Infiltration anesthesia for nasal surgery. The use of infiltration anesthesia in dentistry Anesthetics that can be used for infiltration anesthesia

Therapy of pathologies and injuries to soft tissues of the face, therapeutic manipulations on teeth are carried out without the use of medications that block conductivity nerve endings only in isolated cases: modern medicine has an impressive range of painkillers that relieve surgical interventions. Among the most effective methods used in carrying out these actions includes infiltration anesthesia in dentistry.

The procedure in question is performed by a dentist independently (without the involvement of additional medical personnel) and allows you to achieve desired result in just a few minutes.

What is infiltration anesthesia

Infiltration anesthesia is a type local anesthesia carried out by injection (using a syringe). A solution of a special drug saturates the required area of ​​​​tissue and interrupts transmission nerve impulses. The closer the needle is inserted to the neurovascular bundle, the faster the expected effect occurs.

The procedure is considered safe and relatively uncomplicated. Modern anesthetics allow clinic specialists to perform the necessary manipulations within 45-60 minutes without causing discomfort or pain to the patient.

Indications for the use of infiltration anesthesia in maxillofacial surgery and dentistry are:

• suturing;
• removal (treatment) of teeth - permanent teeth on the upper (less often lower) jaws, milk teeth on both arches;
• opening of abscesses localized under skin and on the mucous membrane oral cavity;
• cosmetic manipulations (elimination of minor defects);
• removal of tumors (benign);
• additional support for mandibular anesthesia.

To carry out the infiltration type of anesthesia, thin short needles are used; administered drugs - procaine, lidocaine, mepivacaine, ultracaine, trimecaine.

An absolute contraindication to the use of infiltration anesthesia is the patient’s history of individual intolerance to the medications used.

Fact possible manifestation Allergic reactions when using anesthetics are not grounds for refusing treatment with anesthesia. In these cases, experts suggest replacing local anesthesia with general anesthesia.

Technique of infiltration type anesthesia

When anesthetizing the soft tissues of the face, antiseptic treatment of the skin is performed before using infiltration anesthesia.

The anesthetic is administered in layers:

1. The procedure begins with injection of the solution with a two-cc (two-milliliter) syringe along the intended line of tissue opening. In this way, an effect called “lemon peel” is created in the thickness of the skin.
2. Repeated injections are carried out using a 5 (10) milliliter syringe through areas already infiltrated with anesthetic. The solution is released into the subcutaneous fatty tissue, also covering soft tissues located outside the area of ​​surgical intervention.
3. The specialist carries out further layer-by-layer saturation of the tissues by using the injection technique according to A.V. Vishnevsky (method of creeping infiltration).

In dentistry, the most commonly used type of anesthesia consists of 5 stages:

1. Treatment of mucous membranes in the injection area by using antiseptics.
2. The doctor, positioned to the right of the patient, uses a spatula or mirror to move the patient’s lip (cheek).
3. The syringe needle is placed on the border between the moving and fixed parts of the gums at an angle of 45º relative to the alveolar ridge.
4. The bevel of the needle, directed towards the jaw bone, is carefully inserted into the soft tissue of the transitional fold until it stops. The level of immersion depends on the injection site and varies from 5 to 15 millimeters.
5. Saturation of tissues with medication is carried out smoothly or under pressure (quickly).

The precision of the technique for performing the above scheme allows for minimal trauma to the infiltration area.

Classification

Dentistry and facial surgery The infiltration technique under consideration is divided into several types. The classification is determined by the area of ​​influence of the anesthetic.

There are 2 types of infiltration anesthesia:

1. Direct - injection of the solution into the tissues in the area of ​​​​which manipulations are planned. The method is recommended for use in facial surgery.
2. Diffuse (indirect) - infiltration of an area located at a short distance from the site of dental intervention. By spreading (from the center to the periphery), the active substance reaches the deep layers of tissue. Often used in dental treatment upper jaw.

