Role of intraseptal anesthesia for pain-free dental treatment

G Gazal, W M Fareed, M S Zafar, G Gazal, W M Fareed, M S Zafar

Abstract

Pain control during the dental procedure is essentials and challenging. A complete efficacious pulp anesthesia has not been attained yet. The regional anesthesia such as inferior alveolar nerve block (IANB) only does not guarantee the effective anesthesia with patients suffering from irreversible pulpitis. This main aim of this review was to discuss various aspects of intraseptal dental anesthesia and its role significance in pain-free treatment in the dental office. In addition, reasons of failure and limitations of this technique have been highlighted. Literature search was conducted for peer-reviewed articles published in English language in last 30 years. Search words such as dental anesthesia, pain control, intraseptal, and nerve block were entered using a web of knowledge and Google scholar databases. Various dental local anesthesia techniques were reviewed. A combination of block anesthesia, buccal infiltration and intraligamentary injection resulted in deep anesthesia (P = 0.003), and higher success rate compared to IANB. For pain-free management of conditions such as irreversible pulpitis, buccal infiltration (4% articaine), and intraosseous injection (2% lidocaine) are better than intraligamentary and IANB injections. Similarly, nerve block is not always effective for pain-free root canal treatment hence, needing supplemental anesthesia. Intraseptal anesthesia is an efficient and effective technique that can be used in maxillary and mandibular adult dentition. This technique is also beneficial when used in conjunction to the regional block or local dental anesthesia.

Keywords: Dental anesthesia; intraseptal injection; medullary diffusion.

Figures

Figure 1
Figure 1
Intraseptal injection technique; (a) marking for the administration of anesthesia (b) positioning of the needle 3 mm apical to the apex of the papillary triangle (c) ischemia of the soft-tissue surrounding the injection site

