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Questions and Answers
Which of the following is a contraindication for PDL injection?
Which of the following is a contraindication for PDL injection?
What is one advantage of using PDL injection?
What is one advantage of using PDL injection?
Which technique is utilized for PDL injection?
Which technique is utilized for PDL injection?
What is a disadvantage of PDL injection?
What is a disadvantage of PDL injection?
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Why is PDL injection well suited for certain procedures?
Why is PDL injection well suited for certain procedures?
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What could result from excessive pressure during a PDL injection?
What could result from excessive pressure during a PDL injection?
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Which has a significantly high success rate in the mandibular molar region as an alternative to PDL injection?
Which has a significantly high success rate in the mandibular molar region as an alternative to PDL injection?
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What is recommended regarding the needle's bevel orientation during a PDL injection?
What is recommended regarding the needle's bevel orientation during a PDL injection?
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What is the significance of the thickness of the rubber stopper in the local anesthetic cartridge?
What is the significance of the thickness of the rubber stopper in the local anesthetic cartridge?
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What volume of local anesthetic does each squeeze of a PDL syringe deliver?
What volume of local anesthetic does each squeeze of a PDL syringe deliver?
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What should you do if the tooth being treated is multirooted?
What should you do if the tooth being treated is multirooted?
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What is a key indicator of the success of a local anesthetic injection?
What is a key indicator of the success of a local anesthetic injection?
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Why is it important to monitor the volume of local anesthetic administered?
Why is it important to monitor the volume of local anesthetic administered?
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In which situation would you use a conventional syringe over a PDL syringe?
In which situation would you use a conventional syringe over a PDL syringe?
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What factor does NOT influence the effectiveness of local anesthetics?
What factor does NOT influence the effectiveness of local anesthetics?
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What is the role of the 'trigger' on a PDL syringe?
What is the role of the 'trigger' on a PDL syringe?
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What is the primary purpose of stabilizing the syringe and your hand during a PDL injection?
What is the primary purpose of stabilizing the syringe and your hand during a PDL injection?
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When should the bevel of the needle face the root of the tooth during a PDL injection?
When should the bevel of the needle face the root of the tooth during a PDL injection?
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What is the recommended volume of local anesthetic to be deposited during a PDL injection?
What is the recommended volume of local anesthetic to be deposited during a PDL injection?
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Why is it necessary to position the patient supine or semisupine during the injection process?
Why is it necessary to position the patient supine or semisupine during the injection process?
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How is the syringe directed when interproximal contacts are tight during a PDL injection?
How is the syringe directed when interproximal contacts are tight during a PDL injection?
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What should be done if the tooth has only one root after advancing the needle?
What should be done if the tooth has only one root after advancing the needle?
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How can the thickness of the rubber stopper in a local anesthetic cartridge be utilized in practice?
How can the thickness of the rubber stopper in a local anesthetic cartridge be utilized in practice?
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What should be monitored to ensure a quick onset of dental treatment after a PDL injection?
What should be monitored to ensure a quick onset of dental treatment after a PDL injection?
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What is the main indication for performing an intrapulpal injection?
What is the main indication for performing an intrapulpal injection?
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Which of the following is a significant advantage of intrapulpal injections?
Which of the following is a significant advantage of intrapulpal injections?
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What is a common disadvantage of the intrapulpal injection technique?
What is a common disadvantage of the intrapulpal injection technique?
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What is a significant reason why the risk of breakage with a bent needle is not a problem during intrapulpal anesthesia?
What is a significant reason why the risk of breakage with a bent needle is not a problem during intrapulpal anesthesia?
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How long after administering an intrapulpal injection can instrumentation typically begin?
How long after administering an intrapulpal injection can instrumentation typically begin?
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How much anesthetic solution is typically necessary for successful intrapulpal anesthesia?
How much anesthetic solution is typically necessary for successful intrapulpal anesthesia?
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Which statement is true regarding the pain experienced during an intrapulpal injection?
Which statement is true regarding the pain experienced during an intrapulpal injection?
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What should be felt during the injection process to ensure success?
What should be felt during the injection process to ensure success?
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Why is intravascular injection during intrapulpal anesthesia considered extremely unlikely?
Why is intravascular injection during intrapulpal anesthesia considered extremely unlikely?
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Which of the following describes a potential alternative to intrapulpal injection?
Which of the following describes a potential alternative to intrapulpal injection?
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What difficulty may arise when performing an intrapulpal injection?
What difficulty may arise when performing an intrapulpal injection?
