Basic Setup

Proper needle landmark for the AMSA injection

Where is the proper needle landmark for the AMSA injection?

The injection site for the AMSA is at a point which bisects the first and second
pre-molars and is midway between the free gingival margin and mid-palatine
suture. This landmark may vary somewhat depending upon the anatomy of the
palatal vault. A more appropriate description may be between the pre-molars
and at the junction of the horizontal and vertical component of the pa late. This
injection can performed with minimal discomfort when performed properly.

Patient experiences tissue sloughing or reaction

Is there anything I should do if my patient experiences tissue sloughing or
adverse tissue reaction from an intraligamentary injection?

One can provide palative treatment and may recommend a topical ointment
to assist in the soft tissue healing. Such ointments include: Topical vitamin
E, or Ora base Ointment.

As with all adverse reactions it is advisable to have the patient return to the
office to monitor the healing.

PDL injection – no anesthetic leaking and no blanching

In doing a PDL injection, everything feels and looks right. No anesthetic is
leaking into the patient’s mouth. However, there is no blanching, and when I
remove the needle from the patient’s tissue a lot of anesthetic flows into the
patient’s mouth. How can I correct this?

What is happening is improper technique. If the bevel is facing against the
bone, it is likely that the needle will become obstructed by the bone, preventing
the blanching from occurring and preventing the anesthetic from flowing
out. When you remove the needle, the pressure inside the tubing will force tl”e
anesthetic into the patient’s mouth.

This can be corrected by keeping the bevel of the needle facing the tooth, and
advancing the needle with the bevel in contact with the tooth until resistance
is met. This will prevent the needle from becoming obstructed with bone.

Blanching but don’t get any pulpal anesthesia

I’ve administered the local anesthetic, and I see blanching, but I don’t get any
pulpal anesthesia. Why?

What is likely happening is the needle is impinging on the crest of bone. The
anesthetic is diffusing into the buccal soft tissue which is why you are not
getting any pulpal anesthesia. To correct this, make certain that your needle
is in contact with the tooth the entire time and that the tip is placed at the
entrance of the PDL space. This will ensure that the anesthetic will be deposited
in the PDL space so that you achieve pulpal anesthesia.

Overpressure alert and unit stops

I placed the needle into the PDL space as instructed and I keep getting an
“OVERPRESSURE” alert and the unit stops, what is the reason for this?

You may have blocked the orifice of the needle by pushing to heavily on the
hand-piece or by placing the bevel of the needle flush against the bone, prohibiting
the anesthetic from flowing freely. There are also situations in which
you have cored a tissue plug and the needle becomes blocked. These are all
situations where the unit is reading more pressure than it should so the unit
will shut down as a safety precaution.

Patient experienced adverse tissue reaction – intraligamentary

After performing the intraligamentary injection my patient experienced
adverse tissue reaction. Why is this so?

The reasons for this are as follows:

Adverse tissue reactions can result from either mechanical damage to the
tissues or excessive volumes of anesthetic solution being improperly placed
within the soft tissues. This may lead to a blockage of blood flow to these
tissues culminating in adverse tissue reaction. It is also quite possible that
certain patients with a thin delicate periodontium may be more prone to
adverse tissue reaction due to the anatomic variations of these patients.

Mechanical trauma can play a role in adverse tissue reaction. You
can prevent mechanical trauma by using delicate, careful needle placement
within the POL. If one notices a very rapid and extreme blanching of the interdental
papilla when performing the POL injection one is advised to verify correct
needle position. This type of extreme response can be related to improper
needle placement or proper placement of the needle on a patient with a
thin, delicate tissue type. Either of these conditions may lead to an excessive
build up of fluid volume within the soft tissues for that patient.

It is also advisable to assess the tissue quality of a patient’s periodontium
prior to performing an intraligamentary injection. Patients with th in, delicate
periodontal tissues may be more prone to adverse tissue reaction when performing
the POL injection, particularly if large volumes of solution are placed
into the overlying soft tissues.

Finally, it is important to adhere to the anesthetic recommendations from the
drug manufacturer when performing the intraligamentary injection.

