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Inside Dentistry
January 2020
Volume 16, Issue 1

Safely Bend Needles for Improved Injections

Greg Tuttle, DDS, on Septodont’s TNN Needle Guide

In 2003, I developed the TuttleNumbNow (TNN) protocol, which is an anesthetic technique for tough-to-numb teeth that permits penetration of the mandibular buccal plate without drills, ports, or sleeves. At my practice, I use the Septoject® Evolution 30 ga short needle for my anesthetic needs. Because of my commitment to this superior needle, I invented a custom device called the TNN Needle Guide to allow clinicians to safely bend it for use in the TNN protocol. Each guide is presterilized for single use and features a groove to apply the device to the cannula of a needle to protect against needlestick injuries.

The TNN Needle Guide was created to increase visibility, stability, control, and safety when performing mylohyoid, periodontal ligament (PDL), and intraosseous injections. Using a bent needle with the TNN Needle Guide gives me an elbow of control to not only push in but also pull out the needle like a push pin. It allows clinicians to apply two-handed leverage without touching the needle, and the translucent blue color helps with visibility of both the needle and the target. For example, in a mylohyoid injection, I can now see, access, and deliver anesthetic to the deep lingual aspect of mandibular second and third molars.

For PDL injections, the TNN Needle Guide gives me three advantages. First, it allows me to see around the crown with proper needle length and an ideal 90° angulation. Second, it allows me to align the needle with the long axis of the tooth. And third, it encourages the force to be applied directly to the guide, which facilitates stability for deeper penetration and less flush-back. With the push in/pull out handle of the TNN Needle Guide, multiple penetrations are possible, and the outcome is an easier to administer and superior PDL injection.

This brings me to the intraosseous injections for which the TNN Needle Guide was primarily invented. Because the guide allows the needle to be bent or even kinked without restricting flow, it provides sufficient stability and control for osseous penetration of the buccal plate without the need for drilling. Learning the TNN protocol minimizes the need for inferior alveolar nerve blocks and reduces waiting time, and it is particularly effective on teeth that are difficult to numb. Now that we have the TNN Needle Guide, the costs, drills, ports, risks, and hassles associated with intraosseous injections are greatly reduced.

Using the TNN system is an effective and fun way to practice. I do a lot of surgery, and I don't need to rely on nitrous oxide or sedation. I use the TNN Needle Guide daily for every lower molar. It provides me with visibility, stability, control, and safety when performing my injections. I no longer have to wait for patients to get numb. The Septoject Evolution needle paired with the TNN Needle Guide and accompanying protocol allows me to "set down the syringe, and immediately pick up the drill" with confidence.

Key Takeaways

1. The TNN Needle Guide is a first-of-its-kind guide that allows dentists to safely bend a needle

2. It provides increased visibility, stability, control, and safety when performing mylohyoid, PDL, and intraosseous injections

3. Guides come presterilized for single use with a groove to apply the guide to the cannula for optimal fit, control, and reduction of needlesticks

4. The guide permits the Septoject Evolution needle to be bent at the 90° to 120° angle that is described in the TNN intraosseous injection protocol

About  the Author

Greg Tuttle, DDS

Private Practice
Sacramento, California
Orem, Utah

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