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Table18.7 Thickness (mm) ofthe gum andcortical plate inthe
mandibular vestibule.
SD 95% CI
Attached gingiva
(Goaslind etal.1977)
Cortical bone First PM 1.8±0.3 1–2
(Denio etal.1992) Second PM 2.0±3.1 0–5
First M 2.7±0.5 2–4
Second M 3.2±0.7 2–5
CI, confidence interval; PM, premolar; M, molar; SD, standard
deviation.
Intermediate
outer component
Figure18.9 X- Tip® with the perforator and guide sleeve. Note
how the perforator and guide sleeve are presented as a unit
with the protective cap (upper image).
Inner
component
Solid metal
needle Guide sleeve
1.22
± 0.4
0.5–2
CapCrown
X- Tip®
This system comprises four elements (X- Tip 2010)
(Figure18.9):
● Hollow metal guide measuring 0.63 × 7 mm (the
active part), which contains the perforator and which,
once placed in the mouth, serves as a guide for the
needle (Gallatin etal.2003b).
3) Protective cap (generally in a bright color, red) that cov-
ers the active part of the complex or perforator-
catheterguide sleeve block. This set is presented together in a
plastic ampoule inside a blister pack.
4) Extrashort 27G needle (0.4 × 9 mm), with measure-
ments identical to those of the perforator to be able to
penetrate the guide sleeve.
Anesthetic Solutions
Clinical trials show that local anesthetic solutions with epinephrine yield better results than those that do not contain
vasoconstrictor (Lilienthal and Reynolds1975b; Replogle
et al. 1997) or those that contain felypressin
(Lilienthal 1976). In addition, no statistically significant
differences have been found between the use of solutions
containing articaine 4% and lidocaine 2%, both of which
contain epinephrine 1:100
000 (Bigby etal.2006).
Despite containing epinephrine, the anesthetic enters
the bloodstream very quickly with this technique (Cannell
and Cannon1976), although the vasoconstrictor attenuates
the increase in plasma concentrations (Wood etal. 2005).
This technique is therefore considered to be equivalent to
an intravascular administration, with positive aspirations
in 60–85% of cases (Peñarrocha etal.1996, 2012).
Finally, when epinephrine is contraindicated, we can use
vasoconstrictor- free solutions, such as mepivacaine 3%
(Reisman et al. 1997; Replogle etal.1999) and prilocaine
3% with felypressin 0.03 IU/ml (Lilienthal1976), although
the results for these agents are somewhat poorer.
1) Perforator, which is formed by a plastic shank with vari-
ous parts:
○ Plastic shank that is introduced into the contra-
angled hand piece.
○ Intermediate outer component to hold the guide
sleeve (cup).
○ Solid metal 27G needle (0.4 × 9 mm) that comes out of
the center of the female component and is the active
part that perforates the cortical plate.
2) Guide sleeve, which is composed of the following parts:
○ Plastic inner component, which fits into the outer
component of the perforator and has a mark at the
top where the needle is introduced.
○ Crown, a plastic outer component surrounding the
inner component and marking the depth stop for
perforation.
Anesthetized Area
The area anesthetized with the intraosseous technique is
very well defined, as is the case in all supplementary
techniques.
● Tooth (pulp and periodontal ligament) on which the
technique is performed distally and frequently extended
to the adjacent tooth mesially.
● Vestibule and lingual area, both the fibromucosa (alveo-
lar mucosa, gum, and interdental papillae) and the bone
and periosteum of the anesthetized tooth. It is important
to remember that this technique is used in a very welldefined area.
● In the mandibula, the lower lip is also anesthetized in
65% of cases (Table 18.8), as is the tongue on many
occasions.
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Table18.8 Variables to be considered in the intraosseous technique with Stabident® and X- Tip®.
Study data Study variables
Reference System Sample size Tachycardia No attached gingiva Anesthesia lower lip
Lilienthal (1976) — 9 — — 55%
Leonard (1995) Stabident® 89 —
— 0%
Coggins etal. (1996) Stabident® 40 78% 8% 58%
Dunbar etal. (1996) Stabident® 20–40 80% 5% —
Replogle etal. (1997) Stabident® 42 — 7% 76%
Reitz etal. (1998) Stabident® 38 68% 2.5% —
Guglielmo etal. (1999) Stabident® 40 78% 7.5% —
Replogle etal. (1999) Stabident® 42 67% — —
Gallatin etal. (2003a) Stabident® 41 85% 5% 100%
Gallatin etal. (2003a) XNusstein etal. (2003) X-
Tip® 41 93% — 94%
Tip® 33 73% — —
Bigby etal. (2006) Stabident® 37 81% — —
Average 78.1% 5.8% 64%
Rounded average 80% 5% 65%
Values are shown as percentages. The percentage of anesthesia in the lower lip only applies to use of the technique in the mandible.