Depending on the site of drug administration, several types of infiltration anesthesia are distinguished: subperiosteal, intrapapillary, intrapulpal and others.

Submucosal (periosteal)

The type of administration is the most common. Another name for the type of anesthesia is intrapapillary. The basic manipulation technique is discussed above.

The peculiarity of the described type of procedure are the following principles:

• on the palatal side, the injection can be applied at the convergence of the alveolar and palatine processes of the upper jaw;
• on lower jaw administration is carried out in the area of ​​​​transition to the sublingual tissues of the mucous membranes alveolar process.

Subperiosteal

The type of anesthesia is also called subperiosteal. The technique is recommended for use when it is necessary to obtain deep anesthesia. The activation technique consists of 4 stages:

• inserting a needle under the mucous membrane at the border of the gum parts (in the transitional fold);
• saturation of tissues with part of the drug;
• piercing the periosteum;

Before introducing the rest of the solution, specialists advance the needle at an angle of approximately 45° to the tooth root.

Spongy intraseptal

The second name of the procedure is intraosseous.

Infiltration anesthesia is performed by inserting a needle into the base of the gingival papilla, at an angle to the axis of the molar. At the level of the interdental septum, a small amount of the substance is released. When the syringe passes through the cortical plate, the remaining active substance is released.

If there is no expected effect, the method is recommended to be used on the opposite side of the tooth.

Intraligamentary

The technique involves introducing a solution into the periodontal fissure area. The injection duration is up to 2 minutes, since the injected liquid encounters significant resistance. Experts advise using computer syringes in combination with ultra-thin needles - this greatly simplifies the procedure.

Intrapulpar

One of the most reliable types of infiltration method. To carry it out, the dentist opens the pulp chamber (the diameter of the hole must correspond to the cross-section of the needle).

The success of the technique is determined by the absence of leaks active substance around the injection instrument.

Additional views

In addition to those listed, the types of anesthesia considered also include:

• "Block field"- used in case of presence of foci of inflammation in the area of ​​perimandibular soft tissues;
• plexual- the necessary manipulation to achieve pain relief is an injection into the alveolar anterior and upper middle plexus;
• intrapapillary- the anesthetic solution is administered directly into the base of the gingival interdental papillae;
• druk-anesthesia- room in carious cavity a swab soaked in an antiseptic solution.

Infiltration anesthesia on the upper jaw

Anesthesia based on the infiltration principle is more often used in the treatment of the upper jaw, since its bone is relatively thin and highly porous.

In order to anesthetize one incisor or first premolar, a needle is inserted between the fixed and moving parts of the gums slightly above the apex of the tooth root.

For infiltration blocking of the nerve endings of the second premolars and molars, the anesthetic is applied to the base of the root. The syringe is inserted between the teeth requiring treatment (extraction) and the adjacent teeth.

Additionally, it is recommended to perform cupping of the nerves located at the angle of convergence of the palatine and alveolar processes. When anesthetizing the latter, up to 0.3 milliliters of the drug solution is injected under the mucous membrane (the direction of entry is from bottom to top)

Anesthesia of the lower jaw

Infiltration anesthesia in the lower jaw is used quite rarely. This is due to the peculiarity of the bone structure: its tissue is denser than that of the upper one.

The maximum micropores contain anterior section jaw bone, therefore, this type of anesthesia is more often used in the treatment (removal) of incisors.

The anesthetic is injected into the transitional fold to the base of the roots of the problem tooth.

If it is necessary to stop the nerve endings of all incisors, the needle is inserted in the same way, after which it is given almost horizontal position. After saturating the tissues with the solution, the injection equipment is slowly moved left and right (towards the fangs).

For the purpose of infiltration anesthesia of the lingual nerve, the tissue under the mucosa in the area of ​​​​the transition to the floor of the oral cavity of the alveolar ridge (next to the diseased tooth) is saturated with the drug. This type of anesthesia is auxiliary for minor surgical interventions, before deleting

Infiltration conduction anesthesia

The conduction type of anesthesia is used in dental practice if direct impact on the nerves is necessary (during serious surgical procedures, in case of emergency intervention in the gum tissue).