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What should be avoided when administering anesthetic for intrapulpal injection?
What should be avoided when administering anesthetic for intrapulpal injection?
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What is one of the safety features of intrapulpal injections?
What is one of the safety features of intrapulpal injections?
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What is the typical duration of action for intrapulpal injections?
What is the typical duration of action for intrapulpal injections?
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What is a precaution when administering intrapulpal anesthesia?
What is a precaution when administering intrapulpal anesthesia?
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What outcome is expected if the intrapulpal injection is performed properly?
What outcome is expected if the intrapulpal injection is performed properly?
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What is the primary reason for significant resistance during the deposition of local anesthetic solution?
What is the primary reason for significant resistance during the deposition of local anesthetic solution?
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What should be done if the local anesthetic flows back into the patient's mouth during the injection?
What should be done if the local anesthetic flows back into the patient's mouth during the injection?
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Which of the following is a key sign indicating profound anesthesia during an injection?
Which of the following is a key sign indicating profound anesthesia during an injection?
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What volume of local anesthetic solution is typically required for a PDL injection?
What volume of local anesthetic solution is typically required for a PDL injection?
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What sensation is commonly reported by patients receiving PDL injections?
What sensation is commonly reported by patients receiving PDL injections?
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What is the implication of ischemia at the injection site?
What is the implication of ischemia at the injection site?
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Why is it significant for the local anesthetic not to flow back into the patient's mouth?
Why is it significant for the local anesthetic not to flow back into the patient's mouth?
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What is a potential consequence of using the wrong syringe for local anesthetic administration?
What is a potential consequence of using the wrong syringe for local anesthetic administration?
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Study Notes
Supplemental Injection Techniques
- This presentation covers various supplemental injection techniques used in dentistry, including PDL, intrapulpal, and comparisons.
- The presenter, Dr. Anuroop Singhai, is from the Oral Surgery division at Batterjee Medical College.
PDL Injection
- Other Names: Peridental (original name) injection, intraligamentary injection
- Nerves Anesthetized: Terminal nerve endings at the injection site and at the apex of the tooth.
- Areas Anesthetized: Bone, soft tissue, apical, and pulpal tissues in the injection area.
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Indications:
- Pulpal anesthesia for one or two teeth in a quadrant.
- Treatment of isolated teeth in two mandibular quadrants (to avoid bilateral IANB).
- Patients needing regional anesthesia for whom residual soft-tissue anesthesia is undesirable.
- Situations where regional block anesthesia is contraindicated.
- Aid in diagnosing pulpal discomfort.
- Adjunctive technique after nerve block if partial anesthesia is present.
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Contraindications:
- Infection or inflammation at the injection site.
- Patients who require "numb" sensation for psychological comfort.
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Advantages:
- No lip, tongue, or other soft tissue anesthesia, enabling treatment in multiple quadrants during the same appointment.
- Minimal local anesthetic dosage needed (~0.2 mL per root).
- Faster onset of profound pulpal and soft-tissue anesthesia (30 seconds).
- Less traumatic than conventional block injections.
- Well-suited for procedures such as extractions, periodontal and endodontic procedures including children.
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Disadvantages:
- Difficult needle placement in certain areas (e.g., distal to the second or third molar).
- Leakage of anesthetic into the mouth causing a bitter taste.
- Potential breakage of the glass syringe cartridge during overly rapid injection.
- May need a special syringe in some cases.
- Potential for focal tissue damage from excessive pressure.
- Post-injection discomfort may persist for several days.
- Potential for tooth extrusion if excessive pressure is used.
- Positive Aspiration: Zero percent
- Alternative: Supraperiosteal injection (for maxilla/mandibular incisor region). Infiltration using articaine hydrochloride is highly successful for mandibular molars.
- Technique (for PDL Injection): A 27-gauge needle is recommended. Insertion targeting mesial or distal roots (singular or multiple-rooted). The needle placement is between the root and the interproximal bone, and within the gingival sulcus. Placement involves the following landmarks: roots, periodontal tissues. The angle of the bevel towards the root facilitates the progress into an apical direction.
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Procedure:
- Proper positioning with sufficient visibility.
- Correct needle angle (adjusts depending on tooth type).
- Positioning the patient appropriately.
- Injecting along the long axis of the root, using a mouth mirror when possible.
- Needle bevel faces root of the tooth, close to the long axis.
- Syringe/hand stabilized while keeping contact to face, teeth, lips.