Intraosseous Technique
● Rubber dams must be removed (Nusstein etal.2003).
● This technique is not very painful as a primary technique
(Annex 23), although in practice it is not painful because
it is used as a supplementary technique when all other
approaches have failed and the adjacent tissues– but not
the dental pulp – are therefore anesthetized. If this
approach is used as the primary technique, then we
advise the following:
○ The Stabident® or X- Tip® extrashort needle can be used.
○ Injecting 0.2–0.6 ml in the area to be drilled
(Lilienthal1975a; Pearce 1976; Leonard1995; Dunbar
etal.1996; Coggins etal. 1996; Replogle etal. 1997;
Gallatin etal.2003a,2003b).
○ Waiting 1minute for the gum, periosteum, and corti-
cal plate to become anesthetized before perforating
(Leonard1995; Peñarrocha etal.1996).
● The best advice is to use a local anesthetic solution con-
taining epinephrine (if there are no contraindications),
similar to the one we are already using in the area
(remember the principle of not mixing two anesthetics
at the one site). For example, if articaine 4% with epinephrine 1:100 000 (A- 100) is used in the maxilla in a
buccal infiltration, then this same solution can be used;
if mandibular block is performed with the standard
solution of lidocaine 2% with epinephrine 1:100 000
(L- 100) and then reinforced with A- 100in buccal area,
then the intraosseous technique should be continued
with A- 100.
● Advise the patient that he/she may experience
palpitations:
○ When solutions with epinephrine are used, 80% of
patients have an increased heart rate that is felt as palpi-
tations (Table18.8), which last 2–4minutes (Lilienthal
and Reynolds 1975b); in 20% of cases, they may last
4–6 minutes (Replogle etal.1999; Guglielmo etal.1999).
○ No palpitations are observed with epinephrine- free
anesthetic solutions (Replogle et al. 1999; Guglielmo
etal.1999). Similarly, palpitations do not appear if the
injection rate is very slow (around 5 minutes) (Susi
etal.2008). This is difficult to ensure manually, although
it is easy with computer- controlled delivery systems.
● Selection of the perforation site.
○ Perforate distally to the tooth to be treated
(Leonard1995); however, perforation may be mesial
in certain cases:
◼ Second permanent molar because it is located
toward the back of the mouth.
◼ Very crowded teeth because there is little cortical
bone between them.
○ Perforate buccally, with an equal distance between the
two teeth (Figure18.10).
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Cortical bone
a
C
2 mm Line
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Pulp
ancellous
bone
Attached gingiv
Figure18.10 Perforation via the buccal area at an equal
distance between the teeth. Source: Redrawn from Leonard
(1995) and Reader etal. (2011).
333
Figure18.11 In the Stabident® system, the dentist perforates
2
mm apically from the imaginary horizontal line that passes
through the gingival margin into the attached gingiva. Notice
how the horizontal line traverses the gingival margins of the
adjacent teeth and the vertical line bisects the interdental
papilla.
Stabident® X- Tip®
● At 2 mm toward the apical
part of the imaginary
horizontal line that passes
through the gingival margin
(Figure18.11).
● Always on the attached
gingiva. If this is missing
(5%, Table18.8), then at
1 mm above the mucogingiv
aljunction.
aAlways on attached gingiva, since if the technique is performed on
the alveolar mucosa, which is mobile, there is movement above the
perforation in the cortical plate and the placement of the insertion
point is then very difficult (Bourke1974). Remember that the teeth
where the attached gingiva is usually less narrow in the area of the
canines and maxillary and mandibular first premolar
(Bowers1963).
○ In edentulous areas, the perforation is made vertically,
a
on the alveolar crest, where the cortical layer is thin-
● Identical to Stabident®,
although we can even go a
further 3–7 mm toward the
apex.
● On attached gingiva or even
on the alveolar mucosa
(Gallatin etal.2003a;
Nusstein etal.2003) since
this approach has a guide
sleeve.
Figure18.12 Perforation is vertical in edentulous areas.
structures may be damaged (mental nerve, mandibular canal, etc.) or the intraosseous technique may
fail because the needle does not penetrate the cancellous bone (maxillary sinus).
● Place the perforator in the contra- angle and proceed as
follows:
Stabident® X- Tip®
Remove the
protective cap
from the active
part
When the protective cap is removed from
the active part, hold the crown of the guide
sleeve with one finger so that the guide sleeve
does not come out of the perforator.
ner (Figure18.12).
○ Observations on the perforation point:
◼ If the perforation is made in areas close to the papilla
(Stabident®), distant from the apex, the bone may be
fragile and the intraosseous technique may fail.
◼ If the perforation is made in very apical areas
(X- Tip®), where the cortical layer is very thick,
● Perforate the cortical layer with the perforator placed at a
contra- angle, as follows:
○ Place the drill perpendicular to the area to be perfo-
rated without activating the handpiece.