The procedure is based on the introduction of an anesthetic (novocaine solution, novocaine-containing drugs) directly into the nerve trunk or into the tissues surrounding it.

The active substance is administered extremely slowly to avoid injury.

When blocking the nerve endings of the lower jaw, 3 types of conduction anesthesia are used:

• mandibular;
• torusal;
• chin (mental).

Conduction anesthesia is one of the the most complex types anesthesia.

Advantages and disadvantages

Like any type of blocking nerve fibers, infiltration anesthesia has positive and negative sides.

Among the advantages of the technique:

• ease of use;
• rapid pain relief;
• the possibility of using anesthetics in minimal concentrations;
• long period of anesthesia;
• the possibility of introducing new doses of medication.

The disadvantages of the procedure include:

• the likelihood of damage to blood vessels and nerve trunks;
• insufficient pain relief with rapid administration of the drug;
• risk of allergic reactions;
• accidental needle breakage;
• overdose of anesthetic due to incorrect treatment regimen.

Most of the above disadvantages of the anesthesia method can cause complications.

According to statistics, up to 90% of the population of our country postpone visiting the dentist due to fear of possible pain. The considered method of anesthesia is one of the best ways to ensure adequate pain relief.

This article will tell you:

• about the advantages of infiltration anesthesia;
• about its shortcomings;
• in what cases is such anesthesia used?

Infiltration anesthesia is a type of local anesthesia most often used in dentistry. An infiltration anesthetic is introduced into the patient’s body by injection and blocks nerve impulses in the area of ​​​​the upcoming dental intervention. Popularly, this pain relief technique is called “freezing.”

Anesthesia with infiltration drugs is a simple and safe procedure. Within a few seconds or minutes, the substance entering the patient’s body begins to act, and the sensitivity of a certain area is completely turned off. The effect can last quite a long time (up to sixty minutes), and during this time the dentist has time to carry out all the necessary manipulations. The patient does not feel any pain or discomfort under anesthesia.

Infiltration anesthesia in dentistry is widely used due to the fact that it is considered the most harmless. Concentration active substance in infiltration anesthetics is minimal, and the painkiller is quickly and completely eliminated from the body. However, this type of anesthesia cannot be called universal. The fact is that minimal concentrations of active substances mean limited effect of the drug. When conducting dental interventions on the upper jaw, infiltration anesthetics do an excellent job of their task, but for manipulations on the lower jaw, the power of these drugs may not be enough. The bones of the lower jaw are thicker and denser than the upper jaw, they have fewer pores, so infiltration anesthetics sometimes cannot reach the nerve endings. In the absence of an analgesic effect after the introduction of an infiltration anesthetic, dentists anesthetize the lower jaw using conductive anesthesia.

Infiltration anesthetics are used in the following cases:

• Treatment of caries.
• Removal permanent teeth on the upper jaw.
• Removal of non-permanent teeth on any jaw.
• Treatment of pulpitis and periodontitis in the upper jaw.
• Surgical interventions in the soft tissues of the oral cavity (opening abscesses, cutting gums for teething, suturing mucous membranes, plastic frenulum of the lip and tongue...).
• Preparing the jaw for dental implantation.
• Accompaniment of mandibular anesthesia (one of the types of anesthesia of the lower jaw).

An absolute contraindication to infiltration anesthesia is intolerance to the components of the anesthetic drug.

How are infiltration anesthetics different?

Infiltration anesthesia can be of two types:

1. Straight. It involves the introduction of an anesthetic drug directly into the area of ​​​​the upcoming medical intervention. This type is most often used in facial surgery.
2. Indirect. Indirect infiltration anesthesia is achieved by administering an anesthetic at some distance from the intended intervention. The anesthetic spreads inside the tissues and reaches the deepest layers.

