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Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_110_библиотеки_им_акад_М_И_Перельмана

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Contents
https://t.me/med1917
x
Contraindications 133
8 Contraindications
forLocalAnestheticTechniquesinDentistry 135
Lack ofCooperation fromthe Patient 135
Predisposing Factors Evaluation ofRisk
135
136
Approach toBehavioral Problems
ASA IV Physical Status
ASA I Patients ASA II Patients ASA III Patients ASA IV Patients ASA V Patients
Clotting Abnormalities
137
137
137
138
139
140
140 High-risk Anesthetic Techniques Systemic Causes ofthe Risk ofHemorrhage
Antiplatelet Agents
140 Oral Vitamin K Antagonists: Anticoagulants Direct Oral Anticoagulants Low Platelet Counts Hemophilia
142
141
142
Alternatives andRecommendations
Other Contraindications
Injection Site Infection
Impossible Physical Access Summary References
143
143
142
142
143
136
140
140
141
142
9 ContraindicationsforLocalAnesthetics 148
Relevant Contraindications 148
Allergy toLocal Anesthetics
Long-acting Anesthetics
Prilocaine, Benzocaine, andMethemoglobinemia
Cholinesterase Deficiency andEsther Anesthetics
Myasthenia Gravis andEsters Minor Contraindications
Procaine andSulfonamides
148
148
148
149
149
149
149 Lidocaine andCimetidine 150 Lidocaine andPropranolol 150 Lidocaine andSuccinylcholine 150 Bupivacaine andCardiotoxicity 150 Amide Anesthetics andMalignant Hyperthermia 151
References 151
10 ContraindicationsforVasoconstrictors 155
Absolute Contraindications 155
Uncontrolled Insulin-dependent Diabetes Mellitus 155 Intolerance toSulfites 156 Asthma Controlled withCorticosteroids 156 Pheochromocytoma-induced Arterial Hypertension 156 Recent Consumption ofCocaine 157 Patients withCardiovascular Diseases Who Take Amphetamines andPsychostimulants 157
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Allergy toVasoconstrictors 157
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Relative Contraindications
Nonselective Beta-blockers COMT Inhibitor-type Antiparkinson Drugs ASA III Patients with Cardiovascular Conditions Digitalis Glycosides (Digoxin) Amphetamines andPsychostimulants Tricyclic Antidepressants Interactions Involving Drugs that are No Longer inUse
Older Antihypertensive Agents (Anti-adrenergic Drugs) General Anesthesia (Halothane andThiopental)
Contraindications ofLittle Relevance
Uncontrolled Hyperthyroidism Phenothiazines andAntipsychotic Drugs
Vasoconstrictors andOsteoradionecrosis Contraindications ofFelypressin References
165
158
158
160
160
161
161
163
163
163
164
164
Contents xi
160
162
162
162
InstrumentsandTopicalAnesthesia
11 InstrumentSetandEquipment 173
Needles 173
Parts ofa Needle
Anterior Part Middle Part Posterior Part
Protective Sheath Lengths andGauges Needles: Critical Aspects
Aspiration andGauge
Pain andGauge
Deflection ofthe Needle andGauge
Lesions Caused by aBarbed Needle
Breakage ofNeedles Criteria forthe Selection ofNeedles
Cartridges 177
Parts ofa Cartridge 178
Anterior Part or Needle Adapter 178
Neck 178
Cylindrical Body 178
Posterior Part 179
Other Elements 179 Storage ofCartridges 179
Norms forAll Cartridges 179
Norms forCartridges Containing Catecholamines 179 Problems Affecting Cartridges 180 Degradation ofDrugs inthe Cartridge 180
Local Anesthesia 181
Sympathomimetic Vasoconstrictors (Epinephrine) 181
Sulfites 181
Syringes 181
173
173
174
174
175
175
175
176
176
177
171
176 177
177
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Contents
Parts ofa Cartridge-type Syringe 181
Anterior Part or Needle Adapter Syringe Barrel or Body ofthe Syringe Posterior Part (Back) Piston
182
Using theSyringe
Set-up
182
Dismantling
182
182
182
Cleaning andSterilization
Self-aspirating Syringes
Characteristics Mechanism ofAction
183
183
184
Advantages andDisadvantages
Variants ofCartridge-type Syringes