- Dosage: 0.2 mL of local anesthetic solution in up to 20 seconds. The use of a conventional syringe, the rubber stopper's thickness equals 0.2 mL, which can be used as a gauge. With a PDL syringe, each trigger provides 0.2 mL.
- Post Injection: Treatment may start within 30 seconds. In multirooted teeth, repeat the procedure to the other root/s.
Signs and Symptoms
- Subjective: When ischemia of the soft tissue and significant resistance are present, adequate anesthesia is likely.
- Objective: Uses a freezing spray/electric pulp tester (EPT) with maximal output (80/80), no response.
Safety Feature
- Intravascular injection is unlikely.
Precautions
- Maintain needle contact with the tooth to prevent damage to the lingual aspect.
- Inject slowly (minimum 20 seconds for .2 mL).
- Do not inject excessive amounts; .2 mL per root.
- Avoid infected or inflamed tissue.
Failures of Anesthesia
- Periapical infection: Reduced efficacy due to pH and vascular changes.
- Solution not retained: Re-inject at different sites until the 0.2 mL is deposited and retained in tissues.
- Each root should be anaesthetized with ~0.2 mL of solution.
Duration of Expected Anesthesia
- Duration varies, not directly related to the drug.
- Example: Lidocaine with epinephrine (1:100,000) ranges from 5-55 minutes.
Complications
- Needle insertion pain: Maintain the needle against the tooth's structure, use topical anesthesia for inflamed tissues.
- Injection pain: Use a slower injection speed (minimum 20 seconds for .2 mL solution).
- Post-injection pain: Excess volume/multiple penetrations can lead to problems. Address with warm saline rinses and analgesics (resolves in 2-3 days).
Intrapulpal Injection
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Nerves Anesthetized: Terminal nerve endings in the pulp chamber and canals.
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Areas Anesthetized: Tissues within the tooth.
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Indications: Pain control for pulpal extirpation/endodontic treatment if repeated other techniques fail.
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Contraindications: None. May be the only option for some clinical situations.
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Advantages: Lack of lip/tongue anesthesia, minimal anesthetic volume needed, immediate onset of action, few postoperative complications.
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Disadvantages:
- Brief pain associated with injection.
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Bitter taste if leakage occurs.
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Short duration of action (15-20 minutes).
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Difficulty entering certain root canals (potential need to adjust needle).
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Intense pulp chamber decay presents challenges to achieving profound anesthesia.
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Technique:
- Insert a 25- or 27-gauge needle into the pulp chamber or root canal as needed.
- Wedge the needle firmly in the chamber/canal.
- Deposit ~0.2 to 0.3mL of anesthetic under pressure.
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Positive Aspiration: Zero percent.
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Alternatives: Intraosseous injection, when intrapulpal fails.
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Resistance (back pressure): Crucial for success, should be felt during injection.
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Needle bending: Used to access the pulp chamber to avoid damage to soft surrounding tissues.
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Post-injection Sensitivity: Brief period of pain, but resolves quickly, allows for atraumatic instrumentation.
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Instrumentation: May start ~30 seconds after injection.
Intrapulpal Injection: Signs and Symptoms
- As with other injections, subjective symptoms are typically not present, making objective symptoms (e.g., no response of the pulp to EPT maximal output) useful to determine successful anesthesia.
Safety Features
- Intravascular injection is exceptionally rare.
- Small anesthetic volumes are used.
Precautions
- Avoid injecting anesthetic into infected tissues.
- Gradual/slow injection (minimum 20 seconds for .2- .3 mL).
- Do not inject excessive amounts.
Intrapulpal Injection: Failures of Anesthesia
- Infected/inflamed tissue: Changes in tissue pH negatively affect anesthetic effectiveness.
- Solution not retained: Re-inject into the pulp chamber or root canal, re-administer 0.2 to 0.3 mL of anesthetic, if needed.
Intrapulpal Injection: Complications
- Injection discomfort: Usually brief, mild to intense.
- Discomfort resolves quickly as the injection site anesthetizes.
- Inhalation sedation (N2O/O2) can lessen the sensation.
Duration of Expected Anesthesia
- Duration is variable after intrapulpal anesthetic injection (~15-20 minutes).
Comparison Chart
- Table comparing the three different injection types (PDL, intraseptal, intraosseous, intrapulpal) in terms of injection location, indications, anatomical considerations, advantages, disadvantages, and limitations.
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Description
Explore various supplemental injection techniques used in dentistry, such as PDL and intrapulpal injections. This quiz highlights their indications, areas anesthetized, and significance in dental practices. Gain insights into alternative methods for effective local anesthesia during dental procedures.