Depending on the site of drug administration, infiltration anesthesia can be of several types:

1. Intraosseous. The needle is inserted into the bone tissue between the tooth roots. Sensitivity disappears only in the injection area, that is, the cheeks, tongue and lips remain sensitive. Pain relief occurs instantly, but does not last very long. The intraosseous technique is used for tooth extraction.
2. Intraligamentous. The anesthetic is injected into the space between the bone and the tooth root - into the ligament of the tooth. The effect appears within a minute and lasts up to half an hour; pain relief does not apply to soft tissues.
3. In-canal. This additional technique anesthesia, implemented by injecting an anesthetic into the dental pulp. It is used in cases where intraligamentous anesthesia is not enough for complete anesthesia in the area of ​​the root canals of the tooth.
4. Intraseptal. The injection is made into the bony interdental septum, and pain relief occurs immediately. This anesthesia is used to facilitate operations on gum tissue, removal of small tumors and dental treatment in children under ten years of age.

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How is infiltration anesthesia performed?

Before injecting an anesthetic, the dentist must make sure that the patient is not allergic to the drug. As a rule, pain relief is carried out using drugs based on articaine, these include: Ubestizin, Ultracaine, Septanest, Orablok. The anesthesia technique looks like this:

1. Aseptic treatment of soft tissue in the area of ​​the intended injection.
2. Opening free access for syringe to soft tissues.
3. Introduction of anesthetic. The syringes are held at specific angles and the anesthetic is injected at different speeds - these parameters depend on the type of anesthesia.

The dentist begins treatment only after the anesthesia has taken effect. Individual anesthetics act differently, and the dentist must take this into account.

If suddenly the duration of the painkiller expires, but the treatment has not yet completed, the infiltration anesthetic is administered again. If the administration of a standard dose of an anesthetic drug is not enough, the specialist either gives another injection of the same drug or uses a different drug.

Unpleasant consequences of anesthesia

Since infiltration anesthetics are considered the safest, after their correct administration no complications arise in the patient's body. However, in some cases, after an injection, the patient may experience the following troubles:

1. Painful sensations. Both the injection and subsequent treatment can be painful. Discomfort can be caused by too rapid administration of the anesthetic, insufficient amount of active substance, as well as a mistake (injecting anesthesia into the wrong place).
2. Vessel damage. If a needle punctures a vessel, a hematoma will form at the injection site.
3. Damage to the nerve trunk. If the needle damages the nerve, pain will appear at the site of injury and sensitivity will be impaired.
4. Spasm of the masticatory muscles.

If the patient turns to an experienced dentist, then there is no need to be afraid of complications after the administration of anesthesia, since qualified specialist immediately injects the anesthetic into the required area in the required dosage and at the required speed.

Pros and cons of infiltration anesthesia

Infiltration anesthesia has the following advantages:

1. Safety. Caused by the use of anesthetics with minimum concentration active substance.
2. Simplicity. The techniques for using infiltration anesthetics are quite simple and do not require special anatomical knowledge from the doctor.
3. Speed ​​of action. Infiltration anesthetics act faster than conductive anesthetics.
4. Opportunity reintroduction medicines. After the infiltration anesthetic wears off, the analgesic effect can be prolonged by giving another injection.

The weaknesses of infiltration anesthesia are as follows:

1. Possibility of damage to nerves and blood vessels.
2. Small area of ​​pain relief.
3. It is very difficult to provide complete anesthesia in the lower jaw of an adult.
4. Rapid resorption of the anesthetic during intracanal anesthesia.

Any medical anesthesia has its advantages and disadvantages, so the presence of disadvantages is not a reason to postpone dental treatment or ignoring its need. Modern anesthetics do not harm the patient’s health, and treatment by a competent doctor minimizes the risk of post-treatment complications.

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Infiltration anesthesia is the most popular method of pain relief in modern dentistry. Used by both therapists and surgeons.

By infiltrating the anesthetic, anesthesia is achieved at the site of its injection.