References

    1. Gazal G, Fareed WM, Zafar MS, Al-Samadani KH. Pain and anxiety management for pediatric dental procedures using various combinations of sedative drugs: A review. Saudi Pharm J. 2014 E-published ahead of print. Doi:10.1016/j.jsps.2014.04.004.
    1. Gazal G, Fareed WM, Zafar MS. Effectiveness of gaseous and intravenous inductions on children's anxiety and distress during extraction of teeth under general anesthesia. Saudi J Anaesth. 2015;9:33–6.
    1. Bansal N, Saha S, Jaiswal J, Samadi F. Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children. Int J Clin Pediatr Dent. 2014;7:71–6.
    1. Verma PK, Srivastava R, Ramesh KM. Anesthetic efficacy of X-tip intraosseous injection using 2% lidocaine with 1:80,000 epinephrine in patients with irreversible pulpitis after inferior alveolar nerve block: A clinical study. J Conserv Dent. 2013;16:162–6.
    1. Nusstein JM, Reader A, Drum M. Local anesthesia strategies for the patient with a “hot” tooth. Dent Clin North Am. 2010;54:237–47.
    1. Claffey E, Reader A, Nusstein J, Beck M, Weaver J. Anesthetic efficacy of articaine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod. 2004;30:568–71.
    1. Mikesell P, Nusstein J, Reader A, Beck M, Weaver J. A comparison of articaine and lidocaine for inferior alveolar nerve blocks. J Endod. 2005;31:265–70.
    1. Ah Pin PJ. The use of intraligamental injections in haemophiliacs. Br Dent J. 1987;162:151–2.
    1. Spuller RL. Use of the periodontal ligament injection in dental care of the patient with hemophilia — A clinical evaluation. Spec Care Dentist. 1988;8:28–9.
    1. Meechan JG. Supplementary routes to local Anesthesia. Int Endod J. 2002;35:885–96.
    1. Brännström M, Nordenvall KJ, Hedström KG. Periodontal tissue changes after intraligamentary anesthesia. ASDC J Dent Child. 1982;49:417–23.
    1. Brannstrom M, Lindskog S, Nordenvall KJ. Enamel hypoplasia in permanent teeth induced by periodontal ligament anesthesia of primary teeth. J Am Dent Assoc. 1984;109:735–6.
    1. Teixeira L, Demarco F, Coppola M, Bonow M. Clinical and radiographic evaluation of pulpotomies performed with intrapulpal injection of anesthetic solution. J Dent Res. 1999;78:385.
    1. Coggins R, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the intraosseous injection in maxillary and mandibular teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996;81:634–41.
    1. Brkovic BM, Savic M, Andric M, Jurisic M, Todorovic L. Intraseptal vs. periodontal ligament Anesthesia for maxillary tooth extraction: Quality of local Anesthesia and haemodynamic response. Clin Oral Investig. 2010;14:675–81.
    1. Idris M, Sakkir N, Naik KG, Jayaram NK. Intraosseous injection as an adjunct to conventional local anesthetic techniques: A clinical study. J Conserv Dent. 2014;17:432–5.
    1. Wood M, Reader A, Nusstein J, Beck M, Padgett D, Weaver J. Comparison of intraosseous and infiltration injections for venous lidocaine blood concentrations and heart rate changes after injection of 2% lidocaine with 1:100,000 epinephrine. J Endod. 2005;31:435–8.
    1. Malamed SF, Trieger N. Intraoral maxillary nerve block: An anatomical and clinical study. Anesth Prog. 1983;30:44–8.
    1. Woodmansey K. Intraseptal anesthesia: A review of a relevant injection technique. Gen Dent. 2005;53:418–20.
    1. Malamed SF. Local anesthesia. J Calif Dent Assoc. 1998;26:657–660.
    1. Kanaa MD, Whitworth JM, Corbett IP, Meechan JG. Articaine buccal infiltration enhances the effectiveness of lidocaine inferior alveolar nerve block. Int Endod J. 2009;42:238–46.
    1. Verma V, Sheikh Z, Ahmed AS. Nociception and role of immune system in pain. Acta Neurol Belg. 2014 E-Published ahead of prints. Doi: 10.1007/s13760-014-0411-y.
    1. Vreeland DL, Reader A, Beck M, Meyers W, Weaver J. An evaluation of volumes and concentrations of lidocaine in human inferior alveolar nerve block. J Endod. 1989;15:6–12.
    1. Hinkley SA, Reader A, Beck M, Meyers WJ. An evaluation of 4% prilocaine with 1:200,000 epinephrine and 2% mepivacaine with 1:20,000 levonordefrin compared with 2% lidocaine with:100,000 epinephrine for inferior alveolar nerve block. Anesth Prog. 1991;38:84–9.
    1. Hannan L, Reader A, Nist R, Beck M, Meyers WJ. The use of ultrasound for guiding needle placement for inferior alveolar nerve blocks. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:658–65.
    1. Simon F, Reader A, Meyers W, Beck F, Nist R. Evaluation of a peripheral-nerve stimulator in human mandibular Anesthesia. J Dent Res. 1990;69:278.
    1. Fernandez C, Reader A, Beck M, Nusstein J. A prospective, randomized, double-blind comparison of bupivacaine and lidocaine for inferior alveolar nerve blocks. J Endod. 2005;31:499–503.
    1. Kanaa MD, Whitworth JM, Meechan JG. A prospective randomized trial of different supplementary local anesthetic techniques after failure of inferior alveolar nerve block in patients with irreversible pulpitis in mandibular teeth. J Endod. 2012;38:421–5.
    1. Nusstein J, Reader A, Beck FM. Anesthetic efficacy of different volumes of lidocaine with epinephrine for inferior alveolar nerve blocks. Gen Dent. 2002;50:372–5.
    1. Lindemann M, Reader A, Nusstein J, Drum M, Beck M. Effect of sublingual triazolam on the success of inferior alveolar nerve block in patients with irreversible pulpitis. J Endod. 2008;34:1167–70.
    1. Malamed SF. St. Louis Missouri, USA: Elsevier Health Sciences; 2004. Handbook of Local Anesthesia.
