8- Suplemental Injection Indications Quiz

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Questions and Answers

In which of the following situations is PDL injection (Intraligamentary Injection) indicated?

Treatment of isolated teeth in bilateral mandibular quadrants (correct)

Anesthesia of one or two maxillary teeth

Treatment of isolated teeth in bilateral maxillary quadrants

As a standalone technique for full mouth anesthesia

When is PDL injection (Intraligamentary Injection) not recommended?

For patients with no response to nerve block anesthesia

For patients who require bilateral IANB (correct)

When residual soft tissue anesthesia is undesirable

For patients with generalized tooth pain

What is the role of PDL injection (Intraligamentary Injection) in the diagnosis of mandibular pain?

It has no role in diagnosing mandibular pain

It can eliminate the need for further diagnostic procedures

It can confirm the presence of mandibular pain

It can be used as a possible aid in the diagnosis of mandibular pain (correct)

What is the advantage of PDL injection (Intraligamentary Injection) over conventional blocks?

Rapid onset (30 secs) Signup and view all the answers

For which dental procedures is PDL injection (Intraligamentary Injection) well suited?

Extractions and endodontic single-tooth procedures Signup and view all the answers

What is not a PDL advantage?

Less risk of nerve damage Signup and view all the answers

What is not a disadvantage of PDL injection (Intraligamentary Injection) related to needle placement?

It requires a longer needle than other injection techniques Signup and view all the answers

What is a potential consequence of excessive pressure or overly rapid injection during PDL injection?

It may break the glass cartridge Signup and view all the answers

What is a post-injection discomfort associated with PDL injection (Intraligamentary Injection)?

Discomfort for several days Signup and view all the answers

In the PDL injection technique, where is the needle inserted for a single-rooted tooth?

Long axis of the tooth, on its mesial or distal to the root Signup and view all the answers

What is the orientation of the bevel of the needle in PDL injection technique?

Toward the root of the tooth Signup and view all the answers

What is the correct pacient's position for PDL injection (Intraligamentary Injection) procedure?

Supine or semisupine position Signup and view all the answers

How much local anesthetic (LA) is administered during PDL injection (Intraligamentary Injection)?

0.2 ml over 20 seconds Signup and view all the answers

Where should the needle be inserted in the PDL injection technique for a single-rooted tooth?

Depth of the gingival sulcus Signup and view all the answers

What are the indications of success for PDL injection (Intraligamentary Injection)?

Significant resistance to the deposition of the LA and Ischemia of the soft tissue adjacent to the injection site Signup and view all the answers

What is a common cause of anesthesia failure in PDL injection?

Inadequate solution retention Signup and view all the answers

What is a potential complication associated with PDL injection (Intraligamentary Injection) related to the needle?

Pain during insertion of the needle Signup and view all the answers

What is a consequence of too rapid injection of local anesthetic solution in PDL injection (Intraligamentary Injection)?

Postinjection pain Signup and view all the answers

What is a potential complication of PDL injection (Intraligamentary Injection) associated with excessive volume of solution?

Pain during injection of solution Signup and view all the answers

What is the primary benefit of the Wand STA: Single Tooth Anesthesia System Periodontal Ligament Injection?

Real-time feedback during needle positioning Signup and view all the answers

What is the recommended use of PDL injection (Intraligamentary Injection) after nerve block anesthesia if partial anesthesia is present?

As an adjunctive technique Signup and view all the answers

What is an advantage of the controlled low-pressure fluid dynamic used in the C-CLAD device for PDL injection?

Reduces the risk of tissue injury Signup and view all the answers

What is a disadvantage of using the C-CLAD device for PDL injection?

Requires the use of a specialized C-CLAD instrument and associated costs of purchase and use Signup and view all the answers

What is a potential benefit of the C-CLAD device with its technology during PDL injection?

Detects excessive pressure and safeguards against glass cartridge breakage Signup and view all the answers

What is the primary purpose of Intraseptal Injection in dentistry?

To provide osseous and soft tissue anesthesia for perio currettage and flap procedures Signup and view all the answers

When is Intraseptal Injection contraindicated?

Infection or severe inflammation at the injection site Signup and view all the answers

What is the path of diffusion of local anesthetic in Intraseptal Injection?

Through the medullary bone Signup and view all the answers

What is a benefit of using Intraseptal Injection over conventional blocks?

a and c Signup and view all the answers

What is an advantage of Intraseptal Injection in dentistry?

Immediate onset of action Signup and view all the answers

What is a disadvantage of Intraseptal Injection in dentistry?

Bitter taste of local anesthetic if leakage occurs Signup and view all the answers

What is a potential consequence of using Intraseptal Injection?

Limited area of soft tissue anesthesia Signup and view all the answers

What is the correct angle at which the needle should be oriented in Intraseptal Injection technique?

45 degrees to the long axis of the tooth Signup and view all the answers

What is required for the success of Intraseptal Injection?

Clinical experience Signup and view all the answers

How much local anesthetic (LA) should be deposited during Intraseptal Injection?

0.4 mL over 20 secs Signup and view all the answers

What is the purpose of the X-Tip in the Stabident System for intraosseous injection?

To eliminate the problem of repositioning the local anesthetic into the previously drilled hole Signup and view all the answers

What is the function of the guide sleeve in the X-Tip of the Stabident System?

To administer local anesthetic easily Signup and view all the answers

What is the advantage of the X-Tip over the conventional Stabident system for intraosseous injection?

Eliminates the problem of repositioning the local anesthetic into the previously drilled hole Signup and view all the answers

What is the recommended local anesthetic or epinephrine concentration to minimize palpitations in intraosseous injection?

Plain local anesthetic Signup and view all the answers

What is a complication associated with intraosseous injection?