This type of pain relief is used for:

• Treatment and removal of upper jaw teeth.
• Opening of purulent foci on the upper jaw.
• Removal of formations on the oral mucosa and on the skin.
• Removal of fixed primary teeth on the upper and lower (up to 8 years) jaws.
• Additional anesthetic effect from the vestibular surface after mandibular anesthesia.
• Suturing wounds.

Methodology

To anesthetize teeth, the following manipulations are performed:

• Retract the cheek or lip.
• The injection is made into the transitional fold at an angle of 45 degrees; the cut of the needle must be facing the bone.
• Advance the needle to a depth of 0.5-1.5 cm (until it touches the bone).
• The anesthetic is released in the projection of the apex of the root of the tooth being anesthetized.

It is worth noting that infiltration in the lower jaw is not as effective as in the upper jaw. This is due to the structure of the alveolar process, the compact plate of which on the upper jaw is thin, with big amount pores and openings. The local anesthetic penetrates through these holes and enters the cancellous bone. On the lower jaw, the bone plate is thick, which causes weak penetration of the anesthetic solution, and, as a result, less effective anesthesia.

Varieties

In addition to the above method, there are several more methods of infiltration anesthesia:

• Intraligamentary – tooth anesthesia through the introduction of a local anesthetic solution into the tooth ligament. This method is very effective, since the drug is administered under high pressure, which ensures its entry into the bone of the alveolar process.
• Intrapapillary - to carry out such anesthesia, a thin and short needle is required. The injection is made into the base of the interdental papilla, the needle is advanced to the bone and 0.1-0.2 ml is released. solution. To fully numb the tooth, you need to give injections on both sides.

• Subperiosteal - an anesthetic depot is created under the periosteum, a syringe with a short (up to 30 mm) and thin needle is used. This technique requires a minimal volume of anesthetic solution (0.1-0.2 ml), while at the same time the anesthesia is very effective.

Benefits of infiltration anesthesia

• More simple technique carrying out – there is no need to accurately search for anatomical landmarks.
• It is safer for patients - firstly, lower concentrations of anesthetic are used, and secondly, after it is performed, fewer traumatic complications arise, since the needle is inserted shallowly.
• Pain relief occurs faster than with conduction anesthesia.
• The branches of neighboring nerves are also switched off, which makes it possible to anesthetize tissues that are innervated by several nerves at once.

Based on the above advantages, it can be noted that this method Anesthesia is the most popular and one of the most effective in dentistry today. In the video below you can see the features of its implementation in children.

Infiltration anesthesia is a type of anesthesia that doctors often encounter over the years of their practice. Various techniques Infiltration anesthesia provides adequate pain relief and minimizes risks for the patient, which allows for optimal results.

When choosing an anesthetic for infiltration anesthesia, it is necessary to take into account the type of procedure, the required duration of anesthesia and the pharmacodynamics of each drug.

Standard procedure for infiltration anesthesia

1. Taking into account the anatomy, select the technique for administering the anesthetic.
2. Take into account possible contraindications:

2.1. Absolute contraindications: patient refusal, injection site infection, allergy to local anesthetic, non-sterile conditions.

2.2. Relative contraindications: coagulopathy, target nerve neuropathy.

1. Discuss the procedure with the patient, including expectations and possible complications, if necessary, obtain informed consent.
2. Assess the surrounding area and areas separated from the injection site for nerve and vascular risks.
3. Select and label the appropriate anesthetic based on the technique chosen and the clinical case; reheat and buffer solutions according to instructions.
4. Clean the injection site (for intact skin, alcohol wipes are as effective as chlorhexidine or povidone/iodine).
5. Quickly insert a 27-30 gauge needle through the skin into subcutaneous layer, using distraction techniques if necessary, aspiration should be performed before injection.
6. Slowly and steadily inject a small amount of anesthetic while withdrawing the needle.
7. Check to see if the anesthesia is working in the treated area.

Anesthetics used for infiltration anesthesia

*—The same for the concentration of each substance.