Difficulty accessing DL and ML line angles on mandibular

I am having difficulty accessing the DL and ML line angles on mandibular
teeth for the intraligamentary injection. Is there anything I can do to make
gaining access easier?

We recommend approaching the PDL space from the lingual as the anatomy
shows that it is the path of least resistance for the anesthetic solution. It is
important to always start the Intra ligamentary injection from the distalingual
of the tooth. This allows the anesthetic to be deposited closest to the
direction from which the nerve enters the tooth.

Trouble accessing the line angles for the POL injection

I’m having trouble accessing the line angles for the POL injection as the hand-piece
seems too large for the patients mouth. Any suggestions?

Break the hand-piece or try bending the hand-piece for better angulation! By
breaking the hand-piece you will have a syringe the size of an endodontic file,
and this will give you better tactile feel, more control and better accessibility
to those hard to reach areas.

Spray back when removing needle during PDL

When I remove the needle from the PDL space there is a spray-back of anesthetic
solution into the patients mouth causing an unpleasant taste. How can
I prevent that?

When properly performing the lntraligamentary Injection there’s an internal
build-up of fluid pressure within the hand-piece tubing. This excess pressure
is relieved when the needle is removed from the PDL tissues sometimes resulting
in spray-back of anesthetic solution.

There are 3 simple ways you can minimize spray-back into your
patient’s mouth.

First Alternative: Wait 15 to 20 seconds before removing the needle to
allow the build up of the pressure to dissipate within the periodontal tissues
before removing the needle.

Second Alternative: Use a cotton-roll or cotton-applicator adjacent to the
needle tip to absorb the anesthetic solution upon removal of the needle
tip from the sulcus.

Third Alternative: Remove the needle from PDL tissues as soon as
Aspiration starts. Aspiration creates a suction at 1-2 seconds of the
aspiration cycle, removing the needle as soon as aspiration starts relieves
the pressure and prevents spray back.

Loaded the anesthetic and cartridge holder into the unit and it did not purge.

I’ve loaded the anesthetic and cartridge holder into the unit and it did not
purge. What is wrong?

First, check to see that the auto purge/retract light is lit. Remove cartridge
holder from unit and make sure that the clear spike inside the cartridge holder
has punctured the diaphragm on the anesthetic cartridge. If the diaphragm is
not punctured, remove cartridge and reload it into the cartridge holder making
sure it punctures the second time. If the diaphragm isn’t punctured wet
diaphragm with an alcohol swab and twist and turn carpule when inserting
into cartridge holder.

If the diaphragm was punctured try turning the cartridge holder a full turn
counter clockwise again. If it isn’t fully engaged, the unit will not recognize
that a cartridge is loaded.

Where do I perform the PASA?

Where do I perform the PASA?

This injection is initiated just lateral to the incisive papilla targeting the incisive
canal. The objective is to gain entrance into the incisive canal, and maintain
contact with the inner bony wall. This injection can be performed with
minimal discomfort when performed properly.

Supraperiosteal Infiltration Injections

It is recommended to use 2% Lidocaine with an epinephrine concentration of
1:100,000

Inferior Alveolar Block Injection

In regard to your choice of anesthetic solutions, it is recommended to use 2%
Lidocaine with an epinephrine concentration of 1:100,000?

When using 4% Articaine a concentration of either 1:100,000 or 1:200,000
epinephrine may be used.
Recommended dosage is 1 full cartridge for a 2% anesthetic with a 1:100,000
concentration of epinephrine or a 1/2 cartridge for a 4% anesthetic with a
1:200,000 concentration of epinephrine.

Palatal Injections

Use 2% Lidocaine with an epinephrine concentration of 1:100,000.
Recommended dosage is from 3/4 to 1 full cartridge.
When using 4% Articaine a concentration of 1:200,000 epinephrine is recommended.
Recommended dosage is 1/4 to a 112 cartridge.

