bull Private pediatric practice in New Jersey bull Past-President American Society of Dentistry for
Childrenbull Past Trustee American Academy of Pediatric
Dentistrybull MBA Healthcarebull Coordinator Dental Continuing Education
Monmouth Medical Centerbull Associate Clinical Professor at New York University
Brief Bio
Shore Pediatric Dental Group
Hygiene Room
Prevention
Restoration
Remineralization
Prevention
American Academy of Pediatrics
American Academy of Pediatric Dentistry
Recommendation
Dental home by age 1
ANTICIPATORY GUIDANCE ndashWhat is it
It is the process of providing practical developmentally appropriate health information about children to their parents in anticipation of significant physical emotional and psychological milestones-Nowak and Casamassimo 1995
Infant Exam
Counseling
Diet amp Nutrition
Oral Hygiene
Habits
Airway Space
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Private pediatric practice in New Jersey bull Past-President American Society of Dentistry for
Childrenbull Past Trustee American Academy of Pediatric
Dentistrybull MBA Healthcarebull Coordinator Dental Continuing Education
Monmouth Medical Centerbull Associate Clinical Professor at New York University
Brief Bio
Shore Pediatric Dental Group
Hygiene Room
Prevention
Restoration
Remineralization
Prevention
American Academy of Pediatrics
American Academy of Pediatric Dentistry
Recommendation
Dental home by age 1
ANTICIPATORY GUIDANCE ndashWhat is it
It is the process of providing practical developmentally appropriate health information about children to their parents in anticipation of significant physical emotional and psychological milestones-Nowak and Casamassimo 1995
Infant Exam
Counseling
Diet amp Nutrition
Oral Hygiene
Habits
Airway Space
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
It is the process of providing practical developmentally appropriate health information about children to their parents in anticipation of significant physical emotional and psychological milestones-Nowak and Casamassimo 1995
Infant Exam
Counseling
Diet amp Nutrition
Oral Hygiene
Habits
Airway Space
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
It is the process of providing practical developmentally appropriate health information about children to their parents in anticipation of significant physical emotional and psychological milestones-Nowak and Casamassimo 1995
Infant Exam
Counseling
Diet amp Nutrition
Oral Hygiene
Habits
Airway Space
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
It is the process of providing practical developmentally appropriate health information about children to their parents in anticipation of significant physical emotional and psychological milestones-Nowak and Casamassimo 1995
Infant Exam
Counseling
Diet amp Nutrition
Oral Hygiene
Habits
Airway Space
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
It is the process of providing practical developmentally appropriate health information about children to their parents in anticipation of significant physical emotional and psychological milestones-Nowak and Casamassimo 1995
Infant Exam
Counseling
Diet amp Nutrition
Oral Hygiene
Habits
Airway Space
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
It is the process of providing practical developmentally appropriate health information about children to their parents in anticipation of significant physical emotional and psychological milestones-Nowak and Casamassimo 1995
Infant Exam
Counseling
Diet amp Nutrition
Oral Hygiene
Habits
Airway Space
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
It is the process of providing practical developmentally appropriate health information about children to their parents in anticipation of significant physical emotional and psychological milestones-Nowak and Casamassimo 1995
Infant Exam
Counseling
Diet amp Nutrition
Oral Hygiene
Habits
Airway Space
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull The pediatric dentist can be the first to identify airway structure issues
bull Learn how to incorporate this knowledge and develop a medicaldental team approach for the developing child
Sleep Apnea
Brodsky Tonsil Scale
W-Loop
Dental Equilibration
Appliances eg ldquoW-looprdquo
Periodic exam
Why every 6 months
Sealants
Ultradent
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
copy 3M ESPE 2010 All Rights Reserved
Ketactrade
Ketactrade Nano Quick Mix Capsule
Direct Restoratives Products
Cumulative Fluoride Release
Oxman et al 2008 AADR Abstract 987
Recaldent
Novamin
Pro-Argin
Remineralizing Agents
Tooth Mousse
NYU 3 visit protocol
First Visit
Exam
Counseling
Varnish
Second Visit
ITR (Interim Therapuetic Resortation)
Fluoride Varnish
Tooth Mousse
Third Visit
Fluoride Varnish
Counsel
Repair
ITS
Interim Therapeutic Strip Crowns
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
bull Correct Diagnosisbull Vitalbull Non-vital
bull Restorationbull Microleakage
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Characteristics of Reported PainProvoked thermal chemical mechanicalbull indicates dentin sensitivity pulp in transitional stage bull usually acute inflammation and reversible
