1. Selection of Anesthetic Technique
Hesham El-Hawary
Selec%on
of
Dental
Anesthe%c
Technique
Dr
Hesham
El-­‐Hawary
Assistant
professor
OMFS

2. Selection of Anesthetic Technique
Hesham El-Hawary
O mankind! Be afraid of your Lord (by
keeping your duty to Him and avoiding all
evil), and fear a Day when no father can
avail aught for his son, nor a son avail
aught for his father. Verily, the Promise of
Allah is true, let not then this (worldly)
present life deceive you, nor let the chief
deceiver (Satan) deceive you about Allah.
Luqmān 33
In the Name of Allah, the Most Beneficent,
the Most Merciful.

3. Selection of Anesthetic Technique
Hesham El-Hawary
The
main
factors
to
be
concirened
are:
1. SelecAon
of
a
suitable
syringe
and
needle
(
see
the
armamentarium
lecture
–
click
to
open)
2.
UAlizaAon
of
the
proper
L.A.
drug
(see
the
pharmacology
lecture
–
click
to
open)
3. InserAon
of
the
needle
in
the
correct
site
for
injecAon

4. Selection of Anesthetic Technique
Hesham El-Hawary

5. Selection of Anesthetic Technique
Hesham El-Hawary
TYPES
OF
LOCAL
ANESTHETIC
TECHNIQUES
Selec%on
of
Anesthe%c
Technique

6. Selection of Anesthetic Technique
Hesham El-Hawary
Local
Anesthe%c
Techniques
1. Topical
anesthesia
2. Local
infiltraAon
3. Field
block
4. Nerve
block

7. Selection of Anesthetic Technique
Hesham El-Hawary
Topical
Anesthesia
• Ointments,
gels,
sprays
and
pastes
on
mucous
membrane
or
skin
• ApplicaAon
of
a
topical
anestheAc
agent
on
the
mucosa
allows
for
the
easy
and
painless
inserAon
of
the
sharp
needle
• Affects
free
nerve
endings

8. Selection of Anesthetic Technique
Hesham El-Hawary
Local
Infiltra%on
Anesthesia
• Flooding
of
the
small
terminal
nerve
endings
with
local
anestheAc
soluAon

9. Selection of Anesthetic Technique
Hesham El-Hawary
Field
Block
Anesthesia
• Referred
to
as
local
infiltraAon
• local
anestheAc
soluAon
is
deposited
in
the
vicinity
of
larger
terminal
nerve
fiber
• so
a
circumscribed
area
is
anestheAzed
• Local
anesthesia
injecAon
above
a
tooth
apex
is
an
example
of
a
field
block,
in
spite
of
being
r e f e r r e d
t o
a s
p a r a p e r i o s t e a l
o r
supraperiosteal
infiltraAon
anesthesia

10. Selection of Anesthetic Technique
Hesham El-Hawary
• Subperiosteal
injecAon
– Not
be
aWempted
– Because
of
• Liability
of
needle
breakage
• Difficulty
of
forcing
the
anestheAc
agent
between
periosteum
and
bone

11. Selection of Anesthetic Technique
Hesham El-Hawary
Nerve
Block
Anesthesia
• The
anestheAc
soluAon
is
deposited
close
to
a
main
nerve
trunk
• Usually
at
a
distance
from
the
operaAve
site
before
the
nerve
divided
into
terminal
branches

12. Selection of Anesthetic Technique
Hesham El-Hawary
FACTORS
AFFECTING
SELECTION
OF
ANESTHETIC
TECHNIQUE
Selec%on
of
Anesthe%c
Technique

13. Selection of Anesthetic Technique
Hesham El-Hawary
1. Area
to
be
anestheAzed
Depending
on
the
type
of
bone
(density
of
bone)
– Maxilla
and
anterior
mandibular
region
• Cancellous
bone
with
thin
corAcal
layer
• InfiltraAon
anesthesia
or
field
block
anesthesia
reaches
the
nerve
filaments
inside
the
cancellous
bone
– Posterior
mandible
• Thick
and
dense
corAcal
bone
• Nerve
block
anesthesia

14. Selection of Anesthetic Technique
Hesham El-Hawary
1. Area
to
be
anestheAzed
Depending
on
the
type
of
bone
(density
of
bone)
– Maxilla
and
anterior
mandibular
region
• Cancellous
bone
with
thin
corAcal
layer
• InfiltraAon
anesthesia
or
field
block
anesthesia
reaches
the
nerve
filaments
inside
the
cancellous
bone
– Posterior
mandible
• Thick
and
dense
corAcal
bone
• Nerve
block
anesthesia

15. Selection of Anesthetic Technique
Hesham El-Hawary
2. Extent
of
surgical
procedure
– MulAple
extracAons,
nerve
block
anesthesia
is
preferable
• Allow
anesthesia
of
the
enAre
operaAve
area
• Prevent
mulAple
needle
punctures

16. Selection of Anesthetic Technique
Hesham El-Hawary
2. Extent
of
surgical
procedure
– MulAple
extracAons,
nerve
block
anesthesia
is
preferable
• Allow
anesthesia
of
the
enAre
operaAve
area
• Prevent
mulAple
needle
punctures

17. Selection of Anesthetic Technique
Hesham El-Hawary
2. Extent
of
surgical
procedure
– MulAple
extracAons,
nerve
block
anesthesia
is
preferable
• Allow
anesthesia
of
the
enAre
operaAve
area
• Prevent
mulAple
needle
punctures