†—Higher concentrations do not provide additional anesthetic effect.

‡—Epinephrine concentration can be 1:100,000 or 1:200,000.

• —It may take up to 5 minutes for epinephrine to take effect.

Pain relief

To reduce pain during anesthetic administration:

• a small needle (27-30 gauge) is used;
• lightly pinch the skin near the site of injection of the anesthetic;
• Slow and steady administration of the anesthetic while removing the needle;
• buffering of lidocaine, especially with epinephrine, using sodium bicarbonate in a ratio of 9:1;
• heating the solution to room temperature.

Existing techniques for infiltration anesthesia

Local skin infiltration

Injecting an anesthetic directly into the area to be numbed is suitable for small wounds or skin biopsies. This technique of infiltration anesthesia is the most commonly used. Limitations: tissue deformation, insufficient anesthesia of surrounding areas and risk toxic effect upon introduction large quantities anesthetic.

REGIONAL ANESTHESIA

Regional anesthesia is performed in case of infected wounds, skin abscesses, and also when it is necessary to avoid tissue deformation (for example, along the red border of the lips). This technique is used to block the innervation of the area around the circumference. A square or diamond-shaped field is often used (Fig. 1). The advantages of this technique of infiltration anesthesia are the duration of action of anesthesia and the ability to “customize” it to suit clinical case. Limitations include: risk of toxicity large doses anesthetic and lack of effectiveness in areas of complex innervation, for example, on the nose.

Conduction anesthesia (nerve block)

Conduction anesthesia targets a specific nerve that provides sensation to a specific area. Most often, such infiltration anesthesia is used on the face and fingers.

Conduction anesthesia of the supraorbital and supratrochlear nerves. The supraorbital and supratrochlear nerves, which arise from the ocular part trigeminal nerve(V 1) innervate the forehead. The supraorbital nerve passes from the supraorbital foramen, which can be felt approximately 2.5 cm from the midline of the face in line with the pupil (when the patient is looking straight ahead). The supratrochlear nerve is located approximately 1 cm from the center of the supraorbital notch along the optic ridge. These nerves can be blocked individually at landmark points. It is also possible to block both nerves by infiltrating 2-4 ml of anesthetic along top edge brows. Complications of blocked nerves in the forehead include swelling, bruising, and periorbital bruising.

Conduction anesthesia of the infraorbital nerve. The infraorbital nerve branches from the maxillary portion (V 2) of the trigeminal nerve and provides sensation from the lower eyelid to the upper lip. It enters the maxilla through the infraorbital foramen, also in line with the pupil (when the patient is looking straight).

There are two approaches to blocking the infraorbital nerve (Figure 2). Extraoral blocking is performed by placing one finger on the lower edge of the orbit just above the infraorbital foramen and simultaneously inserting a needle superolaterally 1 cm below the foramen. To avoid entrapment of an artery or vein, aspiration is recommended.

An intraoral lock is performed as follows: the middle finger is placed on lower limit lower edge of the orbit to guide the needle. Upper lip The patient is grasped with the index finger and thumb, which allows the lip and cheek to be pulled back. The needle is directed parallel to the longitudinal axis of the second premolar and passes towards the infraorbital foramen. Before administering 1 - 3 ml of anesthetic, it is necessary to aspirate, being careful not to go beyond the bony part of the orbit (approximately 2.5 cm) or not to enter the infraorbital foramen itself, so as not to damage eyeball or nerves. Intraoral blocking allows you to double the duration of anesthesia and use local anesthetic on the gums to reduce painful sensations during injection.

Conduction anesthesia of the mental nerve. Anesthesia lower lip and chin can be done by blocking the mental nerve, which branches from the mandibular part (V 3) of the trigeminal nerve and emerges from the mental foramen, which is located 1 cm below and slightly anterior to the second premolar. The mental nerve enters the lower jaw at a point in line with the pupil (when the patient is looking straight). There is extraoral and intraoral blockage of the mental nerve. The latter can be combined with local anesthesia.

