Maxillary Anesthesia Flashcards
what are the 3 types of maxillary anesthesia
- local infiltration
- field block
- nerve block
what is the PSA technique
45 degrees, upward, backward and in
what is the height of the vestibule for PSA
16mm
where should you insert the needle in the vestibule for PSA
at the height of the vestibule
how deep should you insert needle for PSA
16mm
how much fluid should you inject in the PSA technique
0.9mL- 1.8mL
what are the areas anesthetized in the PSA nerve block
- maxillary molar tooth pulps
- MB root of 1st molar in 72%
- buccal periodontium and bone
what are the advantages of the PSA nerve block
-atraumatic
- success rate >95%
- minimal volume of anesthetic
what are the disadvantages of PSA nerve block
- disfiguring hematoma risk
- MB root of 1st molar missed in 28%
- aspiration rate ~3%
describe the middle superior alveolar nerve
- present in some patients
- MB root of 1st molar in 28%
- buccal periodontium and bone
what is the MSA technique
- inject well above premolar apices, bevel facing bone
how much should you inject in the MSA nerve block
0.9-1.2mL
what areas are anesthetized in the MSA nerve block
-premolars
- MB root of first molar 28%
- buccal periodontium and bone
what are the indications of the MSA nerve block
- to treat both premolars
- when a nerve block in indicted
- when supraperiosteal injection has failed
- when infraorbital block does not anesthetize premolars
what does the needle contact in the ASA nerve block
the roof of foramen
where is the anesthetic injected into in the ASA nerve block
into the canal
how can you locate the foramen
palpation
how far away is the foramen from the vestibule
~16mm
what is the insertion depth for the ASA nerve block
1/2 length of needle
where should you orient the needle bevel in the ASA nerve block
towards the bone
how much should you inject in the ASA nerve block
0.9-1.2mL
when should you apply pressure to the foramen during the ASA nerve block
- during injection
- maintain pressure one minute after injection
what areas are anesthetized in the ASA nerve block
- 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
what are the indications for the ASA nerve block
- procedures on two or more teeth
- inflammation or infection
- dense cortical bone making supraperiosteal injections ineffective
maxillary labial bone is:
porous
describe local infiltration/ supraperiosteal injection
-insert superior to root apex
- orient needle bevel towards bone
- inject 0.6 mL of anesthetic
what areas are anesthetized in supraperiosteal injection
-tooth
- buccal periodontium and bone
- labial or buccal mucosa
what are the indications for supraperiosteal injection
- procedures on one tooth
- soft tissue surgery in a small area
what are the advantages and disadvantages supraperiosteal injection
-advantages: simple and high success rate
- disadvantages: not useful in inflamed area, large volumes needed to treat multiple teeth
how do you do a greater palatine nerve block
- path of insertion
- locate foramen with cotton tip
- apply topical for 2 minutes
- move applicator over foramen: apply direct pressure for 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 0.6mL
what areas are anesthetized in the greater palatine nerve block
- posterior portion of hard palate
- overlying soft tissues
- no anesthesia of teeth
what are the indications of the greater palatine injection
- when palatal soft tissue anesthesia is needed - extractions, sub gingival restorations
- pain control during periodontal or oral surgical procedures
how do you do a nasopalatine nerve block
- apply topical for two minutes lateral to papilla
- apply direct pressure
- contact bone, administer 0.45 mL
describe the nasopalatine nerve block- trans papillary approach
-apply topical lateral to frenum
- blanching of labial tissue
- insert through papilla towards palate
- administer 0.3mL into papilla
what are the areas anesthetized with nasopalatine nerve block
- anterior portion of hard palate
- both hard and soft tissues
- no anesthesia of teeth
what are the indications for nasopalatine injection
- when palatal soft tissue anesthesia is needed - extractions, subgignvial restorations
- pain control during periodontal or oral surgical procedures
what are the approaches for the maxillary nerve block
- high tuberosity approach
- greater palatine canal approach
what advantages or disadvantages of the high tuberosity approach for the maxillary nerve block
- advantages: atraumatic, 95% success rate, minimizes volume of local
- disadvantages: risk of hematoma, absent bony landmarks, lack of hemostasis
what are the advantages and disadvantages of the greater palatine canal approach for the maxillary nerve block
-advantages: usually atraumatic, 95% success rate, minimizes volume of local
- disadvantages: lack of hemostasis, potentially painful injection
