armamentarium for la
TRANSCRIPT
ARMAMENT
ARIU
M- Vishal gohil- Nancy hirpara- Bhakti jivani
The equipment necessary for the administration of local anesthetics and for the extraction of the tooth introduced in armamentarium
Armamentaria have evolved to ease surgery ,shortening on table time, widening the surgical field, increasing visibility,mimimizing trauma to surgical areas etc
OBJECTIVES To provide an optimal surgical field For optimum visibility To decrease physical strain of the surgeon To enable patient comfort To protect vital structures
EQUIPMENTI. SyringeII. NeedleIII. Cartridge
ADA CRITERIA FOR ACCEPTANCE OF LOCAL ANESTHETIC SYRINGE 1. they must be durable and able to
withstand repeated sterilization without damage
2. they should be capable of accepting a wide variety of cartridge and needles of different manufacture and should permit repeated use
3. inexpensive , self-contained , lightweight and simple to use with one hand
4. they should provide for effective aspiration and be constructed so that blood may be easily observed in the cartridge
I. SYRINGE It is the vehicle whereby the contents of the anesthetic
cartridge are delivered through the needle to the patient. Four types: 1. Nondisposable syringes: a. Breech-loading , metallic , cartridge-type , aspirating b. Breech-loading , plastic , cartridge-type , aspirating c. Breech-loading , metallic , cartridge-type , self-aspirating d. Pressure syringe for periodontal ligament injection e. Jet injector (needle-less syringe) 2. Disposable syringe 3. Safety syringes 4. Computer-controlled local anesthetic delivery systems
1. NONDISPOSABLE SYRINGESo A. Breech-loading metallic cartridge type aspirating syringe - most commonly used in dentistry - breech loading implies that the cartridge is inserted into the syringe from the side of the barrel of the syringe - the needle is attached to barrel of the syringe at the needle adaptor - the needle than passes into the barrel, where it penetrates the diaphragm of local anesthetic cartridge - the needle adaptor is removable and sometimes is discarded inadvertently along with disposable needle
METALLIC BREECH-LOADING , ASPIRATING SYRINGE........Advantages - visible cartridge - aspiration with one
hand - autoclavable - rust resistant - long lasting with
proper maintenance
Disadvantages - weight(heavier than
plastic syringe) - syringe may be too
big for small operators
- possibility of infection with improper care
B. Breech-loading , plastic , cartridge-type aspirating syringe - a plastic, reusable, dental aspirating
syringe is available that is both autoclavable and chemically sterlizable - with proper handling, this syringe may be used for multiple anesthetic
administrations before it is discarded
PLASTIC, REUSABLE, ASPIRATING SYRINGE......... Advantages - plastic eliminates
metallic,clinical look - lightweight: provide
better feel during injection
- cartridge is visible - aspiration with one
hand - rust resistant - long lasting with proper
maintenance - low cost
Disadvantages - size(may be too big
for small operators) - possibility of
infection with improper care
- deterioration of plastic with repeated autoclaving
C. Breech-loading , metallic , cartridge-type , self- aspirating syringe - to increase ease of aspiration , self-aspirating syringes have been developed - these syringes use the elasticity of the rubber diaphragm in the anesthetic cartridge to obtain the necessary negative pressure for aspiration - the use of a self-aspirating dental syringe permits easy performance of multiple aspirations throughout the period of local anesthetic deposition
METALLIC , SELF-ASPIRATING SYRINGES....... Advantages - cartridge visible - easier to aspirate with
small hands - autoclavable - rust resistant - long lasting with proper
maintenance - piston is
scored(indicates volume of local anesthetic administered)
Disadvantages - weight - feeling of insecurity
for doctors accustomed to harpoon-type syringe
- finger must be moved from thumb ring to thumb disc to aspirate
- possibility of infection with improper care
D. Pressure syringes - it is brought about a renewed interest in the
periodontal ligament injection - it is also known as intraligamentary injection - it is more reliable to achieve pulpal
anesthesia of one isolated tooth in mandible
PRESSURE SYRINGES........ Advantages - measured dose - overcomes tissue
resistance -
nonthreatening(new devices)
- cartridges protected
Disadvantages - cost - easy to inject too
rapidly - threatening(original
devices)
E. Jet injector - jet injection is based on the principle that liquids forced through very small openings , called jets , at very high pressure can penetrate intact skin or mucous membrane - the most frequently used jet injectors in dentistry are syriJet Mark II and MadaJet - the primary purpose of the jet injector is
obtain topical anesthesia before insertion of a needle
JET INJECTORS....... Advantages - does not require
use of needle - delivers very small
volumes of local anesthetics
- used in instead of topical anesthetics
Disadvantages - inadequate for
pulpal anesthesia or for regional block
- some patients are disturbed by the jolt of the injection
- cost - may damage
periodontal tissue
2. DISPOSABLE SYRINGES Most often they are used for intramuscular or
intravenous drug administration, but they also may be used for intraoral injection.