Spontaneous bull throbbing constantbull indicates advanced pulp damagebull pulp usually non-treatablebull irreversible pulpitis or necrosisbull often nocturnal
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Radiographic ExaminationInternal resorptionbull once internal resorption has become advanced to
be seen radiographically there is usually a perforation of the root by the resorptive process
Pathologic bone and root resorption bull Indicative of advanced pulp degeneration The
pulp tissue may remain vital even with such advanced degenerative changes
Medicaments for Pulpotomy
Formocresol
Ferric Sulfate
Mineral Trioxide Aggregate (MTA)
Pulpectomy
VitapexPremixed Calcium Hydroxide
IPT Technique
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Gross caries removalbull Walls extended to sound tooth structure
bull Infected dentin removed
bull Affected dentin remainingbull Should have 1mm sound dentin over remaining pulp
bull Base over remaining dentinbull Final restoration bull Must have good marginal integrity
bull Recall for evaluation
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
IPT Protocol bull Local anesthesia and rubber dam placement bull Excavation of infected dentinbull Caries detector (Sable Seekreg from Ultradent) utilized bull Cavity photographedbull Placement of 20 chlorhexidine gluconate viscous
solution Consepsis Vreg (Ultradent Products Inc) for 60 seconds
bull Placement of a resin-modified glass ionomer (Fuji II-LCreg GC America) on the preparation floor
bull Final restoration placement internal or full coveragebull Final photographbull Recall 3 6 and 12 months
Clinical Procedure
Radiographic findings of primary first molar post-treatment
6 months post-treatment
12 months post-treatment
Findingsbull 3 month recall 100 teeth were WNLbull 6 month follow-up 93 teeth were WNLbull Failure of Class II composite and one SSC restoration
bull 12 month recall all remaining teeth were WNL
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 month follow-up
Restorative Materials
Composites
Flowable
RMGI
Giomers
Crowns
Beautifil II
Sectional Matrix
Isolite System
Local Anesthesia for Patients
Dr William H Lieberman DDS MBA
Pediatric
1975-2013Then amp Now
bull Syringes bull The Wand STA - Single Tooth Anesthesia System Instrument
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Place needle and cap into holder on either side of STA
Step - 3Shorten length of
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Wand Handpiece bull Remove tubing handpiecebull Shorten by ldquobreakingrdquo the length
of the handlebull Mark the bevel
Step - 4
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Insert wings of holder into top of STAbull Turn counter-clockwise
frac14 turn
bull STA activates and purges handpiece of airbull Lights are activated
Insertion of Cartridge Holder
Step - 4b
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Turn clockwise frac14 turn bull Push cartridge out using finger slots at top of cartridge holderbull Remove cartridge and
continue
Removal of Cartridge Holder
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull The Training Mode provides an audible explanation of the various functions of the STAbull Allows one to become familiar
with operating the STAbull Enable Training Mode by
pressing and holding the ldquoHold to Trainrdquo button for 4 seconds
Easy Learn Training Mode
Step - 5
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Lesson 2 Performing the STA-Intra-ligamentary Injection
Learn the Injection of Your Choice
Lesson 3 Performing the AMSA ndash (Palatal) Injection
Lesson 2 Tools needed to perform
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
STA-IL Injectionbull What you need to perform this injectionbull Bonded - 30-g frac12 inch STA-Wandreg Handpiecebull The STA drive-unit set to ldquoSTArdquo modebull Activate Training Mode feature (optional)
Lesson 2 Performing STA-IL Injection
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to learnbull How to use Cruise-control featurebull Understand how DPSreg worksbull How to use STA aspiration to prevent back-spray of anesthetic into patients
mouth
Performing STA-Intra-ligamentary
Injection
Easy Learn Cruise Control
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What is the Cruise Control featurebull The feature allows you to deliver anesthetic
solution without the need of continuously depressing the foot pedal itrsquos analogous to cruise-control in your car in which you release the accelerator and continue to drive
bull How do you activate1 Start injection by depressing pedal2 After 3 seconds voice prompt will
say ldquoCruiserdquo3 Immediately release foot off pedal
to remain in cruise mode
bull How do you de-activatebull Tap foot-control pedal to stop
Step - 1
Easy Learn STA-IL Insertion Site
bull Area effectedbull Single Tooth Anesthesia
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Injection site1 Start on distal2 Bend needle if necessary to gain