NOTE: It is NOT recommended that 4% Articaine with a concentration of a
1:100,000 epinephrine be used for palatal injections. It is also NOT recommended
that 2% Lidocaine with a concentration of 1:50,000 epinephrine be
used for palatal injections.

lntraligamentary Injection

WAND lntraligamentary Injection:

If using 2% Lidocaine with 1:100,000 epinephrine or similar, a 112 cartridge
can be delivered at the Distal line angle site and a 1/2 cartridge at the Mesial
line angle site of a multi-rooted tooth. On a single-rooted tooth you will only
need to deliver a 1/2 cartridge at the DL line angle.

NOTE: The use of 2% anesthetics with a vasoconstrictor of 1:50,000 epinephrine
is NOT recommended for intraligamentary injections.
When using 4% Articaine it is recommended that you only use Articaine with
a concentration of 1:200,000 epinephrine, a 114 of a cartridge can be delivered
at the DL line angle and a 1/4 of a cartridge at the ML line angle site of
a multi-rooted tooth. On a single-rooted tooth you will only need to deliver a
1/4 of a cartridge at the DL line angle.

NOTE: The use of 4% Articaine with 1:100,000 epinephrine is NOT recommended
for intraligamentary injections.

Anesthesia Guidelines

Proper needle landmark for the AMSA injection

Where is the proper needle landmark for the AMSA injection?

The injection site for the AMSA is at a point which bisects the first and second
pre-molars and is midway between the free gingival margin and mid-palatine
suture. This landmark may vary somewhat depending upon the anatomy of the
palatal vault. A more appropriate description may be between the pre-molars
and at the junction of the horizontal and vertical component of the pa late. This
injection can performed with minimal discomfort when performed properly.

Patient experiences tissue sloughing or reaction

Is there anything I should do if my patient experiences tissue sloughing or
adverse tissue reaction from an intraligamentary injection?

One can provide palative treatment and may recommend a topical ointment
to assist in the soft tissue healing. Such ointments include: Topical vitamin
E, or Ora base Ointment.

As with all adverse reactions it is advisable to have the patient return to the
office to monitor the healing.

PDL injection – no anesthetic leaking and no blanching

In doing a PDL injection, everything feels and looks right. No anesthetic is
leaking into the patient’s mouth. However, there is no blanching, and when I
remove the needle from the patient’s tissue a lot of anesthetic flows into the
patient’s mouth. How can I correct this?

What is happening is improper technique. If the bevel is facing against the
bone, it is likely that the needle will become obstructed by the bone, preventing
the blanching from occurring and preventing the anesthetic from flowing
out. When you remove the needle, the pressure inside the tubing will force tl”e
anesthetic into the patient’s mouth.

This can be corrected by keeping the bevel of the needle facing the tooth, and
advancing the needle with the bevel in contact with the tooth until resistance
is met. This will prevent the needle from becoming obstructed with bone.

Blanching but don’t get any pulpal anesthesia

I’ve administered the local anesthetic, and I see blanching, but I don’t get any
pulpal anesthesia. Why?

What is likely happening is the needle is impinging on the crest of bone. The
anesthetic is diffusing into the buccal soft tissue which is why you are not
getting any pulpal anesthesia. To correct this, make certain that your needle
is in contact with the tooth the entire time and that the tip is placed at the
entrance of the PDL space. This will ensure that the anesthetic will be deposited
in the PDL space so that you achieve pulpal anesthesia.

Overpressure alert and unit stops

I placed the needle into the PDL space as instructed and I keep getting an
“OVERPRESSURE” alert and the unit stops, what is the reason for this?

You may have blocked the orifice of the needle by pushing to heavily on the
hand-piece or by placing the bevel of the needle flush against the bone, prohibiting
the anesthetic from flowing freely. There are also situations in which
you have cored a tissue plug and the needle becomes blocked. These are all
situations where the unit is reading more pressure than it should so the unit
will shut down as a safety precaution.

Patient experienced adverse tissue reaction – intraligamentary

After performing the intraligamentary injection my patient experienced
adverse tissue reaction. Why is this so?

The reasons for this are as follows:

Adverse tissue reactions can result from either mechanical damage to the
tissues or excessive volumes of anesthetic solution being improperly placed
within the soft tissues. This may lead to a blockage of blood flow to these
tissues culminating in adverse tissue reaction. It is also quite possible that
certain patients with a thin delicate periodontium may be more prone to
adverse tissue reaction due to the anatomic variations of these patients.