Perforation of lingual plate of bone Signup and view all the answers

How can separation of the perforator or cannula be described in the context of intraosseous injection complications?

Rare Signup and view all the answers

What is a major drawback of intrapulpal injection?

The need to insert the needle directly into a vital, and very sensitive pulp Signup and view all the answers

What is a disadvantage of intrapulpal injection?

Associated with a brief period of pain as anesthetic is deposited Signup and view all the answers

How does pain control occur in intrapulpal injection?

Through both a pharmacological action of the LA and the applied pressure Signup and view all the answers

When is intrapulpal injection indicated?

When pain control is necessary for pulpal extirpation or other endodontic treatment in the absence of adequate anesthesia following repeated attempts with other techniques Signup and view all the answers

What is an advantage of intrapulpal injection over conventional blocks?

Minimal postoperative complications Signup and view all the answers

What is a potential complication of intrapulpal injection related to the taste of the anesthetic?

Bitter taste with leakage Signup and view all the answers

What is the recommended volume of local anesthetic (LA) to be deposited during an intrapulpal injection?

0.2 to 0.3 ml of LA Signup and view all the answers

What is the recommended gauge of the needle for an intrapulpal injection?

27 g short needle Signup and view all the answers

When can the procedure start after an intrapulpal injection?

30 seconds after injection Signup and view all the answers

What is the concentration of lidocaine and prilocaine in the EMLA cream?

25% lidocaine and 25% prilocaine Signup and view all the answers

What is the recommended duration of application for EMLA cream prior to a procedure?

60 minutes Signup and view all the answers

Why is EMLA cream contraindicated in patients under 6 months of age?

Possibility of developing methemoglobinemia Signup and view all the answers

What is the purpose of adding sodium bicarbonate to Lidocaine with Epinephrine?

To neutralize the local anesthetic solution Signup and view all the answers

What is the primary benefit of Onpharma for precision buffering of local anesthetic?

Rapid onset of analgesia Signup and view all the answers

What is the composition of Onpharma solution?

Sodium bicarbonate in water Signup and view all the answers

What is the recommended age and weight criteria for the use of OraVerse (phentolamine mesylate)?

Children over 3 years of age or weighing more than 15 kg Signup and view all the answers

What is the primary indication for the use of OraVerse (phentolamine mesylate)?

Reversal of soft-tissue anesthesia and functional deficits from an intraoral submucosal injection of local anesthetic with vasoconstrictor Signup and view all the answers

How should OraVerse be administered following a dental procedure?

Using the same location(s) and technique(s) employed for the administration of the local anesthetic Signup and view all the answers

Study Notes

PDL Injection (Intraligamentary Injection) Indications and Role

Indicated for localized anesthesia during dental procedures, especially where traditional nerve blocks are less effective.
Not recommended in cases of periodontal disease or when there is risk of dental or anatomical damage.
Useful in diagnosing mandibular pain, helping to identify the affected tooth or periodontal structure.
Preferred for procedures requiring rapid onset of anesthesia in specific teeth, such as extractions or restorations.

Advantages and Disadvantages of PDL Injection

Offers a targeted approach, minimizing systemic side effects compared to conventional blocks.
Disadvantage includes potential discomfort at the injection site and limited depth of anesthesia.
Not a reliable method for areas with significant bone density or when comprehensive anesthesia is required.

Technique and Injection Details

Needle is inserted into the periodontal ligament space of a single-rooted tooth at the height of the mucogingival junction.
The bevel of the needle should face the tooth structure during insertion.
Proper patient positioning is in a supine or semi-reclined manner for optimal access.

Injection Parameters

Approximately 0.2 to 0.5 mL of local anesthetic is administered during the PDL injection.
Success indicated by immediate onset of profound anesthesia in the targeted area with minimal discomfort.
Common cause of failure includes anatomical variations or inadequate technique.

Potential Complications

Excessive pressure during injection can lead to extravasation of anesthetic into surrounding tissues.
Post-injection discomfort may occur, manifesting as transient pain or swelling.
Risk of needle breakage or bending if improper technique or excessive force is used.

Intraseptal Injection Overview

Indicated for localized anesthesia within a singular septum, particularly beneficial for small areas.
Contraindicated in patients with insufficient tissue or anatomical deformities.
Provides rapid diffusion of anesthetic and reduces the need for multiple injections.

Injection Technique for Intraseptal

Angle of needle should be directed towards the interproximal area of the target tooth.
Approximately 0.2 to 0.3 mL of local anesthetic is deposited for effective anesthesia.

Stabident System and Intraosseous Injection

X-Tip provides a guide for more precise intraosseous injections.
The guide sleeve aids in stabilizing the needle during insertion.
Recommended concentration of local anesthetic for minimizing palpitations is typically 1:100,000 epinephrine.

Complications of Intraosseous Injection

Separation of the perforator or cannula may hinder effective injection and requires technical finesse.

Intrapulpal Injection Considerations

Used for direct anesthesia of the pulp during root canal treatments; indicated when profound anesthesia is needed.
Pain control occurs via direct delivery of anesthetic into the pulp chamber.
Common complication includes potential metallic taste due to the anesthetic.

EMLA Cream and OraVerse

EMLA cream contains lidocaine and prilocaine, effective for topically numbing, contraindicated in infants under 6 months.
Application duration is recommended for 30 to 60 minutes before procedures.
OraVerse (phentolamine mesylate) indicated for reversing local anesthesia effects, administered post-procedure to alleviate prolonged numbness.

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Description

Test your knowledge of PDL injection (intraligamentary injection) indications with this quiz. Explore the use of this technique for anesthesia of mandibular teeth, avoidance of bilateral IANB, and as an adjunctive technique after nerve block anesthesia.