The different anesthetic techniques that are used in dentistry are aimed primarily at the pain control.

Pain can be controlled directly, eliminating the cause, or indirectly, blocking the transmission of nerve stimuli. This can be accomplished with locoregional anesthesia, sedation, or general outpatient anesthesia.

Locoregional anesthesia aims to abolish pain sensitivityEither of the limited area, using local or infiltrative anesthesia, or when it comprises a more external area (involving the area innervated by a specific nerve trunk), regional or truncal anesthesia.

How are infiltrative and truncal anesthesia applied

The infiltrative anesthesia or also called supraperiosteal periapical anesthesia, it is the anesthesia technique that is used most frequently in dental practice. This type of technique consists of injecting the anesthetic around the nerve endings or those nerve fibers that are not macroscopically identifiable. The anesthetic is deposited between the mucosa and the periosteum at the level of the dental apex. It is the most used technique in dentistry, and is often called infiltrative. Thus, the local anesthetic has to pass through the periosteum, the external cortex and the part of the bone marrow of the maxilla, until it reaches the level of the nerve fibers that penetrate the apical foramen.

The truncal anesthesia It can be done using two techniques: the direct technique or the indirect technique.

The direct technique of truncal anesthesia is performed in a single stage and anesthesia is obtained first from the inferior alveolar nerve and then from the lingual nerve. The patient should be seated, with the head slightly inclined and with maximum mouth opening. The cheek is traced until it reaches the level of the external oblique line of the mandible, in order to have a greater visibility of the site where the puncture will be performed.

Next, to locate the puncture area, the occlusal faces of the lower molars are taken as a reference, in adults 1 centimeter above these, in children at the same level as these and in edentulous people it is located 2 centimeters from the alveolar rim. Placing the body of the syringe at the level of the contralateral premolars. With this position, the needle is inserted approximately 2 centimeters until it comes into contact with the bone, when this happens it goes back 1 millimeter and then aspiration is performed, if no blood is aspirated, the anesthetic is injected slowly. Afterwards, the needle is withdrawn halfway and it is aspirated, and if no blood is aspirated, the anesthetic is injected. Finally, the needle is carefully withdrawn, as smoothly as possible.

The indirect technique is based on following a path all the time hooked to the inside of the ascending ramus of the mandible. This indirect technique is the one recommended for the inexperienced dentist. The body of the syringe rests on the occlusal aspect of the ipsilateral molarsSliding backwards, the mucosa and buccinator muscle are perforated until they collide with the retromolar trigone bone. The syringe is then forced towards the ipsilateral labial commissure to overcome the obstacle posed by the temporal ridge. The needle is advanced, parallel to the surface of the retromolar trigone, and when the temporal crest is passed, it must be stopped.

Finally, the syringe is brought to the contralateral side, to the premolar area, and the needle is made to slide over the internal cortex of the ascending ramus until reaching the spine of Spix. Just at the beginning of this tour, a little anesthetic is injected to numb the lingual nerve. Once Spix’s spine is reached, 1 millimeter is removed, aspirated, and the anesthetic is injected.


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