Anestesia Local con el Sistema STA Wand

Anestesia Local con elSistema Wand STAMilestone ScientificCorporate HighlightsRecognized global leader in advanced injection technologiesMilestones revolutionary injection systems are currently sold through the Companys global distributor network to dental professionals worldwide. Customer base spans over 50 countries Responsible for over 40 million computer controlled injections worldwide.Supported by an unmatched number of clinical studies2Milestone Scientific introduced the first computer-controlled local anesthetic delivery system (CCLADS), the Wand, in 1997. It was the result of 12 years of development by a practicing dentist and is probably the most widely studied dental device in history with over 75 clinical studies and published articles. The next version, Wand Plus, was launched in 2001 and had significant improvements such as Cruise Control, voice and sound prompts, and a shorter aspiration, ect. Anestesia LocalEs un componente necesario en la prctica odontolgicaPuede estresar al pacientePuede estresar al dentistaEs muy importante para el pacienteNo es considerado como un elemento muy importante para el dentista

Pacientes y AnestesiaPor qu los pacientes normalmente no se quejan de las inyecciones de anestesia convencionales?

Miedo y AnsiedadDe acuerdo con la Asociacin Dental Americana (ADA): 90% de los pacientes tienen miedo y ansiedad con respecto a las inyecciones dentales, siendo el motivo principal para que los pacientes no vean regularmente a su dentistaKrochak M, Friedman N. Compend Contin Educ Dent.1998 Feb;19(2):137-40, 142-3, 146 passim; quiz 150.

Cmo los dentistas son juzgadospor los pacientes10. Altos estndares de esterilizacin9. Examen inmediato de un paciente nuevo8. Servicio de emergencia de acceso veloz7. Paciente feliz con los resultados6. Dentista que escucha; permite preguntas; trata las preguntas tontas con dignidad5. Doctor, fue el examen dental ms prolijo que me han hecho.4. Los horarios de atencin son puntuales.3. El equipo de trabajo es amable, profesional, cuidadoso, clido y preocupado por ayudar2. El doctor no produce dolor.1. Una inyeccin sin dolor.de St. Georges J (2004). Dent Today 23(8) 96-98.Evolucin de la Anestesia Dental1853 Charles Pravaz: jeringa con aguja ventilada1884 William Halsted: bloqueo alveolar inferior (cocana)1904 Procana (Novocana)1943 Nils Lofgren: Lidocana1976 Articana

Evolucin de la Anestesia Dental2008: Evolucin del aparato Wand System para crear el equipo STA (Single Tooth Anesthesia) con el sistema DPS (Dynamic Pressure Sensing de Mark Hochman)

Sistema AlternativoMisma anestesia Menos volumenMismas inyecciones Nuevas inyeccionesMisma anestesia profunda Normalmente sin efectos colaterales de adormecimiento de cara y labios

C-CLADComputer-Controlled Local Anesthesia DeliveryAplicacin de Anestsico Local Monitoreada por ComputadoraComponentes del Wand STAUnidad de Control (CPU)MicroprocesadorMotor de pasos elctricoPieza de mano WandCanal de silicona y sostenedor de cartuchoPedalSwitch de activacin

Tecnologa BaseMedicin precisa del flujoRazn x Volumen = Razn de flujoControl preciso de la agujaCon la yema de los dedosSujecin tipo lapicero

La Jeringa requiere Presin Manual

Medicin Precisa del FlujoControlFlo1 gota cada 2 segundosRazn de flujo menor al umbral del dolor del pacienteRapidFloUn cartucho 1.8 ml en aproximadamente 50 segundosTurboFloUn cartucho 1.8 ml en aproximadamente 30 segundos