access3 It is best to maintain a direct view
of the needle and itrsquos entrance to the sulcus at all times
4 It is important for the shaft of the needle to be parallel with the surface of the root
Step - 2
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
You need a slight bend to the needle to allow proper access
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
NOTE You cannot access the distal of the lower molars properly without bending the needle slightly
Incorrect Correct
Unbent needle Bent needle (allows proper angle and access to PDL)
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Important to maintain direct vision of proper needle angle and needle entrance into the sulcus when using either approach
bull Distal-buccal requires needle to be bent as well
Buccal Approach
Mesial Approach
Incorrect needleangle and entrance
Correct
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Proper angle and entrance can be achieved with bent or straight needle
Incorrect
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Objective of Insertion1 Needle tip to entrance of PDL
Angle of Insertion1 30 to 45 degrees2 Bend needle if necessary3 Direct vision of needle4 Needle shaft parallel to root
Movement of Insertion1 Very SLOWLY advance needle
producing Anesthetic Pathway2 Needle is inserted like a
ldquoPeriodontal Proberdquo gently
Easy Learn Needle Insertion
Step - 3
30ordm
Easy Learn Dynamic Pressure Sensing
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What is the DPS featurebull This feature provides real-time audible and
visual feedback to indicate when the needle is properly positioned when performing the STA-Intra-ligamentary (PDL) injection
bull How to use1 In STA-Mode only2 Start injection3 Insert needle into ldquoassumedrdquo
correct PDL injection location 4 Wait approximately 10-15 seconds
in ldquoassumedrdquo correct location5 Listen amp Watch ldquoascending tonerdquo amp
Increase of Pressure Scale through ldquoorangerdquo LED zone
6 Maintaining the High ldquoorangerdquo or the ldquogreenrdquo LED zone throughout confirms proper needle location
Step - 4
>
>
>
Easy Learn DPSreg technology
Trouble Shootingbull Problem
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Pressure not building1 Insufficient hand pressure on
STAWand handpiece2 Did not wait 10 -15 seconds to allow
pressure to build3 Incorrect needle position
Over-Pressure Alert4 Excessive hand pressure on
STAWand handpiece5 Blocked needle tip with excessive
hand pressure into PDL tissue6 Incorrect needle position
Step - 5
>
>
AMSA Injection
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull A new technique that enables us to anesthetize a maxillary quadrant in the primary dentition with one injection
Lesson 3 Tools needed to perform
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
AMSA - Injectionbull What you need to perform this injectionbull 30-g frac12 inch ndash Bonded STA-Wandreg Handpiecebull Cotton-applicator with wooden-handle requiredbull The STA drive-unit set to ldquoSTArdquo mode
Lesson 3 How to Perform AMSA- Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Easy Learn AMSA Insertion Site
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Area effectedbull The AMSA can produce pulpal anesthesia
from the Central Incisor to the 2nd Premolar and the associated hard and soft palatal tissues
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar2 Mid-way along an imaginary line
from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Bisect premolars Midway between the free
gingival margin and mid-palatine suture
Step - 1
Easy Learn AMSA Insertion Site
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Injection site1 Imagine a line located between
the 1st and 2nd Premolar
2 Mid-way along an imaginary line from the palatal suture to the free gingival margin
3 Approach this site with the hand-piece from the contra-lateral premolars
Step - 1
Clinical Technique AMSA Injection
>
Lesson 4 Performing P-ASA Injection
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to Learnbull How to use Cruise-control featurebull How to perform Pre-Puncture Techniquebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspiration to prevent back-spray of anesthetic into
patients mouth
Clinical Technique P-ASA Injection
Easy Learn P-ASA Insertion Site
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Area effectedbull The P-ASA can produce pulpal
anesthesia of the Central and Lateral Incisors and the associated hard and soft palatal tissues
bull Injection site1 Entry point is the incisive groove
surrounding the incisive papilla2 Final needle tip position is within
the incisive canal
Step - 1
Easy Learn Anesthetic Pathway
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What is the Pre-Puncture techniquebull The technique allows you to penetrate and
advance the needle through the palatal gingiva with minimal discomfort to the patient
bull How to perform1 Place bevel against surface with