    1. Kaufman E, Weinstein P, Milgrom P. Difficulties in achieving local anesthesia. J Am Dent Assoc. 1984;108:205–8.
    1. Moore PA, Cuddy MA, Cooke MR, Sokolowski CJ. Periodontal ligament and intraosseous anesthetic injection techniques: alternatives to mandibular nerve blocks. J Am Dent Assoc. 2011;142(Suppl 3):13S–8.
    1. Clark TM, Yagiela JA. Advanced techniques and armamentarium for dental local anesthesia. Dent Clin North Am. 2010;54:757–68.
    1. Yonchak T, Reader A, Beck M, Meyers WJ. Anesthetic efficacy of unilateral and bilateral inferior alveolar nerve blocks to determine cross innervation in anterior teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2001;92:132–5.
    1. Agren E, Danielsson K. Conduction block analgesia in the mandible. A comparative investigation of the techniques of Fischer and Gow-Gates. Swed Dent J. 1981;5:81–9.
    1. Torabinejad M, Walton RE. Philadelphia: Saunders; 2002. Principles and Practice of Endodontics.
    1. Nusstein J, Kennedy S, Reader A, Beck M, Weaver J. Anesthetic efficacy of the supplemental X-tip intraosseous injection in patients with irreversible pulpitis. J Endod. 2003;29:724–8.
    1. Malamed SF, Gagnon S, Leblanc D. Articaine hydrochloride: A study of the safety of a new amide local anesthetic. J Am Dent Assoc. 2001;132:177–85.
    1. Dunbar D, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the intraosseous injection after an inferior alveolar nerve block. J Endod. 1996;22:481–6.
    1. Reitz J, Reader A, Nist R, Beck M, Meyers WJ. Anesthetic efficacy of the intraosseous injection of 0.9 mL of 2% lidocaine (1:100,000 epinephrine) to augment an inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;86:516–23.
    1. Guglielmo A, Reader A, Nist R, Beck M, Weaver J. Anesthetic efficacy and heart rate effects of the supplemental intraosseous injection of 2% mepivacaine with 1:20,000 levonordefrin. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;87:284–93.
    1. Wong JK. Adjuncts to local anesthesia: separating fact from fiction. J Can Dent Assoc. 2001;67:391–7.
    1. Zarei M, Ghoddusi J, Sharifi E, Forghani M, Afkhami F, Marouzi P. Comparison of the anaesthetic efficacy of and heart rate changes after periodontal ligament or intraosseous X-Tip injection in mandibular molars: a randomized controlled clinical trial. Int Endod J. 2012;45:921–6.
    1. Parirokh M, Sadr S, Nakhaee N, Abbott PV, Askarifard S. Efficacy of supplementary buccal infiltrations and intraligamentary injections to inferior alveolar nerve blocks in mandibular first molars with asymptomatic irreversible pulpitis: A randomized controlled trial. Int Endod J. 2014;47:926–33.
    1. Dou L, Luo J, Yang D. Anaesthetic efficacy of supplemental lingual infiltration of mandibular molars after inferior alveolar nerve block plus buccal infiltration in patients with irreversible pulpitis. Int Endod J. 2013;46:660–5.
    1. Biocanin V, Brkovic B, Milicic B, Stojic D. Efficacy and safety of intraseptal and periodontal ligament anesthesia achieved by computer-controlled articaine epinephrine delivery: A dose-finding study. Clin Oral Investig. 2013;17:525–33.
    1. Doman SM. An audit of the use of intra-septal local Anesthesia in a dental practice in the South of England. Prim Dent Care. 2011;18:67–71.
    1. Dou L, Luo J, Yang D, Wang Y. The effectiveness of an additional lingual infiltration in the pulpal anesthesia of mandibular teeth: a systematic review. Quintessence Int. 2013;44:457–64.
    1. Shabazfar N, Daubländer M, Al-Nawas B, Kämmerer PW. Periodontal intraligament injection as alternative to inferior alveolar nerve block — Meta-analysis of the literature from 1979 to 2012. Clin Oral Investig. 2014;18:351–8.
    1. Stabile P, Reader A, Gallatin E, Beck M, Weaver J. Anesthetic efficacy and heart rate effects of the intraosseous injection of 1.5% etidocaine (1:200,000 epinephrine) after an inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:407–11.
    1. Bigby J, Reader A, Nusstein J, Beck M. Anesthetic efficacy of lidocaine/meperidine for inferior alveolar nerve blocks in patients with irreversible pulpitis. J Endod. 2007;33:7–10.
    1. Replogle K, Reader A, Nist R, Beck M, Weaver J, Meyers WJ. Cardiovascular effects of intraosseous injections of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine. J Am Dent Assoc. 1999;130:649–57.
    1. Chamberlain TM, Davis RD, Murchison DF, Hansen SR, Richardson BW. Cardiovascular effects of intraosseous injections of 2 percent lidocaine with 1:100,000 epinephrine and 3 percent mepivacaine. J Am Dent Assoc. 1999;130:649–57.
    1. Gallatin E, Stabile P, Reader A, Nist R, Beck M. Anesthetic efficacy and heart rate effects of the intraosseous injection of 3% mepivacaine after an inferior alveolar nerve block. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89:83–7.
    1. Borodina OE, Petrkas AZh. Intraceptal anesthesia of lower and upper teeth. Stomatologiia (Mosk) 2009;88:19–20.
    1. Nusstein J, Berlin J, Reader A, Beck M, Weaver JM. Comparison of injection pain, heart rate increase, and postinjection pain of articaine and lidocaine in a primary intraligamentary injection administered with a computer-controlled local anesthetic delivery system. Anesth Prog. 2004;51:126–33.
    1. Lönnqvist PA. Adjuncts should always be used in pediatric regional anesthesia. Paediatr Anaesth. 2015;25:100–6.

Source: PubMed

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