○ Insert the drill by pushing it until the tip touches the
bone after crossing the gum or mucosa (Figure18.13).
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90°
Figure18.13 Approximate angle at which the perforator is inserted with Stabident® (note that it is in the attached gingiva) and
X- Tip® (note that, in this case, it is in the alveolar mucosa).
Stabident® X- Tip®
The angle over the
vertical axis of the
tooth varies:
● Upper teeth 60–80°
● Lower teeth 50–60°
● The angle over the vertical axis of
the tooth will be ≤90°.
● If the alveolar mucosa is involved,
it should be pulled taut with a
finger of the other hand to
minimize the possibility that the
perforator will become stuck in
the mobile mucosa on activation
and detach it.
○ The handpiece is activated at low speed
000–20 000 rpm):
(15
◼ With irrigation to prevent overheating of the bone
and thus reduce postoperative pain.
◼ With short, intermittent impulses, by applying a
slight pressure. When the perforator reaches the
cancellous bone, we feel it “give” as the resistance of
the cortical bone cedes (Schmitt1936; Bourke1974;
Pearce1976). Sometimes, the patient feels a vibration such as that felt during tartar removal
(Peñarrocha etal.1997).
◼ The maneuver lasts 2–5 seconds (Bourke 1974;
Dunbar etal. 1996; Coggins et al. 1996; Replogle
etal.1997). If it takes more than 5seconds, the procedure should be stopped and the area selected
checked. The greater the hardness or thickness of
the cortical layer, the longer it will take, for example
in the posterior parts of the mandibula or when a
dental root is perforated (serious problem).
● Insert the extrashort needle.
○ Hold the syringe with the needle in place with a pen
grip, with the fingers near the hub to help with insertion (Lilienthal1975a) (Figure18.14).
Stabident® X- Tip®
● Remove perforator.
● Identify the orifice of the
perforation. This is done
by drying and blotting the
area with gauze to clean
up any blood and reveal
the little blood spot on the
inserted gingiva
(Schmitt1936).
● Insert the needle across
the perforation, in exactly
the same direction as the
perforation in order not
to touch the walls of the
orifice. This maneuver
● After perforation, and with
the handpiece stopped, use
tweezers to hold the crown
surrounding the inner
component of the sleeve guide
against the gum so that
when the perforator is
removed from the bone, it
does not drag the guide
sleeve and pull it out of the
bone (Figure18.15).
● Insert the needle across the
orifice in the cusp of the
inner component of the
guide sleeve (Figure18.16).
may prove difficult and
have to be tried a few times
(Figure18.16).
○ The needle should be bent in posterior teeth:
◼ Approximately 45° to facilitate insertion (Dunbar
etal.1996; Coggins etal.1996; Replogle etal.1997;
Parente et al. 1998) and even 60–80° (Gallatin
etal.2003a; Nusstein etal.2003).
◼ Squeeze a few drops of anesthetic out of the tip of
the needle to ensure that bending the needle has not
obstructed the lumen.
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50−80°
Figure18.14 Holding the syringe with a pen grip.
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335
◼ Remember that inserting the needle at the level of
the second molar can prove difficult owing to the
lack of accuracy and of angulation (Leonard1995).
● Slow injection of half a cartridge (0.9 ml) in 30 seconds
(Lilienthal and Reynolds1975b) or even more slowly up
to 2
minutes (Pereira etal.2013), and a whole cartridge
(1.8
ml) in 1–2 minutes. The most common approach is
to inject the whole cartridge (Coggins et al. 1996;
Reisman etal.1997; Replogle etal.1997,1999; Guglielmo
etal.1999; Gallatin etal.2003a).
○ Inject slowly since the solution enters the bloodstream
very quickly (Cannell and Cannon 1976; Wood
etal.2005).
○ Little resistance is noted on injecting since the solution
is entering the cancellous bone.
○ When the injection finishes, the needle should be
pressed for a few seconds to prevent reflux and enable
the anesthetic to spread and reach the apexes
(Pearce1976).
○ The needle is not aspirated: we know that aspiration is
positive in 60–85% of cases because it is inevitably
intravascular (Peñarrocha etal.1996, 2012).
● Withdraw the needle.
Figure18.15 In the X- Tip® system, when the perforator is
withdrawn after perforation, the crown (marked with an arrow)
should be held so that the guide sleeve remains inserted in the
gingiva and bone.
Stabident® X- Tip®
Withdrawal of the needle
leaves a blood spot on the
gum.
● Withdraw the needle from the
guide sleeve.
● Then, withdraw the guide
sleeve from the bone with a
hemostat or pliers.
● Note (X- Tip®): Before withdrawing the guide sleeve,
ensure that the tooth is anesthetized in order to be able to
reinject if necessary, without having to start over.
