Anestesia Local con el Sistema Wand STA.

Presentación del tema: "Anestesia Local con el Sistema Wand STA."— Transcripción de la presentación:

1 Anestesia Local con el Sistema Wand STA

2 Milestone Scientific Corporate Highlights
Recognized global leader in advanced injection technologies Milestone’s revolutionary injection systems are currently sold through the Company’s 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 studies Milestone Scientific introduced the first computer-controlled local anesthetic delivery system (CCLADS), the Wand, in 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.

3 Anestesia Local Es un componente necesario en la práctica odontológica
Puede estresar al paciente Puede estresar al dentista Es muy importante para el paciente No es considerado como un elemento muy importante para el dentista

4 Pacientes y Anestesia ¿Por qué los pacientes normalmente no se quejan de las inyecciones de anestesia convencionales?

5 Miedo y Ansiedad De acuerdo con la Asociación 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 dentista Krochak M, Friedman N. Compend Contin Educ Dent. 1998 Feb;19(2):137-40, 142-3, 146 passim; quiz 150.

6 Cómo los dentistas son juzgados por los pacientes
10. Altos estándares de esterilización 9. Examen inmediato de un paciente nuevo 8. Servicio de emergencia de acceso veloz 7. Paciente feliz con los resultados 6. Dentista que escucha; permite preguntas; trata las preguntas tontas con dignidad 5. “Doctor, fue el examen dental más prolijo que me han hecho.” 4. Los horarios de atención son puntuales. 3. El equipo de trabajo es amable, profesional, cuidadoso, cálido y preocupado por ayudar 2. El doctor no produce dolor. 1. Una inyección sin dolor. de St. Georges J (2004). Dent Today 23(8)

7 Evolución de la Anestesia Dental
1853 Charles Pravaz: jeringa con aguja ventilada 1884 William Halsted: bloqueo alveolar inferior (cocaína) 1904 Procaína (Novocaína) 1943 Nils Lofgren: Lidocaína 1976 Articaína

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9 Evolución de la Anestesia Dental
2008: Evolución del aparato Wand System para crear el equipo STA (Single Tooth Anesthesia) con el sistema DPS (Dynamic Pressure Sensing de Mark Hochman)

10 Sistema Alternativo Misma anestesia – Menos volumen Mismas inyecciones
– Nuevas inyecciones Misma anestesia profunda – Normalmente sin efectos colaterales de adormecimiento de cara y labios

11 C-CLAD Computer-Controlled Local Anesthesia Delivery
Aplicación de Anestésico Local Monitoreada por Computadora

12 Componentes del Wand STA
Unidad de Control (CPU) Microprocesador Motor de pasos eléctrico Pieza de mano Wand Canal de silicona y sostenedor de cartucho Pedal Switch de activación

13 Tecnología Base Medición precisa del flujo Control preciso de la aguja
Razón x Volumen = Razón de flujo Control preciso de la aguja Con la yema de los dedos Sujeción tipo lapicero

14 La Jeringa requiere Presión Manual

15 Medición Precisa del Flujo
ControlFlo 1 gota cada 2 segundos Razón de flujo menor al umbral del dolor del paciente RapidFlo Un cartucho 1.8 ml en aproximadamente 50 segundos TurboFlo Un cartucho 1.8 ml en aproximadamente 30 segundos El flujo es independiente de la densidad del tejido

16 The 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.

17 Sistema STA Aplicacion en la Practica
Por Dentistria Pediatrica… Demonstrado clinicamente a reducir significativamente el mal comportamiento de los ninos en varios estodios clinicls realizado en universidades La pieza de mano que se vea no danoso reduce el temor y anxiedad y asegura un paciente mas manegable STA Intraligamentary (PDL) injection elimina las dificutades y los riesgos de hacer un bloqueo alveolar en pacientes pediatricos Elimina la anestesia colateral de la cara, lengua, y labio Una inyection mas comodo ael. 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.

18 Inyecciones Tradicionales Nuevas Bloqueo alveolar inferior
Infiltración maxilar por bucal Nuevas STA – Inyección intraligamentaria (PDL) AMSA (anterior middle superior alveolar): alveolar superior anterior medio P-ASA (palatal – anterior superior alveolar): palatino – alveolar anterosuperior All 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 patient’s 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.

19 Bloqueo Alveolar Inferior
Inserción bi-rotacional elimina la deflección de la aguja Menor cantidad de fallas en los bloqueos Mayor sensación táctil Visibilidad mejorada Mayor comfort Speaker 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 needle’s bevel and cancel needle deflection. This is described as the Bi-Rotational Insertion Technique (BRIT) in Dr. Stanley Malamed’s “Handbook of Local Anesthesia” textbook. This results in better success and a more rapid onset of anesthesia.

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21 STA – Técnica de Inyección Intraligamentaria
Usa DPS – Tecnología Dynamic Pressure Sensing (Detección de Presión Dinámica) Inyección específica para cada sitio Usado como anestesia primaria Dosis de ½ cartucho de lidocaína 1: por raíz Colocación de 2 a 4 minutos Duración de anestesia profunda aproximada de minutos The 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. Hochman M. Compendium, April 2007

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23 Técnica de Inyección P-ASA
Palatal - Anterior Superior Alveolar Palatina - Alveolar Superior Anterior Una inyección para múltiples dientes maxilares: todos los incisivos y caninos maxilares. No risk of intravascular injection Sin efecto colateral de anestesia de los tejidos faciales y labiales Uso reducido en la dosis anestésica Eficiencia clínica mejorada Sin riesgo de inyección intravascular Se puede evaluar la línea de sonrisa The 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. Friedman M, Hochman M. J Esthetic Dent, April 1999.

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27 Técnica de Inyección AMSA
Anterior Middle Superior Alveolar Alveolar Superior Anterior Medio Una inyección para múltiples dientes maxilares: de incisivo central a mesial de primera molar Sin efecto colateral de anestesia de los tejidos faciales y labiales Uso reducido en la dosis anestésica Eficiencia clínica mejorada Sin riesgo de inyección intravascular Se puede evaluar la línea de sonrisa The 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 patient’s 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 patient’s 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. Friedman M, Hochman M. Compendium Cont. Ed. Oct 1997. Friedman M, Hochman M. Quintessence Int May 1998.

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29 AMSA – Zona de Colocación
The injection site is an area, not an exact point. The location of the intended needle placement is ½ 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.

30 Inyección AMSA – Ventajas
Se evita el síndrome de labio caído Permite asesorar la línea de sonrisa cuando el paciente está anestesiado Inyección única palatina Uso exclusivo con la velocidad ControlFlo Técnica de pre-punción usando la técnica 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 world’s 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.

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32 STA-Intraligamentary Injection

33 Validacion Scientifica Publicado
There 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.

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