MAXILLARY ANESTHESIA Flashcards
5 PILLARS of patient management
case selection and treatment planning
identify the patient
intraoperative procedure
post operative management
recall
small terminal nerve endings in the area
infiltration
deposited close to main nerve trunk
nerve block
porous and has thin cortical plate and most common method is infiltration
maxillary anesthesia
has dense cortical plate except the incisor region and method is nerve block
mandibular anesthesia
what nerve is in the cranial nerve V
Trigeminal nerve
sensory to the skin and mucosa
V1 OR ophthalmic division
sensory to dentition and surrounding periodontium
V2 or maxillary
sensory to pulpal,periodontium,mucosa and teeth of the mandible
motor to muscle of mastication
V3 or mandibular
what are the muscle innervated by v3
masseter
temporalis
lateral and medial pterygoid
supply the upper molar except the mesiobuccal root of the first molar and outside of infraorbital canal.
posterior superior alveolar nerve ( PSAN)
from the mesiobuccal root of the 1st molar to 1st and 2nd premolar and supporting structures and will enter the infraorbital canal
middle superior alveolar nerve (MSAN)
Anterior teeth and supporting buccally and will enter the infraorbital canal
anterior superior alveolar nerve (ASAN)
Part of dental plexus of the maxilla
PSAN, MSAN, ASAN
what are the terminal branches of the infraorbital nerve
inferior palpebral nerve
nasal nerve
superior labial nerve
what terminal branch of infraorbital nerve will supply the lower eyelid
inferior palpebral nerve
what terminal branch in infaorbital nerve will supply the side or lateral of the nose
nasal nerve
what terminal branch of infraorbital nerve will supply the upper lip and purely sensory
superior labial nerve
what do you call the buldge behind the central incisor in the hard palate
incisive papilla
what foramen behind the central incisor and underneath of incisive papilla
incisive foramen
what nerve exits the incisive foramen (canine to canine) and does not have pulpal innervation
nasopalatine nerve
mucosa,gingiva, bony strutures and distal to the canine up to the most posterior part of the hard palate
greater palatine foramen
it innervates the soft palate including the uvula
lesser palatine nerve
what nerves exiting the lesser palatine foramen
middle palatine nerve and lesser palatine nerve or posterior palatine nerve
what nerve is not all individiual has this
middle palatine nerve
what kind of anesthesia is used when doing restoration, endodontics and prosthodontics?
pulpal anesthesia
what kind of anesthesia is used when doing extraction
pulpal and palatal anesthesia
what are the nerve anesthesized during supraperiosteal injection
large terminal branches of the dental plexus
what are areas anesthesized during supraperiosteal injection
pulp, root areas of the tooth
buccal periosteum
connective tissue
mucous membrane
means above the periosteum
supraperiosteal
membrane above the bone under the mucosa
periosteum
bevel of the needle should be?
face of the bone
what happen if subperiosteal is injected
painful for the patient
area of insertion of supraperiosteal or local infiltration
height of mesiobuccal fold above the apex of the tooth
how many solution deposited in local infiltration
0.5-1.5 ml
what nerve anesthesized in infraorbital nerve block
ASAN, MSAN
Inferior palpebral nerve
lateral nasal nerve
superior label nerve
what are the areas anesthesized by infraorbital nerve block
pulps of asan
pulps of msan
buccal periodontium and bone
lower eyelid
lateral aspect of the nose
upper lip
what extraoral landmark is needed in infraorbital nerve block
infraorbital notch , 5-10 mm below to locate the infraorbital foramen
what approach in intraoral landmark, opposite the lateral incisor
midline approach
specific landmarks for midline approach
mesioincisal line angle
disto cervical line angle on central incisor
height of the mucolabial fold opposite the lateral incisor
insertion will be at the height of the muccobuccal fold, following the long axis of the tooth using 1st PM
bicuspid or vertical approach
what gauge and length of the needle needed for patients in infraorbital nerve block
25 gauge long needle
what gauge and length of the needle needed for smaller patients in infraorbital nerve block
25 gauge short
position of the clinician in infraorbital nerve block
10 o’clock
position of the patient in infraorbital nerve block
supine or semisupine with neck extended slightly
how many solution deposited in infraorbital nerve block in vertical approach
1 ml
nerve anesthesized in msan block
middles superior alveolar nerve
areas anesthesized in msan block
pulps of maxillary PM
mesiobuccal root of first molar
buccal periodontal tissues and bone
area of insertion of msan block
height of the mucobuccal fold above the maxillary 2nd PM
how many solution deposited in msan block
0.9m-1.2ml
nerve anesthesized in psan block
posterior superior alveolar nerve
areas of anesthesized in psan block
all upper molars except mesiobuccal root of first molar
buccal periodontium and bone
area of insertion of psan block
height of muccobuccal fold above the maxillary 2nd molar
landmarks in psan block
mucobuccal fold
maxillary tuberosity
zygomatic process of the maxilla
how many solution deposited in psan block
0.9-1.8 ml
complication in psan block
hematoma
mandibular anesthesia
what technique of anesthesia used in torus palatinus
nasopalatine nerve block
greater palatine nerve block
local infiltration
a direct vision procedure
nasopalatine nerve block
what is the landmark for nasopalatine nerve block
incisive papilla
how many ml of solution deposited in nasopalatine nerve
0.2-0.3ml
landmark in greater palatine nerve block
opposite or slightly distal to the 3rd molar
how many ml of anesthesia deposited in greater palatine nerve block
0.45- 0.6 ml
what nerve block has the high chance of positive aspiration
greater palatine nerve block
complication in greater palatine nerve block
ischemia of soft palate
anesthesia of the soft palate
reportded by ____ and ____ in 1997
friedman and hochman
area anesthesized in amsan block
maxillary incisors, canine and premolar ( ASAN AND MSAN)
advantages in amsan block
allows for an accurate smile line assesment or cosmetic dentistry
eliminate the postoperative inconvenience of numbness
disadvantage of amsan block
slow administration
can cause operator fatigue because of resistance
uncomfortable
need supplemental anesthesia in central and lateral incisors
ischemia
1:50,000 la with epinephrine is contraindicated
long onset
when using 4% LA such as articaine and prilocaine, reduce the volume by?
0.7-0.9 ml
how many solution deposited using 2% LA in amsan block
1.4-1.8ml
how many solution is needed in asan - palatal block
1.4-1.8 ml
needle penetrates more ______ and more ____ of ______ ______than nasopalatine injection
more deeply and more volume of anesthetic solution
Nerve and area anesthesized in ASAN- palatal
Nerve: nasopalatine nerve and anterior branches of ASAN
Area: pulp of maxillary central and lateral incisor and canine
Facial periodontal tissue and palatal periodontal tissue of same teeth
Nerve and area anesthesized of greater palatine nerve block
Nerve: greater palatine nerve
Area anesthesized: 1.9 mm posterior border of hard palate