Mechanical trauma can play a role in adverse tissue reaction. You
can prevent mechanical trauma by using delicate, careful needle placement
within the POL. If one notices a very rapid and extreme blanching of the interdental
papilla when performing the POL injection one is advised to verify correct
needle position. This type of extreme response can be related to improper
needle placement or proper placement of the needle on a patient with a
thin, delicate tissue type. Either of these conditions may lead to an excessive
build up of fluid volume within the soft tissues for that patient.

It is also advisable to assess the tissue quality of a patient’s periodontium
prior to performing an intraligamentary injection. Patients with th in, delicate
periodontal tissues may be more prone to adverse tissue reaction when performing
the POL injection, particularly if large volumes of solution are placed
into the overlying soft tissues.

Finally, it is important to adhere to the anesthetic recommendations from the
drug manufacturer when performing the intraligamentary injection.

Difficulty accessing DL and ML line angles on mandibular

I am having difficulty accessing the DL and ML line angles on mandibular
teeth for the intraligamentary injection. Is there anything I can do to make
gaining access easier?

We recommend approaching the PDL space from the lingual as the anatomy
shows that it is the path of least resistance for the anesthetic solution. It is
important to always start the Intra ligamentary injection from the distalingual
of the tooth. This allows the anesthetic to be deposited closest to the
direction from which the nerve enters the tooth.

Trouble accessing the line angles for the POL injection

I’m having trouble accessing the line angles for the POL injection as the hand-piece
seems too large for the patients mouth. Any suggestions?

Break the hand-piece or try bending the hand-piece for better angulation! By
breaking the hand-piece you will have a syringe the size of an endodontic file,
and this will give you better tactile feel, more control and better accessibility
to those hard to reach areas.

Spray back when removing needle during PDL

When I remove the needle from the PDL space there is a spray-back of anesthetic
solution into the patients mouth causing an unpleasant taste. How can
I prevent that?

When properly performing the lntraligamentary Injection there’s an internal
build-up of fluid pressure within the hand-piece tubing. This excess pressure
is relieved when the needle is removed from the PDL tissues sometimes resulting
in spray-back of anesthetic solution.

There are 3 simple ways you can minimize spray-back into your
patient’s mouth.

First Alternative: Wait 15 to 20 seconds before removing the needle to
allow the build up of the pressure to dissipate within the periodontal tissues
before removing the needle.

Second Alternative: Use a cotton-roll or cotton-applicator adjacent to the
needle tip to absorb the anesthetic solution upon removal of the needle
tip from the sulcus.

Third Alternative: Remove the needle from PDL tissues as soon as
Aspiration starts. Aspiration creates a suction at 1-2 seconds of the
aspiration cycle, removing the needle as soon as aspiration starts relieves
the pressure and prevents spray back.

Loaded the anesthetic and cartridge holder into the unit and it did not purge.

I’ve loaded the anesthetic and cartridge holder into the unit and it did not
purge. What is wrong?

First, check to see that the auto purge/retract light is lit. Remove cartridge
holder from unit and make sure that the clear spike inside the cartridge holder
has punctured the diaphragm on the anesthetic cartridge. If the diaphragm is
not punctured, remove cartridge and reload it into the cartridge holder making
sure it punctures the second time. If the diaphragm isn’t punctured wet
diaphragm with an alcohol swab and twist and turn carpule when inserting
into cartridge holder.

If the diaphragm was punctured try turning the cartridge holder a full turn
counter clockwise again. If it isn’t fully engaged, the unit will not recognize
that a cartridge is loaded.

Where do I perform the PASA?

Where do I perform the PASA?

This injection is initiated just lateral to the incisive papilla targeting the incisive
canal. The objective is to gain entrance into the incisive canal, and maintain
contact with the inner bony wall. This injection can be performed with
minimal discomfort when performed properly.

Supraperiosteal Infiltration Injections

It is recommended to use 2% Lidocaine with an epinephrine concentration of
1:100,000

Inferior Alveolar Block Injection

In regard to your choice of anesthetic solutions, it is recommended to use 2%
Lidocaine with an epinephrine concentration of 1:100,000?

