Oral and maxillofacial surgery II. Anaesthesia Suture Pain control - anaesthesia Indications Surgical treatment Also for: Preparation of cavities Preparation for crowns Endodontic treatment Principles of anaesthesia Blocking of transfer of excitation on nerve fibers Eletric potential of nerve fibers Excitaion goes through depolarization – repolarization Perception of pain is stopped Anaesthesia General anaesthesia Analgesia (inhalation, sedation) Hypnosis Local anaesthesia Drugs Articain 4% with epinephrine 1: 200 000 Articain 4% with epinephrin 1:100 000 Mepivacain 3%plain Prilocaine 4% with epinephrine 1:200 000 Prilocaine plain Lidocain spray 10% Xylocain spray 10% Benefits of local anaesthesia Comfort for the patient Haemostasis (addtion of epinephrin – hormone of suprarenal gland – arteficial) Operator efficiency Anaesthesia Topical (spray,liquid) applied on mucosa By injection - Infiltration - Nerve block - Intraligamentar - Intrapulpal anaesthesia Contraindications Allergy Serious systemic diseases (blood circulation) Antithrombotic therapy , coagulopathy – nerve blocked anaesthesia Infiltration The drug is delivered by infiltration of soft tissues using syringe and needle. Infiltration anaesthesia Suitable for - indications - simple extractions in maxilla, mandibular incisors, canines - soft tissue surgery Infiltration Syringe Short needle Raise lip or cheek The puncture is situated into mucosa appr. 1cm from fornix vestibuli. Do not touch periosteum. Nerve block anaesthesia Foramen mandibulare Foramen mentale Foramen palatinum majus Foramen incisivum Foramen infraorbitale Tuber maxillae Nerve block anaesthesia N. alveolaris inferior Foramen mandibulare N. Alveolaris inferior N. lingualis Nerve block anaesthesia Nervus alveolaris inferior In sulcus colli mandibulae Nerve block anaesthesia N. alveolaris inferior Indirect Direct Nerve block anaesthesia N. alveolaris inferior Indirect Put the forefinger on the occlusal surface Rotate inside (nail inside) 1 cm up occlusal surface the puncture is situated Nerve block anaesthesia N. alveolaris inferior Indirect 1. The needle goes behind the crista temporalis, the syringe on the opposite canine Nerve block anaesthesia N. alveolaris inferior Indirect 2. The needle goes deeper in the contact with the bone The syringe goes mesial Nerve block anaesthesia N. alveolaris inferior Indirect 3. The contact with bone Is lost, the syringe goes back Nerve block anaesthesia N. alveolaris inferior Direct Put the forefinger on the occlusal surface Rotate inside (nail inside) 1,5 cm deep Nerve block anaesthesia N. alveolaris inferior Area blocked Molars Premolars Tongue Nerve block anaesthesia N. alveolaris inferior Direct  The puncture at the same place  The syringe on opposite premolars  The puncture goes into the small pink depression medial from crista temporalis and lateral from plica prerygomandibularis 1,5 cm deep Molars, premolars, mucosa, skin, bone Nerve block anaesthesia N. mentalis F. mentale The puncture is situated behind he distal surface of 2nd premolar The needle goes between roots of premolars Nerve block anaesthesia N. mentalis F. mentale The puncture is situated behind the distal surface of 2nd premolar The needle goes between roots of premolars, From up to down Forward and mesial Premolars and canine, mucosa, skin. Nerve block anaesthesia Foramen palatinum majus Distal surface of l.st molar The puncture is 0,5 – 1 cm before Half of palate Nerve block anaesthesia Foramen incisivum Nervus incisivus Papilla incisiva Next tu papilla, mesial direction Triangular area behind incisors Anaesthesia on f. infraorbitale Find the margo infraorbitalis Raise the lip The puncture is sitruated between canine and 1st premolar The needle goes to the region (appr 1 cm below margo infraorbitalis) Anaesthesia on tuber maxillae The durg si delivered on tuber maxillae Tje puncture is situated behind 2nd molar (distal surface), goes behind and upper around tuber maxillae. Intraligamentar Special syringe (pen or gun) The needle is introduced into periodontal space – few drops on anaesthetic Indication: single extraction, preparation, pulp exstirpation Intrapulpal Exstirpation of the pulp – additional step. Anaesthesia - complications Bleeding Breakage og needle Heamatoma Allergy (swelling, collaps) Patient´s history is needed !!! Suture Suture material Silk,nylon Needels - bent, rounded - straight Needle holders - autofix -without fixation Suture Suture material Silk,nylon Needels - bent, rounded - straight Needle holders - autofix -without fixation Suture Suture material Silk,nylon Needels - bent, rounded - straight Needle holders - autofix -without fixation Tweerers – tissue forceps