I don't routinely - buccal is enough for restorative in my hands. However some colleagues who remove teeth would do lingually, or if you wanted more anaesthesia and definitely avoid a block (eg. patient on an anticoagulant) then yes can extend to lingual
@@protrusive I always give lingual as well especially if I am working on a lower 7 or 8 and routinely use 2 cartridges of articaine. I have not given an ID block since 2009
Love your work! After the initial infiltration I use a super short tip and give PDL injection at mid buccal which honestly rarely fails. I give very few ID blocks these days. I do lingual infiltration of a few drops for comfort with matrix, wedge placement and in case I need to laser some interprox tissue.
What would you recommend to someone who has lingual nerve damage I can’t do nerve blocks because it damages my lingual nerve and make it worse it tooth number 18 my bottom molar that I need the filling redone in
After doing 25k extractions myself..I would still prefer giving a safe IANB, followed by buccal infiltration and a good intraligamentary injection with a 30g or 31g needle..works the best for extractions and there's absolutely no pain during the procedure..for endodontics would prefer the same but avoid buccal infiltration
I’ve been a dentist since 1989. I could count on one hand the number of times I have an entire dosage of LA right off the bat. My method-4/5 minutes of topical. Then I ask my assistant to blow air at the site while I inject about 0.4ml, wait a minute and then give the rest. Pts love it
Great video. Any reason you do buccal infiltration only compared to lingual as lingual bone is much thinner near the apex of the root on mandibular molars? I got away with lingual only for pulpal anesthesia in my experince where i didnt want to do mandibular block.
Great Q - one of my highest values is painless anaesthesia. I can do this buccally but unsure of this lingually? Perhaps it's a limiting belief I hold - can this be given in a painless way?
Thanks for your videos! I much appreciate them. However, it seems to me that you are going through more trouble doing it this way than doing a straightforward IA block, using proper technique and landmarks and of course appropriately aspirating with a slow injection. Over many years I have had much success and minimal complications doing this with 2% lidocaine, and almost always achieve profound anesthesia.
Hi Robert, I totally understand both sides of the view. Some colleagues have emailed me to say they haven't done an ID block for 11+ years (including extractions!) and others suggest, like yourself, that the age test ID block is just fine. For me I do about 1 ID block every 6 weeks or so, and get the profound anaesthesia with this technique. Main thing for me is that in my hands I am able to give a more comfortable injection via infiltration than ID block
1) can you confirm: so the first time you inject was that below the MGJ or above? 2) do you do this technique for 2nd molars? I find it a lot more challenging for 2nd molars as I feel like I hit bone immediately at my buccal infiltration and will often see anesthetic just leaking out of as opposed to actually going inside the tissue. where exactly do you inject the needle for 2nd molars (relative to MGJ please) to minimize this happening? Thanks doc!
sorry for the delay doc. I do indeed inject below the MGJ in the looser tissue first. Once that is numb, I can then enter the attached gingiva and observe blanching. 2nd molars can still work too but slightly less predictable in my hands
Is this technique enough even for a root canal? I’m a new dentist and I’m a little scared when I’m doing IANB and sometimes it doesn’t even work for me that well.. this seems like such a better alternative
Thank you for the reply, I’m getting near 100% success with this tecnique but in my hands it often leads to papilla ulceration in the site of injection. I’m using 4% articaine 1:100.000 and injecting less than 0.3 ml per site. Am I probably doing excessive pression while injecting? Best Regards, Marco O.
I believe its to do with holding/retaining the LA for longer and also it being adjacent to the emissary canals in the bone allowing the LA get right to the nerve
I used to think this - but it's not 100% true. There are ways and scenarios we can utilise articaine infiltrations for blocks - see my recent episode PDP143 for a whole discussion on this and the CIA technique I then went on to connect with Dentists all over the world who have not done an ID block in a decade +a
Good Q! I find it helpful to use the mirror to retract the tongue away. Then advance the needle towards the floor of the mouth close to the tooth in question - what you will find sometimes is as the patient swallows, the floor of the mouth will rise and it will carry out the penetration for you. Other time it can be tough to get the penetration in this area - go slow, use good lighting, be gentle
One quick question, I have seen you wearing loupes with hood . Can you please tell which loupes are the as I wanted to buy but not sure either it works with hood .
Hi Jaz. Thank you so much for this technique! Couple of questions please: 1. For the injection you did at minute 5.41, was it just an intra-papillary to numb the attached gingivae before beginning the proper technique? 2. For the injections into the attached gingivae, does the needle contact the bone before you deposit the LA? Thanks! 😊
Hiya Ee Ping! 1. I wouldn't say that it's to facilitate the proper technique, it is very much part of the proper technique to give LA to the attached gingiva - this could be in the middle or mesial and distal - I do like mesial and distal as it gives more coverage. 2. It does not have to contact bone, but many time I do, but I will withdraw a TINY bit to allow the LA to flow easy in to the attached gingiva Thanks for your question - I actually have a new 4K video of this showing lingual infiltration I need to upload