18. Selection of Anesthetic Technique
Hesham El-Hawary
3. DuraAon
and
profoundness
of
anesthesia
Nerve
block
anesthesia
produces
a
more
profound
and
longer
duraAon
than
infiltraAon
anesthesia
4. Age
of
the
paAent
Older
individuals
have
dense
bone,
thus
it
is
more
difficult
for
infiltraAon
anesthesia
to
penetrate
into
the
bone

19. Selection of Anesthetic Technique
Hesham El-Hawary
3. DuraAon
and
profoundness
of
anesthesia
Nerve
block
anesthesia
produces
a
more
profound
and
longer
duraAon
than
infiltraAon
anesthesia
4. Age
of
the
paAent
Older
individuals
have
dense
bone,
thus
it
is
more
difficult
for
infiltraAon
anesthesia
to
penetrate
into
the
bone

20. Selection of Anesthetic Technique
Hesham El-Hawary
4. Age
of
the
paAent
Older
individuals
have
dense
bone,
thus
it
is
more
difficult
for
infiltraAon
anesthesia
to
penetrate
into
the
bone

21. Selection of Anesthetic Technique
Hesham El-Hawary
5. Homeostasis
When
required
for
the
procedure,
infiltraAon
anesthesia
is
recommended
to
allow
the
vasoconstrictor
present
with
the
local
anestheAc
to
act
directly
on
the
blood
vessels
and
reduce
bleeding

22. Selection of Anesthetic Technique
Hesham El-Hawary
5. Homeostasis
When
required
for
the
procedure,
infiltraAon
anesthesia
is
recommended
to
allow
the
vasoconstrictor
present
with
the
local
anestheAc
to
act
directly
on
the
blood
vessels
and
reduce
bleeding

23. Selection of Anesthetic Technique
Hesham El-Hawary
6. Presence
of
infecAon
InfiltraAon
anesthesia
should
be
avoided
to
prevent
injecAon
into
an
infected
area
which
can
spread
the
infecAon

24. Selection of Anesthetic Technique
Hesham El-Hawary
6. Presence
of
infecAon
InfiltraAon
anesthesia
should
be
avoided
to
prevent
injecAon
into
an
infected
area
which
can
spread
the
infecAon

25. Selection of Anesthetic Technique
Hesham El-Hawary
7. Skill
of
the
operator

26. Selection of Anesthetic Technique
Hesham El-Hawary
INFILTRATION
ANESTHESIA
Maxillary
Anesthe%c
Techniques

27. Selection of Anesthetic Technique
Hesham El-Hawary
§ The
most
commonly
used
technique
§ It
is
divided
into
§ SoM
%ssue
infiltra%on
§ Submucosal
§ Paraperiosteal
§ Bony
infiltra%on

28. Selection of Anesthetic Technique
Hesham El-Hawary
SoM
%ssue
infiltra%on
anesthesia
In
this
technique
anesthesia
is
deposited
into
the
soa
Assue
in
close
proximity
to
bone
which
is
then
absorbed
via
pores
in
the
bone
surface
All
it
reaches
the
nerve
filaments
inside
the
cancellous
bone

29. Selection of Anesthetic Technique
Hesham El-Hawary
SoM
%ssue
infiltra%on
anesthesia
In
this
technique
anesthesia
is
deposited
into
the
soa
Assue
in
close
proximity
to
bone
which
is
then
absorbed
via
pores
in
the
bone
surface
All
it
reaches
the
nerve
filaments
inside
the
cancellous
bone

30. Selection of Anesthetic Technique
Hesham El-Hawary
Soa
Tissue
InfiltraAon
Submucosal
anesthesia
§ Needle
is
inserted
at
a
slight
depth
just
below
the
mucous
membrane
§ In
cases
just
need
superficial
anesthesia
§ Hypertrophied
Assue
§ High
muscle
aWachment

31. Selection of Anesthetic Technique
Hesham El-Hawary
Soa
Tissue
InfiltraAon
Submucosal
anesthesia
§ Needle
is
inserted
at
a
slight
depth
just
below
the
mucous
membrane
§ In
cases
just
need
superficial
anesthesia
§ Hypertrophied
Assue
§ High
muscle
aWachment
Paraperiosteal
Anesthesia
§ Called
local
infiltraAon
§ Mostly
used
for
anestheAzing
§ All
maxillary
teeth
§ Lower
anterior
mandibular
teeth
§
It’s
acAon
depends
on
the
diffusion
of
the
L.A.
soluAon
through
the
periosteum
and
the
minute
foramina
in
the
corAcal
bone

32. Selection of Anesthetic Technique
Hesham El-Hawary
Paraperiosteal
Anesthesia
Advantages
1. High
success
rate
2. Technically
it
is
an
easy
injecAon
3. Usually
it
is
enArely
atraumaAc

33. Selection of Anesthetic Technique
Hesham El-Hawary
Paraperiosteal
Anesthesia
Advantages
1. High
success
rate
2. Technically
it
is
an
easy
injecAon
3. Usually
it
is
enArely
atraumaAc
Disadvantages
• Not
suitable
for
large
areas
– Needs
mulAple
punctures
– AdministeraAon
of
large
amount
of
L.A.
soluAon

34. Selection of Anesthetic Technique
Hesham El-Hawary
Author: Hesham El-Hawary
Email: hesham@elhawarydentalclinic.com
Website: www.elhawarydentalclinic.com
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