Maxillary Anesthesia Techniques

- basic types of injections (3)

- local infiltration deposition of LA directly into tissue in the area of treatment
- field block deposition of LA near larger terminal nerve branches
- anesthetized are in circumscribed area
- eample is a canine fossa injection
- nerve block deposition of LA usually at a distance form target area and main
nerve trunk is anesthetized
!! almost all mandibular injections are nerve blocks
- techni"ues
- supraperiosteal infiltration
- periodontal ligament (#$L)
- intraseptal-for perio surgery
- #%A
- &%A
- A%A
- infraorbital
- '
nd
division block
- (#
- )#
- intraosseous (used for endodontics therapy *here you cannot get anesthesia)
- drill into bone to access root tip
- supraperiosteal injection
- most fre"uently employed local anesthetic techni"ue for achieving maillary
pulpal anesthesia
- #%A
- also called tuberosity block
- for regional anesthesia of +
st
, '
nd
, and 3
rd
molars (not &- root of +
st
molar , as
the &%A supplies this root in './ of population)
- depth of penetration 0 +1 mm
- target area direction2 posterior-superior-medial (back, up, and in)
- posterior2 34 degrees to long ais of '
nd
molar
- medially2 to*ard midline at 34 degree angle to occlusal plane
- up*ard2 superiorly at a 34 degree to the occlusal plane
- aspirate in ' planes
- complications2 hematoma, anesthesia of 5
3
if too lateral
- needle must be superior to the root position of the 3
rd
molar
- you do not touch bone on a #%A
- &%A
- present in './ of population
- indicated for procedures on premolars and &- root of +
st
molar
- if absent, area innervated by A%A
- impossible to miss
- is really an infiltration techni"ue although everyone calls it a block
- insert into movable mucosa and you *ill probably touch bone
- must be superior to the ape of the premolars
- infraorbital injection
- is a true block
- profound anesthesia of pulpal and buccal tissue from the maillary central
through the premolars in 6'/ of patients
- anesthesia of A%A, &%A, inferior palpebral, lateral or eternal nasal, and
superior labial
- positive aspiration 76/ of the time
- need long needle to perform
- about 4 mm lateral to the puncture point of the &%A
- A%A
- is more like an infiltration type of injection
- anesthetizes the incisor8canine region
- impossible to miss
- lo* hematoma formation8lo* positive aspiration
- palatal anesthesia
- pressure anesthesia is the key to comfort
- do not release the pressure until after the administration of the LA
- greater palatine foramen located at the palatal root of the '
nd
molar
approimately mid*ay in the palatal vault
- may see a bluish discoloration
- *ill touch bone and *ithdra* 74-+ mm
- anesthesia to everything distal to the canine
- after injection the palate *ill look like it is s*eating
- this is the constriction of salivary glands
- for the anterior mailla, the )# injection is the techni"ue of choice (not for pts7)
as it is e"uisitely uncomfortable
- pressure is very important *ith administration
- enter the incisive papilla at the base of the papilla and not at its9 most
conve surface
- you *ill have problems *ith s*allo*ing *ith palatal anesthesia
- more serious *8 people *8 long uvula
- nerves of the palate
- :) 5, 5;;, ;<
- midpalatal injection
- is used for some restorative *ork
- you are not anesthetizing the *hole palate
- '
nd
division block
- may approach *ith a long needle and traverse the greater palatine foramen
- you should only aspirate at the final destination = not *hile going up the track
- utilize *hen inflammation inhibits profound anesthesia of the molars8premolars
and to stop possibility of seeding an infection