Table 2 Approaches for effective dental anaesthesia
Approach | Upper arch | Lower arch |
|---|---|---|
First line | 4% articaine with 1:100,000 adrenaline buccal and palatal infiltration total volume 3.2 mL | Conventional IDB and lingual nerve block with 2% lidocaine with 1:80,000 adrenaline, total volume 2.2 mL and 4% articaine with 1:100,000 adrenaline buccal infiltration, total volume 2.2 mL |
Second line | 4% articaine with 1:100,000 adrenaline buccal and palatal infiltration, total volume 3.2 mL | Repeat conventional IDB and lingual nerve block with 2% lidocaine with 1:80,000 adrenaline 2.2mL or consider IDB and lingual nerve block with 4% articaine with 1:100,000 adrenaline, total volume 2.2 mL |
2% lidocaine with 1:80,000 adrenaline as intra-ligamentary injection up to 1.4 mL | 4% articaine with 1:100,000 adrenaline lingual infiltration, total volume 2.2 mL | |
Further options | Intra-osseus infiltrations using 2% lidocaine with 1:80,000 adrenaline, up to 1.4 mL | 2% lidocaine with 1:80,000 adrenaline as intraligamentary injection, up to 1.4 mL |
Regional block techniques using up to 2.2 mL 2% lidocaine with 1:80,000 adrenaline can be helpful in the presence of swelling in the region of normal infiltration position Infraorbital nerve blocks Greater palatine nerve block Nasopalatine nerve block | High block techniques (Vazirani-Akinosi/Gow-Gates technique) 2% lidocaine with 1:80,000 adrenaline, total volume 2.2 mL | |
Mental nerve block using up to 2.2 mL 2% lidocaine with 1:80,000 adrenaline can be helpful in the presence of swelling in the region of normal infiltration position | ||
Intra-pulpal infiltration using any local anaesthetic up to 0.5 mL | ||
Long-acting | Levobupivicaine 2.5 mg/mL (0.25%) or 5 mg/mL (0.5%) solution as IDB, or infiltrations up to 5 mL Provided upon completion of operative procedure, where appropriate, for enhanced duration of post-operative pain control | |