When using 4% Articaine a concentration of either 1:100,000 or 1:200,000
epinephrine may be used.
Recommended dosage is 1 full cartridge for a 2% anesthetic with a 1:100,000
concentration of epinephrine or a 1/2 cartridge for a 4% anesthetic with a
1:200,000 concentration of epinephrine.

Palatal Injections

Use 2% Lidocaine with an epinephrine concentration of 1:100,000.
Recommended dosage is from 3/4 to 1 full cartridge.
When using 4% Articaine a concentration of 1:200,000 epinephrine is recommended.
Recommended dosage is 1/4 to a 112 cartridge.

NOTE: It is NOT recommended that 4% Articaine with a concentration of a
1:100,000 epinephrine be used for palatal injections. It is also NOT recommended
that 2% Lidocaine with a concentration of 1:50,000 epinephrine be
used for palatal injections.

lntraligamentary Injection

WAND lntraligamentary Injection:

If using 2% Lidocaine with 1:100,000 epinephrine or similar, a 112 cartridge
can be delivered at the Distal line angle site and a 1/2 cartridge at the Mesial
line angle site of a multi-rooted tooth. On a single-rooted tooth you will only
need to deliver a 1/2 cartridge at the DL line angle.

NOTE: The use of 2% anesthetics with a vasoconstrictor of 1:50,000 epinephrine
is NOT recommended for intraligamentary injections.
When using 4% Articaine it is recommended that you only use Articaine with
a concentration of 1:200,000 epinephrine, a 114 of a cartridge can be delivered
at the DL line angle and a 1/4 of a cartridge at the ML line angle site of
a multi-rooted tooth. On a single-rooted tooth you will only need to deliver a
1/4 of a cartridge at the DL line angle.

NOTE: The use of 4% Articaine with 1:100,000 epinephrine is NOT recommended
for intraligamentary injections.

Injection Techniques

DPS lights not in Green Zone for intraligamentary

Why can’t I get the DPS LED lights to go to the GREEN ZONE for the intraligamentary
injection?

Make sure the needle is being held in a steady position to allow the DPS adequate
time to determine the needle’s position within the tissue. If the problem
is that the LED lights are only part way up the scale, then the solution is to
advance that needle slightly, and hold the needle steady again to determine if
you’ve achieved a more optimal position within the PDL space.

Restart the injection using less force and lighter hand-pressure
while stabilizing the needle into the PDL space. Excessive hand-pressure
leads to the overpressure alert. With consistent use, you will quickly find
the optimal amount of hand pressure required to allow the back-pressure to
gradually build but which doesn’t cause the overpressure alert, due to the
DPS real-time feedback technology.

Where do I perform the PASA?

Where do I perform the PASA?

This injection is initiated just lateral to the incisive papilla targeting the incisive
canal. The objective is to gain entrance into the incisive canal, and maintain
contact with the inner bony wall. This injection can be performed with
minimal discomfort when performed properly.

Which teeth are anesthetized using the PASA?

Which teeth are anesthetized using the PASA?

The PASA is the only dental injection that can cross the midline of the alveolus
and will produce bilateral anesthesia of the maxillary incisors and canines
from a single palatal injection.

Which teeth are anesthetized using the AMSA?

Which teeth are anesthetized using the AMSA?

The AMSA will produce anesthesia from the maxillary central incisor to the
mesial buccal root of the maxillary first molar on the side it is performed.

The Wand System isn’t aspirating fully

The Wand System isn’t aspirating fully. How can this be fixed?

If the unit isn’t performing a full aspiration, remove the cartridge of anesthetic,
put the unit in NORMAL Mode, turn the auto retract/purge light off and step
on the foot control to expose the plunger on the top of the unit fully. Once the
plunger is in full view, inspect the plunger and check the 0-ring to see if it is
worn, dry or cracked. If so, rep lace the 0-ring and lightly lubricate the 0-ring
and plunger.

Different ml volume for PDL injection techniques

Why do we recommend a volume of 0.9 ml’s when other PDL injection techniques
recommend a volume of 0.2 ml ‘s per injection site?

