techniques maxillary anethesia Flashcards
where is the PSA located
pterygopalatine fossa
PSA Anesthetized Area
palatal tissue not included
PSA Technique
- 45 degrees upward,backward, and in
- 16mm past height of vestibule
- Aspirate, then Inject 0.9ml-1.8ml
why must we aspirate with PSA
pull back gently to see if blood enter needle= do not inject and reposition injection
req a - aspiration before we inject
PSA Nerve Block
Areas Anesthetized
Maxillary molar tooth pulps
MB root of 1st molar in 72%
Buccal periodontium and bone
PSA Nerve Block
Advantages
Atraumatic
Success rate > 95%
Minimal volume of anesthetic
PSA Nerve Block
Disadvantages
Disfiguring hematoma risk (pterygoid plexus) must aspirate
MB root of 1st molar missed in 28%
Aspiration rate ~3%
Middle Superior Alveolar
Nerve
presence?
MB root 1st molar?
perio/bone?
Present in some patients
MB root of 1st molar in 28%
Buccal periodontium and bone
MSA Anesthetized Area
MSA Technique
- Inject well above premolar
apices, bevel facing bone - 0.9 to 1.2 ml
3.
MSA Nerve Block
Areas Anesthetized
Premolars
MB root of first molar, 28%
Buccal periodontium and bone
MSA Nerve Block
Indications
To treat both premolars
When a nerve block is indicated
When supraperiosteal injection has
failed
When infraorbital block does not
anesthetize premolars
Anterior Superior Alveolar
Nerve / Infraorbital Nerve Block
nn out of infraorbital foramen
1.Locate the Foramen by Palpation
2.Foramen ~ 16 mm Above Vestibule
2. Insertion Depth ~ ½ Long Needle
3. Orient Needle Bevel Towards Bone
3. Needle Contacts Roof of Foramen
2. Aspirate and Inject 0.9 to 1.2 ml
3. Anesthetic Directed into Canal
4. Maintain Pressure During Injection/ and 1 min after
ASA Nerve Block
Areas Anesthetized
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
Procedures on two or more teeth
Inflammation or infection
Dense cortical bone making
supraperiosteal injections ineffective
Supraperiosteal Injection/ Local Infiltration anetghesized area
Maxillary Labial Bone Is:
Maxillary Labial Bone Is Porous
supraperiosteal injection technique
- Anesthetic Is Placed Apical to Apex
- 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
Tooth
Buccal periodontium
and bone
Labial or buccal
mucosa
Supraperiosteal Injection
Indications
Procedures on one tooth
Soft tissue surgery in a small area
Supraperiosteal Injection
Advantages
Simple
High success rate
Supraperiosteal Injection Disadvantages
- Not useful in inflamed area
- Large volumes needed to treat
multiple teeth
target for palatal anesthesia
Greater Palatine Nerve
Greater Palatine Nerve Block
steps
- 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
Posterior portion of hard palate
Overlying soft tissues
No anesthesia of teeth
Greater Palatine Injection
Indications
When palatal soft tissue anesthesia
is needed – extractions, subgingival
restorations, etc.
Pain control during periodontal or
oral surgical procedures
ant palate anesthesia target
NP nn
Nasopalatine Nerve Block steps
- Apply Topical for Two Minutes to incisive papilla
- **Apply Direct Pressure
- Contact Bone, Administer 0.45 ml
Trans-Papillary Approach of NP block steps
- apply topical lateral to frenum
- blanching of labial tissue
- insert needle thru papilla towards palate
- administer 0.3mL
Nasopalatine Nerve Block
Areas Anesthetized
Anterior portion of hard palate
Both hard and soft tissues
No anesthesia of teeth
Nasopalatine Injection Indications
When palatal soft tissue anesthesia
is needed – extractions, subgingival
restorations, etc.
Pain control during periodontal or
oral surgical procedures
Second Division Nerve Block/
Maxillary Nerve Block goal and approaches
goal to anesthesize entire CNV2
high tuberosity and greater palatine approaches
Maxillary Nerve Block
High Tuberosity Approach
Advantages
- Atraumatic
- 95 % success rate
- Minimizes volume of local
Maxillary Nerve Block
High Tuberosity Approach
Disadvantages
- Risk of hematoma
- Absent bony landmarks
- Lack of hemostasis
Maxillary Nerve Block
Greater Palatine Canal Approach
Advantages
- Usually atraumatic
- 95 % success rate
- Minimizes volume of local
Maxillary Nerve Block
Greater Palatine Canal Approach
Disadvantages
- Lack of hemostasis
- Potentially painful injection