Figure18.16 Insert the needle for injection.
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● Pulpal anesthesia takes effect quickly (Leonard 1995;
Parente et al.1998; Peñarrocha et al.1996), generally in
about 2
minutes (Gallatin etal.2003a; Nusstein etal.2005b;
Pereira etal. 2013), and lasts about 25
minutes (Nusstein
etal.2005b).
○ If the tooth remains sensitive after 2 minutes, we can
reinject (Magnes 1968; Reisman et al.1997; Parente
etal.1998).
○ Anesthesia is restricted to the tooth and adjacent teeth,
therefore the patient generally experiences few symptoms in the soft tissues. If this approach is used only as
the primary technique, the soft tissue anesthesia can
last 25–30
○ When an intraosseous injection has been performed in
minutes (Lilienthal1976).
the mandibula, the lower lip is affected by soft tissue
anesthesia in 65% of cases (Table18.8).
Efficacy
The efficacy of this technique evaluated using electrical pulp
testing shows that it is successful in 95% of cases in maxillary
teeth and in 85% of cases in mandibular teeth (anterior and
posterior) (Table18.9); the effect of pulpal anesthesia lasts for
around 25 minutes (Nusstein etal.2005b). Evaluation of clinical success (more subjective and less rigorous) reveals a success rate of around 95%, although this may be with one or
two injections (two if the first one fails) (Magnes 1968;
Pearce1976).
Specific Complications
Complications Dueto Mechanical Aspects
1) Pain during perforation of the cortical plate in approxi-
mately 10% of cases (Annex 23). This may be due to the
following:
○ Inappropriate anesthesia of the gum, alveolar
mucosa, and periosteum. This can be improved by
increasing infiltrative anesthesia.
○ Teeth with irreversible acute pulpitis. In such cases,
the tissues are very sensitive despite the infiltrative
anesthesia and anesthesia of the soft tissues. In some
series, moderate-
to- intense pain is recorded in around
50% of cases (Nusstein etal.2003).
○ Perforation of the periodontal ligament or lamina
dura of any of the adjacent teeth. In these cases, we
must remove the drill and modify the angle of perforation or search for an alternative interdental space
mesially or distally.
2) Not perforating the cortical plate in less than 5 seconds
and not feeling that the perforator has reached the cancellous bone. This may be caused by the following:
○ Lack of cancellous bone because the teeth are close
together. The solution is to move the perforation point
mesially or distally.
○ The root of an adjacent tooth is being perforated
(Coggins et al. 1996; Dunbar et al. 1996; Replogle
etal.1997). In terms of touch, a difference can be felt
Table18.9 Percentage ofpulpal anesthesia, evaluated using anelectric pulp tester after theintraosseous technique
withstandard lidocaine 2% withepinephrine 1:100 000 solution (L- 100) and in mesial and distal tooth.
Anesthesia
Pulpal
Tooth Reference Sample size
Maxillary arch
First M Coggins etal. (1996) 40 93% 68% 93%
LI Coggins etal. (1996) 40 90% 73% 88%
Nusstein etal. (2005b) 40 98% — —
Average 93.6% 70% 90%
Rounded average 95%
Mandibular arch
First M Coggins etal. (1996) 40 75% 52% 90%
Replogle etal. (1997) 42 74% 57% 76%
Gallatin etal. (2003a) 41 93% 81% 95%
“ “ 93% 83% 95%
LI Coggins etal. (1996) 40 78% 52% 58%
Average 82.6% 65% 83%
Rounded average 85%
First M, first molar; LI, lateral incisor.
anesthesia
Mesial Distal
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between the bone and the root, and it takes considerable strength to perforate the root (Coggins
etal.1996). The solution in these cases is to reorient
the perforation or change the perforation site.
○ Cortical layer excessively thick (>8 mm). This situa-
tion arises in 2.5% of cases (Table18.7), although it
has arisen in 8% of cases in some series (Peñarrocha
etal.1996). In these situations, the direction of the
perforation can be changed or, if this does not work,
an alternative technique, such as the PDL injection,
can be applied. Remember that with Stabident®, the
angle of perforation may be excessively open or
closed, with the result that the cortical layer becomes
thicker.
3) Excessive pressure is needed to inject the anesthetic
solution. This situation may arise in 10% of cases
(Table18.10) because of the lack of cancellous bone,
obstruction of a bent needle, or insufficient perforation
of the cortical layer (Lilienthal1975a). The measures to
be taken are as follows (Gallatin etal.2003a):
○ Rotate the needle a quarter turn to inject via a differ-
ent part of the bevel, where there may be cancellous
bone or the cortical plate has been perforated.
○ If this does not work, remove the needle and verify
that it is not obstructed. This situation is more common with bent needles.
○ If the all of the above fail, start again.
