RU2424002C1 - Method of local anesthesia of mandbular molars with no periodontium pathology - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: invention refers to medicine, namely, to anaesthesiology and dentistry, and can be used as an anaesthesia care of dental interventions. That is ensured by infiltration anaesthesia as follows. In the middle of each gingival papilla adjoining a tooth to be anaesthetised, a short-needle syringe is pricked in from a vestibular side at an angle 90 degrees to a surface of a mucous membrane of the medial and distal gingival papilla. The needle is moved forward firmly to a bone. Then an anaesthetic drug 0.2 ml of 4 % articaine and adrenaline of various concentrations is introduced from each side. ^ EFFECT: method provides the adequate and prolonged anaesthesia ensured by the most exact delivery of the anaesthetic drug and vasoconstrictive agent to nerve fibres. ^ 1 ex

Description

The invention relates to medicine, namely to anesthesiology in dentistry.

A known method of intra-septal (intraseptal) anesthesia, which is a type of intraosseous anesthesia. It consists in the introduction of a local anesthetic solution into the bone septum between the holes of adjacent teeth (S. Rabinovich. Modern technologies of local anesthesia in dentistry. - M., VNUMTs MZ RF, 2000. - 116 pp.).

With intra-septal (intraseptal) anesthesia, nerve fibers of the bone and soft tissues are blocked and periodontal tissues become bleeding, and the analgesic effect is enhanced due to additional toxic blockade of myelinated fibers. Thus, with septal (intraseptal) anesthesia, a deeper analgesia develops than with infiltration anesthesia. In addition, the occurrence of hemostasis creates additional convenience during curettage and other surgical operations on hard and soft periodontal tissues (patchwork, implantation surgery).

With intra-septal (intraseptal) anesthesia, as with other methods of intraosseous anesthesia, a small volume of solution is injected - 0.2-0.4 ml. The analgesic effect develops rapidly (within no more than one minute). The technique of intra-septal (intraseptal) anesthesia consists in inserting a needle into the bone tissue of the septum. To do this, use a short needle of size 27, which is injected at an angle of 90 degrees to the surface of the mucous membrane of the gums. After the introduction of a small amount of anesthetic, it is immersed until it comes into contact with the bone and then, overcoming the resistance, it is injected into the bone tissue of the interdental septum to a depth of 1-2 mm. Slowly, in order to minimize the distribution area of the anesthetic, 0.2-0.4 ml of solution is administered (Anesthesia in the conditions of a dental clinic. Bizyaev AF, Ivanov S.Yu., Lepilin AV, Rabinovich S.A. - M., Dentistry of the XXI century, - p. 42).

However, in the clinical use of this method, the following disadvantages can be distinguished: a limited area of anesthesia, a short period of anesthesia of the pulp of the teeth, due to the resorption of a small amount of the injected solution, the need to injure bone tissue during injection and, as a result, microtrauma of the soft tissues when removing the needle due to a change in its end shape . The effectiveness of this anesthesia in the treatment of molars of the lower jaw is: when preparing tissues for the treatment of secondary caries - 83%; about the treatment of deep caries - 65%; with depulpation - 60%. The duration of all interventions did not exceed 15-17 minutes, the duration of anesthesin was sufficient. When teeth were depulpated in order to increase the duration of anesthesia during endodontic interventions, an additional intra-pulp method of anesthetic administration was used (Anisimova E.N. Oleinikova E.V., Gasanova Z.M. "Clinical rationale for the use of periodontal methods of local anesthesia in the treatment of major dental diseases". Sat tr. XIV international conference of maxillofacial surgeons, Russia, May 12-14, 2009, - St. Petersburg, 2009. - P.24).

There is a method of infiltration anesthesia on the lower jaw in the region of large molars from the buccal side, for its implementation it is recommended to inject the needle with a cut to the bone into the mucous membrane of the transitional fold at the level of the roots of large molars, releasing 0.5-1 when moving the needle along the transitional fold , 0 ml of local anesthetic solution. The second premolar, the first and partially the second molar, the mucous membrane of the lower jaw from the buccal side fell into the anesthesia zone. According to G.N. Kassilya (“The Science of Pain.” 1st ed. - M., 1968. - P.13), the depth of anesthesia made it possible to carry out all therapeutic interventions, and surgical ones required additional administration of the drug from the lingual side. This method is selected for the prototype.

However, with the clinical use of this method, the effectiveness of anesthesia of molars of the lower jaw was insufficient. According to E.N. Anisimova, E.V. Oleinikova (Improving the effectiveness of anesthesia of molars of the lower jaw Sat. tr. X111 of the international conference of maxillofacial surgeons, Russia, May 22-24, 2008 - St. Petersburg, 2009. - С .21) this method, as an independent one, is effectively used only in 15% of cases. In 85% of cases, this method is used as an adjunct to conduction anesthesia in the mandibular foramen. The use of 4% articaine with an adrenaline of 1: 200000 for buccal anesthesia (Pain control in Local Anaesthesia by John G. Mechan p.29. Dental Congress in Modern Pain Control. 14 to October 19, 2009, Australia) provides effective anesthesia of the lower jaw molars 55% of cases. Thus, buccal anesthesia, as an independent method of anesthesia of molars of the lower jaw, is not consistent.

