Cleft lip and palate: recommendations for dental anesthetic procedure\nbased on anatomic evidences
A 20-year-old male patient with a complete unilateral CLP was seen at the\nOrthognathic Surgery Clinic of the Hospital for Rehabilitation of Craniofacial\nAnomalies, University of São Paulo, Brazil, for extraction of the pre-canine\nsupernumerary tooth adjacent to the cleft for prosthetic rehabilitation purposes\n( and ).\nAfter skin and oral antisepsis with 0.12% chlorhexidine (PerioGard®,\nColgate-Palmolive, São Bernardo do Campo, SP, Brazil), a topical anesthetic gel with\n20% benzocaine (Benzotop, DFL, Rio de Janeiro, RJ, Brazil) was applied at the bottom\nof the vestibule to reduce pain during the regional injectable anesthetic procedure\n(mepivacaine with epinephrine 1:100,000; Mepíadre, DFL).\nA first puncture was performed in the first premolar region (), away from the area to be handled in order to avoid a\npuncture near the nose as a direct infiltration in this area is usually very painful.\nThen, after approximately 5 min, when the area was partially anesthetized, a second\npuncture was made at the apex of the tooth to be extracted (), in a slow and gradual manner, with the needle\ninclined 45º to the apex of the pre-canine tooth. Injections throughout the marginal\nbuccal mucosa () and palate () were also performed. After the\nanesthetic procedure, the tooth was extracted following the steps: intra-sulcular\nincision (), dislocation and tooth\nextraction () and, finally, suture ().