4) Specific complications of the Stabident® system:
○ Breakage of the perforator with separation of the
metal needle from the plastic shank (2% of cases)
(Table18.10). In this case, the needle can be removed
easily with pliers or a hemostat (Coggins etal.1996;
Replogle et al. 1997; Parente etal.1998). This situation is now uncommon because of improvements in
the materials used.
○ Inability to locate the perforation site to insert the
needle in 8% of patients (Table18.10). This may arise
for two reasons:
1) The alveolar mucosa has been perforated instead
of the attached gingiva, with the result that the
soft tissues move above the perforation in the cortical plate, thus making the insertion site difficult
to locate. If the site is not located after several
attempts, the only solution is to make a second
perforation, only this time in the attached gingiva.
2) The needle is not inserted into the perforation at
the same angle, therefore it makes contact with
the lateral walls and does not cross the cancellous
bone. This situation is common in mandibular
molars (Replogle etal.1997). The solution is one
of trial and error, in which the dentist attempts to
redirect the needle. In the case of posterior teeth, it
could prove useful to bend the needle to reach the
opening more easily. If these approaches fail, we
can start again with a fresh perforation.
5) Specific complications of the X- Tip® system:
○ There are two reports of breakage of the guide sleeve,
which separated from the metal cannula of the plastic
inner component (Gallatin et al. 2003a; Pereira
etal.2013). The solution is to withdraw the metal part
with a hemostat or pliers, given that it projects by
3
mm. The procedure should be restarted or the opening should be used as if we were working with the
Stabident® system.
○ As the openings are larger, reflux of anesthetic solu-
tion via the guide sleeve is observed in approximately
10% of cases (Gallatin et al. 2003a; Nusstein
etal.2003). This can be avoided by pressing the needle in the top part of the inner component of the
guide sleeve for a few seconds after the injection to
enable the solution to spread through the cancellous
bone without reflux.
Note: When the perforation is repeated close to the initial
site as a result of a problem, there is some reflux of the
anesthetic solution through the first opening (Peñarrocha
etal.1996).
Postoperative Complications
Postoperative complications are caused by injury to tissue
resulting from drilling and the maneuvers applied in this
technique. However, they are not associated with the anesthetic solutions used (Replogle etal.1997).
1) Moderate to severe pain at the perforation site in 10% of
cases (Table18.10). This usually disappears spontaneously in 1–3 days (Peñarrocha et al. 1996; Gallatin
etal.2003b).
2) The tooth feels high during occlusion in around 10% of
cases (Table18.10) owing to damage to the periodontal
ligament and inflammation of the bone. This disappears spontaneously in 1–3
days (Replogle etal. 1997;
Gallatin etal.2003b). Occlusion can always be adjusted.
3) Injection site lesions in 5% of cases (Table18.10) with
inflammation, reddening, pain, and even purulent exudate, which may require treatment with antibiotics, disinfectant solution, and analgesics (Coggins etal.1996;
Peñarrocha etal.1996; Replogle etal.1997). This may
last up to 14 days (Coggins et al. 1996; Replogle
etal.1997). In addition, these lesions are thought to be
caused by overheating of the bone and pressure during
drilling. Hematomas have also been reported (Dunbar
et al. 1996), as have aphthous ulcers (Replogle
etal.1997), which resolve spontaneously in a few days.
4) Osteonecrosis. There is one report of osteonecrosis that
resulted in extraction of the two mandibular molars in
an HIV- infected patient who was taking antiretroviral
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Table18.10 Percentage ofcomplications ofthe intraosseous technique during theprocedure andafterwards.
Study data Complications during technique Complications after surgery
Excessive
Reference System Sample size
Leonard (1995) Stabident® 89 11% — 4% — — —
Coggins etal. (1996) Stabident® 40–160 9% 0.6% — 2–15% 4% 3%
Dunbar etal. (1996) Stabident® 40 15% —
Peñarrocha etal. (1996) Stabident® 50 —
Replogle etal. (1997) Stabident® 44–84 19% 4% 10% 2–10% 13% 5%
Parente etal. (1998) Stabident® 37 —
Reitz etal. (1998) Stabident® 38 — — — 11% 0% 0%
Guglielmo etal. (1999) Stabident® 80 —
Gallatin etal. (2003a) and
Gallatin etal. (2003b)
Gallatin etal. (2003b) X- Tip® 41 2.5% 2.5% — 25% 15% 22%
Nusstein etal. (2003) XPeñarrocha- Oltra etal.
