hi I'm dr. Michael at Ola and I'd like to welcome you to this clinical presentation on the rapid
anesthesia technique this is the technique that I stumbled on two years ago because of
my frustration giving lower blocks and if you look at the literature you'll see that I'm not
the only one frustrated with lower blocks because the incidence of a missed lower block on the first
attempt is about 15 to 20 percent if you look through the literature and I just got tired of
having to reinterpreting the tooth they would still feel it in one spot so we could prep the
entire tooth but every time we went around the distal buccal the patient would jump and when
that would happen and I would give them another carpool as a block and that still wouldn't help
I would finally go to the league Magette and I'd give a PDL injection at that spot at the
distal lingual spot and then the patient would be numb and I'd handling Magette to my assistant
I say good old league Magette it always works and she's and she said one day if that always
works then why don't we do that right off the bat and I had to think and I said because because I'm
the doctor and you're the assistant and I make the rules and you're right as it turns out and so as
I thought about it more I thought why don't we do that and right about that time I saw somebody who
was showing a technique on dental town which was doing single tooth anesthesia with a lid
Magette the only thing I didn't like about that technique was the fact that I could never tell
if I was getting a good PDL injection or not and so I was doing this technique by hand and
I liked the results I didn't like the uncertainty of knowing whether or not I was there you really
never really knew if the patient was anesthetized until you started prepping the tooth but at least
I hadn't given him a couple blocks where I had missed and started prepping and then had to go
back in so a few years back when I stumbled on to milestones Scientifics sta device the single
tooth anesthesia device which is basically made exactly for this purpose it's made to
anesthetize single teeth and so the first thing I started to do was anesthetized lower molars
with it so I wouldn't have to give lower blocks anymore and there is a small learning curve like
there is with any technique in dentistry but once I began to master this technique I loved
the fact that I didn't have to give lower blocks anymore the patients loved it even more you know
for all the things we talked about in dental practice that patients really love this is one
that they do really love not having to open wide for a lower block not having to have a 27 gauge
extra-long needle go through two muscles to get back to the injection site it's really a nice way
to do it as you'll see we just go to one or two spots on the tooth it's basically a closed mouth
injection they really don't have to open wide and it's one where you can really sneak in there and
give this injection and with the combination of the super-strong topical that you're going to see
here and the ability to give this PDL injection to get profound Popol anesthesia on these molars it's
a win win for the doctor and the patient alike so let's go ahead and take a little closer look
at the STA device itself this is the STA device from milestone scientific this is kind of the the
follow-up to the wand and the wand was their first product and I never really used that in
fact I kind of used to make fun of it because it was just basically it was a system like this that
was able to give injections electronically but it didn't have the dynamic pressure sensing that the
STA device has which allows you to see whether or not you're in the PDL space so when you use the
single anesthesia setting the STA setting right here as you'll see in the video as the pressure
increases letting you know that you're in the PDL you get audio tones and you get visual tones as
these lights begin to light up and that lets you know that you're in the right position and that
you're giving a PDL ejection that that will result in profound Popol anesthesia you can see we've got
a full carpool Hillier as well we have a couple other speeds for infiltrations on the upper if
you need to give an infiltration a normal and a turbo and there's two speeds within each of
those in fact you can actually if you're going to use this for a lower block I still do give lower
blocks I love the single tooth anesthesia for single molars but if I'm working on two molars
or a whole lower quadrant I'm still going to give a lower block because it it makes sense to me not
to go to each individual tooth and do this sta technique the great thing about the sta technique
is as soon as you set the syringe down you can start prepping the tooth you don't have to wait
ten minutes for the anesthetic to soak in but when we've got a quadrant you know and you're going to
go do that to each of these different teeth spend 60 to 90 seconds and neset izing them and then you
only get 45 minutes of Popol anesthesia that's not quite enough so I'm still going to use a block I
love giving blocks with the STA and the reason is you'll notice where the anaesthetic car pool
is actually located so in the patient's mouth when we give the block and we actually penetrate with
