It has been quite a while since the days of the “Painless Parker,” and dental anaesthesia has come a long way in being a more comfortable procedure. Key to that advancement has been the use of a vibrational device attached to the anaesthetic syringe.

The brain recognises changes in pressure and temperature ad translates that information into pain. Furthermore, the brain can handle only one impulse at a time. To compensate for the puncture the syringe needle makes through tissue (read pain), main dentists use the “wiggle and jiggle” technique when injecting onto the mucobuccal fold, hoping this action distracts the patient. Such distraction causes the nerves endings to sense only the vibrations and not the sensation associated with the injection.

A vibrational device attached to a syringe uses this same concept of tricking the mind to recognize only the sensation caused by the “wiggle and jiggle” vibrations. The VibraJect device offers a simple and easy-to-use solution that can anaesthetize patients quickly in a more comfortable manner (Figure 1 and Figure 2). Use of this two-piece device is simple: Just clip the VibraJect motor unit ( a small battery -operated unit) onto the barrel of a conventional and/or intraligamentary syringe, turn it on, and use any standard technique for injecting the patient.

Not only is the device ideal for “normal” patients, but even more so for those patients who have a phobia of dental injections. The device also can be used with paediatric patients five years of age and older (as recommend by the manufacturer). In almost all cases the need for topical anaesthetic is eliminated, which saves time and money. A key point to remember when attaching the clip is that it must not cover or touch the anaesthetic cartridge.

The system is useful with all types of routine dental injections. Typically, the most painful area for the patient to endure an injection is the palate. This, of course, is because the already taut tissue is stretched further when a bolus of anaesthetic fluid is introduced, causing a great deal of pressure. The VibraJect enables a less painful palatal injection because it delivers small amounts of anaesthetic solution over a period of time. To anaesthetize the mandible, most dentists were taught to do a regional block technique. While this technique is viable, three adverse effects are associated with the procedure: the risk of “missing” the site (ie, the area surrounding the inferior-alveolar canal orifice), second, the risk of paresthesia, and third, the patient’s lip and tongue may remain numb for many hours, thus impeding the ability to speak and function in a work or school environment. This author no longer gives traditional mandibular block injections. Following is a technique for Mandibular injections that helps to eliminate these adverse effects and provide a positive experience for patients. The technique can be used for maxillary injections. In both instances, the technique relies on a very slow drip deposition of anaesthetic fluid and using vibration, via the VibraJect.

VibraJect Injection Technique

• Supplies:
• Conventional aspirating syringe for maxillary injections
• N-Tralig (Miltex, Inc) type syringe for mandibular injections
• VibraJect R3
• Articaine hydrochloride 4% with epinephrine 1:100,000
• 30-gauge, extra-short hypodermic needles

Mandibular Technique

Step 1: Approach the midline of the buccal sulcus with an N-Tralig syringe with a 30 gauge extra-short hypodermic needle, loaded with the anaesthetic solution. Clip the VibraJect on to the barrel, close to the hub of the syringe. The syringe should be vibrating.

Step 2: With the ling aspect of the bevel of the needle parallel to the long axis of the tooth, begin a slow drip (2 to 4 drops) of anaesthetic fluid when approaching and entering the buccal sulcus.

Step 3: After entering the sulcus, slowly drip fluid until resistance is felt at the the periodontal ligament

Step 4: At the periodontal ligament, deposit another 2 to 4 drops while penetrating slightly beyond the ligament.

Step 5: Next, repeat Step 1 through Step 4 for the mesiobuccal and the distobuccal aspects of the tooth, remembering to inject slowly.

Step 6: Approach the midline of the lingual sulcus. Again, have the long aspect of the bevel of the needle parallel to the long axis of the tooth and slowly drip anaesthetic fluid when approaching the sulcus.

Step 7: After reaching the lingual periodontal ligament, slowly deposit another 2 to 4 drops of anaesthetic fluid while penetrating slightly beyond it.

Step 8: Repeat steps 1 through 5 for the mesiolingual and distolingual aspects of the tooth, remembering to inject slowly.

Tips

• Recharge the batteries overnight: do not leave the batteries in an unplugged charger.
• Do not autoclave the motor unit: simply wipe it with any cold sterilizing solution.
• The first time a patient says “ouch”, it is time to either check the technique and/or recharge the battery.
• The injection should be a very slow drip technique.

Maxillary Technique

Step 1: Attach a 30-gauge extra-short hypodermic needle loaded with anaesthetic solution on to an aspirating syringe. Clip the VibraJect on to the barrel close to the hub end. The syringe should be vibrating.

Step 2: Approach the mucobuccal fold in the apical area of the tooth with the long aspect of the bevel parallel to the long access of the tooth, and slip the tissue over the bevel by elevating the lip and slowly deposit only a few drops of anaesthetic solution.

Step 3: For the palatal injection, again approach the palatal surface near the approximate apical root end of the involved tooth with the long aspect of the bevel parallel to the long axis of the tooth.

Step 4: Puncture the tissue, and slowly deposit only a few drops of anaesthetic fluid.

A benefit to patients and the practice

Undoubtedly, an extra benefit is the practice building that will result when patients tell family and friends about their painless injections. This technique also saves time by eliminating the time it takes for topical and block anaesthesia to take effect. With this technology, dentists can treat multiple quadrants, often eliminating the need for additional appointments. This time savings also has economic benefits, creating time to treat an additional patient each day and ultimately adding to the practice’s bottom line. After becoming comfortable with this technique, dentists will be not only high-tech, but also make happy, loyal and referring patients.

For more information contact: Imtec
Dental Phone (03) 9893 2399
Web: www.imtecdental.com.au
Reprinted from: Inside Dentistry. 2009;5(7):92.
Copyright 2009, AEGIS Communications.
Used with permission.