Technique of Maxillary Anesthesia Flashcards
three types of LA injections
- local infiltration
- field blcok
- nerve block
local infiltration
small terminal nerve endings in the area of the dental tx will be flooded with LA
- the treatment occurs in the same area in which the LA is administered
- usually not just doing this one
field block
LA is deposited NEAR the larger terminal nerve branches so the anestherized area will be circumscribed
- tx occurs in an area away from the site of injection
- prevents passage of impulses to the CNS
- maxillary injections ABOVE THE APEX OF THE TOOTH
** getting coverage over a couple of teeth
Nerve block and examples
LA deposited close to a main nerve trunk, usually at a distance from the operative site
examples :
posterior superior alveolar (PSA), inferior alveolar, nasopalatine
bigger area – used in quadrant
supraperiosteal injection
most of the time we can use this when working in the maxilla and this is the MOST FREQUENT TECHNIQUE USED for obtaining anesthesia in the maxilla
indications for supraperiosteal injection?
Pulpal anesthesia of the maxillary teeth when tx is limited to one or two teeth
soft tissue anesthesia in a circumscribed area
contraindications for supraperiosteal injection?
- infection or acute inflammation in the area of injection
2. dense bone overlying apices of teeth
advantages of supraperiosteal injection?
- high success rate
- technically easy injection
- usually atruamatic
disadvantages of supraperiosteal injection?
- not recommended for larger areas (volume of LA – may end up using more so just do a block technique instead)
- positive aspiration (less than 1%)
land marks for a supraperiosteal injection?
- mucobuccal fold
- crown of the tooth
- root contour of the tooth
injection for supraperiosteal injection?
needle use?
area of insertion?
target area?
using a 25-27 gauge short needle
area of insertion - height of the mucobuccal fold above the apex of the tooth being anesthetized
target area- apical region of the tooth
orient the bevel of needle toward the bone
failures of anesthesia in supraperiosteal injection?
needle tip lies below the apex
needle tip lies too far from the bone
complications in supraperiosteal injection?
pain on needle insertion with the needle tip against the periosteum
Posterior Superior Alveolar Nerve Block areas anesthetized
PSA when used for pulpal anesthesia for the maxillary 3rd, second, and first molars is effective in 77- 100% of patients
- ** MB root of the 1st molar is not consistently innervated by the PSA nerve
- may nee supplemental injection to adequately anesthetize the max 1st molar
max first molar innervation with PSA?
MB root of the 1st molar is not consistently innervated by the PSA nerve – need supplemental LA as supraperiosteal injection to adequate the maxillary 1st
areas anesthetized in PSA
pulps of the max 3rd, 2nd, and first molars
buccal periodontium and bone overlying these teeth
indications to do a PSA
- when tx involves two or more maxillary molars
- when supraperiosteal injection is contraindicated
- when supraperiosteal injection has proven ineffective
contraindications for PSA
when the risk of hemorrhage is too great
bleeding disorders?
heart disorders that are on anti-coagulants?
advantages of PSA?
atruamatic
high success
minimum number of injections needed
minimizes he total volume of LA
disadvantages of PSA?
risk of hematoma
technique is somewhat arbituary – no use of landmarks
second injection is usually necessary for tx of 1st molars in 28% of patients
positive aspiration in how much of PSA?
3.1%
PSA block technique? needle use? area of insertion? target area? landmarks?
needle use? = 25- gauge or 27 gauge short
area of insertion? = height of mucobuccal fold above the maxillary second molar
target area?
landmarks = mucobuccal fold, maxillary tuberosity, and zygomaic process of teh maxilla
PSA technique - directions?
upward and inward
backward
upward - superiorly at a 45 degree angle to the occlusal plane
inward = medially toward the midline at a 45 degree angle to the occlusal plane
backward / posteriorly at a 45 degree angle to the long axis of the second molar
PSA technique - aspirate in?
two planes – rorate syringe barrel one-fourth turn and reaspirate
depth of PSA in normal sized adult?
depth of 16 mm in a normal size adult
Precaustions with PSA
depth of needle penetration should be checked – overextension increases the risk of hematoma – too shallow might still provide adequate anesthesia
failure to obstain anesthesia in PSA?
too lateral, needle not high enough, needle too far posterior
hematoma in PSA?
one of the complications that occurs in this injection and occurs if the needle is placed too far posteriorly and hits the pterygoid plexus of veins – + the maxillary artery may also be perforated so use a short needle to minimize this risk
mandibular anesthesia associated with PSA block?
yes – one of the complications that can occur.
CNV3 is located lateral to the PSA nerve – so if too far lateral this could occur
working on the second pre-molar? MSA present in how many people?
MSA block
28%
MSA block areas anesthetized?
pulps of max first and second premolars, MB root of the first molar+ buccal periodontal tissue and bone over same teeth
indications for MSA?
when infraorobital nerve block fails to provide pulpal anesthesia distal to the max canine
dental procedures involving both maxillary pre molars only
if MSA nerve is absent - what is the innervation through?
ASA nerve
contraindications to MSA?
injection in the area is inflammed or infected
where the MSA nerve is absenet, innervation is through ASA nerve technique
advantages of MSA?
minimizes the number of injections and volume of solution
MSA block technique? needle use? area of insertion? target area? landmarks? bevel orientation?
25-27 short needle
area of insertion = height of the mucobuccal fold of max 2nd pre-molar
landmark = mucobuccal fold of max 2nd pre molar
bevel is oriented towards the bone
failure to anesthetize with MSA?