El flujo es independiente de la densidad del tejido

16The STA-Intraligamentary Injection is given in the STA Mode, using the ControlFlo rate of a drop every two seconds. The series of ascending tones and lights informs the clinician when they have arrived at the proper injection site, the Periodontal Ligament Space. As long as the lights are ascending from Orange to Yellow to Green, the needle is in the corrected spot. If the lights are not flashing and the tones are not ascending the needle has not been retained at the injection site. If the lights arrive at the middle range of the Yellow Zone, there is a good probability that successful anesthesia will be achieved. If the lights arrive at the Green Zone, a voice will indicate PDL and there is a very good probability that successful anesthesia has been achieved. Sistema STA Aplicacion en la PracticaPor Dentistria PediatricaDemonstrado clinicamente a reducir significativamente el mal comportamiento de los ninos en varios estodios clinicls realizado en universidadesLa pieza de mano que se vea no danoso reduce el temor y anxiedad y asegura un paciente mas manegableSTA Intraligamentary (PDL) injection elimina las dificutades y los riesgos de hacer un bloqueo alveolar en pacientes pediatricosElimina la anestesia colateral de la cara, lengua, y labioUna inyection mas comodo

17ael. Another clinical study from the University of Nebraska, Department of Pediatric Dentistry showed that pediatric patients were 5 times less disruptive when the Wand Handpiece was used as compared with the traditional dental syringe. With proper technique the pediatric patient often does not realize that an anesthetic has been delivered until after the injection. InyeccionesTradicionalesBloqueo alveolar inferiorInfiltracin maxilar por bucal

NuevasSTA Inyeccin intraligamentaria (PDL)AMSA (anterior middle superior alveolar): alveolar superior anterior medioP-ASA (palatal anterior superior alveolar): palatino alveolar anterosuperior

18All traditional and newly discovered injections can be delivered more comfortably with the computer-controlled technology of the STA, according to many clinical studies. The patented ControlFlo of a drop of anesthetic every two seconds is precise, constant, and consistent and is below the patients pain threshold. This technology, along with greater needle control, allows the newly discovered injections to be delivered more comfortably, more successfully, and with greater ease than with a syringe. This is 21st Century Anesthesia. Bloqueo Alveolar InferiorInsercin bi-rotacional elimina la defleccin de la agujaMenor cantidad de fallas en los bloqueosMayor sensacin tctilVisibilidad mejoradaMayor comfort

19Speaker can poll the audience about the incidence of missed Mandibular Blocks for discussion below.

One of the reasons for missed blocks may be needle deflection. All needles deflect due to the mono bevel on the needle tip. This deviation can be up to 7mm. The dental syringe is used with a straight linear injection technique, and it is almost impossible to re-orient the bevel of the needle. The Wand Handpiece can be rotated back and forth 180 degrees to re-orient the needles bevel and cancel needle deflection. This is described as the Bi-Rotational Insertion Technique (BRIT) in Dr. Stanley Malameds Handbook of Local Anesthesia textbook. This results in better success and a more rapid onset of anesthesia. Usa DPS Tecnologa Dynamic Pressure Sensing (Deteccin de Presin Dinmica)Inyeccin especfica para cada sitioUsado como anestesia primariaDosis de cartucho de lidocana 1:100000 por razColocacin de 2 a 4 minutosDuracin de anestesia profunda aproximada de 40-60 minutos

STA Tcnica de Inyeccin Intraligamentaria Hochman M. Compendium, April 200721The STA-Intraligamentary Injection should be considered as a primary injection for anesthesia on all teeth, not just when the Mandibular Block or any other injection has failed. This injection uses the PDL space as the injection site. Using the ControlFlo rate, anesthetic solution travels via the periodontal ligament and associated space through the cribriform plate into the medullary bone surrounding the apical region of the tooth achieving predictably successful anesthesia with almost immediate onset and significantly longer duration of anesthesia. Tcnica de Inyeccin P-ASAPalatal - Anterior Superior AlveolarPalatina - Alveolar Superior Anterior

Una inyeccin para mltiples dientes maxilares: todos los incisivos y caninos maxilares.No risk of intravascular injectionSin efecto colateral de anestesia de los tejidos faciales y labialesUso reducido en la dosis anestsicaEficiencia clnica mejoradaSin riesgo de inyeccin intravascularSe puede evaluar la lnea de sonrisaFriedman M, Hochman M. J Esthetic Dent, April 1999.

