Pain Management in Implant Surgery. A Challenge for the Young Dentist?

Ionut Luchian (Romania), Artjom Meier (Germany)

Ionut Luchian

Pain has always been a challenge for every dentist no matter if we are talking about general dentistry or specialty dental treatment. Unortunately pain is still the main international reason which brings patients to the dental clinic. As young dentists or dental students we should always be aware that our successful management of patient’s pain before starting our treatment can represent a valuable business card.

Oral Implantology has become a trend among the patients and although it’s a relative new specialty, it has changed alot of concepts and replaced many classical therapeutical solutions.

Artjom Meier

As a young dentist is more difficult to convince your patients that you are well enough trained to provide him a high quality oral rehabilitation on implants and that patient should choose you instead of a more experienced doctor.

The main problem when you propose the implant solution instead of a classical bridge is the pain associated to the surgery itself. For most of the patients implant surgery sounds very complicated and painful. That’s why it is extremely important to convince the patient that sometime an extraction can be more complicated and painful than the surgery itself.

Intra-operative

x-ray post-operative

We will try to present you in this article some considerations about the intraosseous anaesthesia. We believe that these methods are applicable in every dental office and can increase your rate of success regarding pain management.

Although intraosseous has been introduced in dental practice for some time it’s still not that popular among all dentists. There are many systems for delivering intraosseous anaesthesia. The most used systems available are: X- TIP (Dentsply-Maillefer),STABIDENT (Fairfax Dental), QUICKSLEEPER (Dental HI TEC), INTRAFLOW (INTRAVANTAGE), HYPO (MPL Technologies).

xtip kit

The principal on which all intraosseous anaesthesia techniques base on is common and it refers to depositing the anaesthestic substance in the spongy bone after we have perforated the cortical with the special drill included in the kit. Although the procedure seems very painful and complicated you will be surprised how simple and efficient it is. Some systems have special guides that remain inserted in the bone and help the dentist to easily inject the anaesthetic inside.

Usually every intraosseous anaesthesia technique kit is single use and it includes a perforator, a guide canule and a special short needle. The clinical protocol includes the topical anaesthesia, the perforation of the cortical and the injection of the anaesthetic inside the spongy bone.

There are two different ways to deliver an intraosseous anaesthesia : the lateral perforation and the vertical perforation.

Horizontal perforation

If the lateral perforation is indicated when teeth are present in the dental arch, the vertical perforation is recommended to the edentated arches.

Vertical perforation

In implant surgery we use the vertical perforation and we can say that it is a minimally invasive technique because we use the same spot of perforation were the incicision will be made and the implants will be inserted in their neo-alveoles.

Vertical perforation

The question is why to choose a new and maybe more complicated anaesthesia technique instead of the classical one?

Some of the intraosseous anaesthesia advantages are:

-       The effect of the anaesthesia is almost immediate;

-       This type of anaesthesia requires a less quantity of substantance than the classical one and the toxicity is diminuated;

-       The classical technique mistakes can be avoided. This is very important for patients with special anatomy where young dentists can face difficulties in performing a qualitative anaesthesia;

Vertical perforation

-       The soft tissues like lips or tongue are no longer affected by the unpleasent effect of the anaesthesia;

-       The intraarterial accidental injection of the anaesthetic substance is eliminated;

Like any alternative technique it has disadvantages aswell:

-       Incapacity of perforating the cortical due to its’ thickness;

-       Local complications at the perforating spot;

-       It’s a more expensive technique compared to the classical one;

Intra-operative aspect

In conclusion we would like to say that the young dentists should keep in mind that intraosseous anaesthesia with vertical perforation is a minimally invasive, easy to learn and very efficient technique in implant surgery. This technique proved to be a real and viable alternative to the classical ones but without trying to become an absolutely neccessary substitute or a replacement of these.

Source- dentapress