PART 2 anesthesia by infiltration. Third molar extraction.

This is a case of third molar extraction with no block anesthesia. This was done with septicaine ® local infiltration and can work with any tooth in the mouth. We selected third molars as perhaps the more difficult tooth to remove with infiltration and no block. Note this patient is not sedated in any way. The method is to use a tiny droplet of septicaine as a topical. Septicaine is a better topical than other products since the sulfone ring has better fat solubility than benzine ring anesthetics. Then infiltration into the papilla on both sides of the tooth. The use of the electrosurg which is an Ellman Dento-surg® 90 F.F.P. is used to first test for profound anesthesia, and then to detach gingiva from the tooth. The unit also sterilizes the tooth killing bacteria which can cause bacteremia.
The result of using this unit is virtually bloodless surgery. In addition, laying flaps with this unit is effortless and far more controllable than using a scalpel. We use this unit in the cut coagulate mode. This video was posted to show a friend the technique, thus the conversation mentioning Miles who is a friend in Alabama. For the rest of you enjoy and I hope you can speed up your dentistry and get more profound anesthesia. One advantage of using infiltration is that often aberrant pathways are covered as well, since the anesthetic solution floods the marrow space adjacent to the root tips. Occasionally when the crestal bone is very dense the technique is thwarted. In which case after numbing the gingiva you can drill through the cortical plate with a fissure bur to the distal of the tooth and inject into the marrow space plugging the hole with a mirror handle to keep anesthetic from running out as you inject. The vertical boney soft tissue impaction show in this video has the root tip buried deeply. This also demonstrates the need of fine tuning the process by observing where the electrosurg unit elicits pain as we go around the tooth. Adding a few drops will usually solve that problem. The technique is either you have the anesthesia or not. There is no need to wait as you do in blocks. If you have succeeded, the patient is numb instantly. If not use more for a longer period of time. One undesirable side effect is occasional eschemic damage to a papilla caused by pressure of the anesthetic displacing blood. Do not use the technique repeatedly in anterior teeth with tiny papilla. You will cause necrosis of the papilla with repeated injections. If you use this technique, do the procedure immediately! The effect is limited to a relatively short time. 10 - 15 minutes.

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Douglas M Martin DDS. FAAID, FAIT, FICOI, ABOI/ID

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Science & Technology

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• dental
• extraction
• with
• no
• block.
• anesthesia
• infiltration