Local Anesthetic Technique Flashcards
MSA nerve in V2 is present —% of time
28%
ASA of V2 provides pulpal innervation to
central and lateral incisors
canine
PDL, buccal bone, mucous membrane of teeth
3 major types of local anesthesia
- local infiltration
- field block
- nerve block
where is the foramen rotundum?
pterygopalatine fossa
landmark for posterior superior alveolar nerve block
- mucogingival sulcus
- maxillary tuberosity
- zygomatic process of maxilla
*insert needle at height of vestibule (16 mm depth)
PSA nerve block anesthetizes what?
maxillary molar tooth pulps
mesiobuccal root of 1st molar in 72%
buccal periodontium and bone
advantages of PSA nerve block
- atraumatic
- success rate >95%
- minimal volume of anesthetic
PSA nerve block disadvantages
- disfiguring hematoma risk
- mesiobuccal root of 1st molar missed in 28%
- aspiration rate about 3%
MSA anesthetizes what area
alveolar mucous membrane of premolars
mesiobuccal root of first molar 28% of time
buccal periodontium and bone
MSA nerve block landmark
- depth of mucogingival sulcus above the maxillary second premolar
- inject above premolar apices
anterior superior alveolar nerve areas anesthetized
through infraorbital nerve foramen
- maxillary central through canine
- premolars
- mesiobuccal root of first molar in 28% of patients
- buccal periodontium and bone
- lower eyelid, side of nose, upper lip
indications of ASA nerve block
- procedures on two or more teeth
- inflammation or infection
- dense cortical bone making supraperiosteal injections ineffective
maxillary labial bone is —
porous
supraperiosteal injection indications
- procedures on one tooth
- soft tissue surgery in small area
advantages of local infiltration
simple
high success rate
disadvantages of local infiltration
not as useful in setting of abscess
slightly more volume needed to treat multiple teeth
in order to do a greater palatine nerve block, you have to —
contact bone
landmarks of greater palatine nerve block
- greater palatine foramen
- junction of maxillary alveolar process and palatine bone adjacent to the maxillary first molar
areas anesthetized by greater palatine nerve block
- posterior portion of hard palate
- overlying soft tissues
- no anesthesia of teeth
greater palatine nerve block indications
- when palatal soft tissue anesthesia is needed –extractions, subgingival rest
- putting on rubber dam for restoration
landmarks for nasopalatine nerve block
- central incisors
- incisive papilla (lateral to papilla)
areas anesthetized by nasopalatine nerve block
- anterior portion of hard palate
- both hard and soft tissues
- no anesthesia of teeth
indications of nasopalatine injection
- when palatal soft tissue anesthesia is needed
- pain control during periodontal or oral surgery
- application of rubber dam
buccal nerve is sensory to
molar buccal gingiva
buccal nerve block landmarks
- mandibular molars
- mandibular buccal vestibule/mucogingival sulcus
tissues anesthetized by buccal nerve block
- gingiva buccal to molars
- retromolar pad mucosa
- buccal mucosa in molar area
- NO hard tissues anesthetized
largest branch of posterior division of mandibular nerve
inferior alveolar nerve
landmarks for inferior alveolar nerve block
- coronoid notch
- pterygomandibular raphe
- occlusal plane of the mandibular posterior teeth
for inferior alveolar nerve block, place the syringe at the level of?
coronoid notch across arch
inferior alveolar nerve block—penetration lateral to –>
pterygomandibular raphe
nerves anesthetized by inferior alveolar nerve block
- inferior alveolar
- incisive
- mental
- lingual
disadvantages of inferior alveolar nerve block
- wide area anesthetized
- unsuccessful in 15-20% of pts
- inconsistent oral landmarks
- 10-15% positive aspiration
alternatives to inferior alveolar nerve block
- mental nerve block
- incisive nerve block
- gow-gates block
- vazirani-akinosi block
- intraosseous or intraseptal injection
landmarks of mental nerve block
- mandibular premolars
- mandibular vestibule
areas anesthetized by mental nerve block
- mucosa anterior to foramen
- skin of lower lip
- chin
- anterior mandibular teeth (incisive branch of IAN)
incisive nerve supplies–
incisors, canine, premolars
incisive nerve block areas anesthetized
- mucosa on buccal
- lower lip
- skin of chin
- premolars, canines, incisors
indications of incisive nerve block
- procedures on anterior teeth
- when inferior alveolar block is not indicated
- to avoid bilateral mandibular blocks
advantages of incisive nerve block
- provides pulpal and hard tissue anesthesia without lingual anesthesia
- high success rate
disadvantages of incisive nerve block
- no lingual anesthesia
- may be sensory overlap and midline (rare)
lingual nerve innervates —
anterior 2/3 of tongue
lingual nerve blocked with:
- inferior alveolar nerve block (halstead)
- gow-gates mandibular block
- vazirani-akinosi block
- infiltration in lingual sulcus
gow gates nerve block
true mandibular nerve block
needle contacts neck of condyle
landmarks for gow gates nerve block
-extraoral: lower border of tragus (intertragic notch)
corner of mouth
-intraoral: height of injection established by placement of needle tip just below the mesiopalatal cusp of maxillary second molar
nerves anesthetized by gow gates nerve block
-inferior alevolar
-lingual
-mylohyoid
auriculotemporal
buccal
disadvantages of gow gates nerve block
- longer onset, >5 mins
- no intraoral landmarks
vazirani-akinosi nerve block landmarks
- mucogingival junction of maxillary third (or second) molar
- maxillary tuberosity
- coronoid notch on mandibular ramus
height of vazirani-akinosi nerve block
in between gow gates and standard
at maxillary muco-gingival line
directly parallel to ramus
depth of vazirani-akinosi nerve block
25 mm
nerves anesthetized by vazirani-akinosi nerve block
- inferior alveolar
- lingual
- mylohyoid
advantages of vazirani-akinosi nerve block
- atraumatic
- no need to open mouth
- aspiration rate < 10 %
disadvantages of vazirani-akinosi nerve block
- difficult visualization
- no bony contact
- arbitrary insertion depth