23The P-ASA is similar to the AMSA in that it is a single site palatal injection that anesthetizes multiple teeth (6 anteriors) and related gingival tissue without collateral numbness to the lips and face, and was also first described by Drs. Friedman and Hochman. In this injection, the needle is placed into the nasal-palatine canal where anesthetic is delivered in a dosage necessary to anesthetize the teeth. The pulpal and palatal anesthesia is profound and extends from cuspid to cuspid. The anesthetic effect may not be completed on the cuspids if they are unusually long. The transitory labial anesthesia extends from cuspid to cuspid, but is often not as profound. It is usually sufficient to perform most procedures such as scaling and root planing, placing a rubber dam clamp, placing retraction cord for impressions, and placing buccal gingival restorations.

Tcnica de Inyeccin AMSAAnterior Middle Superior AlveolarAlveolar Superior Anterior Medio

Una inyeccin para mltiples dientes maxilares: de incisivo central a mesial de primera molarSin efecto colateral de anestesia de los tejidos faciales y labialesUso reducido en la dosis anestsicaEficiencia clnica mejoradaSin riesgo de inyeccin intravascularSe puede evaluar la lnea de sonrisa

Friedman M, Hochman M. Compendium Cont. Ed. Oct 1997.Friedman M, Hochman M. Quintessence Int May 1998.27The STA System allows one to perform an exciting new injection technique for the maxilla that has been recently reported in the dental literature, the Anterior Middle Superior Alveolar nerve block or AMSA for short. It is an alternative to the supraperiosteal infiltration injection performed into the mucobuccal fold. An infiltration will produce unwanted collateral anesthesia to the patients lip, face, and muscles of facial expression. This unintentional side effect is inconvenient and uncomfortable to the patient and distorts their smile line, which is undesirable especially when performing esthetic dentistry. The AMSA can anesthetize 5 teeth using a palatal approach without anesthetizing the patients lip and face. The pulpal anesthesia is profound and extends from the central incisor through the mesial-buccal root of the maxillary 1st molar. Anesthesia on the buccal/facial attached gingiva my not be profound, but it is usually sufficient to perform most procedures such as scaling and root planning, placing a rubber dam clamp, placing retraction cord for impressions, and placing buccal-gingival restorations. The profound palatal anesthesia extends form the central incisor posteriorly to the area of the second molar. This AMSA can be performed virtually painlessly using the ControlFlo rate of the STA system.

AMSA Zona de Colocacin

29The injection site is an area, not an exact point. The location of the intended needle placement is way along an imaginary line between the free gingival margin and the mid-palatal suture that bisects the contact point between the first and second pre-molars. Another way to find the injection site is to locate the junction of the horizontal and vertical parts of the palate that bisect the contact point between the pre-molars. As you can see on the dry skull slide, the palatal bone is very porous and has many nutrient canals that will allow the anesthetic to profuse through to anesthetize the tooth from the palatal approach rather than from the buccal aspect. Inyeccin AMSA VentajasSe evita el sndrome de labio cadoPermite asesorar la lnea de sonrisa cuando el paciente est anestesiadoInyeccin nica palatinaUso exclusivo con la velocidad ControlFloTcnica de pre-puncin usando la tcnica del bisel contra el paladar

The AMSA in conjunction with the traditional PSA (Posterior Superior Alveolar) injection behind the maxillary second molar takes the place of multiple infiltrations and palatal injections to anesthetize a maxillary quadrant. This injection technique is very valuable for scaling and root planing. This injection was first described by Drs. Hochman and Friedman in 1997, is now considered a State of the Art injection, is being taught in many dental schools, and is being used successfully by most of the worlds most prominent esthetic dentists, such as Drs. Goldstein, Hornbrook, Dorfman, Dickerson, Sheets, and Crispin. Dr. Stanley Malamed includes this important injection in his textbook and lectures on local anesthesia.30

STA-Intraligamentary Injection

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Validacion Scientifica Publicado33There have been over 25 clinical studies and over 50 published articles about the CCLADS technology. All of these studies validate the efficacy and multiple benefits of the STA System as it represents the next generation of Computer controlled local anesthesia delivery systems. The original Wand System has been used in dentistry for a decade now. There are many references to the original Wand in the dental literature and in textbooks written on dental local anesthesia. It is no wonder that it has established a new standard of care for pain control. The STA System represents the next innovation in CCLADS technology.

34Thank You for your Attention. I would be pleased to answer any questions.