Maxillary local aethesia
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1. This document discusses techniques for maxillary anesthesia including local infiltration, field blocks, and nerve blocks. It describes specific techniques such as the posterior superior alveolar nerve block, middle superior alveolar nerve block, and greater palatine nerve block. 2. Each technique is indicated for anesthetizing certain areas like the maxillary molars, premolars, canines, and incisors as well as associated gingiva and bone. Landmarks, needle position, aspiration, and volume of local anesthetic solution are outlined. 3. Advantages include high success rates and being technically easy. Risks include hematoma and failure to adequately anesthetize if proper technique is not followed
Maxillary local aethesia
- 1. Maxillary Anaesthesia 19 October 2017 I.Kassem,BDS,MSc,MFDS RCS Ed,MOMS RCPS Glasg, FDSRCS Consultant Oral & Maxillofacial surgeon
- 2. Techniques of Maxillary Anesthesia Local Infiltration Field Block Nerve Block
- 3. Maxillary Injection Techniques Supraperiosteal Periodontal ligament Intraseptal injection Posterior superior alveolar nerve block Middle superior alveolar nerve block
- 4. Maxillary Injection Techniques Anterior superior alveolar nerve block Maxillary (second division) nerve block Greater (anterior) palatine nerve block Nasopalatine nerve block
- 5. Indications Pulpal anesthesia of one or two maxillary teeth Soft tissue anesthesia when indicated Hemostasis
- 6. Contraindications Infection or acute inflammation in the area Dense bone covering apices of teeth
- 7. Advantages High success rate (>95%) Technically easy injection Usually entirely atraumatic
- 8. Areas Anesthetized Entire area innervated by the large terminal nerve branches: Tooth pulp and root area Buccal periosteum Mucous membrane and connective tissue
- 9. Disadvantages Not suitable for large areas Multiple needle insertions Large volumes of anethetic solution
- 10. Percent Positive Aspiration: Negligible, but possible (<1%)
- 11. Alternatives Periodontal ligament injection Regional nerve block
- 12. Technique Apply topical Landmarks - mucobuccal fold long axis of tooth Insert needle at height of mucobuccal fold Target area - apex of tooth Aspirate, deposit approx. 0.6-1 ml solution
- 18. Signs and Symptoms Numbness Absence of pain during dental therapy
- 19. Safety Feature Minimum opportunity for intravascular administration
- 20. Failures of Anesthesia Inadequate needle penetration - not adjacent to tooth apex Needle too far from bone
- 21. Posterior Superior Alveolar Nerve Block Nerve Anesthetized: Posterior Superior Alveolar Nerve (PSA) - for maxillary molars and buccal tissue
- 23. Indications for PSA Block First or second maxillary molar Supraperiosteal injection is contraindicated
- 24. Contraindication Risk of hemorrhage is too great (eg. hemophelia, coumadin)
- 25. Advantages Atraumatic High success rate Less number of injections Minimize amount of local used
- 26. Disadvantages Risk of hematoma Does not anesthetize first molar completely No bony landmarks
- 28. Landmarks Mucobuccal fold Maxillary tuberosity Zygomatic process of maxilla
- 29. Area of Insertion Mucobuccal fold above maxillary second molar
- 30. Technique 25 gauge, long needle Position patient and identify landmarks Advance needle upward, inward and backward Aspirate, inject 1.8 ml of solution
- 34. Failures of Anesthesia Needle too lateral Needle not deep enough Needle too far superior
- 37. 1. PSA Block 1. Anesthetize the pulps and periodontal ligaments of the maxillary molars, corresponding buccal alveolar bone and gingival tissue and posterior portion of the maxillary sinus. Mesiobuccal root 6 can be innervates by middle superior alveolar nerve ! Technique - between 1st and 2nd molar at a height of insertion of mucobuccal fold, angle at 45° superiorly and medially
- 40. 2. MSA Block 1. Anesthetize the maxillary premolars, corresponding buccal alveolar bone and gingival tissue 2. Used if the infraorbital block fails to anesthetize premolars Technique - between 1st and 2nd premolar at a height of insertion of mucobuccal fold
- 44. 3. ASA Block 1. Anesthetize the canine, incisors, corresponding buccal alveolar bone and gingival tissue Technique - the area of lateral incisor at a height of insertion of mucobuccal fold
- 46. 4. Infraorbital Nerve Block 1. Combinate ASA and MSA block 2. Anesthetize the maxillary premolars, canine, incisors, corresponding buccal alveolar bone and gingiva, also the terminal branches of infraorbital nerve (lower eyelid, external nose tissue, upper lip, the anterior aspect of the maxillary sinus) Technique - palpate infraorbital foramen → retract the upper lip → inject to area of 3/4 → contact bone in infraorbital region → inject 0,9 -1,2ml
- 48. 5. Greater Palatine Nerve Block 1. Anesthetize all palatal mucosa of the side injected and lingual gingivae posterior to the maxillary canines and corresponding bone Technique - on the hard palate between the 2nd and 3rd molars approximately 1cm medially, inject cca 0,3 - 0,5ml
- 50. 6. Nasopalatine Nerve Block 1. Anesthetize the soft and hard tissue of the maxillary anterior six teeth - from canine one side to canine other side Technique - approximately 1,5 cm posterior to the alveolar crest between the central incisors - posterior to the incisive papilla; depth less than 10mm and inject 0,3 - 0,5 ml