The Wand System uses a totally different fluid dynamic.

The system deposits the anesthetic slowly at a constant rate, so the anesthetic
will diffuse along the path of least resistance, allowing for a larger volume to
be delivered.

With other techniques, a smaller volume is placed under high pressure. In
that situation, more patients will have post-operative discomfort. When the
larger volume is placed in slowly, it is rare to have a patient complain of post
anesthetic discomfort with the PDL injection. Some patients may mention
that their tongue or lip gets numb following the PDL injection. In our experience,
this is entirely normal in some patients.

Why not use one in fifty thousand concentration EPI?

Why not use one in fifty thousand concentration EPI?

Experience has shown that the eschemia or blanching that occurs in the PDL
injection with one in a hundred thousand concentration epinephrine is more
than adequate to provide profound anesthesia of the tooth and the soft tissues.
There is really no reason to use as much epinephrine as is found in a
one to fifty thousand concentratio

Bi-directional insertion technique

What is the bi-directional insertion technique and why should I use it for the
Mandibular Block Injection?

With a traditional dental syringe, missed blocks are usually due to needle deflection.
During a traditional injection, the static needle bevel orientation forces the
needle to deflect as the needle is inserted. Holding the Wand like a pen, allows
the user to roll the hand-piece between their thumb and forefinger creating an
axial-rotation. This continual rotation of the needle bevel prevents needle
deflection. This technique is called the Bi-rotational insertion technique.

What do you mean by the pre-puncture technique

What do you mean by the pre-puncture technique and why is topical not needed?

The pre-puncture technique is a technique that is used to minimize the sensation
that can occur from needle penetration so that a topical anesthetic is
not necessary.

The technique is performed as follows:
Gently lay the bevel of the needle against the palatal tissue, but do not puncture
it. This can be achieved by holding the hand-piece at a 45 degree angle
to the palatal surface. Secure the tip of the needle in place by gently applying
pressure with a cotton applicator on the needle tip and tissue. This causes
pressure anesthesia and will help to absorb any excess anesthetic and make
for a more comfortable needle entry. Next, initiate cruise control by depressing
the foot control pedal. After 3 seconds the Wand System will announce
“cruise”. Upon hearing the “cruise” announcement remove your foot from the
foot control pedal.

This begins the anesthetic flow to the injection site- allowing anesthetic to
contact and diffuse through the outer layers of the gingiva and mimics the
effect of a topical anesthetic. Do not puncture the tissue at this time. Continue
to allow the needle to stay on the surface for 8-10 seconds before initiating
penetration of the surface. You may now slowly penetrate the surface
of the tissue by gently rotating the needle back and forth.

Proper needle landmark for the AMSA injection

Where is the proper needle landmark for the AMSA injection?

The injection site for the AMSA is at a point which bisects the first and second
pre-molars and is midway between the free gingival margin and mid-palatine
suture. This landmark may vary somewhat depending upon the anatomy of the
palatal vault. A more appropriate description may be between the pre-molars
and at the junction of the horizontal and vertical component of the pa late. This
injection can performed with minimal discomfort when performed properly.

Post-Operative

Proper needle landmark for the AMSA injection

Where is the proper needle landmark for the AMSA injection?

The injection site for the AMSA is at a point which bisects the first and second
pre-molars and is midway between the free gingival margin and mid-palatine
suture. This landmark may vary somewhat depending upon the anatomy of the
palatal vault. A more appropriate description may be between the pre-molars
and at the junction of the horizontal and vertical component of the pa late. This
injection can performed with minimal discomfort when performed properly.

Patient experiences tissue sloughing or reaction

Is there anything I should do if my patient experiences tissue sloughing or
adverse tissue reaction from an intraligamentary injection?

One can provide palative treatment and may recommend a topical ointment
to assist in the soft tissue healing. Such ointments include: Topical vitamin
E, or Ora base Ointment.

As with all adverse reactions it is advisable to have the patient return to the
office to monitor the healing.

