Advances in Local Anesthesia Techniques PDF

A d v a n c e s I n LOCAL ANESTHESIA Under Supervision of : Prof. Hany Saber  OUTLINE: RECENT IN TOPICAL ANESTHESIA VIBROTACTILE DEVICES CRYOANRSTHESIA TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION & LASER ANALGESTIA JET INJECTION & SAFTY DENTAL SYRINGE COMPUTERIZED LOCAL ANEST...

A d v a n c e s I n LOCAL ANESTHESIA Under Supervision of : Prof. Hany Saber  OUTLINE: RECENT IN TOPICAL ANESTHESIA VIBROTACTILE DEVICES CRYOANRSTHESIA TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION & LASER ANALGESTIA JET INJECTION & SAFTY DENTAL SYRINGE COMPUTERIZED LOCAL ANESTHESIA NANOTECHNOLOGY IN LOCAL ANESTHESIA & OREVERSE  OUR TEAM: TOQA HISHAM FATHY (RECENT IN TOPICAL ANESTHESIA) DOHA AHMEDKHALIL (VIBROTACTILE DEVICES) MAYVEN REFAAT (CRYOANRSTHESIA) SARAH BAHR HUSSEIN(TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION & LASER ANALGESTIA) MARIAM MAHMOUD SALAH(JET INJECTION & SAFTY DENTAL SYRINGE) NAIRA ESSAM FAROUK (COMPUTERIZED LOCAL ANESTHESIA) MAHA AHMED MANSOUR (NANOTECHNOLOGY IN LOCAL ANESTHESIA & OREVERSE) Advances In Topical Anesthesia EMLA CREAM Advanced Formula EMLA cream contains a unique blend of lidocaine and prilocaine, which work together to provide deep, long-lasting numbness. Proven Effectiveness EMLA has been extensively studied and is considered a gold standard in topical anesthesia.  LIDOCAINE PATCHES Targeted Relief Convenience Lidocaine patches are designed to The patches are easy to apply and can be provide localized pain relief by left on for several hours, making them delivering the anesthetic directly to the ideal for managing chronic pain. affected area. Reduced Side Effects By applying the anesthetic topically, minimizing the risk of systemic side effects.  TAC 20 ALTERNATE Tetracaine Adrenaline Cocaine The "T" in TAC 20 stands for The "A" represents adrenaline, The "C" was originally for cocaine, tetracaine, a powerful local which constricts blood vessels to but has been replaced with an anesthetic. prolong the numbing effect. alternative, safer ingredient. NOT regulated by the FDA, no information available regarding safe application, indications, contraindications or adverse reactions.  ORAQIX Needle-Free 1 Oraqix is a non-injectable topical anesthetic gel that numbs the gums without the need for a needle. Dental Applications 2 It is specifically formulated for use in dental procedures, such as scaling and root planing. Fast-Acting 3 The gel begins to numb the target area within 30 seconds of application.  CETACAINE Spray Application 1 Cetacaine is a topical anesthetic spray that can be easily applied to the target area Rapid Onset 2 The anesthetic ingredients in Cetacaine work quickly to numb the skin or mucous membranes. Prolonged Effect 3 The numbing sensation can last for up to an hour, providing ample time for medical procedures. Do not uFe Cetacaine li5uid o@ Fp@ay to t@eat infantF o@ child@en younge@ than 2 yea@F.  VIBROTACTILE DEVICES Vibratory stimulation is the prospective technique used in pain reduction. Many devices have been designed based on the “Gatecontrol” theory, which states that the neural gate can be closed while applying pressure and vibration, reducing itch and pain perception. The brain can only recognize one sensation from one area at a given time; thus, vibrating the cheek has been followed to distract the brain from the discomfort of the anesthetic shot. Nuvvula, S., Saiki@an, K. V., Eliche@la, S. R., Sahithi, V., Nunna, M., & Challa, R. R. (2021). Local AneFtheFia in Pediat@ic DentiFt@y: A Lite@atu@e @eview on cu@@ent alte@native techni5ueF and app@oacheF. Jou@nal of South AFian AFFociation of Pediat@ic DentiFt@y, 4(2), 148–154. httpF://doi.o@g/10.5005/jpNjou@nalFN100KKN30K6  VIBRAJECT It is a small device that aims to block the pain from injections through the use of vibrations. It is a small battery-operated attachment that snaps on to the standard dental syringe. It delivers a high-frequency vibration to the needle that is strong enough for the patient to feel.  DENTALVIBE This device comprises a rechargeable, cordless handheld. It delivers injections with soothing percussive microoscillations at the site of administration. It contains a U-shaped vibrating tip connected to a microprocessor-controlled VibraPulse motor which quietly stimulates the injection site’s sensory receptors, thereby closing the pain gate and blocks the painful sensation of injection prick  ACCUPAL It is a cordless device that employs vibration coupled with pressure to condition the oral mucosa. Accupal delivers pressure, and it vibrates the injection site at 360° proximal to the needle infiltration that shuts the “pain gate”. After placement of the device at the injection site, the unit vibrates by applying moderate pressure. The needle is positioned in a hole with the disposable tip head, and it is attached to the battery based motor. BUZZY DEVICE It is a bee-shaped device comprising two components: the bee’s body vibration and the detachable ice wings. It works on the gate control theory principle. the vibration produced by the buzzy body will block the afferent pain-receptive fibers (A-delta and C fibers), resulting in the reduction of the pain.  