Topic 14: Anaesthesia of upper teeth

Question 1

Maxillary block anaesthesias:

Answer 1

Maxillary block anaesthesia:
 Infraorbital (Infraorbital N. and Ant. Superior Alveolar N)
 Tuberal (Post. Superior Alveolar N.)
 Matas (Maxillary N)
 Greater palatine foramen (Greater Palatine N)
 Incisive foramen (Incisive N)

Question 2

Infraorbital block:

Answer 2

Infraorbital block:
 The nerve to be blocked is the infraorbital nerve.
 The aim is the most optimal approach of the infraorbital foramen, becase the anaesthetic infiltrated here diffuses to the infraorbital canal
 This will anesthetise the superior anterior nerves as well
as the infraorbital nerve.

Question 3

Infraorbital block: structures anesthetised

Answer 3

Infraorbital block: structures anesthetised:
 Teeth: Generally 5 to 5 (so incisors, canines and maybe premolars)
 Soft tissues of the face in the infraorbital area

Question 4

Infraorbital block: method

Answer 4

Infraorbital block: method
 Stand in front of patient and grab upper lip between thumb and index finger
 Link the pupil to the second molar and move the index finger across this imaginary line under the infraorbital margin so it will reach the infraorbital foramen.
 Pull the upper lip with the thumb
 The insertion point of the needle will be from the axis of the canine up high in the vestibule.
 INJECT WITH LONG NEEDLE!

Question 5

Tuberal block: structures anesthetised and method

Answer 5

Tuberal block: structures anesthetised and method
 The nerve to be blocked is the Post. Superior Alveolar N
 Teeth anesthetised: molars and premolars 6+

Method:
 Retract the soft tissues towards the back of the vestibulum
 The point of insertion is in the axis of the DB root of the second upper molar, high up in the vestibule
 Needle is then directed parallel with nasal bone
 After 1cm direct the needle slightly medially following the curvature of the maxillary tuberosity and continue a further 8-10mm.
 INJECT WITH SHORT NEEDLE!
 Total depth of inserion is around 18-20mm

Question 6

Matas block: structures anesthetised

Answer 6

Matas block: structures anesthetised and method
 Is the anaesthesia of the Maxillary N in the pterygopalatine fossa
 Used in bigger surgical interventions or in the case of neuralgia.

The nerves being anesthetised:

1. Infraorbital n.
2. Sup. Post alveolar n.
3. Pterygopalatine gang
4. Major + minor palatine n.
5. Nasopalatine n.
6. Pharyngeal n.

Structures anesthetised:
 Teeth: all of the upper teeth
 Soft tissues:
all the upper portion of the face until the eyes,
mucosa of palate and upper lip
and all of gingiva.
The upper portion of the pharynx,
and part of the nasal cavity.

Question 7

Matas block: method

Answer 7

Matas block: method
 First anesthetise the area of the major palatine foramen
with a 45degree curved needle (aprox. 0.1-0.2ml solution)
 Then direct into the pterygopalatine canal to 3cm depth and inject aprox. 1ml of anasthetic

Question 8

Major palatine foramen block: structures anesthetised

Answer 8

Major palatine foramen block: structures anesthetised
 The nerve anesthetised here is the anterior (greater) palatine nerve.

Structures anesthetised:
 Teeth: upper molars and premolars
 Soft tissues: mucous membrane of palate to the area of the canines

Question 9

Major palatine foramen block: method

Answer 9

Major palatine foramen block: method
 Link the distal surface of the 2 upper 2nd molars.
 The insertion point is on this imaginery line 1cm from the gingival margin.
 Hold the needle sharply onto the bone and inject 0.2-0.3ml of anaesthetic

Question 10

Incisive foramen block: structures anesthetised

Answer 10

Incisive foramen block:
 The nerve anesthetised here is the incisive nerve (the terminal part of the nasopalatine nerve).

Structures anesthetised:
 Teeth: generally 5 to 5 (the premolars have dual innervation will be explained during anaesthesia of premolars)
 Soft tissues: the soft tissues of the palate from 5 to 5

Question 11

Incisive foramen block: method

Answer 11

Incisive foramen block: method
 The insertion point is from the lateral side on edge of the incisive papilla
 If the anaemic zone appears, try to get 1-2mm deeper into the incisive canal so the anaesthesia will be more effective.
 Total depth should be around 3-4mm.
 Any deeper then the anaesthetic can get into the nasal cavity (We don’t want that)

Question 12

Individual teeth anaesthesia: Upper incisors and canines

Answer 12

Upper incisors and canines:
Innervations:
 Vestibular: Sup. Ant. Alveolar N.
 Palatal: Incisive N.

Anasthesisa methods:

 Vestibular:
Terminal: submucosal (insert from distal tooth into the vestibular fold and avoid the frenulum)
(1.8ml injection)
Block: infraorbital N. Block

 Palatal:
Terminal (generally for canine) 0.5-1cm from palatal gingival margin
Block: incisive n. Block

Question 13

Individual teeth anaesthesia: Premolars

Answer 13

Individual teeth anaesthesia: Premolars
Innervations:
 Vestibular: Sup. Ant + Med. + Post. Alveolar N.
 Palatal: Greater Palatine N.

Anaesthesia methods:
 Vestibular
Terminal: Submucosal (insertion from direction of canine)
Block: Infraorbital N. Block
 Palatal:
Block: Greater Palatine N. Block

Question 14

Individual teeth anaesthesia: Molars

Answer 14

Individual teeth anaesthesia: Molars
Innervations:
 Vestibular: Sup. Post. Alveolar N.
 Palatal: Ant. (Greater) Palatine N.

Anaesthesia methods:
 Vestibular:
Terminal: submucosal **BE CAREFUL of Crista zygomaticoalveolaris between the buccal and
distal roots for Upper 1st Molar.
Made of thick cortical bone so diffusion is limited
Need to give 0.6-0.7ml MB root.
And then 1.2-1.3ml to the DB root behind crista
Block: Tuberal or Matas
 Palatal:
Block: Greater Palatine n. Block