These syringes contain a luer-lock screw on needle attachment with no aspirating tip.
Because there is no thumb ring aspiration ,it requires both hands.
In addition this syringes do not accept dental cartridges.
DISPOSABLE SYRINGE........ Advantages - disposable, single
use - sterile until opened - lightweight
Disadvantages - does not accept prefilled dental cartridges - aspiration difficult
3. SAFETY SYRINGES Safety syringes minimize the risk of an
accidental needle-stick injury occurring to a dental health provider with a contaminated needle after administration of a local anesthetics
These syringes possess a sheath that “locks” over the needle when it is removed from the patient’s tissues , preventing accidental needle-stick
These are designed as single-use items , although they permit reinjection
SAFETY SYRINGES...... Advantages - disposable , single
use - sterile until opened - lightweight
Disadvantages - cost: more
expensive than reusable syringe
- may feel awkward to a first-time user
4. COMPUTER-CONTROLLED LOCAL ANESTHETIC DELIVERY(C-CLAD) SYSTEMS This system enables a dentist or hygienist to
accurately manipulate needle placement with finger-tip accuracy and deliver the local anesthetic with a foot-activated control
RECOMMENDATIONS1. A safety syringe, minimizing the risk of
accidental needle-stick injury, is recommended for use during all local anesthetic injections
2. A self-aspirating syringe is recommended for practitioners with small hands
3. All reusable syringes must be capable of being sterilized
4. Nonreusable syringes must be disposed of properly
5. Non-aspirating syringes should never be used for local anesthetics
II. NEEDLE Needle is a vehicle that permits local
anesthetic solution to travel from the dental cartridge into the tissues surrounding the needle tip
Most needles used in dentistry are stainless-steel and disposable
PARTS OF NEEDLE Bevel Shaft Hub Syringe adaptor Cartridge penetration end
GAUGE Gauge refers to the diameter of the lumen of
the needle: the smaller the number , the greater the diameter of the lumen
A 30-gauge needle has a smaller internal diameter than 25-gauge needle
There is a growing trend toward the use of smaller diameter needles based on the assumption that they are less traumatic to the patient than needles with larger diameter
The most commonly used needles in dentistry are 30-gauge short and 27-gauge long
ADVANTAGES OF LARGER NEEDLE OVER SMALLER GAUGE NEEDLE1. Less deflection , as needle advances
through tissues2. Greater accuracy of injection3. Less chance of needle breakage4. Easier aspiration5. No perceptual difference in patient comfort
LENGTH Dental needles are available in three lengths:
Long : 30-35mm
Short : 20-25mm
Ultra-short : <20mm
RECOMMENDATIONS1. Sterile disposable needles should be used2. If multiple injections are to be administered,
needles should be changed after three or four insertions in a single patient
3. A needle should never be forced against resistance
4. Needles should remain capped until used and should be made safe immediately when withdrawn
5. The direction of a needle should not be changed while it is still in tissue
III. CARTRIDGE The dental cartridge is a glass cylinder
containing the local anesthetic drug , among other ingredients
Cyli
ndri
cal
gl
ass t
ube
Stoppers(plunger,burg)
Aluminium cap
diaphragm
components
PROBLEMS1. Bubble in cartridge2. Extruded stopper3. Burning on injection4. Sticky stopper5. Corroded cap6. Rust on the cap7. Leakage during injection8. Broken cartridge
RECOMMENDATIONS1. Dental cartridges must never be used on
more than one patient2. Cartridges should be stored at room
temperature3. It is not necessary to warm cartridge before
use4. Cartridges should not be used beyond their
expiration date5. Cartridges should be checked carefully for
cracks, chips, and the integrity of the stopper and cap before use