CRYOANESTHESIA This procedure involves cooling a constricted body area with ice or refrigerant sprays to prevent nerves from transmitting pain signal Precooling the soft tissue area before routine dental operations decreases the pain perception for infiltrations and blocks anesthesia. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10103831/  ADVANTAGES Safe and Simple physiologically active Immediate anesthesia Economical as it suppresses both Technique pain and pressure.  TENS TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION  TENS The principle of Transcutaneous Electrical Nerve Stimulation (TENS) which has been used to relief the pain by application of electric current that loads the nerve stimulation pathway to the extent that pain stimulus is blocked. Kasat, V., Gupta, A., Ladda, R., Kathariya, M., Saluja, H. and Farooqui, A.A., 2014. Transcutaneous electric nerve stimulation (TENS) in dentistry-A review. Journal of clinical and experimental dentistry, 6(5), p.e562.  Advantages No need for needle (useful for Patient having needle phobia). No need for injections of Contraindications drugs. Mental Disability Compared to local anesthesia there is no Epileptic patients postoperative anesthesia. Patients wearing pacemakers Disadvantages: Acute pain cases/pain of High cost unknown etiology. Technique sensitive Demands patient cooperation Kasat, V., Gupta, A., Ladda, R., Kathariya, M., Saluja, H. and Farooqui, A.A., 2014. Transcutaneous electric nerve stimulation (TENS) in dentistry-A review. Journal of clinical and experimental dentistry, 6(5), p.e562.  LASER ANALGESIA  It is a noninvasive, nonthermogenic biomodulation of the dental 1 pulp. Utilizes low-level laser therapy (LLLT). 2 This LLLT does not achieve profound anesthesia (a complete loss 3 of sensation). An adjunctive anesthetic procedure should be used along with the laser analgesia. LASER ANALGESIA It causes temporary disruption of the sodium-potassium pump and alters the behavior of neuronal cells. This stops the conduction of impulses to the brain temporarily and produces analgesia.  LASER ANALGESIA In a recent RCT they evaluated and compared pain perception following low level laser therapy photobiomodulation (PBM), topical anesthesia, precooling of the injection site during administration of local anesthesia injection in pediatric patients aged 6–13 years. Results and conclusion : The study showed PBM exhibited the lowest mean scores of anxiety/pain using VAS, Wong–Baker Faces Pain Rating Scale, and pulse rate as compared to precooling, and topical anesthesia. They concluded that Photobiomodulation (PBM) was found to be effective means of reducing injection pain, demonstrating much better efficacy than other tested method  JET INJECTION  JET INJECTION Is based on the principle of using a mechanical energy source to create a high pressure sufficient to push a liquid medication through a very small orifice creating a thin column of fluid with enough force that it can penetrate into the submucosa tissues.  Advantages Painless injection Less tissue damage Disadvantages Faster injection Cannot be used for nerve Faster rate of drug blocks absorption Less effective than traditional Used with needle-phobia methods patients Abrupt noise Needle free devices Super Shot Omfort in Injex https://www.mdpi.com/1648-9144/58/2/278 (Jet) https://actascientific.com/ASDS/pdf/ASDS-06-1349.pdf SAFETY DENTAL SYRINGE  SAFTY DENTAL SYRINGE It aims to prevent the risk of accidental needle stick injury occurring with a contaminated needle after local anesthesia administration. These syringes possess a sheath that locks over the needle when it is removed from the patient's tissues preventing accidental needle stick injury. Advantages Compatible with any type of needle Clear Barrel window+ Plunger Design = Aspiration Disadvantages Cost Bulkier design SAFTY DENTAL SYRINGE  COMPUTER CONTROLLED LOCAL ANESTHESIA ADMINISTRATION It is a device that slowly administers anesthetics by using a computerized device to control the injection speed reducing pain during local anesthesia Most of these systems consist of a computer- controlled unit, a handpiece component , a foot pedal and lightweight, pen-like handpiece. Such devices can be used for all local anesthetic techniques Kwak EJ, Pang NS, Cho JH, Jung BY, Kim KD, Pa@k W. Compute@Ncont@olled local aneFthetic delive@y fo@ painleFF aneFtheFia: a lite@atu@e @eview. J Dent AneFth Pain Med. 2016 JunJ16(2):81N88. doi: 10.1K245/jdapm.2016.16.2.81. Epub 2016 Jun 30. PMID: 288K9299J PMCID: PMC5564086. Advantages Improves patient comfort Reduces the perception of pain and therefore fear of injection As,The lightweight, pen-like handpiece allows for more controlled insertion of the needle slow flow setting allows the drops of solution to anesthtesia the tissue immediately in front of the needle Less threatening visual appearance As, the needle is close to the pen handle. Avoidance of needle deflection Reduce force of insertion As, the handpiece can be rotated back and forth while insertion Profound positive impact on patient behavior and more cooperative Types 1-The Wand (in 1997 first introduced by Milestone