PDL injection – no anesthetic leaking and no blanching

In doing a PDL injection, everything feels and looks right. No anesthetic is
leaking into the patient’s mouth. However, there is no blanching, and when I
remove the needle from the patient’s tissue a lot of anesthetic flows into the
patient’s mouth. How can I correct this?

What is happening is improper technique. If the bevel is facing against the
bone, it is likely that the needle will become obstructed by the bone, preventing
the blanching from occurring and preventing the anesthetic from flowing
out. When you remove the needle, the pressure inside the tubing will force tl”e
anesthetic into the patient’s mouth.

This can be corrected by keeping the bevel of the needle facing the tooth, and
advancing the needle with the bevel in contact with the tooth until resistance
is met. This will prevent the needle from becoming obstructed with bone.

Blanching but don’t get any pulpal anesthesia

I’ve administered the local anesthetic, and I see blanching, but I don’t get any
pulpal anesthesia. Why?

What is likely happening is the needle is impinging on the crest of bone. The
anesthetic is diffusing into the buccal soft tissue which is why you are not
getting any pulpal anesthesia. To correct this, make certain that your needle
is in contact with the tooth the entire time and that the tip is placed at the
entrance of the PDL space. This will ensure that the anesthetic will be deposited
in the PDL space so that you achieve pulpal anesthesia.

Overpressure alert and unit stops

I placed the needle into the PDL space as instructed and I keep getting an
“OVERPRESSURE” alert and the unit stops, what is the reason for this?

You may have blocked the orifice of the needle by pushing to heavily on the
hand-piece or by placing the bevel of the needle flush against the bone, prohibiting
the anesthetic from flowing freely. There are also situations in which
you have cored a tissue plug and the needle becomes blocked. These are all
situations where the unit is reading more pressure than it should so the unit
will shut down as a safety precaution.

Patient experienced adverse tissue reaction – intraligamentary

After performing the intraligamentary injection my patient experienced
adverse tissue reaction. Why is this so?

The reasons for this are as follows:

Adverse tissue reactions can result from either mechanical damage to the
tissues or excessive volumes of anesthetic solution being improperly placed
within the soft tissues. This may lead to a blockage of blood flow to these
tissues culminating in adverse tissue reaction. It is also quite possible that
certain patients with a thin delicate periodontium may be more prone to
adverse tissue reaction due to the anatomic variations of these patients.

Mechanical trauma can play a role in adverse tissue reaction. You
can prevent mechanical trauma by using delicate, careful needle placement
within the POL. If one notices a very rapid and extreme blanching of the interdental
papilla when performing the POL injection one is advised to verify correct
needle position. This type of extreme response can be related to improper
needle placement or proper placement of the needle on a patient with a
thin, delicate tissue type. Either of these conditions may lead to an excessive
build up of fluid volume within the soft tissues for that patient.

It is also advisable to assess the tissue quality of a patient’s periodontium
prior to performing an intraligamentary injection. Patients with th in, delicate
periodontal tissues may be more prone to adverse tissue reaction when performing
the POL injection, particularly if large volumes of solution are placed
into the overlying soft tissues.

Finally, it is important to adhere to the anesthetic recommendations from the
drug manufacturer when performing the intraligamentary injection.

Difficulty accessing DL and ML line angles on mandibular

I am having difficulty accessing the DL and ML line angles on mandibular
teeth for the intraligamentary injection. Is there anything I can do to make
gaining access easier?

We recommend approaching the PDL space from the lingual as the anatomy
shows that it is the path of least resistance for the anesthetic solution. It is
important to always start the Intra ligamentary injection from the distalingual
of the tooth. This allows the anesthetic to be deposited closest to the
direction from which the nerve enters the tooth.

Trouble accessing the line angles for the POL injection

I’m having trouble accessing the line angles for the POL injection as the hand-piece
seems too large for the patients mouth. Any suggestions?

Break the hand-piece or try bending the hand-piece for better angulation! By
breaking the hand-piece you will have a syringe the size of an endodontic file,
and this will give you better tactile feel, more control and better accessibility
to those hard to reach areas.

Spray back when removing needle during PDL

When I remove the needle from the PDL space there is a spray-back of anesthetic
solution into the patients mouth causing an unpleasant taste. How can
I prevent that?