cotton-applicator on-top2 Wait 8 seconds- then rotate and
penetrate surface 1 - 2 mm 3 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
4 Advance needle until bevel contacts surface of bone
Step - 2
Clinical Technique P-ASA Injection
Lesson 5Tools needed to perform IA
Block Injection
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to perform this injectionbull Smaller Children 30-g 1 inch ndash Bonded STA-Wandreg Handpiecebull Adolescents 27-g 1 frac14 inch ndash Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 5Performing IA Block Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use Bi-Rotational Insertion Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Bi-rotation Insertion
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Bi-rotation Insertion techniquebull This technique allows you to minimize needle
deflection during insertion
bull How to performbull Rotate needle in a back-n-forth fashion
Rotational Insertion
Linear Insertion
Deflection
X X
Linear Rotational
Insertion Techniques
Easy Learn 2-Speed Operation
Step - 1
1
2
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Using ldquoNormalrdquo mode 2-speed operationbull You can more effectively and efficiently perform
the IA Block using the 2-speeds
How to use1 Depressing the foot control lightly allows
you to start the injection using the ControFlo (slower) flow rate ndash Use for the first frac14 cartridge of IA Block
2 Depressing the foot control all the way down allows the second more rapid rate to administer the remaining volume of anesthetic
Easy Learn Aspiration
Step - 2
1
2
3
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Using Aspiration to prevent intravascular needle placementbull You can prevent needle placement into a vessel
by use of aspiration
How to usebull After completion of needle placement1 Press and then release foot-control
pedal to activate aspiration which is six beeps for the complete cycle
2 If you see blood in the needle hub re-position needle and re-aspirate until negative observation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Anesthetic Pathway techniquebull This technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1- 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Lesson 7Tools needed to Perform SupraperiostealBuccal
Infiltration Injectionbull What you need to perform this injectionbull 30-g 1-inch Bonded STA-Wandreg Handpiecebull Normal Mode
Lesson 7 Performing Supraperiosteal Buccal
Infiltration Injection
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull What you need to Learnbull How to change to Normal Modebull How to use Cruise-control featurebull How to perform Anesthetic Pathway Techniquebull How to use STA-aspirationbull How to use 2 speed operation
Easy Learn Anesthetic Pathway
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Anesthetic Pathway techniquebull The technique allows you to penetrate and
advance the needle through the mucosa and soft-tissues with minimal discomfort to the patient
bull How to perform1 Penetrate mucosa2 Advancement Pace 1 - 2 mm
then wait 4 seconds to allow anesthetic to proceed needle
3 Advance needle until contact against surface of bone
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
AspirationAfter purging STA defaults to Aspiration ON
If not needed Aspiration can be turned OFF by pressing Aspirate button
Cartridge Volume
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull LED lights indicate amount of anesthetic solution remainingbull STA ldquobongsrdquo once when
frac14 cartridge is expressed twice when frac12 is expressed and three times when frac34 is used
Sound Volume Control
To Change AudibleVolume
bull Press up arrow to increase volume
bull Press down arrow to decrease volume
Modes of operationSTA Normal Turbo
ldquoSelectrdquo button change
bull A - STA Mode ndash 1 speedControlFlo only
DPSreg (Dynamic Pressure Sensing)
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull B - Normal Mode ndash 2 speed ControlFlo and RapidFlo
bull C - Turbo Mode - 3 speed ControlFlo RapidFlo and TurboFlo
A
B C
Foot Control and Mode Selections
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Depress Pedal Slightlybull ControlFlo Speed bull Used for Palatal and PDL injections
exclusivelybull Start of all injections during the first frac14
cartridge
bull Depress Pedal Moderatelybull RapidFlo Speedbull Infiltration amp Mandibular Blockbull After first frac14 cartridge only
bull Depress Pedal Firmlybull TurboFlo Speedbull After first frac12 cartridge only
DPSreg - Dynamic Pressure Sensing
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Informs the Dentist of Correct Injection Site (PDL Space) with Ascending Lights and Soundsbull Informs the Dentist if the Needle has Left the Correct Sitebull Informs the Dentist if the Needle has been Blockedbull All Feedback Information in Real Time
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull Hold needle steadily in place with minimal pressure for approximately 15 seconds
bull Ascending tones and lights will indicate the needle is in the correct injection site the periodontal ligament space