the needle I can spend a whole carpool getting back to where I need to go to tap around on the
inside of the mandible looking for the mandibular nerve and then once we use up that car pool we can
take this out here the needle stays in the mouth my assistant will load another carpool in put it
back into the device and I can give a second carpool now with the tip of the needle all the
way back where it needs to be in fact I can give a third car fuel and come out and get the lingual
nerve and the long buccal on the way out as well so the ability to give multiple anaesthetic car
peels without taking the needle out and having to penetrate the mucosa three different times is huge
for me because I'm all about comfort when it comes to the patient so it's one needle stick and then
I can give three car pills without ever taking it out of the patient's mouth and that's a big
deal for me that actually makes blocks a much more pleasurable to give on the occasions where I have
to give the block so there's a couple different speeds that you'll see here for in filtrations I
now use it on all single teeth whether I'm working in the mandible or the maxilla and I use it for
the blocks as well you can see it automatically aspirates when you let off the foot pedal if you
have that setting turned on as well and so it's it's really gone from something that's taken my
single tooth anesthesia from the old days of using a hand League Magette and guessing if I was in the
PDL space to scientifically knowing that I'm in the PDL space and being able to do predictable
single tooth anesthesia and in those cases where I do have to give a block it allows me to give them
them in a very patient friendly way and I can tell you this now that I give three car peels
for lower blocks one to get back where I'm going a full second one at the at the target zone and then
a third one at the target zone and then getting the lingual and the long buccal on the way out I
do not miss many lower blocks anymore doing that but the patient still has to be completely numb
on their cheeks in their tongue and they're going to be numb for hours so the patient still prefers
that we do the single single tooth anesthesia whenever we can but I do love giving blocks
with this device as well let's go ahead and take a closer look at the STA being used in the rapid
anesthesia technique clinically you can see here I'm putting some pfg gel on the lingual into the
lingual sulcus of this lower molar that we're getting ready to prepare and this P of G gel is
extremely strong in fact it's the most profound local anesthesia that I've ever found and we use
the P of G gel at full strength when we're using it in a sulcus like this if we're using it in a
vestibule you know before an infiltration we'll use the P of G light the half-strength version
of this and so once we do that I slowly place the tip of the needle into the sulcus give a few drops
and then I slowly advance the tip of the needle into the attachment and down to the bone and when
you're in a spot where you've got healthy tissue you can see the lights and you can hear the audio
tones as the signals progress up letting you know that you're encountering more pressure at the tip
of the needle when the lights get all the way to the right and have filled up the entire bar you
get an audio response telling you PDL PDL and it actually tells you that you're in the PDL if you
don't get in that spot you can take the needle out and move to another position on the sulcus
in fact many times on these molars I will do the distal lingual first and then move to the mesial
lingual because typically once I get the PDL Alert I'm only going to put about half a car
pool maybe a quarter to half a car people in that area and then move on to another area like the
mesial-lingual here and usually by the time you finish the mesial-lingual you've got that whole
papilla numb and approximately and so I'll just come over a lot of times on the buccal if I have
a few drops left and do a little infiltration over there if I feel the need to go under the tissue on
the buccal I'm just doing it here is demonstration you can see where the margin is on that gold crown
with the recurrent decay that we're replacing and we're not going to have to go sub gingival on the
buccal and the great thing is as soon as we finish giving the anesthesia we have profound anesthesia
we can set down the syringe and pick up the handpiece as you can see here we're working
on a first bicuspid and we're going to be doing a restorative procedure on crown and it's the same
thing so I'm going to give single tooth anesthesia on this upper bicuspid and by doing this I'm going
to make sure that we don't numb the lip and it's not a painful injection so we've got the P of
G gel on again it's going to be on for about 45 seconds into the sulcus with the alternate syringe
we rinse it out now we take the 30 gauge extra short needle and slip it into the sulcus before
we penetrate the attachment we're going to give a couple of drops of anesthetic I honestly don't
know if that does anything but it makes me feel better so I guess it does that but I also feel
like if you've got a technique and it's working why switch from it once we give a couple drops
in the FERC Asian I mean in the attachment we're going to slide through to the tip of the needle