Extraoral mental nerve block: The mental foramen is probed from the outside of the mandible. The needle is inserted perpendicular to the bone and inserted into the periosteum. The needle is then withdrawn 2 - 3 mm and 2 - 4 ml of anesthetic is injected near the mental foramen, but not directly into it (Fig. 3).

Intraoral mental nerve block: the lower lip is pulled back by the great and index finger, the needle is inserted at the junction of the lower lip and gum under the second premolar. Then 1 - 2 ml of anesthetic is injected near the mental opening. If the surgical site is located near the midline, bilateral mental nerve blocks must be performed to ensure proper anesthesia.

Conduction anesthesia of digital nerves. The dorsal digital nerves pass into the phalanges of the fingers at approximately the 2 and 10 o'clock positions, and the palmar digital nerves at approximately the 4 and 8 o'clock positions. Because of the sensory distribution of these nerves (Figure 4), only two palmar digital nerves are blocked in procedures involving the three middle fingers. If it is necessary to work with thumb and little finger, it is necessary to block all four nerves. The nerves can be blocked in several places, but the most convenient area is near the head of the metacarpal or metatarsal bone.

When blocking all four nerves of the phalanx, it is preferable to use a dorsal approach at the level of the interdigital space on the side of the proximal phalanx (Fig. 4). After penetration into the skin, 0.5 - 1 ml of 1% lidocaine is administered subcutaneously. The needle is then passed laterally to the phalanx until it reaches the palmar/plantar surface. Then, without piercing the palmar/plantar skin, another 0.5 - 1 ml of anesthetic is injected. The procedure is repeated on the opposite side of the phalanx.

When the palmar digital nerves in the three middle fingers are blocked, the anesthetic can be injected through one point, but this method is more painful because it involves injecting the anesthetic into the palmar surface. The needle is inserted at a 45-degree angle to the skin just above the head of the metacarpal bone. The needle is inserted until it touches the bone. A small amount of anesthetic may be injected as the needle is inserted. After contact with the bone, the needle is slightly extended and directed 4 mm medially, and then 4 mm laterally - 0.5 ml of anesthetic is injected at both points.

You may be interested in the video:

Infiltration anesthesia - a type local anesthesia. Patients often call it “freezing.” This method is most often used for drilling carious tissues and treating root canals and removing teeth.

Unlike other types local anesthesia, infiltration acts almost immediately, anesthetics are used in concentrations that are safer for health and are eliminated from the body quickly.

Mechanism of action

The anesthetic penetrates the tissue near the diseased tooth and blocks the conduction of nerve impulses directly in the injection area or in surrounding tissues. In this case, loss of sensitivity may occur not only at the endings of the desired nerve, but also at the fibers of neighboring nerves.

This type of anesthesia is effective mainly for dental procedures on the upper jaw. Why is that? The fact is that bone the upper jaw is thinner and has many pores through which blood vessels and nerves pass. In this environment, the anesthetic spreads quickly and easily reaches the nerve endings.

In the lower jaw, the alveolar bone is thicker and denser, and has significantly fewer pores. Because of this, the painkiller may not always be able to reach the nerve endings and block them. If anesthesia does not have the desired effect on the lower jaw, doctors resort to conduction anesthesia.

Indications

• Treatment of caries;
• tooth extraction;
• treatment of root canals of the teeth of the upper jaw with pulpitis and periodontitis;
• periostitis (opening a purulent tumor under anesthesia);
• removal of cysts;
• pericoronarotomy - cutting the gum that prevents the crown from erupting;
• removal of soft tissue tumors: tongue, mucous membrane of lips and cheeks.

Types of infiltration anesthesia

Intraosseous anesthesia

The needle is inserted directly into the bone between the roots of the teeth in the surgical area. The tissues in the injection area immediately go numb, but there is no loss of sensitivity in the soft tissues of the cheeks, tongue and lips. The effect does not last long, but occurs instantly. Used for tooth extraction. However, if there are purulent formations in the surgical area, the procedure is contraindicated.

