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Highly anxious patients, atypical nerve anatomy, irreversibly inflamed lower molars and past experiences of poor anesthesia all combine to create the perfect storm for endodontic pain-control challenges. Being a full-time endodontist in private practice, this clinical scenario, to one degree or another, presents itself frequently. Aside from common nerve blocks, some forms of advanced local anesthesia techniques are often essential to provide a comfort in the aforementioned scenarios.
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To this end, the Wand STA All-Injection System (Aseptico, Woodinville, Wash.) device and the Anesto handpiece (W&H, Windsor, Ontario, Canada) have proven invaluable.
I use the Wand STA on every patient. It has become an indispensible part of my anesthesia technique. All infiltrations, blocks and PDL injections are given with it. The injections are more controlled, comfortable (for both me and the patient!) and predictable than standard injections.
The pen-style grip of the Wand STA handpiece allows the clinician to inject with far greater tactile control. Various handpiece sizes are available for the different injections. While economical, the unit is also simple to learn and use.
While the Wand STA has three injection speeds, in my hands all injections are given at the slower of the three speeds with exceptional patient acceptance. Empirically, it is my experience that the Wand STA leads to far fewer (none in three years) epinephrine reactions (increased heart rate, patient anxiety, etc.) and incidence of an “electric shock” reaction, which happens with traditional systems if the needle touches the nerve bundle.
Finally, for cases in which intraosseous anesthesia is required, I favor the Anesto system by W&H. Anesto is a solid choice, as the perforating and injection needle are one, eliminating some of the pieces required for other systems.
In clinical practice, once the clinician believes adequate anesthesia has been obtained, it is advisable to confirm profound anesthesia with both percussion and hot and cold (depending on the diagnosis as indicated). Once accessed, especially for vital inflamed cases, consideration should be given to also providing an intrapulpal injection into the orifice of each canal, followed by placing a small handfile to the apex.
Ideal for this purpose are the Mani #6 K files and Mani #8 D finders (D Finders are stiffer than a K file and used for negotiation of calcified canals). Exploration of the canal in this manner, done without discomfort, provides absolute confirmation of total anesthesia, invaluable for the anxious patient.
I welcome your feedback.
Note: This article was published in today: Greater New York Dental Meeting, Official Meeting News, Dec. 1, 2013.
Dr. Rich Mounce