hits the bone doesn't take a lot of pressure when you get down to that area and now we're inserting
the tip of the needle at the mesial facial line angle and again just giving a few drops here this
is less important to hit these different areas but the point is on a single rooted tooth like
this or even a bicuspid that might have two roots if you go into one area and you don't get the PDL
signal you may have a localized periodontal condition there that's not allowing you to
achieve a successful PDL injection and so you don't just set it down and say okay well I'm
guess I'm going to have to give a block here you look for a night or the area because it only takes
one area for you to be successful in order to get that tooth profoundly numb and so it may not be in
an area where you've got an app fraction lesion or maybe some gingival recession where you're going
to be able to do that you might have to scooch forward to a mesial area as we did here and be
able to do it and then never count out the lingual as well you know it's not a true palatal injection
when you do the sta injection on the lingual because of the fact that we're not penetrating
that fibrous palatal tissue we're still just going into the sulcus albeit on the lingual rather than
the facial but as far as pain perception from the patient I haven't noticed any difference whether
on the we're on the lingual or the facial of the tooth so don't become discouraged if it doesn't
work in the first spot that you go to there may be some anatomical underlying reason why you can't
see maybe there's some anomaly on the tooth where the bevels not in close contact with it it's not
a reason to get discouraged if I don't see the lights climbing and I don't hear the audio tones
going up when I'm in where an area I'll simply remove the tip of the needle from the sulcus and
I'll ask my assistant Jen can I have a little suction here because it's almost always under
a little bit of pressure and so when you take it out you do get a squirt of anesthesia so if
the suctions next to it the patient won't taste any of it and then I move the tip of the needle
to another area and and just prospect again you know take that down through the attachment down to
the bone and start to give anesthesia and see if we're going to hear the the PDL tone to say in one
spot if you're not getting the climbing escalating tones and the lights going up on the STA unit it's
kind of silly because there's nothing magically that's going to happen to make that a good area
and so you need to take that out and do it and and some dentists say well isn't that a little
frustrating and no it's not because at least I can see what I'm doing when I would give a lower block
and I'd be in the wrong spot I had no indication that I was in the wrong spot and I could try to go
higher quote-unquote with the needle next time but I still wasn't exactly sure where I was going I
like when I have to move around being able to see exactly where I'm placing the tip of the needle
in the sulcus so even when it doesn't work on the first and in some cases the second attempt I feel
like I'm really in control because I can see what I'm doing as I go to another area and try that
out and so this tooth is now numb and you can see we're using our round bur as the first step of the
reverse preparation technique and here we are on an anterior tooth this is tooth number nine again
using the pfg gel placing it into the sulcus with an ultra dent syringe and tip and we leave that on
for about 45 seconds and we're going to rinse this off and so when we're working on a single anterior
tooth like this how much more comfortable is it to give one of these pain-free PDL injections
than it is to do an infiltration where we go under the lip in the anterior right under the
patient's nose patients definitely feel these in filtrations it's probably the most painful
infiltration we give you always know that as the patient starts to get numb it irritates their nose
and their sinus starts to drain and they become convinced that the anesthetic is spilling back
into their throat even though that's anatomically impossible when we're giving a maxillary until
tration and they feel like it's going down their throat and it's it's hard to convince them that
it's not is they feel some sort of fluid salty fluid going down the throat but it's probably
from their sinuses so as we go in here we pick that one spot and you can see the blanching where
I got the PDL alert and we put about a quarter carpel in there and then we'll just move over a
little bit you can see on the mesial and by doing this we're going to get some bleed through to the
lingual for that tissue and we use septa cane as you see every time we do one of these PDL
in filtrations with one to two hundred thousand epinephrine because of the fact that it does have
half the epinephrine that we're used to using and it's really absorbed so well that we're able to
usually not have to give any kind of injection on the palatal to be able to pack cord over on that
side as well so we've got profound pulp Leninist even as you can see here we're starting the first
step of the reverse preparation technique by breaking the contacts on behalf of all of us
here at the laboratory thanks for your time and your continued commitment to quality dentistry
you