Una nueva alternativa para la localización y la recuperación de agujas fracturadas durante la anestesia odontológica. Presentación de técnica y caso clínico / A new alternative for locating and removing a needle fractured during dental anesthesia. Technique and case report

Objetivo: Describir en un caso clínico una nueva técni- ca para la localización y la remoción de agujas fracturadas du- rante la anestesia odontológica mediante planificación virtual. Caso clínico: Una paciente de género femenino de 52 años de edad concurre a la Cátedra de Cirugía y Traumatolo- gía Bucomaxilofacial I de la Facultad de Odontología de la Universidad de Buenos Aires y relata que dos meses atrás, durante la atención odontológica, se produjo la fractura de la aguja durante la anestesia troncular mandibular. Se realiza diagnóstico y planificación virtual para conocer la ubicación exacta de la aguja y se confecciona un modelo estereolito- gráfico y una guía quirúrgica individualizada para removerla. El uso de una guía quirúrgica individualizada y confeccio- nada mediante planificación virtual permitió ubicar la aguja tridimensionalmente y con mayor precisión en espacios pro- fundos y disminuir tiempos operatorios (AU)

Aim: To describe in a clinical case a new virtual plan- ning technique for locating and removing a fractured dental anesthetic needle. Clinical case: A 52-year-old patient visited the De- partment of Oral and Maxillofacial Surgery I (School of Dentistry, University of Buenos Aires) with a retained den- tal needle in the pterygomandibular space. The needle had fractured during inferior alveolar nerve block two months previously. Virtual diagnosis and planning were performed to locate the needle and a stereolithographic model and a customized surgical guide were prepared. The use of cus- tomized surgical guides prepared by virtual planning ena- bled precise location of the dental needle in deep spaces and reduced operating times (AU)

Deflexión de agujas dentales 30G: comparación de cinco marcas comerciales / Deflection of dental needles 30G: comparison of five trademarks

Abstract Introducción: El grado o nivel de deflexión de la aguja dental, en la mayoría de los casos, puede determinar el éxito o fracaso en la técnica de anestesia dental. Objetivo: Medir el grado de deflexión de la aguja dental, comparando 5 diferentes marcas disponibles en la ciudad de Hermosillo, Sonora, México. Métodos: Se realizó un estudio experimental, en el que con ayuda de un modelo creado con un nivel profesional y una jeringa tipo cárpul, se realizaron diversas punciones en un trozo de carne de res, simulando la realización de una técnica lineal de anestesia bucodental. Se tomaron radiografías periapicales de cada una de las punciones, y con ayuda de una malla milimetrada, se realizaron las mediciones. Dentro de cada grupo de agujas, se presentaron diferentes medidas de deflexión, y se obtuvo un promedio de cada marca. El rango abarcó desde los .65 mm hasta 2.1 mm de deflexión, tomando como referencia un plano recto. Conclusiones: Se demostró que la de la marca Septodont®, fue la que presentó menor deflexión a la punción. Es recomendable verificar y examinar el estado de las agujas antes de ser utilizadas para realizar procesos quirúrgicos, y así disminuir riesgos y/o complicaciones postoperatorias.

Resumen Introduction: The degree or level of deflection of the dental needle, in most cases, can determine the success or failure of the dental anesthesia technique. Objective: Measure the degree of deflection of the dental needle, comparing 5 different brands available in the city of Hermosillo, Sonora, Mexico. Method: An experimental study was carried out, with a model created with a professional level and a carpul syringe, various punctures were made in a piece of beef, simulating the performance of a linear technique of oral anesthesia. Periapical radiographs of each of the punctures were taken, and with the help of a millimeter mesh, measurements were made. Within each group of needles, different deflection measures were presented, and an average of each brand was obtained. The range ranged from .65 mm to 2.1 mm of deflection, taking as reference a straight plane. Conclusions: It was shown that the Septodont® brand was the one that presented the lowest puncture deflection. It is advisable to verify and examine the condition of the needles before being used to perform surgical procedures, and thus reduce risks and / or postoperative complications.

