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11446 Views - Mar 2016

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Root canal procedures have the reputation of being painful; without effective pain control, an endodontic treatment cannot be performed in a calm, precise fashion. Achieving clinically acceptable anesthesia in the maxilla is rarely a problem, while anesthesia of mandibular teeth is more difficult to achieve on a consistently reliable basis.
Patients who are experiencing pulpal pain, particularly in mandibular molars, have additional anesthetic problems. The inferior alveolar nerve block does not always provide profound pulpal anesthesia in mandibular molar with pulpitis, and supplemental local anaesthesia is often required. A “bull’s eye approach” is useful in difficult cases: inferior alveolar nerve - buccal / lingual - intraligamental - intraosseous - intrapulpal. Other problems arise with apprehensive patients, who report a history of previous difficulty with anesthesia; because of technical problems or individual factors, sometimes a larger dose of anesthetic is required. A “rule of the thumb” for remembering maximal dosages with currently formulated local anesthetic cartridges (Mepivacaine3%, Mepivacaine2% with ephinephrine 1:100.000, Articaine 4% with ephinephrine 1:100.000) is to use one cartridge of local anesthetic for every 12 kg of patient weight.
Anyway, the inferior alveolar nerve block unfortunately has an high percentage of failures, even when properly administered. Mandibular teeth may receive innervation from more than one nerve trunk, such as long buccal nerve, lingual nerve and mylohyoid nerve; buccal and lingual infiltration adjacent to the tooth of interest may be effective.
The most popular supplementary injection is the intraligamentary injection or periodontal ligament (PDL) injection. It uses the periodontal ligament to administer the local anesthetic solution. The success of supplemental intraligamentary injections in achieving pulpal anesthesia for endodontic procedures has been reported to be 50% to 96%. A short needle is placed in the sulcus and advanced along the root, until resistance is met. Anesthetic is injected with considerable pressure. Sometimes it is painful on delivery, and can cause post-operative discomfort. Using a conventional syringe, the possibility of breakage of the anesthetic cartridge does exist.
Recently, a computer-controlled local dental anaesthetic system has been developed. This technology utilises an electro-mechanical motor regulated by a central processor unit functioning in concert with a force/pressure transducer. The machine continuously monitors the exit pressure of the anaesthetic solution, and automates the injection at a controlled rate, thus reducing pain and post-op discomfort.

the clinical use of this type of local anesthesia is very useful because it reduces the waiting times and allows to avoid nerve blocks and numbness
At the University of Brescia it has begun a preliminary study conducted by Dr.ssa Chiara Dossena and Dr. Tonini Riccardo to objectively evaluate the pain perceived by the patient during anesthesia. Conventionally the visual analogue scale or visual analog scale (VAS) is used to measure pain level, but It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured.
Instead for this research has been used a an experimental method that can measure the Pupillary Reflex Dilation (RPD).
RPD has proved its specificity and consistency in measuring the analgesia level of patients, in the operating theatre as well as in intensive care. 
Using an exclusive process, the Pupillometer  quantifies within seconds the reflex papillary dilatation through an integrated digital sensor and represents a clinical tool for LIVE analgesia monitoring .
The preliminary test was performed from the same operator to the same patient. At level of  tooth 4.6 was used conventional anesthesia while for  3.6 tooth  the STA anesthesia. Pupillometer  measured before and during any injection the pupil diameter. The results were incredible because STA has shown a weak sensibility compared to the very strong sensibility of conventional system.
the traditional anesthesia show a great pain reaction by the patient
the induction of the anesthesia with WAND technology show a perfect patient comfort


Further results will be published soon.


Efficacy of the Computer-Controlled Injection System STATM, the Ligmaject, and the dental syringe for intraligamentary anesthesia in restorative patients
Marco Ferrari1, Maria Crysanti Cagidiaco2, Alessandro Vichi1, Cecilia Goracci1

Effect of computerized delivery intraligamental injection in primary molars on their corresponding permanent tooth buds
1Department of Pediatric Dentistry, Tel Aviv University; currently Private Practice, Tel Aviv, Israel, 2Department of Pediatric Dentistry, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel, and 3Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
International Journal of Paediatric Dentistry 2010; 20: 270– 275

Maxillary nerve block- a new approach using a computer controlled anesthetic delivery system for maxillary sinus elevation procedure. A perspective study. Devorah Schwartz-Arad , DMD, PhD/Eran Dolev, DMD/Wayne Williams , BDS, MChD Quintessence International

???Friedman MJ, Hochman MN.P-ASA Block injection: A new palatal technique to anaesthetize maxillary anterior teeth . J Esthet Dent 1999 ; 11 : 63-71


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