Plastic Syringes Uniject-type Syringes
184
184 Disposable Antineedle Stick Syringes Power-operated Syringes Other Injection Devices
Additional Instruments
Complementary Devices
185
185
185
185
Alkalinization System (pH Onset System®)
Advantages Mechanism ofAction Cartridges forthe Device Mixing Pen Mixing pH
188
Vibrating Devices
Gate Control Theory VibraJect DentalVibe
Cartridge Heaters
References
186
186
187
187
188
188
189
189
189
190
190
181
182
183
184
184
184
186
12 TopicalAnesthesia 195
Factors Affecting Topical Anesthesia withLocal Anesthetics 195
Local Anesthetic 195 Application Time 195 Method ofApplication 195 Amount Administered 196 Types ofPain 196
Area ofthe Mouth Effect ofTopical Anesthesia 197 Topical Anesthetics inDentistry 197
Benzocaine 197
Maximum Dose 197 Advantages andDisadvantages 197 Specific Adverse Effects 198
Lidocaine 199
Maximum Dose 199 Advantages andDisadvantages 199
197
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Specific Adverse Effects 199
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Lidocaine Adhesive Patches (DentiPatch®)
Maximum Dose Advantages andDisadvantages Specific Adverse Effects
EMLA Cream
Advantages of the Structure and Composition of EMLA Maximum Dose Advantages andDisadvantages Specific Adverse Effects
Tetracaine (Amethocaine)
Maximum Dose Advantages andDisadvantages Specific Adverse Effects
Cocaine
Topical Anesthetic Compounds
Other Experimental Formulations
Topical Cooling
Cold Aerosols Refrigerants Topical Ice
Indications forTopical Anesthetic
For Symptomatic Relief ofPain
Indication asAnesthetic
Periodontal Oraqix® Gel 209
Oraqix System (Needle-free Anesthesia) 210
References
203 Maximum Dose Advantages andDisadvantages Specific Adverse Effects Formulations forUse inDentistry
Composition Advantages andApplication Adverse Effects Clinical Efficacy
Pain Resulting fromTooth Decay Painful Ulcers andLesions onthe Mucosa
Minor Surgical Interventions Clinical Procedures Management ofthe Gag Reflex 209
Method ofApplication 210 Efficacy 211 Specific Adverse Effects 211
211
199
199
200
200
200
200 201 201
201
201 201
203
203 203
203
203
205
205
205
205
206
206
207
207
208
209
209
209
209
199
203
209
209
Contents xiii
200
LocalAnestheticTechniquesinDentistry
13 Basic
InjectionTechnique 219
Comment onRetraction 219 Phases ofthe Injection 219
Initial Preparation 219 Preparation Phase 220
217
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Contents
Application ofTopical Anesthetic 222
Method ofApplication
222
Observations onAerosols Transfer ofthe Syringe Insertion ofthe Needle Aspiration
226
223
225
False Positives andNegatives
How toInterpret aPositive Aspiration
Aspiration Technique
Remarks Injection Final Phase
228
228
229 Evaluation ofAnesthesia Post-treatment Phase
227
230
231
Causes ofPain During theInjection
Factors That Cause Pain
232 Factors That Play aRole inPain Unimportant Causes (Myths)
Terminology Appendix References
234
235
235
223
226
227
232
232
233
14 MaxillaryAnesthesiaI:PulpalAnesthesia 241
Introduction 241
Maxilla Maxillary Nerve (V Buccal Anesthesia ofthe Upper Molars
Buccal Infiltration
Zones Anesthetized Technique Efficacy ofthis Technique Complications Specific tothis Technique Factors That Lead toSuccess Modified Cotton Roll Approach
Infraorbital Nerve Block
Uses Zones Anesthetized
241
246
242
) 241
2
242
242
246
241
245
245
245
245
245
Intraoral Technique 246 Extraoral Technique 248 Efficacy ofthis Technique
249 Complications Specific tothis Technique 249 Remarks 250
Posterior Superior Alveolar Nerve Block 251
Zones Anesthetized 251 Technique 251 Efficacy ofthis Technique 252 Complications Specific tothis Technique 253 Modified Adatia Technique 253
High Tuberosity Approach 253
Uses 253 Zone Anesthetized 254 Technique 254
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Efficacy ofthis Technique 256
