Frequently Asked Questions

Q: What is the best way to become proficient with the X-Tip intraosseous anesthesia system?
A: The most difficult aspect of learning to use the X-Tip is drilling a hole in the bone the very first time. It is normal to be apprehensive at first, but after one or two successful uses, you will begin to look forward to predictable, instant and profound anesthesia. It is very important to use a gentle "pecking" motion while running the slow-speed handpiece to efficiently penetrate the cortical plate of bone.

Q: Will patients experience rapid heart rate from X-Tip system injections?
A: Use the X-Tip system as recommended. Slowly and gently inject 1/3 to ½ cartridge of anesthetic through the guide sleeve and into cancellous bone. Rapid injection may cause discomfort to the patient. Practice will determine the optimal rate of injection. The recommended concentration of epinephrine is 1:100,000 or less. When using vasoconstrictor anesthetics, inform patients that they may have a temporary rapid heartbeat, which is normal and will quickly pass. A plain solution of local anesthetic can be used to avoid any heart rate effects or in patients who have contraindications to the use of a vasoconstrictor.

Q: Can I leave the X-tip guide sleeve in place during long procedures?
A: It is perfectly acceptable to leave the X-Tip guide sleeve in place until completing treatment. Be sure to remember to remove it prior to dismissing the patient. You may find it easiest to insert the X-tip device prior to placing the rubber dam. Lifting the edge of the dental dam allows for access to the X-Tip guide sleeve should re-injecting be necessary.

Q: What post-op instructions should I give the patient?
A: No special post-op instructions are necessary. The majority of patients will have little or no postoperative pain.  In such cases, the patient will usually experience immediate discomfort, and a new perforation site should immediately be selected. The other source of post-op pain is overheating the bone during perforation. In rare cases (less than 5%) the patient may experience a localized swelling with or without infection. These situations usually heal uneventfully but in some cases may require antibiotic therapy.

Q: How can I be sure I won't perforate the root?
A: Always take a pre-op radiograph to make certain there is adequate room between the roots. If the roots have been closed together orthodontically, for example, you may have to inject one or two teeth mesial or distal to the tooth you will be treating.

Q: How do I remove the guide sleeve from the bone and dispose of the used X-tip devices?
A: The guide sleeve is easily removed by gripping it with a hemostat or needle holder. The guide sleeve, drill and 27-gauge needle are then placed in a standard sharps container for safe disposal.

Q: What would happen if I accidentally hit a root with the X-tip drill?
A: If you had not pre-numbed the area, the patient might report a slight pain when you hit the periodontal ligament. At that point, it would feel like you hit a brick wall, and it would be very difficult to progress further. The nicking of the ligament should heal quickly and uneventfully, with little or no post-op pain.

Q: Every now and then I notice some of the anesthetic solution leaking back around the needle. Am I doing anything wrong, and will the patient still get numb when this happens?
A:  No, you are not doing anything wrong. You may occasionally see some anesthetic leakage. Injecting at a slower rate helps minimize this leakage and most of the time you will still get profound anesthesia. It's also a good idea to have your assistant use the suction to collect any leakage to keep the bitter taste away from the patient's tongue. Remember the following tips for using the X-tip:
Be certain to use the 27-gauge extra-short needle included with the X-Tip guide sleeve. If a 30-gauge or smaller needle is used, or a needle is used that is made by another manufacturer, extra space between the needle and the guide sleeve can cause leakage.
Always hold the drill perpendicular to the bone. Holding the drill at an angle increases the amount of bone that must be penetrated, and may not result in successful penetration of the cortical plate.
Even if you feel the sudden give and are convinced you are through the cortical plate, you might have pressed the guide sleeve against a tooth root, an exceptionally dense area of bone. If you are too close to the crest of the ridge you may have entered the opposite cortical plate of bone. All of these situations can block the tip of the guide sleeve forcing the solution back around the needle. If this occurs, insert a new X-Tip device in the hand piece, move to a more favorable site, and try again.
A rubber stopper over the ultra-short anesthetic needle may also provide a positive seal against the guide sleeve.

Q: Can I bend the anesthetic needle for better access in the posterior area?
A: It is not recommended. Bending the needle may weaken the needle and cause separation. For posterior cases, it may be more ideal to inject mesial vs. distal to the tooth to be anesthetized.