(2012)
Pereira etal. (2013) X- Tip® 60 — 1.5% — — — 1.5%
Stabident® 41 12% 0% —
Tip® 33 18% 0% — — — —
Stabident® 100 — 6% 6% 11% — —
Average 12.4% 2.2% 7.5% 11% 8% 4.9%
Rounded average 10% 2% 8% 10% 10% 5%
pressure
— 10% 24% — 2%
3% — — — —
— — 10–13% 9% 3%
Perforator
breakage
— 2% 10% 3%
Failure to locate
perforation Severe pain High teeth
7% 5% 5%
Local
lesions
drugs. In this case, the X- Tip® system was used by a
young, inexperienced dentist who may have applied the
technique without irrigation. These factors may have
contributed to the accident (Woodmansey etal.2009).
Final note: The intraosseous technique has fewer adverse
effects than the PDL injection.
Pulpal Abnormalities
Pulpal abnormalities have not been detected in humans in
clinical studies to date (Dunbar et al. 1996; Replogle
etal.1997; Reitz etal.1998; Guglielmo etal.1999; Gallatin
etal.2003b).
Final Remarks
When performed with pressure, the intrapulpal technique
is 100% effective (see above). However, in endodontic treatments, it is often necessary to reach the pulp (this may be
impossible because of the pain in acute pulpitis) and the
technique is of no use in nonpulpal treatments (e.g. cutting
or a very deep cavity). In these cases, we can use the PDL
injection and intraosseous technique, both of which
require special equipment and have advantages and disadvantages, as follows:
● Advantages of the intraosseous technique over the PDL
injection:
○ Greater pulpal anesthesia in the first injection (85% vs.
65% in acute pulpitis [Annex 35]).
○ Greater duration of pulpal anesthesia (25 minutes vs.
10
minutes).
○ Fewer postoperative adverse events.
● Disadvantages of the intraosseous technique with respect
to PDL injection:
○ Later onset of pulpal anesthesia (2 minutes vs. 30 sec-
onds), although this is of little clinical relevance.
○ The rubber dam has to be removed during endodontic
treatments.
○ In central incisors (upper and lower) with little can-
cellous bone, it is not possible to use the intraosseous technique, therefore the PDL injection must
be used.
t.me/Dr_Mouayyad_AlbtousH
References
https://t.me/med1917
339
Alantar, A. (1993). L´anesthésie intraseptale. A propos de sept
cas cliniques. Rev. Odonto Stomatol. (Paris) 22 (2): 105–112.
Albers, D.D. and Ellinger, R.F. (1988). Histologic effects of
high pressure intraligamental injections on the periodontal
ligament. Quintessence Int. 19 (5): 361–363.
Annex 23. Pain resulting from injection techniques.
Annex 35. Irreversible acute pulpitis (hot tooth). Efficacy of
dental local anesthesia.
Ashkenazi, M., Blumer, S., and Eli, I. (2010). Effect of
computerized delivery intraligamental injection in primary
molars on their corresponding permanent tooth buds. Int.
J. Paediatr. Dent. 20 (4): 270–275.
Berini, L. and Gay, C. (1997). Anestesia odontológica. Madrid:
Ediciones Avances Médico- Dentales SL. 201.
Berlin, J., Nusstein, J., Reader, A. etal. (2005). Efficacy of
articaine and lidocaine in a primary intraligamentary
injection administered with a computer- controlled local
anesthetic delivery system. Oral Surg. Oral Med. Oral
Pathol. 99 (3): 361–366.
Bigby, J., Reader, A., Nusstein, J. etal. (2006). Articaine for
supplemental intraosseous anesthesia in patients with
irreversible pulpitis. J. Endod. 32 (11): 1044–1047.
Birchfield, J. and Rosenberg, P.A. (1975). Role of the
anesthetic solution in intrapulpal anesthesia. J. Endod.
1(1): 26–27.
Bourke, K. (1974). Intra- osseous anaesthesia. Dent. Anaesth.
Sedat. 3 (2): 13–19.
Bowers, G.M. (1963). A study of the width of attached
gingiva. J. Perodontol. 34 (3): 201–209.
Brännström, M., Nordenvall, K.- J., and Hedström,
K.G. (1982). Periodontal tissue changes after
intraligamentary anesthesia. J. Dent. Child. 49 (6): 417–423.
Brännström, M., Lindskog, S., and Nordenvall, K.-
Enamel hypoplasia in permanent teeth induced by
periodontal ligament anesthesia of primary teeth. J. Am.
Dent. Assoc. 109 (5): 735–736.
Cannell, H. and Cannon, P.D. (1976). Intraosseous injections
of lignocaine local anaesthetics. Br. Dent. J. 141 (2): 48–50.
Cannell, H., Kerawala, C., Webster, K., and Whelpton,
R. (1993). Are intraligamentary injections intravascular?
Br. Dent. J. 175 (8): 281–284.
Cassamani C. Une nouvelle technique d’anesthesia
intraligamentaire. These de Doctorat. Paris. 1924.
Chenaux, G., Castagnola, L., and Colombo, A. (1976).
L´anesthésie intraligamentaire avec la seringue “Péripress”.
