The PDL Intraligamentary Syringe

Falmouth, Maine_October 4, 1994
Latest Update Saturday, January 17, 1998

Many dentists have stopped doing mandibular blocks except in rare instances.

Others have attracted many new patients because their patients can leave the office and go directly to work or school without a numb lip.

Many dentists are using the PDL syringe for endo, extractions, operative and crown and bridge.

If you haven't thought about intraligamentary anesthesia because the only syringes you have seen are the 'shiny six guns' take a look at the PDL.

It is small, and surprisingly easy to operate.

It's pencil grip design makes positioning the needle much easier than the pistol grip types.

There are only a couple of technique tips that you will have to learn.

• The main one is to insert the needle with the bevel against the tooth and then when you have it inserted, rotate it so the bevel is at right angles to the tooth.

  This way the anesthetic flows into the periodontal ligament spaces where it can flow to the apex unimpeded.

  If you put the bevel either against the tooth or against the bone, it takes tremendous pressure to get it to flow.

• The PDL syringe barrel can be rotated to align the bevel because the nosepiece can be rotated without rotating the part you hold.

  One little tip to help anyone with eyes as poor as mine is to express a tiny amount of anesthetic and notice the position of the drop on the needle.

• The other important ingredient in a good injection is time.

  It takes about 45 seconds and about two to three 'clicks' of the lever to get enough pressure and volume to reach the apex.

  If the needle is not firmly in the PDL, the anesthetic leaks into the soft tissue and you may or may not get it to the apex.

  If you stop flowing anesthetic 1 mm short of the apex, the PDL will be numb but the pu-lp will not.

• On multi-rooted teeth you will need to inject all the roots separately.

  So where is PDL anesthesia most useful?

  All upper anteriors, canines and premolars are ideal candidates because they require at most two injections and the patient gets the maximum benefit.

  Upper molars are usually not good candidates because they require three injections and upper blocks usually are not too uncomfortable anyway.

• Lower anteriors, canines and premolars are also ideal candidates for just about the same reasons.

  Lower molars are sort of in the same class as upper molars with one exception.

  Even though two or three injections may be necessary, it may be worth it because the post operative comfort of the patient is enhanced.

• It seems the difficulty getting dentists used to PDL anesthesia is that there is no way the patient can tell YOU they are numb.

  You have to tell them.

  This confidence comes with experience.

E-mail your comments to drjack@BetterEndo.com