Scientific (Piscataway, NJ, USA) 2-Comfort control syringe 3-Single tooth anesthesia system 4-Ezjet 5-Dental pen The Wand Consists of 3 components ( base unit,footpedal and disposable hand piece) The hand piece is an ultralight pen like handle which is linked to a conventional anesthetic cartridge with plastic micro tubing It depends on the automatic delivery of the local anesthetic solution at a fixed pressure regardless of variations in tissue resistance Has been on the market for the longest period of time, and is known for its ease in operation due to its lightweight and a circumference that is about half that of traditional anesthetic syringes  COMFORT CONTROL SYRINGE Is an electronic pre-programmed computerized local anesthetic injection device. By beginning the injection at an extremely slow rate and then gradually increasing the flow, pain is managed and patients experience little to no discomfort. Injection and aspiration can be controlled directly from the syringe The CCS comprises a main control unit, a syringe-and-needle hand-piece, ultra tubing connecting the control unit to the syringe-and-needle hand piece. The CCS has five pre-programmed speeds for different injection techniques and can be used for all types of injections.( nerve block, infiltration, PDI,IO and palatal injections) With the touch of a button, it can start and stop the injection procedure, control aspiration, and can double the flow rate. The base unit has three digital readouts that provide the feedback during the injection procedure. The display shows the rate of injection, time elapsed during the injection, and the cumulative volume injected. Compa@iFon of the pain pe@ception in child@en uFing comfo@t cont@ol Fy@inge and a conventional injection techni5ue du@ing pediat@ic dental p@ocedu@eF N Scientific Figu@e on ReFea@chGate. Available f@om: httpF://www.@[email protected]/figu@e/MidweFtNcomfo@tNcont@olNFy@ingeNFhowingNtheNbaFeNunitNandNtheNanaeFtheticNca@t@idge_fig1_236066K8K  STA The STA anesthesia was performed using the Wand. The STA technique requires the needle tip to be physically guided to the periodontal ligament (PDL). This is achieved using a real-time dynamic pressure-sensing (DPS) technology. As the needle is introduced into the tissue, the system provides continuous audible and visual feedback to the clinician. The system has a visual pressure-sensing scale (orange, yellow, and green). The orange lights indicated minimal pressure; the yellow light indicated mild to moderate pressure; the green lights indicate moderate pressure into the PDL tissue Campanella, V., Libonati, A., Na@di, R., Angotti, V., GalluFi, G., Montemu@@o, E., D=Ama@io, M. and Ma@zo, G., 2018. Single tooth aneFtheFia ve@FuF conventional aneFtheFia: a c@oFFNove@ Ftudy. Clinical o@al inveFtigationF, 22, pp.3205N3213. Ezject 4step control of injection speed As Dental syringe, ezject is designed to minimize patient’s pain by keeping stable syringe speed. 3step pressure sensor Additional speed control with a pressure sensor. Ampule indicator Injection amount is easily identified. Dental pen Computer controlled local anesthesia administration Ora verse (phentolamine mesylate) Accelerate the return to normal sensation of lip and tongue twice faster than normal as reverse of local anesthesia in soft tissue Mechanism of action act as vasodilator and result is faster diffusion of anesthetic into cardiovascular system and away from the site so reducing un wanted side effect of lingering lip and tongue numbness Indication In pedo faster return to normal sensation so reduce or avoid lips and tongue injury In adult regain normal sensation and function faster Contraindication Avoid in children less than 3 year In patients with cardiovascular disease Onset onpharm (sodium bicarbonate) Buffering system use sodium bicarbonate to raise PH of local anesthesia Raise pH of local anesthesia so Increase onset of analgesia Decrease injection pain Nanorobotics in local anesthesia Several advancements have been made on the exact release of local anaesthetics formulation and its efficiency at inducing motor and sensory block for an extended time has been harnessed in clinical practice. The use of sustained release formulations delivers analgesia for a lengthier period of time with one administration, thereby reducing complications that usually arise with administration of conventional analgesia. In addition, controlled release of an anaesthetic drug is said to prevent overdosing, reduced side effects, especially cardiotoxicity, neurotoxicity and tissue lesions Nanorobotics in local anesthesia Anesthesia can cause discomfort and many associated complications, especially in pediatric patients an analgesic colloidal suspension containing many functional micron- sized dental nanorobot particles injected into the patient's gingival mucosa → migrate through the gingival sulcus pass painlessly through lamina propria or layer of loose tissue on the CEJ into the pulp where they control nerve impulses by blocking the nerve endings Upon completion of dental treatment, the dentist stimulates the nanorobots to restore all nerve impulses and leave the tooth in a similar manner THANK YOU