Virtual Reality simulator for dental anesthesia training in the inferior alveolar nerve block

Abstract Objectives This study shows the development and validation of a dental anesthesia-training simulator, specifically for the inferior alveolar nerve block (IANB). The system developed provides the tactile sensation of inserting a real needle in a human patient, using Virtual Reality (VR) techniques and a haptic device that can provide a perceived force feedback in the needle insertion task during the anesthesia procedure. Material and Methods To simulate a realistic anesthesia procedure, a Carpule syringe was coupled to a haptic device. The Volere method was used to elicit requirements from users in the Dentistry area; Repeated Measures Two-Way ANOVA (Analysis of Variance), Tukey post-hoc test and averages for the results' analysis. A questionnaire-based subjective evaluation method was applied to collect information about the simulator, and 26 people participated in the experiments (12 beginners, 12 at intermediate level, and 2 experts). The questionnaire included profile, preferences (number of viewpoints, texture of the objects, and haptic device handler), as well as visual (appearance, scale, and position of objects) and haptic aspects (motion space, tactile sensation, and motion reproduction). Results The visual aspect was considered appropriate and the haptic feedback must be improved, which the users can do by calibrating the virtual tissues' resistance. The evaluation of visual aspects was influenced by the participants' experience, according to ANOVA test (F=15.6, p=0.0002, with p<0.01). The user preferences were the simulator with two viewpoints, objects with texture based on images and the device with a syringe coupled to it. Conclusion The simulation was considered thoroughly satisfactory for the anesthesia training, considering the needle insertion task, which includes the correct insertion point and depth, as well as the perception of tissues resistances during the insertion.

Detección de glutaraldehído en tubos anestésicos dentales mediante espectrofotometría UV-VIS / Detection of gluteraldehyde in dental anesthetics tubes using UV-Vis spectrophotometry

El proceso de esterilización de tubos anestésicos se realiza mediante una solución de glutaraldehído activado al 2 por ciento, pero el émbolo o la membrana de goma del tubo anestésico puede permitir una difusión del compuesto esterilizante. El objetivo del estudio es detectar la presencia de glutaraldehído dentro de tubos anestésicos después de aplicar protocolo de esterilización en frío (Normas de Desinfección MINSAL, 2008) mediante espectroscopía de absorción molecular. Al someter los tubos de anestésico al protocolo de esterilización podemos observar que existe una interacción entre el anestésico y la solución esterilizadora de glutaraldehído activado al 2 por ciento, entre los 220 y 250 nm, además se observa una laxitud en la membrana semipermeable después de la exposición por 10 horas al agente esterilizante. El glutaraldehído activado al 2 por ciento toma contacto con el anestésico mediante su filtración por el émbolo o diafragma.

The sterilization process is performed anesthetic tube with a solution of 2 percent activated gluteraldehyde, but the piston or diaphragm anesthetic tube allows a diffusion of sterilizing compound. The objective of this study is to detect the presence of gluteraldehyde into tubes after applying anesthetic cold sterilization protocol (Normas de Desinfección MINSAL) by molecular absorption spectroscopy. By making the pipes of anesthetic to the sterilization protocol we see that there is an interaction between the anesthetic and sterilizing solution of gluteraldehyde to 2 percent , between 220 and 250 nm, in addition there is a laxity in the semipermeable membrane after exposure for 10 hours a sterilizing agent. The activated 2 percent gluteraldehyde made contact with the anesthetic through its filtration by the piston or diaphragm.

Avaliação da técnica anestésica local utilizada por alunos de graduação em odontologia / Evaluation of local anesthetic technique used by dental graduation students

Introdução: A anestesia local constitui etapa essencial para procedimentos odontológicos, visando o conforto e ausência de dor. Objetivos: Com o intuito de observar a técnica anestésica local realizada por alunos de graduação da PUC-Campinas, realizou-se um estudo observacional não intervencionista. Métodos: Para isso, preencheu-se 26 formulários nos quais foram observadas as seguintes questões: anestesia tópica, aspiração prévia do anestésico local, tempo de injeção, número de tubetes utilizados, conhecimento dos alunos em relação ao tipo de sal anestésico utilizado, peso e condição sistêmica do paciente. Resultados: Os resultados mostraram que 92,3% dos alunos avaliados utilizaram anestésico tópico, nenhum deles realizou aspiração prévia, apenas 3,85% tinham conhecimento sobre o peso do paciente e 69,23% dos alunos sabiam qual sal anestésico estava sendo utilizado sem consulta no tubete (p<0.0001 teste Qui-Quadrado para os resultados apresentados anteriormente). Conclusão: Concluiu-se que os alunos avaliados não cumpriram corretamente todas as etapas necessárias para a realização de uma correta técnica anestésica local na criança.

