MAXILLARY ANESTHESIAMAXILLARY ANESTHESIA

Techniques of Maxillary Techniques of Maxillary AnesthesiaAnesthesia

Local InfiltrationLocal Infiltration

Field BlockField Block

Nerve BlockNerve Block

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

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

Supraperiosteal InjectionSupraperiosteal Injection

IndicationsIndications

Pulpal anesthesia of one or two maxillary Pulpal anesthesia of one or two maxillary teeth teeth

Soft tissue anesthesia when indicatedSoft tissue anesthesia when indicated

HemostasisHemostasis

ContraindicationsContraindications

Infection or acute inflammation in the areaInfection or acute inflammation in the area

Dense bone covering apices of teeth Dense bone covering apices of teeth

AdvantagesAdvantages

High success rate (>95%)High success rate (>95%)

Technically easy injectionTechnically easy injection

Usually entirely atraumaticUsually entirely atraumatic

Areas Anesthetized Areas Anesthetized

Entire area innervated by the large terminal Entire 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

DisadvantagesDisadvantages

Not suitable for large areasNot suitable for large areas

Multiple needle insertionsMultiple needle insertions

Large volumes of anethetic solution Large volumes of anethetic solution

Percent Positive Aspiration: Percent Positive Aspiration:

Negligible, but possible (<1%)Negligible, but possible (<1%)

AlternativesAlternatives

Periodontal ligament injectionPeriodontal ligament injection

Regional nerve blockRegional nerve block

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

Signs and SymptomsSigns and Symptoms

NumbnessNumbness

Absence of pain during dental therapyAbsence of pain during dental therapy

Safety FeatureSafety Feature

Minimum opportunity for intravascularMinimum opportunity for intravascular

administrationadministration

Failures of AnesthesiaFailures of Anesthesia

Inadequate needle penetrationInadequate needle penetration

- not adjacent to tooth apex- not adjacent to tooth apex

Needle too far from bone Needle too far from bone

Posterior Superior Alveolar Posterior 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

Indications for PSA BlockIndications for PSA Block

First or second maxillary molarFirst or second maxillary molar

Supraperiosteal injection is contraindicatedSupraperiosteal injection is contraindicated

ContraindicationContraindication

Risk of hemorrhage is too greatRisk of hemorrhage is too great

(eg. hemophelia, coumadin)(eg. hemophelia, coumadin)

AdvantagesAdvantages

Atraumatic Atraumatic

High success rateHigh success rate

Less number of injectionsLess number of injections

Minimize amount of local usedMinimize amount of local used

DisadvantagesDisadvantages

Risk of hematomaRisk of hematoma

Does Does notnot anesthetize anesthetize first molarfirst molar completely completely

No bony landmarksNo bony landmarks

Positive AspirationPositive Aspiration

Approximately 3.1%Approximately 3.1%

LandmarksLandmarks

Mucobuccal foldMucobuccal fold

Maxillary tuberosityMaxillary tuberosity

Zygomatic process of maxillaZygomatic process of maxilla

Area of InsertionArea of Insertion

Mucobuccal fold above maxillary second Mucobuccal fold above maxillary second molarmolar

TechniqueTechnique

25 gauge, long needle25 gauge, long needle

Position patient and identify landmarksPosition patient and identify landmarks

Advance needle upward, inward and Advance needle upward, inward and backwardbackward

Aspirate, inject 1.8 ml of solutionAspirate, inject 1.8 ml of solution

Failures of AnesthesiaFailures of Anesthesia

Needle too lateralNeedle too lateral

Needle not deep enoughNeedle not deep enough

Needle too far superiorNeedle too far superior

ComplicationsComplications

HematomaHematoma

Mandibular anesthesiaMandibular anesthesia