The introduction of computerized local anaesthetic delivery systems (Fig. 5) has introduced novel techniques such as the palatal anterior superior alveolar nerve block and the anterior middle superior alveolar nerve block. These palatal approaches are possible as the slow injection of solution allowed by computerized systems permits greater volumes of solution to be injected without discomfort into the palate.
The palatal anterior superior alveolar nerve block is a means of anaesthetizing the upper anterior teeth (canine to canine and sometimes the premolars as well) by depositing solution deep in the incisive canal. (Friedman & Hochman 1998, Williams 2001). The method is reputed to provide pulpal anaesthesia of the maxillary anterior teeth bilaterally without loss of sensation labially (Friedman & Hochman 1999). After entry into the incisive foramenaround1.0 mL solution is deposited slowly as the needle advances deep into the canal.
Figure 5. The advent of computerized delivery systems like that illustrated has introduced novel techniques such as the anterior middle superior alveolar nerve block.
The anterior middle superior alveolar nerve block is also claimed to provide pulpal anaesthesia without facial numbness. It is a palatal approach to both the anterior and middle superior alveolar nerves. The point of injection is midway between the gingival margin and the mid-line of the palate between the first and second premolars. Around 1.0 mL solution is deposited slowly at this site. It is claimed that this will produce anaesthesia of the teeth on that side from the central incisor to the second premolar. It has been suggested that excessive blanching of the tissues during injection with this method can lead to ulceration of the palatal mucosa (Friedman & Hochman1998).
The palatal anterior superior alveolar nerve block and the anterior middle superior alveolar nerve block have not received thorough appraisal at this time, but the advent of computerized delivery systems may result in scientific evaluation of these potentially useful techniques.
Other routes to pulpal anaesthesia which have been investigated include the application of anaesthetics topically. The advent of more powerful topical anaesthetics including novel delivery systems such as incorporation into liposomes (Zed et al.1996) and the use of iontophoresis (Won et al. 1995) may lead to advances in this area. Although limited degrees of success relating to pulpal anaesthesia after topical application has been reported (Vickers & Punnia Moorthy1993), there is still scope for development in this area.
Non pharmacological methods of anaesthesia such as transcutaneous electronic nerve stimulation (TENS) have been used both as a means of reducing the discomfort of injections and as a method of achieving pulpal anaesthesia. Meechan et al. (1998) reported that the use of intraoral TENS decreased the discomfort of inferior alveolar nerve block injections compared to the use of topical anaesthetics and no pretreatment. Wilson et al. (1999) reported that TENS reduced the discomfort of maxillary infiltrations in young children receiving treatment under sedation. This method of anaesthesia can provide pain control for operative dentistry in some patients, however, success is poor for endodontic procedures (Clark et al.1987). Quarnstrom (1992) has reviewed the history and use of electronic anaesthesia in dentistry.
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