาเฉีพาะท�ทางท�นิตกรรม

• ตั�วยาชา (Local Anesthetics)• Vasoconstrictor• Methy paraben

o LA preservation (not recommended)• Sodium metabisulphite

o Vasoconstrictor preservation• Isotonic solution ex. Sodium chloride

Dental Injection Techniques

Dental Anesthesia Techniques

• Topical technique• Local infiltration• Nerve block• Supplemental techniques

o Intrapulpal injectiono Intraligamentary injectiono Intrapapillary injectiono Intraosseous injection

Maxillary injection techniques

• Aim point:o Maxillary division of Trigeminal nerve

Maxillary injection techniques

• Techniques:o Supraperiosteal injection (Local infiltration)o Posterior superior alveolar nerve blocko Middle superior alveolar nerve blocko Infraorbital nerve blocko Nasopalatine nerve blocko Greater palatine nerve blocko Maxillary nerve block

Local Infiltration

Posterior superior alveolar nerve block

Infraorbital nerve block

Nasopalatine nerve block

Greater palatine nerve block

Maxillary nerve block

Mandibular injection techniques

• Aim point:o Mandibular division of Trigeminal nerve

Mandibular injection techniques

• Techniques:o Supraperiosteal injection (Local infiltration)o Inferior alveolar nerve blocko Lingual nerve blocko Long buccal nerve blocko Mental nerve blocko Mandibular nerve block ( Gow gates, Akinosi)

Local infiltration

Inferior alveolar nerve block

Long buccal nerve block

Mental nerve block

Mandibular nerve block

Supplemental techniques

• Intrapulpal injection• Intraligamentary injection• Intrapapillary injection• Intraosseous injection

Complications

• Improper injection techniques • Local anesthetics and Components• Patient status:omental status, systemic diseases, etc.

• Others

Complications

• Needle Broken• Pain on injection• Burning on injection• Persistent paresthesia• Trismus

• Hematoma• Infection• Sloughing of tissues• Facial nerve

paralysis

Local Anesthetics / Vasoconstrictor overdose

• Causes;o Intravascular injection (rapid onset)

Lip chewing

Further Reading

• ทองนารถ คำ�าใจ. ยาชาเฉีพาะท�ในิทางท�นิตกรรม โคำรงการตั�าราคำณะท�นตัแพทยศาสตัร�มหาว�ทยาลั�ยเช�ยงใหม , 2533

• ก�!งแก"ว อ"นเกษม. ยาชาเฉีพาะท�. ใน: วรภาส%วรรณจ�นดา, อ�งกาบ ปราการร�ตัน�, บรรณาธิ�การ. ต�าราว�ส่�ญญว�ทยา. กร%งเทพฯ, เร+อนแก"วการพ�มพ�, 2538

• Malamed SF. : Handbook of local anesthesia. 4th edition, St. Louis: Mosby, 1997.

Further Reading

• Roberts GJ., Rosenbaum NL. : A colour atlas of Dental Analgesia & Sedation. Aylesbury: Wolfe, 1991.

• Robinson PD., Ford TRP., McDonald F. : Local Anaesthesia in Dentistry. Oxford: Wright,2000.