Subperiosteal Injection,In this method, the local anesthetic solution is injected beneath the periosteum. Subperiosteal injection has superiority over supraperiosteal injection.,Technique,Needle: Recommended length and gauge, 25 respectively. The needle is inserted midway between gingival margin and the approximate apex of the tooth; and at right angle to the buccal alveolar plate, in order to penetrate mucous membrane, gingival tissue and periosteum. The needle is then placed at an angle of 45 to the alveolar plate, bevel facing the bone and then it is advanced towards the apex of the tooth, beneath the periosteum.,Infiltration-subperiosteal injection in anterior maxilla-the position of the point of the needle is at an angle of 90 to the long axis of the tooth and the alveolar bone as seen from the side.,Advantages,It is more appropriate, more specific and definite in region. There is no great trauma, contrary to belief. It is safe and much more effective than supraperiosteal injection. Less solution is required to produce the desired results. Total amount of solution sufficient to produce satisfactory and profound anesthesia is 0.3-0.5 ml. The onset of action is rapid. The depth of anesthesia for extraction is achieved immediately, however, for conservative restorative procedures such as preparation of cavities and crowns, and extirpation of pulps, it is advisable to wait for five minutes to allow the solution to reach pulp chamber and anesthetise the neural component. This method greatly reduces the incidence of intravascular administration. Reduces needle punctures.,Disadvantages,There is theoretical damage to the periosteum. No greater trauma is created by injecting local anesthetic solution beneath the periosteum.,Intraligament (Periodontal or Peridental) Injection,It is a very efficient method of producing anesthesia especially for cavity preparation, crown preparation, pulp extirpation, etc. - Advantages: i. Rapid onset of action. ii. Specific analgesia to isolated teeth. Single mandibular tooth can be anesthetised without performing a pterygomandibular block. This avoids numbness of the lip and tongue. There is less likelihood of inadvertently traumatising these structures in the immediate post injection phase. iii. Useful adjunct to conventional local anesthesia; and in experienced hands for minor surgical procedures. - Disadvantages: i. Post injection discomfort due to temporary extrusion. ii. Apparent increase in the incidence of “dry socket“.,Technique,Needle: 25-gauge is recommended. The local anesthetic solution is injected along periodontal membrane of maxillary and mandibular teeth, using small amounts of local anesthetic solution, usually 0.2 ml, delivered via a specifically designed system, which comprises of high pressure syringes and ultrafine needles. The high pressure forces the solution rather than causing diffusion, through the periodontal ligament to the nerves in that area.,Intrapulpal Anesthesia,This technique is indicated for obtaining anesthesia for procedures which require direct instrumentation of the pulpal tissue. First, put a cotton ball soaked in local anesthetic solution in the cavity, wait for a minute; and then a 25 or 27-gauge needle is inserted directly into the pulp chamber. The needle should be held firmly or wedged into the pulp chamber or the root canal. Initially, slight discomfort is felt by the patient which subsequently gets subsided. Sometimes the needle is bent to get a proper angle for good approach,Intraosseous Injection Technique,In this method, the local anesthetic solution is deposited directly into the cancellous bone adjacent to the tooth to be anesthetised, between the two cortical plates of bone of maxilla and mandible. Intraosseous injection is usually an adjunct, and is used when conventional methods have been tried and failed.,Technique,The soft tissues overlying the apex of the tooth are first anesthetised with paraperiosteal injections. This injection should be made either mesial or distal to the tooth to be anesthetised, and slightly above the roots, in order to avoid injury to the teeth,Intraseptal Anesthesia,It is considered as a variation of intraosseous anesthesia. A needle is forced gently into the porous interseptal bone on either side of the tooth to be anesthetised,Local Infiltration of the Palate,The anesthesia of the hard palate is necessary for dental procedures involving manipulation of palatal soft and hard tissues. The palatal injections are one of the most painful injections. It is advisable to inform the patient prior to injection about the pain during the injection. This helps in preparing the patient psychologically.,Nerves anesthetised: Terminal branches of greater palatine and nasopalatine nerves. Areas anesthetised: Soft tissues and bony hard palate in the vicinity of the injection.Indications: Anesthesia in a small area of injection. Hemostasis in the area of surgery. Contraindications: Presence of acute inflammation or infection at the site of surgery. Provides a small area of anesthesia.,