LA not delivered over apex of tooth (2nd pre-molar)
deposition of LA was too far from maxillary bone with needle placed in tissues laeral to the height of muccobucal fold
bone of zygomatic arch (thick bone) at site of injection prevents the diffusion of the LA
anterior superior alveolar nerve block AKA
infraorbital
nerves anesthetized in anterior superior alveolar nerve block ; infraorbital nerve block
ASA
MSA
Infraoribital – inferior palpebral, lateral nasal, superior labial
nerves asociated with infraorbital
inferior palbebral, lateral nasal, superior labial
areas anesthetized with anterior superior alveolar nerve block ; infraorbital nerve block
pulps of the max central incisors through the canine on side of injection
in 72% of patients – gets the pulps of the max pre molars and MB root of the first molar
buccal periodontium and bone of same teeth
lower eyelid, lateral aspect of nose, upper lip
ASA block technique? needle use? area of insertion? target area? landmarks? bevel orientation?
25 gauge long needle
area of insertion = height of muccobuccal fold directly over the first pre molar
target area - infraorbital foramen
landmarks = mucobuccal fold, infraorbital notch, infraorbital foramen
orient bevel towards the bone
ASA technique
locate the infraorbital foramen
- feel for the infraorbital notch
- move finger down from the notch, applying gentle pressure to the tissues
- bone immediately inferior to infraorbital notch is convex – represents the lower border of the orbital rim and roof of the infraorbital foramen
- as your finger continues inferiorly, a concavity is felt which is the infraorbital foramen
- applying pressure, feel the outlines of foramen
- maintain finger on foramen, or mark skin
- make tissue taight in the muccobuccal fold
- insert needle to height of muccobuccal fold over first pre-molar
- orient towards the foramen with the needle
- needle should be held parallel to long axis of the tooth
bone immediately inferior to infraorbital notch is…
is convex – represents the lower border of the orbital rim and roof of the infraorbital foramen
in ASA- advance the needle slowly until …
bone is gently contacted
- the point of contact should be the upper rim of the infraorbital foramen
- the general depth of needle penetration is 16,,, but can vary
- aspirate
- deliver .9 to 1.2 cc’s
- maintian firm pressure over the injection for a minimum of 1 minute after the injection
complications and how to adverse with an ASA?
hematoma - and just apply pressure for 2-3 minutes and should resolve
palatal anesthesia? - two nerves and when?
greater palatien nerve block
nasopalatine nerve block
necessary for dentwal tx involving manipulation of palatal soft or hard tissue
autramatic aministration of palatal anesthesia
- provide adequate topical
- use pressure anesthesia at the site before and during the needle insertion and deposition
- maintain control over the needle
- deposit slowly
- believe that it can be an a-traumatic experience
greater palatine nerve block useful?
useful for dental procedures involving palatal soft tissues distal to the canine
greater palatine nerve block areas anesthetized?
posterior portion of the hard palate and its overlying soft tissues, anteriorly as far as the first pre-molar and medially to the midline
greater palatine nerve block landmarks?
greater palatine foramen and junction of the maxillary alveolar process and palatine bone
orientation of bevel in greater palatine nerve block
toward the palatal soft tissue
failure to anesthetize in Greater palatine nerve block
LA deposited too far anteriorly
anesthesia of the max 1st premolar may be inadequate due to overlaping fibers of nasopalatine nerve
what happens if you concentrate a vasoconstricting solution on soft tissue?
ischemia and necrosis of tissue can occur
other names for nasopaltine nerve block
incisive nerve block and sphenopalatine nerve block
areas anesthetized in nasopaltine nerve block
anterior portion of the hard palate (soft and hard tissue) from the mesial of the right first premolar to the mesial of the left first premolar
technique for nasopaltine nerve block needle use? area of insertion? target area? landmarks? bevel orientation?
needle use? = 27-gauge short needle
area of insertion? = palatal mucosa just lateral to the incisive papilla
target area? = incisive foramen, beneath the incisive papilla
landmarks? = central incisors and incisive papilla
bevel orientation? = towards palatal soft tissue
failure of reaching anesthesia in nasopalatine nerve blcok?
(usually minimal with high success rate of 95%)
- could have unilateral anesthesia as it did not get to other side yet
- inadequate palatal soft tissue in the area of the maxillary canine and 1st premolar
where is the inadequate anesthetic with nasoplatine block if occurs?
where there would be potential overlap between this nerve and the greater palatine nerve
- around the tissues of max canine and 1st pre-molar
complications in nasopaltine
hematoma
necrosis of soft tissue
maxillary nerve block aka
second division block, V2 nerve block
area anesthetized in maxillary nerve block
- pulpal anesthesia of the max teeth on the side of the block
- buccal periodontium and bone overlying these teeth
- soft tissues and bone of the hard palate and part of the soft palate, medially to the midline
- skin of the lower eyelid, side of the nose, cheek, and upper lip
Indications for maxillary nerve block
- pain control for extensive procedures requiring anesthesia of the entire maxillary division
- when tissue inflammation or infection precludes the use of other regional nerve blocks or supraperiosteal injection
- diagnostic or therapeutic procedures for neuralgias of V2
*usually not doing in dentistry
contraindications for maxillary nerve block
- inexperienced administrator
- pediatric patients
- uncooperative pt’s
- inflammation or infection of tissues overlying the injection site
- when hemorrhage is a concern
- in Greater palatine approach - inability to gain access to the canal - since bony obstructions may be present
most utilized technique in administering LA in maxilla?
infiltration anesthetic via SUPRAPERIOSTEAL INJECTION
