techniques maxillary anethesia

Question 1

where is the PSA located

Answer 1

pterygopalatine fossa

Question 2

PSA Anesthetized Area

Answer 2

palatal tissue not included

Question 3

PSA Technique

Answer 3

1. 45 degrees upward,backward, and in
2. 16mm past height of vestibule
3. Aspirate, then Inject 0.9ml-1.8ml

Question 4

why must we aspirate with PSA

Answer 4

pull back gently to see if blood enter needle= do not inject and reposition injection
req a - aspiration before we inject

Question 5

PSA Nerve Block
Areas Anesthetized

Answer 5

 Maxillary molar tooth pulps
 MB root of 1st molar in 72%
 Buccal periodontium and bone

Question 6

PSA Nerve Block
Advantages

Answer 6

 Atraumatic
 Success rate > 95%
 Minimal volume of anesthetic

Question 7

PSA Nerve Block
Disadvantages

Answer 7

 Disfiguring hematoma risk (pterygoid plexus) must aspirate
 MB root of 1st molar missed in 28%
 Aspiration rate ~3%

Question 8

Middle Superior Alveolar
Nerve
presence?
MB root 1st molar?
perio/bone?

Answer 8

 Present in some patients
 MB root of 1st molar in 28%
 Buccal periodontium and bone

Question 9

MSA Anesthetized Area

Answer 9

Question 10

MSA Technique

Answer 10

1. Inject well above premolar
   apices, bevel facing bone
2. 0.9 to 1.2 ml
   3.

Question 11

MSA Nerve Block
Areas Anesthetized

Answer 11

 Premolars
 MB root of first molar, 28%
 Buccal periodontium and bone

Question 12

MSA Nerve Block
Indications

Answer 12

 To treat both premolars
 When a nerve block is indicated
 When supraperiosteal injection has
failed
 When infraorbital block does not
anesthetize premolars

Question 13

Anterior Superior Alveolar
Nerve / Infraorbital Nerve Block

Answer 13

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

Question 14

ASA Nerve Block
Areas Anesthetized

Answer 14

 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

Question 15

ASA Nerve Block
Indications

Answer 15

 Procedures on two or more teeth
 Inflammation or infection
 Dense cortical bone making
supraperiosteal injections ineffective

Question 16

Supraperiosteal Injection/ Local Infiltration anetghesized area

Answer 16

Question 17

Maxillary Labial Bone Is:

Answer 17

Maxillary Labial Bone Is Porous

Question 18

supraperiosteal injection technique

Answer 18

1. Anesthetic Is Placed Apical to Apex
2. Insert Superior to Root Apex
3. Orient Needle Bevel Towards
   Bone
   insert to Level Above Tooth Apex
   Inject 0.6 ml of anesthetic

Question 19

Supraperiosteal Injection
Areas Anesthetized

Answer 19

 Tooth
 Buccal periodontium
and bone
 Labial or buccal
mucosa

Question 20

Supraperiosteal Injection
Indications

Answer 20

 Procedures on one tooth
 Soft tissue surgery in a small area

Question 21

Supraperiosteal Injection
Advantages

Answer 21

 Simple
 High success rate

Question 22

Supraperiosteal Injection Disadvantages

Answer 22

• Not useful in inflamed area
• Large volumes needed to treat
  multiple teeth

Question 23

target for palatal anesthesia

Answer 23

Greater Palatine Nerve

Question 24

Greater Palatine Nerve Block
steps

Answer 24

1. Locate Foramen With Cotton Tip
2. Apply Topical for 2 Minutes
3. Move Applicator Over Foramen –
   Apply Direct Pressure 30 Seconds
4. Place Needle Bevel Against Tissue
   and Bow the Needle
5. Administer a Few Drops of Local
6. Straighten and Advance the Needle
7. Contact Bone
8. Aspirate, Deposit 0.45 to 0.6 ml

Question 25

Greater Palatine Nerve Block Areas Anesthetized

Answer 25

 Posterior portion of hard palate  Overlying soft tissues  No anesthesia of teeth

Question 26

Greater Palatine Injection Indications

Answer 26

 When palatal soft tissue anesthesia is needed – extractions, subgingival restorations, etc.  Pain control during periodontal or oral surgical procedures

Question 27

ant palate anesthesia target

Answer 27

NP nn

Question 28

Nasopalatine Nerve Block steps

Answer 28

1. Apply Topical for Two Minutes to incisive papilla 2. **Apply Direct Pressure 3. Contact Bone, Administer 0.45 ml

Question 29

Trans-Papillary Approach of NP block steps

Answer 29

1. apply topical lateral to frenum 2. blanching of labial tissue 3. insert needle thru papilla towards palate 4. administer 0.3mL

Question 30

Nasopalatine Nerve Block Areas Anesthetized

Answer 30

 Anterior portion of hard palate  Both hard and soft tissues  No anesthesia of teeth

Question 31

Nasopalatine Injection Indications

Answer 31

 When palatal soft tissue anesthesia is needed – extractions, subgingival restorations, etc.  Pain control during periodontal or oral surgical procedures

Question 32

Second Division Nerve Block/ Maxillary Nerve Block goal and approaches

Answer 32

goal to anesthesize entire CNV2 high tuberosity and greater palatine approaches

Question 33

Maxillary Nerve Block High Tuberosity Approach Advantages

Answer 33

* Atraumatic * 95 % success rate * Minimizes volume of local

Question 34

Maxillary Nerve Block High Tuberosity Approach Disadvantages

Answer 34

* Risk of hematoma * Absent bony landmarks * Lack of hemostasis

Question 35

Maxillary Nerve Block Greater Palatine Canal Approach Advantages

Answer 35

* Usually atraumatic * 95 % success rate * Minimizes volume of local

Question 36

Maxillary Nerve Block Greater Palatine Canal Approach Disadvantages

Answer 36

* Lack of hemostasis * Potentially painful injection