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Anesthesia in Endodontics :

Anesthesia in Endodontics


by Ahmed labib

Slide 3:

Pain is an unpleasant sensation that is experienced by the patient; however, an interpretation of pain always exists, which is disproportionate to the stimulation.

Slide 4:

Methods of pain control: Raising the pain threshold by using drugs of analgesic nature. Using cortical depressants (general anesthesia). Using subcortical depressants either barbiturates or non-barbiturates sedation.

Slide 5:

Blocking the pathway of painful stimuli by means of local anesthesia, which is considered one of the effective means of relieving dental pain.

Slide 6:

Local anesthetic agents are esters of amino benzoic acid ,either: Para group (as Novocaine , Monocaine , Pentocaine ). Meta group (as Uracaine , Primacaine ). Non-ester types of local anesthesia are also available such as Xylocaine and carbocaine .

Slide 7:

The problem of inadequate pain control during endodontic treatment is explained through alterations in the pulp and periapical tissues.  

Slide 8:

Inflammation of pulpal and periapical tissues leads to decrease of tissue pH below normal . This decreased pH will lead to incomplete dissociation of the anesthetic solution resulting in weak anesthetic effect.


Techniques of local anesthesia in endodontics

Major techniques of anesthesia :

Major techniques of anesthesia 1-Local infiltration anesthesia

Technique :

Technique The tip of 25 –27-gauge needle is pushed through the mucosa until the fibrous periosteal tissue overlying the bone is pierced in the area of root apex. Then the anesthetic solution is deposited beneath the periostium .


2-Regional nerve block

Slide 14:

Nerve block anesthesia is achieved by depositing the local anesthetic solution close to the main nerve trunk. Nerve block anesthesia is more successful when the infiltrating solution (anesthetic solution) is deposited some distance from the inflamed or infected tissues.

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  II- Supplementary techniques

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Complete anesthesia of pulp tissue is necessary if vital pulp tissue is to be removed without pain. This requires supplementary injections beside the routine infiltration or nerve block anesthesia.

1-Intraseptal or Intraosseous injection: :

1-Intraseptal or Intraosseous injection: It is accomplished by passing the needle tip through the previously anaesthetized gingival papilla and thin cortical plate, penetrating into the cancellous bone of inter dental septum. Few drops of anesthetic solution are deposited under pressure. Two separate inter septal injections are usually used, one mesial and one distal to the tooth to be anaesthetized.

Slide 19:

The angulation of the needle should be 45  to the long axis of the tooth. The needle should contact bone at the height of the interdental crest of bone where the cortical layer is thinnest and most easily penetrated, by rotation of the needles as it pressed into the crystal bone.

Slide 20:

Perforating the alveolar plate of bones using Busch power reamer if the dentist cannot penetrate the bone by the needle. Through this entrance, a needle can enter the cancellous bone and a solution deposited under pressure to anaesthetize the particularly refractory cases.

2-Interpulpal injection: :

2-Interpulpal injection : This technique depends on the injection of the anesthetic solution into the pulp tissue itself. Profound anesthesia will only be obtained if a drop of anesthetic solution is deposited directly into the partially anesthetized pulp. The tooth is isolated and any debris in the area of the pulp exposure is removed.

Slide 22:

A sharp explorer is used to pinpoint the exposure, then the needle deliver few drops of anesthetic solution into the pulp tissue. This profoundly anesthetizes the pulp tissue.

Slide 23:

Additional intrapulpal injections are necessary to anaesthetize completely the deeper tissue within the root canal(s); the needle must fit tightly in the canal.  

3-Periodontal ligament injection (intraligamental) technique: :

3-Periodontal ligament injection ( intraligamental ) technique: Technique The needle is inserted at 30  angle, wedged with force into the periodontal ligament space between crystal bone and root surface . The fingers of the operator should support the needle to prevent buckling, and then the anesthetic solution is injected with maximal pressure on mesial and distal surfaces of the treated tooth.

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