Supplemental Injections_2019

Supplemental Injections Local Anesthesia Reversal

Supplemental Infiltration

• Supraperiosteal injection

  • Used due to overlapping fibers of contralateral inferior alveolar nerve

  • Applicable if other injections like PSA, MSA, or ASA are unsuccessful

• Technique:

  • Infiltrate into the mucobuccal fold below the apex of the tooth in question

  • Use a 27-gauge short needle

  • Administer less than 0.6 ml of solution

Gow-Gates Technique: Mandibular Nerve Block (GGMNB)

• Characteristics:

  • True mandibular nerve block

  • Provides sensory anesthesia to entire V3 which includes IA, L, Mental, Incisive, Buccal, Mylohyoid, and Auriculotemporal nerves

  • Higher success rate with a lower incidence of aspiration

  • No concern for accessory nerve innervations not covered with IANB.

• Needle Direction:

  • Directed toward the neck of the condyle

Vazirani-Akinosi Close-Mouth Mandibular Nerve Block

• Indication:

  • Used when limited mandibular opening prevents use of other MD injections

• Technique:

  • Needle inserted about 25 mm into tissue at maxillary mucogingival junction, mesial to the mandibular ramus

  • Bevel facing mesially

PDL (Periodontal Ligament) Injection

• Provides anesthesia to pulp, soft tissue, and bone of a single tooth

• Technique:

  • Use 27-gauge short needle; bevel on root

  • Deposit 0.2 ml over a minimum of 20 seconds

Intraseptal Injection

• Purpose:

  • Provides osseous and soft tissue anesthesia and hemostasis

• Insertion Area:

  • Interdental papilla adjacent to the tooth being treated; 2 mm below tip

• Technique:

  • Use a 27-gauge short needle with bevel toward apex

  • Insert at a 45-degree angle to long axis of tooth

  • Slightly penetrate, inject few drops, then advance until contacting bone (1-2mm)

  • Deposit 0.2-0.4 ml over a minimum of 20 seconds

Local Anesthesia Reversal

• Need for Reversal:

  • Lingering numbness results in inconvenience, discomfort, and potential soft-tissue injury (especially in children)

  • Patients often discharged with numbness lasting 3-5 hours after dental procedures

• Reversal Targets:

  • Anesthesia of the lip and tongue, addressing functional deficits from intraoral submucosal injection

Clinical Indications and Contraindications for Reversal of LA

• Indications:

  • Prolonged soft tissue anesthesia (STA) poses potential risks or negatively affects lifestyle (e.g., inability to speak or eat)

• Contraindications:

  • Post-surgical patients benefiting from prolonged STA

  • Patients under 6 years of age or weighing less than 33 lbs

  • Pregnancy

Phentolamine Mesylate: OraVerse

• Description:

  • Injectable phentolamine mesylate designed to terminate unwanted numbness from LA

  • Contains 0.4 mg PM (0.235 mg/mL) in a 1.7 mL cartridge

• Mechanism with NV-101:

  • Increases blood flow, accelerating elimination of the anesthetic

Clinical Effects of PM in Dentistry

• Effects:

  • Localized peripheral vasodilation

  • Increased perfusion at injection site

  • Facilitates rapid redistribution of local anesthetic from injection site

Recommended Use of OraVerse in Dentistry

• Dosage:

  • Based on the number of cartridges of LA + vasoconstrictor given

  • Administered in equal volume, up to 2 cartridges

• Administration Method:

  • Same location and technique as LA administration

Return of Normal Sensation After OraVerse Administration

• Median Times to Return:

  • Upper lip: 50 mins

  • Lower lip: 70 mins

Adverse Reactions to Phentolamine Mesylate

• Reactions May Include:

  • Diarrhea

  • Facial swelling

  • Increased blood pressure/hypertension

  • Injection site reactions

  • Jaw pain, oral pain, and tenderness

  • Paresthesia

  • Upper abdominal pain and vomiting

• Resolution:

  • Majority are mild and resolve within 48 hours