Supplemental Injections_2019

Supplemental Injections Local Anesthesia Reversal

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  Instructor: Darlene O'Brien RDH, MSDHSpringfield Technical Community College

Supplemental Infiltration

• Supraperiosteal injection

  • Used due to overlapping fibers of the contralateral inferior alveolar nerve

  • Also performed if PSA, MSA, ASA injections are unsuccessful

• Technique:

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

  • Utilize a 27-gauge short needle

  • Administer less than 0.6 ml of solution

Gow-Gates Technique: Mandibular Nerve Block (GGMNB)

• Definition:

  • True mandibular nerve block offering sensory anesthesia to the entire V3 (IA, L, Mental, Incisive, Buccal, Mylohyoid, Auriculotemporal nerves)

• Advantages:

  • Higher success rate

  • Lower incidence of positive aspiration

  • Covers accessory nerve innervations not addressed by IANB

Gow-Gates Technique - Target Area

• Needle Placement:

  • Directed toward the neck of the condyle

  • Accurate targeting is essential for effective anesthesia

Vazirani-Akinosi Close-Mouth Mandibular Nerve Block

• Indications:

  • For cases where limited mandibular opening prevents use of other MD injections

• Technique:

  • Needle inserted approximately 25 mm into tissue at the level of the maxillary mucogingival junction

  • Mesial to the mandibular ramus with the needle bevel facing mesially

Periodontal Ligament (PDL) Injection

• Properties:

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

• Technique:

  • 27-gauge short needle, bevel on root

  • Deposit 0.2 ml of solution over a minimum of 20 seconds

Intraseptal Injection

• Purpose:

  • Provides osseous and soft tissue anesthesia as well as hemostasis

• Insertion Area:

  • Located at the interdental papilla adjacent to the tooth to be treated (2mm below tip)

• Technique:

  • 27-gauge short needle with bevel toward the apex of the tooth

  • Insert at a 45-degree angle to the long axis of the tooth, inject a few drops before advancing until contact with bone (1-2mm), then deposit 0.2-0.4 ml over a minimum of 20 seconds

Local Anesthesia Reversal

• Problem:

  • Lingering numbness can be inconvenient, uncomfortable, and can lead to soft tissue injury, especially in children

  • Patients often leave the dental office with residual numbness in lips and tongue lasting 3 to 5 hours

Indications and Contraindications for Reversal of LA

• Indications:

  • When prolonged soft tissue anesthesia (STA) presents risks or negatively impacts lifestyle (e.g., inability to speak or eat)

• Contraindications:

  • Post-surgical patients needing prolonged STA as pain control

  • Children under 6 years old or weighing less than 33 lbs

  • Pregnancy

Phentolamine Mesylate: OraVerse

• Description:

  • Injectable form of phentolamine mesylate (PM) designed to terminate the numbing sensation associated with LA when no longer needed

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

Mechanism of Action of PM

• Without NV-101:

  • Local dental anesthetic is removed through passive diffusion into blood vessels

• With NV-101:

  • Increases blood flow, accelerates anesthetic elimination

Clinical Effects of Phentolamine Mesylate

• Effects:

  • Localized peripheral vasodilation

  • Increased perfusion at the injection site

  • Faster redistribution of local anesthetic from site of injection

Clinical Use of PM in Dentistry

• Recommended Dosage:

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

  • Administer in equal volume up to a maximum of 2 cartridges

• Administration:

  • Given at the same location(s) and using the same techniques as the prior LA procedure

Median to Normal Lip Sensation

• Timing Results:

  • Upper Lip: Median - 50 minutes (n=240), Control - 133 minutes

  • Lower Lip: Median - 70 minutes (n=244), Control - 155 minutes

Adverse Reactions to Phentolamine Mesylate

• Possible Reactions:

  • Diarrhea, facial swelling, increased blood pressure/hypertension, injection site reactions, jaw pain, oral pain, tenderness, paresthesia, upper abdominal pain, vomiting

• Frequency:

  • Majority of reactions are mild and resolve within 48 hours

Citations

• Malamed, Stanley F. Handbook of Local Anesthesia, 6th Edition. Mosby Elsevier, 2013

• Google Images

• Designed by: Sharon L Hilton RDH, Med

• Revised by: Darlene O’Brien RDH, MSDH, 2016