Dental Injection Techniques

09-12-2022

Fear of pain is the most common reason people avoid the dentist and delay treatment. Injection of local anesthesia is an important part of pain control in dentistry, essential to making the experience as comfortable as possible. 
There are a variety of different techniques that can be used, depending on the situation. Selection depends on many factors, such as the type of procedure, success rate, and potential complications. 
Inibsa

Types of Local Anesthetic Dental Injections 

Local anesthetic for dental pain control can be generalized into three categories — local infiltration, field block, and nerve block. 

 

  • Local Infiltration1,2 

Supraperiosteal injection, also known as local infiltration, is the most common type of dental injection. It is used to anesthetize a single tooth and the small area close to the site of the tooth. It is used for routine dental procedures, such as fillings or extractions. 

The procedure is performed by first locating the mucobuccal fold above the target tooth. The syringe is held against the long axis of the tooth. 

The advantages of local infiltration are ease of injection and a high success rate. Infiltration cannot be used for procedures that need a larger area to be anesthetized, such as multiple teeth that need to be anesthetized, root canals, and crowns. Contraindications include acute inflammation and infection. 

 

  • Field Block2 

Field block anesthesia is a dental injection that anesthetizes a larger area than local infiltration. The dentist will inject the anesthetic into several areas around the tooth or teeth that need to be treated. This type of injection may be used for more complex procedures such as root canals, crowns, or maxillary extractions. 

 

  • Nerve Block2 

Nerve block anesthesia numbs a larger area of the mouth and face. It is used when two or three teeth are involved in the procedure, or for more complex procedures such as wisdom teeth removal. A local anesthetic is injected near one or more nerves that supply sensation to the area, away from the site of surgery near the main trunk of the nerve that is involved. 

 

Selection of Local Anesthetic 

The selection of injectable anesthetic depends on factors including the type of procedure, onset time, duration of action, and individual tolerance. Local anesthetic options are summarized in the table below. 

 

Local Anesthetic 

Ingredients 

Each ml contains 

Uses 

Onset 

Duration in Pulpal Anesthesia 

Duration in Soft Tissue 

Xilonibsa 2% 

1:80,000 

Lidocaine HCl 2% 

Epinephrine 1:80,000 

Lidocaine hydrochloride 20.00 mg 

 

Epinephrine 0.0125 mg 

 

Local infiltration and nerve block 

Adaptability to different procedures 

3 to 5 minutes 

60 minutes 

180 to 300 minutes 

Artinibsa 4% 

1:100,000 

Articaine HCl 4% 

 

Epinephrine 1:100,000 

Articaine hydrochloride 40 mg 

 

Epinephrine tartrate 0.018 mg 

(equivalent to 0.01 mg epinephrine base) 

 

Local infiltration and nerve block 

 

Increased efficacy and duration for complicated procedures that require prolonged anesthesia 

2 minutes 

 

 

60 to 75 minutes 

180 to 360 minutes 

Artinibsa 4% 

1:200,000 

 

Articaine HCl 4% 

Epinephrine 1:200,000 

Articaine hydrochloride 40 mg 

Epinephrine tartrate 0.009 mg (equivalent to 0.005 mg epinephrine base) 

 

Local infiltration and nerve block 

Increased efficacy and duration for complicated procedures that require prolonged anesthesia 

2 minutes 

45 to 60 minutes 

120 to 300 minutes 

Scandinibsa 2% 

1:100,000 

 

Mepivacaine HCl 2% 

 

Epinephrine 1:100,000 

Mepivacaine hydrochloride 20 mg 

 

Epinephrine tartrate 0.01 mg 

 

Local infiltration and nerve block 

Medium duration procedures 

2 to 3 minutes 

60 minutes 

180 to 300 minutes 

Scandinibsa 3% 

 

Mepivacaine HCI 3% 

Mepivacaine hydrochloride 30 mg 

Local infiltration and nerve block 

 

For patients with contraindications to vasoconstrictors 

 

Often appropriate for pediatric and geriatric patients 

 

3 to 5 minutes 

25 minutes for maxillary infiltration 

 

40 minutes for inferior alveolar nerve block 

 

90 minutes for maxillary infiltration 

 

165 minutes for inferior alveolar nerve block 

 

Inibsacain 0.5% 

1:200,000 

 

Bupivacaine HCl 0.5% 

 

Epinephrine 1:200,000 

Bupivacaine hydrochloride 5 mg 

 

Epinephrine tartrate 0.009 mg (equivalent 

to 0.005 mg epinephrine base) 

 

Local anesthesia for induction for dental procedures in adults, by injection or trunk blockade 

Long-acting postoperative pain management 

6 to 10 minutes 

90 to 180 minutes 

240 to 540 minutes 

 

Preparation for Injection With Topical Anesthetic Spray 

Topical anesthetic spray can be used to help prevent discomfort, pain, and anxiety during dental procedures. The dosage varies according to the area to be anesthetized, the extent of vascularization, individual tolerance, and the anesthetic technique to be used.  Use the lowest dose possible that provides the required anesthetic effect. It is recommended to spray onto a dry mucous membrane.3 Xilonibsa Spray 10% contains 100 mg of lidocaine in each ml. The onset of action is 1 to 3 minutes, and the duration of anesthesia of the mucous membrane is 15 minutes. 

 

References: 

  1. Ghavimi MA, Kananizadeh Y, Ghoreishizadeh S. Overview of Local Anesthesia Techniques. In: MHK  Motamedi, ed. A Textbook of Advanced Oral and Maxillofacial Surgery Volume 2. IntechOpen. 2015. Accessed from: https://www.intechopen.com/chapters/47578
  2. Benaifer D, Preziosi, Hershkin AT, Seider PJ, Casey GM. Oral & Maxillofacial Regional Anesthesia. The New York School of Regional Anesthesia. Accessed May 28, 2022. Accessed from: https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/head-and-neck/maxillofacial/oral-maxillofacial-regional-anesthesia/
  3. Lee HS. Recent advances in topical anesthesia. J Dent Anesth Pain Med. 2016;16(4):237-244. doi:10.17245/jdapm.2016.16.4.237. Accessed from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5564188/
  4. Summary of Product Characteristics of Artinibsa 4% 1:100,000, Artinibsa 4% 1:200,000, Xilonibsa 2% 1:80,000, Xilonibsa Spray 10%, Scandinibsa 3% and Inibsacain 5 mg/ml + 0.005 mg/ml.