MAXILLARY ANESTHESIAMAXILLARY ANESTHESIA
DR V.RAMKUMARDR V.RAMKUMAR
CONSULTANT CONSULTANT DENTAL&FACIOMAXILLARY SURGEONDENTAL&FACIOMAXILLARY SURGEON
REG NO:4118-TAMILNADU-INDIA(ASIA)REG NO:4118-TAMILNADU-INDIA(ASIA)
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
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