Introduction: Local anesthesia is an essential stage for dental procedures, with comfort and no pain. Objectives: In order to observe the local anesthetic technique performed by undergraduate students of PUC-Campinas, held a non-interventional observational study. Methods: For this, filled with 26 forms in which we observed the following issues: local anesthesia, aspiration prior local anesthetic injection time, number of tubes used, students? knowledge about the type of salt used anesthetic, weight and systemic condition of the patient. Results: The results showed that 92.3% of students assessed using topical anesthetic, none prior aspiration, only 3.85% had knowledge about the patient?s weight and 69.23% of the students knew which anesthetic salt was being used without consulting in tubete (p <0.0001 Chi-Square for the above results). Conclusion: Concludes that the evaluated graduation students didn?t meet properly all necessary steps to achieve a correct local anesthesia technique in children.

Comparison of the pain levels of computer-controlled and conventional anesthesia techniques in prosthodontic treatment

OBJECTIVE: The objective of this study was to compare the pain levels on opposite sides of the maxilla at needle insertion during delivery of local anesthetic solution and tooth preparation for both conventional and anterior middle superior alveolar (AMSA) technique with the Wand computer-controlled local anesthesia application. MATERIAL AND METHODS: Pain scores of 16 patients were evaluated with a 5-point verbal rating scale (VRS) and data were analyzed nonparametrically. Pain differences at needle insertion, during delivery of local anesthetic, and at tooth preparation, for conventional versus the Wand technique, were analyzed using the Mann-Whitney U test (p=0.01). RESULTS: The Wand technique had a lower pain level compared to conventional injection for needle insertion (p<0.01). In the anesthetic delivery phase, pain level for the Wand technique was lower (p<0.01). However, there was no difference between the Wand and conventional technique for pain level during tooth preparation (p>0.05). CONCLUSIONS: The AMSA technique using the Wand is recommended for prosthodontic treatment because it reduces pain during needle insertion and during delivery of local anaesthetic. However, these two techniques have the same pain levels for tooth preparation.

Avaliaçäo da percepçäo dolorosa e da eficácia anestésica da seringa sem agulha: um estudo comparativo com a seringa tradicional / Evaluation of the painful perception and of the syringe without needle anesthetic effectiveness: a comparative study with the traditional syringe

Este trabalho avaliou a eficácia anestésica e a percepçäo dolorosa da seringa sem agulha MadaJet XL (Mada Equipment Co. Carlstadt, New Jersey, USA) comparativamente com a seringa carpule tradicional, através de métodos qualitativos, auxiliados por questionários, e quantitativos, com a utilizaçäo de uma escala visual analógica em 18 adultos jovens, durante a realizaçäo de procedimentos restauradores e cirúrgicos. Os resultados mostraram que a percepçäo dolorosa da injeçäo com a seringa sem agulha foi menor, sendo esta diferença estatisticamente significante quando comparada com a seringa tradicional no arco superior e näo estatisticamente significante quando comparada no arco inferior. A eficácia anestésica foi suficiente em procedimentos em tecido mole e crista óssea alveolar, necessitando de complementaçäo da carpule em procedimentos que envolveram o bloqueio pulpar principalmente em molares

Anestesia eletrônica com injetor automatizado / Eletronic anesthetic injector

Utilizando o injetor eletrônico de anestesia, capaz de ajustar a velocidade de administraçäo e a dosagem do anestésico, o autor passou a trabalhar com essa variáveis e a observar a sintomatologia obtida para a técnica subperióstea na sua fase operatória e pós-operatória. Um novo comportamento hidráulico da soluçäo anestésica no sítio ósseo e perióstea esteve presente quando a velocidade de dispensaçäo foi estabelecida em 0,3 ml/min de aplicaçäo. O volume depositado neste sítio era absorvido pelo osso sem causar traumas teciduais. Na prática esta técnica passa a ser totalmente indolor e de indicaçäo rotineira. O trabalho foi realizado com base em observaçöes clínicas, abrangendo 2.500 casos no período de trinta meses, onde foi adequada uma técnica específica

Iontophoresis. A novel drug administration for extraction of deciduous teeth. A clinical evaluation.

Iontophoresis has a wide range of application in dentistry, one of which is to produce a non invasive technique of analgesia. With the avoidance of needle, in this technique better patient management and good doctor-patient relationship can be built. This study provides an insight into the comparative evaluation of 2%, 4% and 6% lignocaine hydrochloride (plain) in providing analgesia iontophoretically while extraction of deciduous teeth. Patient satisfaction was seen when higher drug concentration and longer duration of iontophoresis was applied.