bull If ascending tones and lights are not initiated after 15 seconds move needle slightly until the correct position is attained and lights and tones are seen and heard
THE ROLE OF cclad
IN Pediatric dentistry
Behavioral Management
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bull CCLAD technology has improved the overall acceptance of the anesthetic injection in the pediatric population leading to less disruptive behavior
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
Referencesbull Lieberman William H Clinical Session The Wand Pediatric
Dent 1999212bull Allen KD Kotil D Larzelere RE Hutfless S Beiraghi S
Comparison of a computerized anesthesia device with a traditional syringe in preschool children Pediatric Dent 2002 Jul-Aug24(4) 315-20
Pediatric Restorative Dentistry
Painless amp Predictable
Bi-LateralRestorative Dentistry
Efficient
No Lip Biting
No Soft Tissue Numbness
STA-IL Anterior Teeth
Bevel orientation
Mark the Bevel
Patient Compliance
Lack of Disruptive Behavior
Prevent ldquoDrippingrdquo
HAPPY PATIENTS
Cooperative Patients
Dr Billrsquos Helpful Tips
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
bullNeedle choice o 30 gauge for all o1rdquo for older children mandibular blockso frac34rdquo for infiltration and blocks in younger childreno frac12rdquo for STA (periodontal ligament injection)
bull Break the Wand for any injection to better ldquocuprdquo the needle
bull Mark the bevel with a permanent marker
bull Bend the needle with caution as needed for a better angle
Dr Billrsquos Helpful Tips
Dr Billrsquos Helpful Tips
bull Instrument location - LEDrsquos should be clearly visible to operator amp within reach
bull Start instrument prior to injection to avoid startling the patient
bull Use cruise control- NEVER turbo w pediatric patient
Dr Billrsquos Helpful Tips
bull Avoid dripping the anesthetic in the mouth - the bitter taste is the easiest way to lose a compliant patient
bull Develop a consistent pattern of injection site (distolingual is best due to anatomy if manageable)
bullRule of 2rsquos for STA o20 seconds MAXIMUM time to be in one
locationo2 minute window to begin procedureo20 minutes to complete treatment
bull Watch the videos on the websitehellipvery helpful wwwSTAis4Ucom
Dr Billrsquos Helpful Tips
Timeliness
Summary
Audible amp visible assurance of pulpal anesthesia
Painless- minimizes disruptive behavior
Immediate onset of anesthesia
o no delay is important for a childrsquos short attention span
o saves chair time
Multiple quadrants at the same visit
No soft tissue numbness - no risk of lip biting
William Lieberman DDS MBA Pediatric Dentist
Dr William H Lieberman DDS MBA
Shore Pediatric Dental Group
Slide 4
Hygiene Room
Prevention
Prevention (2)
Slide 8
Slide 9
Slide 10
ANTICIPATORY GUIDANCE ndash What is it
Infant Exam
Counseling
Slide 14
Slide 15
Sleep Apnea
Slide 17
Slide 18
W-Loop
Periodic exam
Slide 21
Sealants
Remineralization
White Spot Demineralization
Fuji Triage
Triage
Mila
Fuji II LC
Slide 29
Cumulative Fluoride Release
Recaldent
Tooth Mousse
NYU 3 visit protocol
First Visit
Second Visit
Third Visit
ITS
Slide 38
Slide 39
Restoration
Pulp Therapy for Primary Teeth
Successful Pulp Therapy requires
Characteristics of Reported Pain
Radiographic Examination
Medicaments for Pulpotomy
Pulpectomy
Vitapex Premixed Calcium Hydroxide
IPT Technique
IPT Protocol
Clinical Procedure
Radiographic findings of primary first molar post-treatment
Prospective IPT in Primary Molars using RMGI and 2 CHX A 12 m
Restorative Materials
Beautifil II
Slide 55
Sectional Matrix
Isolite System
Local Anesthesia for Patients
1975-2013 Then amp Now
Drug choice and Volume
What do you see
Prevalence of Dental Fear
Slide 63
Slide 64
Slide 65
Disruptive Technology
Slide 67
Slide 68
Slide 69
Slide 70
Lesson 1 Set Up and Basic Operation
Step - 1
Step - 2
Step - 3
Step - 3 (2)
Step - 4
Step - 4b
Slide 78
Step ndash 6 System is Ready
Lesson 2 Performing the STA-Intra-ligamenta
Lesson 2 Tools needed to perform STA-IL Injection
Lesson 2 Performing STA-IL Injection
Performing STA-Intra-ligamentary Injection
Easy Learn Cruise Control
Easy Learn STA-IL Insertion Site
Slide 86
Slide 87
NOTE You cannot access the distal of the lower molars properly
Important to maintain direct vision of proper needle angle an
Mesial Approach
Slide 91
Easy Learn Dynamic Pressure Sensing
Easy Learn DPSreg technology
AMSA Injection
Lesson 3 Tools needed to perform AMSA - Injection
Lesson 3 How to Perform AMSA- Injection
Easy Learn AMSA Insertion Site
Easy Learn AMSA Insertion Site (2)
Slide 99
Slide 100
Lesson 4 Performing P-ASA Injection
Slide 102
Easy Learn P-ASA Insertion Site
Easy Learn Anesthetic Pathway
Slide 105
Lesson 5 Tools needed to perform IA Block Injection
Lesson 5 Performing IA Block Injection
Easy Learn Bi-rotation Insertion
Slide 109
Easy Learn 2-Speed Operation
Easy Learn Aspiration
Easy Learn Anesthetic Pathway (2)
Slide 113
Lesson 7 Tools needed to Perform SupraperiostealBuccal Infiltr
