Anesthesia

Infiltration anesthesia with or without vasoconstrictor, depending on the general anamnesis normally applies. Mandibular block anesthesia should be considered in the distal areas of the lower jaw, since diffusion of local anesthetics is prevented by a thick mandibular cortex. Conscious sedation or general anesthesia for single implant insertion should only be considered when patient psychology renders surgery very problematic. This should be provided by a properly educated and trained workforce.

• Topical anesthesia should precede injection by needle
• Lidocaine, articaine or mepivacaine, with or without a vasoconstrictor are delivered through a carpule containing syringe to allow sufficient pressure to inject submucosally
• Bevel of needle should be parallel with periosteum
• Slow injection of anesthetic which should be warmed to body temperature
• Duration of anesthesia varies with patient metabolism and anxiety
• Preoperative clonidine (reduces blood pressure) or benzodiazepines reduce the dose of local anesthetics needed

Conscious sedation

• Although the central nervous system is depressed patient remains conscious and can respond appropriately to verbal commands
• Nitrous oxide and oxygen administered through the nose. Nitrous oxide has sedative and analgesic effects
• Intravenous (IV) delivery of midazolam or propofol is a safe and widely-used method for obtaining conscious sedation
• Contraindications are pregnancy, allergy and alcohol intoxication. A thorough general anamnesis is important
• Resuscitation equipment, a positive-pressure oxygen delivery system and an intubation tube should always be available during conscious sedation
• National regulations regarding administration of conscious sedation should be followed
• Depending on the country sedation may be applied by a medical doctor, a dentist and oral hygienist or therapist
• Informed consent should whenever possible not be obtained on the same day as surgery