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Complications Specific tothis Technique Remarks
Transpalatal Technique
Uses Zone Anesthetized Technique Efficacy ofthis Technique
256
256
257
257
257
260 Complications Specific toThis Technique Factors That Lead toSuccess
Final Remarks References
263
263
263
256
261
15 MaxillaryAnesthesiaII:ComplementaryAnesthesiaofthePalate 267
Introduction 267
The Nasopalatine Nerve Innervates Less than Previously Thought The Potency ofthe Anesthetic is not Important
267
267
Anesthesia ofthe Palate Without Complementary Palatal Anesthesia
Indications Methods forReducing Pain inPalatal Techniques
Topical Anesthesia Pressure Techniques Topical Cooling Periodontal Ligament Technique Minimal Intervention Technique
Nasopalatine Nerve Block
Anesthetized Area Technique Specific Complications ofThis Technique Intranasal Variant Technique
Greater Palatine Nerve Block
Area Anesthetized Technique Specific Complications ofThis Technique Partial Variant ofthe Palate
268
269
269
270
270
270 271
271
271
271
273
274
274
274
274
275
276
276
Transpapillary Technique inChildren 276
Technique 277
References 278
Contents xv
267
16 MandibularAnesthesiaI:PulpalAnesthesia 281
Mandibular Block: General Remarks 281
Zone Anesthetized Factors toConsider forthe Mandibular Block 282
Efficacy is Correlated tothe Location ofTooth inthe Mandible 282 High Failure Rate 283 Unreliability ofLower Lip Anesthesia 283 Sequential Nature 283 The Longer theTime, theMore Intense theAnesthesia 283 Minor Effect ofthe Type ofAnesthetic 283 Impact ofthe Volume Injected 284 Minor Effect ofthe Specific Mandibular Block Technique 284
282
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Contents
Bilateral Mandibular Blocks 284 Long, Caliber 25G Needles Slow Injection
285
284
Mandibular Block: Conventional or Direct Technique
Distribution ofthe Anesthetic Solution Zone Anesthetized Technique
286
Efficacy ofthis Technique
286
291
Complications Specific tothis Technique
Mandibular Block: Gow-Gates Technique
Mechanism
292
285
291
292
Advantages, Disadvantages, andNon-advantages
Advantages Disadvantages
Non-advantages Zone Anesthetized Technique Efficacy ofthis Technique Complications Specific tothis Technique Remark on the Gow-Gates Technique
294
294
295
296
296
299
299
300
Mandibular Block: Laguardia–Akinosi Technique
Advantages andDisadvantages
301
Use Distribution ofthe Anesthetic Solution Zone Anesthetized Technique
301
301
Efficacy ofthis Technique Complications Specific tothis Technique
Double Infiltration inAnterior Teeth
Keys toSuccess Zone Anesthetized Technique
304
304
304 Efficacy ofthis Technique Complications Specific tothis Technique
References
307
300
301
303
303
304
306
306
285
294
300
17 MandibularAnesthesiaII:ComplementaryAnesthesia 312
Introduction 312 Indications 312 Lingual Nerve Block 312
Anesthetized Area 312 Technique 312 Complications ofthis Technique Partial Variant asComplementary Anesthesia 314
Buccal Nerve Block 314
Anesthetized Area 315 Technique 315 Specific Complications ofthis Technique 316
References 316
18 SupplementaryTechniquesinCasesofFailure 318
Introduction 318 Intrapulpal Anesthesia 318
314
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Traditional Technique 318
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Keys toa Successful Approach Intrapulpal Technique
319
Topical Anesthetic Technique
Technique
319
Periodontal Ligament Technique (PDL)
Indications andContraindications
Indications Contraindications
Diffusion ofthe Solution
320
320
320
Factors that Determine Efficacy
Major Factors Minor Factors
Instrument Set
Syringes Needles
Cartridges Anesthetized Area Technique
321
321
322
322
324
324
324
324 Efficacy ofThis Technique Specific Complications ofthe Technique
318
319
320
320
321
326