Scheweiz Monatsschr. Zahnheilkd. 86 (11): 1165–1173.
Childers, M., Reader, A., Nist, R. etal. (1996). Anesthetic
efficacy of the periodontal ligament injection after an
inferior alveolar nerve block. J. Endod. 22 (6): 317–320.
J. (1984).
Coggins, R., Reader, A., Nist, R. etal. (1996). Anesthetic
efficacy of the intraosseous injection in maxillary and
mandibular teeth. Oral Surg. Oral Med. Oral Pathol. 81 (6):
634–641.
Cohen, H.P., Cha, B.Y., and Spangberg, L.S.W. (1993).
Endodontic anesthesia in mandibular molars: a clinical
study. J. Endod. 19 (7): 370–373.
Coolidge, E.D. (1937). The thickness of the human periodontal
membrane. J. Am. Dent. Assoc. Dent. Cosmos 24 (8):
1260–1270.
Council on Clinical Affairs (2015). Guideline on use of local
anesthesia for pediatric dental patients. Pediatr. Dent. 37
(Special issue): 199–205.
Council on Dental Materials, Instruments, and Equipment
(1983). Status report: the periodontal ligament injection.
J. Am. Dent. Assoc. 106 (2): 222–224.
Cowan, A. (1986). A clinical assessment of the
intraligamentary injection. Br. Dent. J. 161 (8): 296–298.
D’Souza, J.E., Walton, R.E., and Peterson, L.C. (1987).
Periodontal ligament injection: an evaluation of the extent
of anesthesia and postinjection discomfort. J. Am. Dent.
Assoc. 114 (3): 341–344.
Davidson, L. and Craig, S. (1987). The use of the
periodontal ligament injection in children. J. Dent. 15
(5): 2004–2008.
Denio, D., Torabinejad, M., and Bakland, L.K. (1992).
Anatomical relationship of the mandibular canal to its
surrounding structures in mature mandibles. J. Endod. 18
(4): 161–165.
DeNunzio, M. (1998). Topical anesthetic as an adjunct to
local anesthesia during pulpectomies. J. Endod. 24 (3):
202–203.
Dreven, L.J., Reader, A., Beck, M. etal. (1987). An evaluation
of an electric pulp tester as a measure of analgesia in
human vital teeth. J. Endod. 13 (5): 233–238.
Dreyer, W.P., Heerden, J.D., and Joubert JJ de V. (1983). The
route of periodontal ligament injection of local anesthetic
solution. J. Endod. 9 (11): 471–474.
Dunbar, D., Reader, A., Nist, R. etal. (1996). Anesthetic
efficacy of the intraosseous injection after an inferior
alveolar nerve block. J. Endod. 22 (9): 481–486.
Edwards, R.W. and Head, T.W. (1989). A clinical trial of
intraligamentary anesthesia. J. Dent. Res. 68 (7):
1210–1214.
Faulkner, R.K. (1983). The high- pressure periodontal
ligament injection. Br. Dent. J. 154 (4): 103–105.
Fuhs, Q.M., Walker, W.A. III, Gough, R.W. etal. (1983). The
periodontal ligament injection: histological effects on the
periodontium in dogs. J. Endod. 9 (10): 411–415.
t.me/Dr_Mouayyad_AlbtousH
https://t.me/med1917
340
Galili, D., Kaufman, E., Garfunkel, A.A., and Michael,
Y. (1984). Intraligamentary anesthesia– a histological
study. Int. J. Oral Surg. 13 (6): 511–516.
Gallatin, J., Reader, A., Nusstein, J. etal. (2003a). A
comparison of two intraosseous anesthetic techniques in
mandibular posterior teeth. J. Am. Dent. Assoc. 134 (11):
1476–1484.
Gallatin, J., Nusstein, J., Reader, A. etal. (2003b). Comparison
of injection pain and postoperative pain of two
intraosseosus anesthetic techniques. Anesth. Prog. 50 (3):
111–120.
Garfunkel, A.A., Kaufman, E., Marmary, Y., and Galili,
D. (1983). Intraligamentary– intraosseous anesthesia.
Aradiographic demonstration. Int. J. Oral Surg. 12 (5):
334–339.
Giffin, K.M. (1994). Providing intraosseous anesthesia with
minimal invasion. J. Am. Dent. Assoc. 125 (8): 1119–1121.
Goaslind, G.D., Robertson, P.B., Mahan, C.J. etal. (1977).
Thickness of facial gingiva. J. Periodontol. 48 (12): 768–771.
Graetz, C., Fawzy-
E. (2013). Root damage induced by intraosseous
C.anesthesia– an invitro investigation. Med. Oral Patol. Oral
Cir. Bucal 18 (1): e130–e134.