The objective of the invention is to increase the effectiveness of anesthesia of molars of the lower jaw in the treatment of major dental diseases.

The technical result consists in increasing the duration of anesthesia, sufficient for basic dental interventions on an outpatient basis.

This is achieved due to the fact that in the middle of each of the gingival papillae adjacent to the tooth to be anesthetized, they are injected from the vestibular side with a syringe with a short needle at an angle of 90 degrees to the surface of the mucous membrane of the medial and distal gingival papilla until it stops with the bone and produce the introduction of 0.2 ml of anesthetic based on 4% articaine with adrenaline of various concentrations.

The introduction of a local anesthetic in the middle of each gingival papilla, adjacent to the causative tooth (vestibularly from the medial and distal sides), provides an accurate supply of it to the nerve fibers that innervate the hard tissues and pulp of the tooth (Bender I., Seltzer S. Pulp of the tooth. - M ., Medicine, 1971.- 223 p.).

Investigations by S. N. Vaisblat (S. N. Vaisblat. Local anesthesia during operations on the teeth, face and jaws. - Kiev, 1962. - P.442), performed on 100 lower jaws, showed increased bone porosity in the molars, which indicates the possibility of using the infiltration method of administering a local anesthetic drug to achieve effective anesthesia. In addition, preparations based on a 4% solution of articaine with adrenaline of various concentrations have high diffusion ability, and a total dose of 0.4 ml, as practice has shown, is optimal for major dental interventions (treatment of caries and its complications, tooth extraction, preparation of teeth for orthopedic constructions.

The method is as follows: the patient undergoes application anesthesia in the area of the causative tooth, in the middle of each of the periodontal papillae adjacent to the tooth, from the vestibular side, inject with a syringe with a short needle at an angle of 90 degrees to the surface of the mucous membrane of the medial and distal periodontal papilla until it stops with bone and produce the introduction of 0.2 ml of anesthetic based on 4% articaine with adrenaline of various concentrations (for example, 4% articaine 1: 200000).

As shown by the application of the proposed method, in clinical practice, effective anesthesia was achieved in the first, second and third molars of the lower jaw, sufficient for major dental interventions: treatment of caries and its complications (efficiency was 95%), tooth extraction (95% efficiency ), the preparation of teeth under orthopedic designs (efficiency was 90%).

Efficiency was determined subjectively clinically using an analog-visual scale. With intraseptic anesthesia, the efficiency for tooth depulpation was 75%, for preparation 80%, for tooth extraction 85%.

Clinical example.

Patient S., 23 years old, and / b No. 260279.

I turned to the GLPU No. 2 of the Ministry of Economic Development of the Russian Federation with complaints of short-term pain from a cold tooth in the 36 area.

Anamnesis: On the part of organs and systems without pathology, I have not previously noted complications associated with local anesthesia, and do not suffer from allergic reactions. She is not infected with HIV, she does not have socially dangerous infections.

Objectively: on the distal contact surface of the tooth 36 there is a deep carious cavity filled with food debris and softened dentin, sensing along the bottom of the cavity is painful, a cold test is positive, EDI-10 μA.

Diagnosis: K02.1 caries of dentin 36 teeth.

After determining the functional state of the patient (Blood pressure 115/68 mm Hg, heart rate 80 beats / min), local anesthesia of 36 teeth was performed: anesthesia was applied in the region of 36 teeth, in the middle of each of the gingival papillae adjacent to the 36 tooth, s the medial and distal sides on the buccal surface were injected with a syringe with a short needle at an angle of 90 degrees to the surface of the mucous membrane of the gingival papilla until it stops with the bone, while administering 0.2 ml of local anesthetic - 4% articaine 1: 200000, the total dose of whichleft 0.4 ml, bleeding occurred periodontal tissue, clinically defined whitening gum around the injection site. 2 minutes after anesthesia - EDI - 70 μA. Excavation of softened dentin was painless. After 5 min, the EDI from the bottom of the cavity was 100 μA, the preparation and formation of the cavity was painless. A Vitribond insulating pad was applied, filling the Grandio light curing composite. Grinding, polishing fillings.

The patient's condition after anesthesia and intervention is satisfactory, blood pressure 120/70 mm Hg, heart rate 80 beats / min.

Claims (1)

A method of local anesthesia of molars of the lower jaw without periodontal pathology by means of infiltration anesthesia, characterized in that in the middle of each of the periodontal papillae adjacent to the tooth to be anesthetized, they are injected from the vestibular side with a syringe with a short needle at an angle of 90 ° to the surface of the mucous membrane the medial and distal periodontal papilla completely against the bone and inject 0.2 ml of anesthetic based on 4% articaine with epinephrine of various concentrations.