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.
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