Gray, R.J.M. and Rood, J.P. (1987). Periodontal ligament
injection: with or without a vasoconstrictor. Br. Dent. J. 162
(7): 263–265.
Grundy, J.R. (1984). Intraligamentary anaesthesia. A survey
of use by general practitioners and by staff and students in
a dental school. Restorative Dent. 1 (2): 36–42.
Guglielmo, A., Reader, A., Nist, R. etal. (1999). Anesthetic
efficacy and heart rate effects of the supplemental
intraosseous injections of 2% mepivacaine with
1:20,000levonordefrin. Oral Surg. Oral Med. Oral Pathol.
87 (3): 284–293.
Handler, L.E. and Albers, D.D. (1987). The effects of the
vasoconstrictor epinephrine on the duration of pulpal
anesthesia using the intraligamentary injection. J. Am.
Dent. Assoc. 114 (6): 807–809.
Hawkins, J.M. and Moore, P.A. (2002). Local anesthesia:
advances in agents and techniques. Dent. Clin. N. Am. 46
(4): 719–732.
Hochman, M.N., Friedman, M.J., Williams, W., and
Hochman, C.B. (2006). Interstitial tissue pressure
associated with dental injections: a clinical study.
Quintessence Int. 37 (6): 469–476.
Hull, T.E. and Rothwell, B.R. (1998). Intraosseous anesthesia
comparing lidocaine and etidocaine. J. Dent. Res. 77
(Special issue A): 197. (abstract no. 733).
Johnson, G.K., Hlava, G.L., and Kalkwarf, K.L. (1985). A
comparison of periodontal intraligamental anesthesia
using etidocaine HCL and lidocaine HCL. Anesth. Prog.
32(5): 202–205.
El- Sayed, K.- M., Graetz, N., and Dörfer,
Kaufman, E., Valli, D., and Garfunkel, A.A. (1983).
Intraligamentary anesthesia: a clinical study. J. Prost. Dent.
49 (3): 337–339.
Kaufman, E., Dworkin, S.F., LeResche, L. etal. (1984).
Intraligamentary anesthesia: a doublestudy. J. Am. Dent. Assoc. 108 (2): 175–178.
Kaufman, E., Solomon, V., Rozen, L., and Peltz, R. (1994).
Pulpal anesthesia efficacy of four lidocaine solutions
injected with an intraligamentary syringe. Oral Surg. Oral
Med. Oral Pathol. 78 (1): 17–21.
Khedari, A.J. (1982). Alternative to mandibular block
injections through intraligamental anesthesia. Quintessence
Int. 13 (2): 231–237.
Kim, S. (1986). Ligament injection: a physiological
explanation of its efficacy. J. Endod. 12 (10): 486–491.
Kleber, C.H. (2003). Intraosseous anesthesia. Implications,
instrumentation and techniques. J. Am. Dent. Assoc. 134
(4): 487–491.
Kronfeld, R. (1931). Histologic study of the influence of
function on the human periodontal membrane. J. Am.
Dent. Assoc. 18: 1242–1274.
Lafargue, R. (1973). Anesthésie intraligamentaire
possibilitésd´une nouvelle technique. Actual
Odontostomatol. (Paris) 27 (103): 551–573.
Lamian, L. and Simard-
intrapulpal injections on the systemic blood pressure.
J. Dent. Res. 58 (A): 209. (abstract no. 465).
Leonard, M.S. (1995). The efficacy of an intraosseous
injection system of delivering local anesthetic. J. Am. Dent.
Assoc. 126 (1): 81–86.
Lilienthal, B. (1975a). A clinical appraisal of intraosseous
dental anesthesia. Oral Surg. Oral Med. Oral Pathol. 39 (5):
692–697.
Lilienthal, B. (1976). Cardiovascular responses to intraosseous
injections of prilocaine containing vasoconstrictors. Oral
Surg. Oral Med. Oral Pathol. 42 (5): 552–556.
Lilienthal, B. and Reynolds, A.K. (1975b). Cardiovascular
responses to intraosseous injections containing
catecholamines. Oral Surg. Oral Med. Oral Pathol. 40 (5):
574–583.
List, G., Meister, F.J., Nery, E.B., and Prey, J.H. (1988).
Gingival crevicular fluid response to various solutions
using the intraligamentary injection. Quintessence Int.
19(8): 559–563.
Magnes, G.D. (1968). Intraosseous anesthesia. Anesth. Prog.
15 (9): 264–267.
Maita, E. and Horiuchi, H. (1984). Measurements of
pressures developed in the syringe during dental
infiltration anaesthesia. Br. Dent. J. 156 (11): 399–400.
Malamed, S.F. (1982). The periodontal ligament (PDL)
injection: an alternative to inferior alveolar nerve block.
Oral Surg. Oral Med. Oral Pathol. 53 (2): 117–121.
Savoie, S. (1979). The effect of
blind comparative
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