Buccal Articaine Local Anaesthesia for Molars (Avoid ID Blocks)
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- Опубликовано: 7 авг 2024
- Molar anesthesia using buccal articaine technique (without an inferior alveolar nerve block)
I should of emphasised this more but the buccal sub-periosteal is also really important!
0:00 Introduction
1:17 Clinical Video
1:36 Step 1 - Numbing Gel and checking for Occlusion
3:27 Step 2 - Slowly depositing Articaine Hydrochloride
5:28 Step 3 - Anesthetized Attached gingiva
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Buccal Articaine Local Anaesthesia for Molars
Do you do the lingual infiltration as well?
I don't routinely - buccal is enough for restorative in my hands. However some colleagues who remove teeth would do lingually, or if you wanted more anaesthesia and definitely avoid a block (eg. patient on an anticoagulant) then yes can extend to lingual
@@protrusive I always give lingual as well especially if I am working on a lower 7 or 8 and routinely use 2 cartridges of articaine. I have not given an ID block since 2009
@@EvolveDentalHealing brilliant thank you!!!
Love your work!
After the initial infiltration I use a super short tip and give PDL injection at mid buccal which honestly rarely fails.
I give very few ID blocks these days.
I do lingual infiltration of a few drops for comfort with matrix, wedge placement and in case I need to laser some interprox tissue.
What would you recommend to someone who has lingual nerve damage I can’t do nerve blocks because it damages my lingual nerve and make it worse it tooth number 18 my bottom molar that I need the filling redone in
V helpful Jazz . Many thanks ❤️
That was brilliant; you're a real pro. Thank you for sharing
very kind mate thank you!
Thanks for the great information
Brilliant,
I’ve been a dentist since 1989. I could count on one hand the number of times I have an entire dosage of LA right off the bat. My method-4/5 minutes of topical. Then I ask my assistant to blow air at the site while I inject about 0.4ml, wait a minute and then give the rest. Pts love it
amazing - thanks for sharing this!
After doing 25k extractions myself..I would still prefer giving a safe IANB, followed by buccal infiltration and a good intraligamentary injection with a 30g or 31g needle..works the best for extractions and there's absolutely no pain during the procedure..for endodontics would prefer the same but avoid buccal infiltration
Appreciate you sharing your experience Dr Shetty!
Another great video Jaz. Which loupes are you using here? They look like the Surgitel 8x or 10x ones. Cheers.
thanks bud they are Xenosys / Bryant 7.5 :)
Great video. Any reason you do buccal infiltration only compared to lingual as lingual bone is much thinner near the apex of the root on mandibular molars? I got away with lingual only for pulpal anesthesia in my experince where i didnt want to do mandibular block.
Great Q - one of my highest values is painless anaesthesia. I can do this buccally but unsure of this lingually? Perhaps it's a limiting belief I hold - can this be given in a painless way?
Is this technique enough even for a root canal? I’m a new dentist and I’m a little scared when I’m doing IANB and sometimes it doesn’t even work for me that well.. this seems like such a better alternative
great - if necrotic tooth it's enough. If hot pulp, then needs this PLUS ID block
Hi Jaz. Thank you so much for this technique! Couple of questions please:
1. For the injection you did at minute 5.41, was it just an intra-papillary to numb the attached gingivae before beginning the proper technique?
2. For the injections into the attached gingivae, does the needle contact the bone before you deposit the LA?
Thanks! 😊
Hiya Ee Ping!
1. I wouldn't say that it's to facilitate the proper technique, it is very much part of the proper technique to give LA to the attached gingiva - this could be in the middle or mesial and distal - I do like mesial and distal as it gives more coverage.
2. It does not have to contact bone, but many time I do, but I will withdraw a TINY bit to allow the LA to flow easy in to the attached gingiva
Thanks for your question - I actually have a new 4K video of this showing lingual infiltration I need to upload
One quick question, I have seen you wearing loupes with hood . Can you please tell which loupes are the as I wanted to buy but not sure either it works with hood .
I have a very spacious hood - my loupes are massive. Hood is Airtek- some other hoods have limited space!
They look like bryant loupes?
@@maz7953 well spotted - yes 7.5x
Dear. Dr. Gulati, can you tell me how much articaine do you inject in the attached gengiva and how long it usually lasts?
Best Regards,
Marco O.
hi Doc! Hmm in total about maybe 0.3ml? so not very much! The blanching goes away after some minutes
Thank you for the reply, I’m getting near 100% success with this tecnique but in my hands it often leads to papilla ulceration in the site of injection. I’m using 4% articaine 1:100.000 and injecting less than 0.3 ml per site. Am I probably doing excessive pression while injecting?
Best Regards,
Marco O.
Isnt the mandible bone too dense for infiltration alone to be sufficient at molar sites?
I used to think this - but it's not 100% true. There are ways and scenarios we can utilise articaine infiltrations for blocks - see my recent episode PDP143 for a whole discussion on this and the CIA technique
I then went on to connect with Dentists all over the world who have not done an ID block in a decade +a
How to give lingual infiltration . Any tips
Good Q! I find it helpful to use the mirror to retract the tongue away. Then advance the needle towards the floor of the mouth close to the tooth in question - what you will find sometimes is as the patient swallows, the floor of the mouth will rise and it will carry out the penetration for you. Other time it can be tough to get the penetration in this area - go slow, use good lighting, be gentle
Thanks for your videos! I much appreciate them. However, it seems to me that you are going through more trouble doing it this way than doing a straightforward IA block, using proper technique and landmarks and of course appropriately aspirating with a slow injection. Over many years I have had much success and minimal complications doing this with 2% lidocaine, and almost always achieve profound anesthesia.
Hi Robert, I totally understand both sides of the view. Some colleagues have emailed me to say they haven't done an ID block for 11+ years (including extractions!) and others suggest, like yourself, that the age test ID block is just fine. For me I do about 1 ID block every 6 weeks or so, and get the profound anaesthesia with this technique. Main thing for me is that in my hands I am able to give a more comfortable injection via infiltration than ID block
1) can you confirm: so the first time you inject was that below the MGJ or above?
2) do you do this technique for 2nd molars? I find it a lot more challenging for 2nd molars as I feel like I hit bone immediately at my buccal infiltration and will often see anesthetic just leaking out of as opposed to actually going inside the tissue. where exactly do you inject the needle for 2nd molars (relative to MGJ please) to minimize this happening? Thanks doc!
sorry for the delay doc. I do indeed inject below the MGJ in the looser tissue first. Once that is numb, I can then enter the attached gingiva and observe blanching. 2nd molars can still work too but slightly less predictable in my hands
Is this technically suitable for RCT for the same?
If its a necrotic pulp, absolutely! For a HOT PULP then they are notoriously difficult to numb and I would throw the kitchen sink at that!
Why does infiltration of attached gingiva help anesthetize the tooth? I don't get it.
I believe its to do with holding/retaining the LA for longer and also it being adjacent to the emissary canals in the bone allowing the LA get right to the nerve
What kind of numbing gel are you using?
benzocaine 18 or 20% :)
You are bevelling towards the bone?
yes Sabastian thanks for your Q