by Michael DiTolla, DDS, FAGD
As I get set to enter my 20th year of clinical practice, I can finally say that I am happy with my injection technique for all types of injections. No wonder they call it practice!
With the combination of the ultra-strong topical Profound and the computer-controlled Single Tooth Anesthesia (STA) anesthesia device, I can predictably give painless injections.
I use this product (available from Steven’s Pharmacy at www.stevensrx.com) as a topical prior to all injections. This includes the molar furcation injections for which the STA was made. Profound works well because it is a combination of prilocaine, lidocaine and tetracaine. Meanwhile, most topicals are just benzocaine.
The STA anesthesia device has made it easy to anesthetize individual mandibular molars. In dental school, we were taught the inferior alveolar block. It was certainly the toughest injection to learn. Expereinced clinicians have learned that the success rates of maxillary and mandibular anesthesia are different. I have even joked at lectures that I am so good at local anesthesia that I never miss a maxillary infiltration!
With thinner bone over the apices of the maxillary teeth and easier access to the nerve blocks we give in the maxillary, success rates usually approach 95 to 98 percent. These rates are even applicable for less-experienced practitioners.
Unfortunately, the same thing cannot be said of the mandible. In addition to being an unpleasant injection, the success rate for IA blocks in the mandible hovers around 80 percent. According to Dr. Stanley Malamed, due to the density of the bone in the mandible, you should place the anesthetic solution to within 1 mm of the target nerve. The day I learned about the 1 mm rule was the day I started looking for mandibular block alternatives.
Due to anatomical variation of the position of the mandibular foramen and the depth of soft-tissue penetration that is necessary to get there, this injection is missed more than any other. It has a positive aspiration rate of 10 to 15 percent. This is the highest of all intraoral injection techniques. In addition, the patient can be saddled with lingual and lower lip anesthesia for which no one is pleased. Many dental schools recommend giving this injection with a 25-gauge needle. This makes it difficult to do it painlessly.
While doing a quadrant of dentistry or a whole side, such as the lower left, the IA block still makes sense. But to use the IA block for one or two teeth strikes me as overkill. This is a lot of soft-tissue anesthesia for a couple of teeth. At the lab, most of the cases I see are still one or two adjacent crowns. For these types of cases, I have stopped giving lower blocks.
When you add up these facts, it becomes apparent that mandibular blocks are not necessarily the easiest path to anesthesia. So, when I learned about a technique that afforded fast and painless anesthesia of lower molars, I was interested. This is for cases in which I am prepping one or two posterior molars only, and I want to be able to work relatively quickly.
To be honest, in past lectures, I made fun of devices like the STA. I always wondered why I needed a $1,500 product to do what I could do with a $20 syringe. Did I really need a computer to give a slow injection for me? Had I not been giving slow injections my whole career much to the pleasure of my patients?
I always hated having to give a carpule on a lower block and then remove the syringe, load another carpule, and reinject. I have long dreamed about a double-sized carpule. When I saw that the STA allows you to load a second carpule without removing the needle, I was sold on the product.
What I didn’t realize was how stress-free it makes injections, especially when you have to give multiple maxillary infiltrations. Of course, the fact that it works with the Rapid Anesthesia technique (featured on my latest DVD) of injecting into the furcation of a lower molar to achieve single tooth anesthesia, made this product an easy purchase for me.
For more information on the product and clinical techniques, go to www.stais4u.com.Dr. Michael DiTolla is the Director of Clinical Research and Education at Glidewell Laboratories in Newport Beach, Calif. He lectures nationwide on both restorative and cosmetic dentistry. Dr. DiTolla has several free clinical programs available online or on DVD at www.glidewell-lab.com. For more information on this article or his seminars, please contact him at www.drditolla.com.