When properly performing the lntraligamentary Injection there’s an internal
build-up of fluid pressure within the hand-piece tubing. This excess pressure
is relieved when the needle is removed from the PDL tissues sometimes resulting
in spray-back of anesthetic solution.

There are 3 simple ways you can minimize spray-back into your
patient’s mouth.

First Alternative: Wait 15 to 20 seconds before removing the needle to
allow the build up of the pressure to dissipate within the periodontal tissues
before removing the needle.

Second Alternative: Use a cotton-roll or cotton-applicator adjacent to the
needle tip to absorb the anesthetic solution upon removal of the needle
tip from the sulcus.

Third Alternative: Remove the needle from PDL tissues as soon as
Aspiration starts. Aspiration creates a suction at 1-2 seconds of the
aspiration cycle, removing the needle as soon as aspiration starts relieves
the pressure and prevents spray back.

Loaded the anesthetic and cartridge holder into the unit and it did not purge.

I’ve loaded the anesthetic and cartridge holder into the unit and it did not
purge. What is wrong?

First, check to see that the auto purge/retract light is lit. Remove cartridge
holder from unit and make sure that the clear spike inside the cartridge holder
has punctured the diaphragm on the anesthetic cartridge. If the diaphragm is
not punctured, remove cartridge and reload it into the cartridge holder making
sure it punctures the second time. If the diaphragm isn’t punctured wet
diaphragm with an alcohol swab and twist and turn carpule when inserting
into cartridge holder.

If the diaphragm was punctured try turning the cartridge holder a full turn
counter clockwise again. If it isn’t fully engaged, the unit will not recognize
that a cartridge is loaded.

Where do I perform the PASA?

Where do I perform the PASA?

This injection is initiated just lateral to the incisive papilla targeting the incisive
canal. The objective is to gain entrance into the incisive canal, and maintain
contact with the inner bony wall. This injection can be performed with
minimal discomfort when performed properly.

Supraperiosteal Infiltration Injections

It is recommended to use 2% Lidocaine with an epinephrine concentration of
1:100,000

Inferior Alveolar Block Injection

In regard to your choice of anesthetic solutions, it is recommended to use 2%
Lidocaine with an epinephrine concentration of 1:100,000?

When using 4% Articaine a concentration of either 1:100,000 or 1:200,000
epinephrine may be used.
Recommended dosage is 1 full cartridge for a 2% anesthetic with a 1:100,000
concentration of epinephrine or a 1/2 cartridge for a 4% anesthetic with a
1:200,000 concentration of epinephrine.

Palatal Injections

Use 2% Lidocaine with an epinephrine concentration of 1:100,000.
Recommended dosage is from 3/4 to 1 full cartridge.
When using 4% Articaine a concentration of 1:200,000 epinephrine is recommended.
Recommended dosage is 1/4 to a 112 cartridge.

NOTE: It is NOT recommended that 4% Articaine with a concentration of a
1:100,000 epinephrine be used for palatal injections. It is also NOT recommended
that 2% Lidocaine with a concentration of 1:50,000 epinephrine be
used for palatal injections.

lntraligamentary Injection

WAND lntraligamentary Injection:

If using 2% Lidocaine with 1:100,000 epinephrine or similar, a 112 cartridge
can be delivered at the Distal line angle site and a 1/2 cartridge at the Mesial
line angle site of a multi-rooted tooth. On a single-rooted tooth you will only
need to deliver a 1/2 cartridge at the DL line angle.

NOTE: The use of 2% anesthetics with a vasoconstrictor of 1:50,000 epinephrine
is NOT recommended for intraligamentary injections.
When using 4% Articaine it is recommended that you only use Articaine with
a concentration of 1:200,000 epinephrine, a 114 of a cartridge can be delivered
at the DL line angle and a 1/4 of a cartridge at the ML line angle site of
a multi-rooted tooth. On a single-rooted tooth you will only need to deliver a
1/4 of a cartridge at the DL line angle.

NOTE: The use of 4% Articaine with 1:100,000 epinephrine is NOT recommended
for intraligamentary injections.

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