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8/14/2019 Maxillary Anesthesia -2
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Techniques of MaxillaryTechniques of Maxillary
AnesthesiaAnesthesia
Local InfiltrationLocal Infiltration
Field BlockField Block
Nerve BlockNerve Block
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Maxillary Injection TechniquesMaxillary Injection Techniques
SupraperiostealSupraperiosteal
Periodontal ligamentPeriodontal ligament
Intraseptal injectionIntraseptal injection
Posterior superior alveolar nerve blockPosterior superior alveolar nerve block
Middle superior alveolar nerve blockMiddle superior alveolar nerve block
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Maxillary Injection TechniquesMaxillary Injection Techniques
Anterior superior alveolar nerve blockAnterior superior alveolar nerve block
Maxillary (second division) nerve blockMaxillary (second division) nerve block
Greater (anterior) palatine nerve blockGreater (anterior) palatine nerve block
Nasopalatine nerve blockNasopalatine nerve block
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Supraperiosteal InjectionSupraperiosteal Injection
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IndicationsIndications
Pulpal anesthesia of one or two maxillaryPulpal anesthesia of one or two maxillary
teethteeth
Soft tissue anesthesia when indicatedSoft tissue anesthesia when indicated
HemostasisHemostasis
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ContraindicationsContraindications
Infection or acute inflammation in the areaInfection or acute inflammation in the area
Dense bone covering apices of teethDense bone covering apices of teeth
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AdvantagesAdvantages
High success rate (>95%)High success rate (>95%)
Technically easy injectionTechnically easy injection
Usually entirely atraumaticUsually entirely atraumatic
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Areas AnesthetizedAreas Anesthetized
Entire area innervated by the large terminalEntire area innervated by the large terminal
nerve branches:nerve branches:
Tooth pulp and root areaTooth pulp and root area
Buccal periosteumBuccal periosteum
Mucous membrane and connective tissueMucous membrane and connective tissue
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DisadvantagesDisadvantages
Not suitable for large areasNot suitable for large areas
Multiple needle insertionsMultiple needle insertions
Large volumes of anethetic solutionLarge volumes of anethetic solution
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Percent Positive Aspiration:Percent Positive Aspiration:
Negligible, but possible (
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AlternativesAlternatives
Periodontal ligament injectionPeriodontal ligament injection
Regional nerve blockRegional nerve block
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TechniqueTechnique
Apply topicalApply topical
Landmarks - mucobuccal foldLandmarks - mucobuccal fold
long axis of toothlong axis of tooth
Insert needle at height of mucobuccal foldInsert needle at height of mucobuccal fold
Target area - apex of toothTarget area - apex of tooth
Aspirate, deposit approx. 0.6-1 ml solutionAspirate, deposit approx. 0.6-1 ml solution
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Signs and SymptomsSigns and Symptoms
NumbnessNumbness
Absence of pain during dental therapyAbsence of pain during dental therapy
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Safety FeatureSafety Feature
Minimum opportunity for intravascularMinimum opportunity for intravascular
administrationadministration
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Failures of AnesthesiaFailures of Anesthesia
Inadequate needle penetrationInadequate needle penetration
- not adjacent to tooth apex- not adjacent to tooth apex
Needle too far from boneNeedle too far from bone
i S i Al l
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Posterior Superior AlveolarPosterior Superior Alveolar
Nerve BlockNerve Block
Nerve Anesthetized:Nerve Anesthetized:
Posterior Superior Alveolar Nerve (PSA)Posterior Superior Alveolar Nerve (PSA)
- for maxillary molars and buccal tissue- for maxillary molars and buccal tissue
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Indications for PSA BlockIndications for PSA Block
First or second maxillary molarFirst or second maxillary molar
Supraperiosteal injection is contraindicatedSupraperiosteal injection is contraindicated
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ContraindicationContraindication
Risk of hemorrhage is too greatRisk of hemorrhage is too great
(eg. hemophelia, coumadin)(eg. hemophelia, coumadin)
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AdvantagesAdvantages
AtraumaticAtraumatic
High success rateHigh success rate
Less number of injectionsLess number of injections
Minimize amount of local usedMinimize amount of local used
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DisadvantagesDisadvantages
Risk of hematomaRisk of hematoma
DoesDoes notnot anesthetizeanesthetize first molarfirst molar completelycompletely
No bony landmarksNo bony landmarks
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Positive AspirationPositive Aspiration
Approximately 3.1%Approximately 3.1%
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LandmarksLandmarks
Mucobuccal foldMucobuccal fold
Maxillary tuberosityMaxillary tuberosity
Zygomatic process of maxillaZygomatic process of maxilla
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Area of InsertionArea of Insertion
Mucobuccal fold above maxillary secondMucobuccal fold above maxillary second
molarmolar
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TechniqueTechnique
25 gauge, long needle25 gauge, long needle
Position patient and identify landmarksPosition patient and identify landmarks
Advance needle upward, inward andAdvance needle upward, inward andbackwardbackward
Aspirate, inject 1.8 ml of solutionAspirate, inject 1.8 ml of solution
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Failures of AnesthesiaFailures of Anesthesia
Needle too lateralNeedle too lateral
Needle not deep enoughNeedle not deep enough
Needle too far superiorNeedle too far superior
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ComplicationsComplications
HematomaHematoma
Mandibular anesthesiaMandibular anesthesia