1. Periodontal Ligament Injection
Indications
Anesthesia for 1-2 teeth
Bilateral mandibular treatment needed
Isolated treatment in children
Nerve blocks contraindicated (hemophiliacs)
Aid diagnosis of mandibular pain

2. Periodontal Ligament Injection
Contraindications
Primary teeth
Infection/inflammation
Psychological need for “feeling numb”

3. Periodontal Ligament Injection
Advantages
Avoid unecessary areas of anesthesia
Minimizes dosage of anesthetic
Supplements partially effective block

4. Periodontal Ligament Injection
Disadvantages
Administration difficult in some areas
May cause post-op discomfort, tooth extrusion, &/or tissue necrosis
Excess pressure may break cartridge

5. Periodontal Ligament Injection
Technique
Insert needle on long axis of tooth
Deposit 0.2 ml slowly (30 secs)
Should feel resistance to deposition

9. Intraosseous Infiltration
Indications
Local factors preclude adequate anesthesia
dense cortical plate
infection / inflammation
severe pulpal irritation

10. Intraosseous Infiltration
Injection site
Lateral - distil to tooth treated
avoid mental foramen area
Vertical - for edentulous area
on alveolar crest, mesial or distil
to treatment area

11. Intraosseous Infiltration Stabident System
Technique
Apply topical, consider local infiltration
Push perforator through tissue to bone
Activate in short spurts until resistance is lost ( approx. 2 secs)
Hold syringe in pen grip, into perforation
Inject “plain” anesthetic (0.6 ml-1-2 teeth)

12. Mylohyoid Nerve Infiltration
Mylohyoid nerve may provide sensation to molar teeth
May be used as a supplement to IAN block
Supplements lingual anesthesia

13. Mylohyoid Nerve Infiltration
Technique
Retract tongue medially
Penetrate mucosa of floor of mouth by alveolus
Aspirate, deposit 0.5 ml solution

18. Extraoral Nerve Blocks
Maxillary
Infraorbital
Mandibular

19. Extraoral Nerve Blocks
Indications
Infection
Inability to open mouth
Presence of pathology
Trauma
Diagnostic or Theraputic reasons

20. Extraoral Maxillary/Mandibular Nerve Block
Target area
Foramen Rotundum / Foramen Ovale
Penetration Point
Skin overlying sigmoid notch
Landmarks
Pterygoid plates

21. Extraoral Maxillary/Mandibular Nerve Blocks
Armamentarium
20-22 gauge spinal needle (3-5 inch)
3 ml syringe
Alcohol skin prep

23. Extraoral Maxillary/Mandibular Nerve Blocks
Technique
Prep skin overlying sigmoid notch,
Anesthetize skin and masseter muscle
Pass spinal needle through sigmoid notch until the pterygoid plate is contacted

24. Extraoral Maxillary/Mandibular Nerve Blocks
Technique
Withdraw, then re-direct anterior/superior to 4.5 cm for maxillary block
Re-direct posterior/superior toward Foramen Ovale for mandibular block

25. Extraoral Maxillary/Mandibular Nerve Blocks
Technique
Remove stylette
Place filled syringe on spinal needle
Aspirate and deposit 3 ml of anesthetic solution

34. Extraoral Infraorbital Nerve Block
Landmarks
Infraorbital rim
Infraorbital foramen
Pupil

35. Extraoral Infraorbital Nerve Block
Technique
Palpate foramen- 6 mm below rim on pupillary line
Prep skin
Penetrate skin and contact bone
Redirect until foramen entered
Advance 2-3 mm and deposit solution