326 Complications Dueto Performance ofthe Technique Periodontal Abnormalities Pulpal Abnormalities Cardiovascular Abnormalities
Intraseptal Technique
328 Factors Underlying aSuccessful Technique Contraindications Anesthetized Area Technique
328
328
328
Specific Complications ofthe Technique
Intraosseous Technique
326
327
328
328
329
329 Indications, Contraindications, andDisadvantages Instrument Set
Stabident® X-Tip®
330
330
331 Anesthetic Solutions 331 Anesthetized Area 331 Intraosseous Technique 332 Efficacy 336 Specific Complications 336
Complications Dueto Mechanical Aspects 336 Postoperative Complications
337
Pulpal Abnormalities 338 Final Remarks 338 References 339
Contents xvii
326
330
19 FailureofDentalLocalAnesthesia 344
Frequency 344 Consequences ofFailure 344 Failures: General Causes 345
Highly Anxious Patients 345 Patients withDrug Addiction andAlcoholism 346
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Contents
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xviii
Teeth Affected by Irreversible Acute Pulpitis 346
Reasons forFailure ofAnesthesia inAcute Pulpitis Approach
347 Resistance toLocal Anesthetics Other Causes ofFailure
348
Specific Failures After Maxillary Infiltration
Causes ofMaxillary Failure Approach
349
348
Specific Failures After Mandibular Block
Reasons forFailure After Mandibular Block
Failure Owing toInappropriate Technique Failure forAnatomical Reasons Failure Arising fromAccessory Innervation
Approach
References
354
354
20 AlternativestoConventionalTechniques 360
Jet Injection 360
Distribution ofthe Solution Indications Disadvantages Advantages Equipment
Syrijet® Injex®
Technique
361
361
361
361
361
362
362
360
Complications ofthis Technique
Electronic Anesthesia: Electronic Dental Anesthesia
Mechanism ofAction Indications
364 Disadvantages Advantages
366 Contraindications Equipment Technique
367
367
364
366
366
Complications ofthis Technique
Computer-Controlled Injection Systems (The Wand®) 368
Description ofthe Device 369
Central Processing Unit 369 Foot Control 370 Handpiece 370 Needles 370 Set-up
370
Advantages andDisadvantages 371
P-AMSA 371
Anesthetized Area 371 Technique 371 Efficacy of the P-AMSA Technique 373 Specific Complications ofthis Technique 373 Advantages of the P-AMSA Technique 373
P-ASA 373
Anesthetized Area 373
346
348
348
349
349
349
349
350
363
364
368
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Technique 374
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Efficacy of P-ASA Specific Complications withthis Technique Advantages of P-ASA
The Wand and Conventional Techniques
Periodontal Ligament Technique Mandibular Block
Other Computer-controlled Injection Systems
Comfort Control Syringe fromMidwest Quicksleeper
Equipment Anesthetized Area Transcortical Technique Efficacy of QuickSleeper Disadvantages
Intranasal Maxillary Local Anesthesia (Kovanaze®)
Composition ofthe Solution Zone Anesthetized Indications andContraindications
Indications Contraindications
Equipment
Preparation Technique Efficacy ofthe Technique Complications Specific tothis Technique Advantages andDisadvantages
Advantages
Disadvantages
References
380
380
384
375
375
375
375
375
376
376
376
377
377
377
377
378
379
379
379
379
379
380
380
381
381
383
383
384
Contents xix
379
21 LocalAnesthesiainChildren 389
The Problem withChildren andAdolescents 389 Local Anesthetic Solutions Anesthetic Technique inChildren Anesthesia ofthe Primary Mandibular Molars
Needles andMandibular Block 392 Remarks onBuccal Infiltration 392
References 392
Complications
22 LocalComplicationsofDentalLocalAnesthesia 397
Persistent Post-injection Pain 397 Self-inflicted Injury 397 Facial Blanching 398
Anesthetic Techniques Involved 399 Clinical Manifestations 399 Causes andPathophysiology 399
Proposed Causes 399
Pathophysiology 400
395
389
390
391
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