Local Anesthesia pt. 6 Flashcards
3 major types of local
anesthesia
Local Infiltration
Field Block
Nerve Block
Height of Vestibule
16 mm
PSA Nerve Block
(3)
Insert Needle at Height of Vestibule
to 16 mm Depth
Aspirate, then Inject 0.9ml-1.8ml
PSA Nerve Block
Areas Anesthetized
(3)
Maxillary molar tooth pulps
MB root of 1st molar in 72%
Buccal periodontium and bone
PSA Nerve Block
Advantages
(3)
Atraumatic
Success rate > 95%
Minimal volume of anesthetic
PSA Nerve Block
Disadvantages
(3)
Disfiguring hematoma risk
MB root of 1st molar missed in 28%
Aspiration rate ~3%
Middle Superior Alveolar
Nerve
(3)
Present in some patients
MB root of 1st molar in 28%
Buccal periodontium and bone
Inject well above premolar
apices, bevel facing bone
0.9 to 1.2 ml
MSA Nerve Block
Areas Anesthetized
(3)
Premolars
MB root of first molar, 28%
Buccal periodontium and bone
MSA Nerve Block
Indications
(4)
To treat both premolars
When a nerve block is indicated
When supraperiosteal injection has
failed
When infraorbital block does not
anesthetize premolars
ASA Nerve Block
Needle Contacts
Roof of Foramen
Anesthetic Directed into Canal
ASA Nerve Block
steps (9)
Locate the Foramen by Palpation
Foramen ~ 16 mm Above Vestibule
Insertion Depth ~ ½ Long Needle
Orient Needle Bevel Towards Bone
Insert Gently Until Bone Contacted
Aspirate and Inject 0.9 to 1.2 ml
Maintain Pressure During Injection
Maintain Pressure One Minute
After Injection
ASA Nerve Block
Areas Anesthetized
(5)
Maxillary central through canine
Premolars
MB root of first molar in 28% of patients
Buccal periodontium and bone
Lower eyelid, side of nose, upper lip
ASA Nerve Block
Indications
(3)
Procedures on two or more teeth
Inflammation or infection
Dense cortical bone making
supraperiosteal injections ineffective
Supraperiosteal Injection
steps (4)
Insert Superior to Root Apex
Orient Needle Bevel Towards
Bone
Insert to Level Above Tooth Apex
Inject 0.6 ml of anesthetic
Supraperiosteal Injection
Areas Anesthetized
(3)
Tooth
Buccal periodontium
and bone
Labial or buccal
mucosa
Supraperiosteal Injection
Indications
(2)
Procedures on one tooth
Soft tissue surgery in a small area
Supraperiosteal Injection
Advantages
(2)
Simple
High success rate
Supraperiosteal Injection
Disadvantages
(2)
• Not useful in inflamed area
• Large volumes needed to treat
multiple teeth
Greater Palatine Nerve Block
steps (9)
Path of Insertion
Locate Foramen With Cotton Tip
Apply Topical for 2 Minutes
Move Applicator Over Foramen –
Apply Direct Pressure 30 Seconds
Place Needle Bevel Against Tissue
and Bow the Needle
Administer a Few Drops of Local
Straighten and Advance the Needle
Contact Bone
Aspirate, Deposit 0.45 to 0.6 ml
Greater Palatine Nerve
Block
Areas Anesthetized
(3)
Posterior portion of hard palate
Overlying soft tissues
No anesthesia of teeth
Greater Palatine Injection
Indications
(2)
When palatal soft tissue anesthesia
is needed – extractions, subgingival
restorations, etc.
Pain control during periodontal or
oral surgical procedures
Nasopalatine Nerve Block
steps (7)
Apply Topical for Two Minutes
Apply Direct Pressure
Contact Bone, Administer 0.45 ml
apply topical lateral to frenum
blanching of labial tissue
insert through papilla towards palate
administer 0.3 ml into papilla
Nasopalatine Nerve Block
Areas Anesthetized
(3)
Anterior portion of hard palate
Both hard and soft tissues
No anesthesia of teeth