Intraligamentary

An anesthetic solution is injected into the periodontal space – between the tooth root and the bone. Pain relief occurs within 15-45 seconds and lasts 20-30 minutes (the soft tissues of the cheeks, lips and tongue do not become numb). The procedure is practically painless and requires little anesthetic, so in one visit to the doctor, using this method of anesthesia, treatment can be performed on both jaws at once.

Exception - purulent inflammation periodontal disease, in which this type of anesthesia is contraindicated.

It is worth noting that intraligamentary anesthesia is often called intraligamentous, but this name is not entirely correct, since the anesthetic solution is not injected directly into the ligament.

Methods of administering an anesthetic

Intrapulpal (intracanal)

If intraligament anesthesia is not enough for root canal treatment, intrapulpal anesthesia is performed. The anesthetic is injected directly into the pulp - vascular bundle tooth The thinnest needles are used for this.

Applies only as additional method and after preliminary intraligamentous anesthesia.

Intraseptal (intraseptal)

The drug is injected into the bone septum between the teeth, the effect occurs immediately and is manifested by a powerful blockade of nerve fibers in the bone and soft tissues at the injection site.

It is used for operations on gums (curettage, flap operations), removal of small tumors in the oral cavity, and dental treatment in children under 10 years of age.

Syringe with a needle with a diameter of 0.3 mm

Technique

• Direct - used in the treatment of root canals, gums, etc.;
• indirect - most often practiced when removing teeth.

With the direct technique, the injection is made directly into the tissue in the surgical area. A loss pain sensitivity is achieved only in this area.

With indirect anesthesia, the anesthetic is distributed in layers: when making an injection, the doctor injects the medicine as the needle moves (deeper or along the surface). This way it gets into different layers of tissue and increases the area of ​​pain relief.

In both cases, the injection is performed with a syringe with a carpule needle with a diameter of only 0.3 mm (twice as thin as a normal one) and is almost painless.

Preparation

First, the doctor finds out whether the patient has any contraindications to the procedure (allergy to the anesthetic). Then preliminary anesthesia is performed - superficial anesthesia at the injection site (gel or spray) or an anesthetic injection into the gum mucosa. When the gums are numb, infiltration anesthesia is performed directly.

Drugs

Articaine-based products are considered effective and safe:

1. Ubistezin. Contains epinephrine, a vasoconstrictor that can provide a long-lasting and stable anesthetic effect.
2. Ultracaine. Available with or without epinephrine. Epinephrine is contraindicated in patients with diabetes, hypertension, asthma, and anyone who is prohibited from taking medications with epinephrine and epinephrine.
3. Septanest. Contains epinephrine and preservatives that are not found in ubistezin and ultracaine.
4. Orablock. The drug is similar to ubistezin and septanest.

Novocaine and lidocaine are not used: they are more toxic compared to anesthetics based on articaine. Novocaine, in addition, is powerless against purulent inflammatory processes.

Price

Prices for infiltration anesthesia start at 300 rubles. The final cost is determined taking into account the consumption of the drug.

Complications

To the most frequent unpleasant consequences infiltration anesthesia includes:

• pain and/or burning during the injection is a temporary inconvenience caused by too rapid administration of the anesthetic;
• temporary sensitivity disorders: numbness or tingling in the injection area resulting from the needle touching the nerves;
• trismus of the jaw - spasm of the masticatory muscles, usually disappears in 2-3 days;
• hematoma - the formation of a bruise due to puncture of blood vessels;
• swelling of soft tissues - allergic reaction for anesthetic, in severe cases causes obstruction respiratory tract;
• needle breakage. Occurs rarely, due to sudden sudden movements of patients. The needles are usually removed quickly and without problems.

Although extremely rare, infection of healthy tissue can still occur. Even though the needles are sterile, they can touch infected tissue and “push” pathogens further.