Maxillary Injections

T or F? Maxillary injections are generally easier to do than mandibular injections

TRUE - success rate is higher, shorter duration, increased vascularity leading to rapid uptake of solution, more solution may be required

What teeth can you do supra-periosteal infiltrations on in the maxilla?

premolars, canines, incisors, AND MB root of max 1st molar

(can do single or multiple teeth)

How are supra-periosteal infiltrations done in the maxilla?

-Depth: to the apex of the tooth

-Stick needle right down on the periosteum without actually touching bone

-Give 1/2 to 3/4 of a carpule

What will supra-periosteal infiltrations anesthetize?

For a SINGLE tooth injection, it will numb the tooth/pulp, the alveolus, and surrounding gingiva

How is a posterior superior alveolar nerve (PSA) block given?

-45 deg down from occlusal plane, 45 deg lateral from the lateral alveolar plane

-Into the depth of vestibule over the max 2nd molar (16mm deep)

-ASPIRATE more than once

-Deposite 3/4 carpule

Why are positive aspirations common for the posterior superior alveolar nerve (PSA) block?

Due to close proximity to pterygoid plexus of veins

What are some common complicating factors of the posterior superior alveolar nerve (PSA) block?

-Soft tissue hard to retract (buccal fat)

-Positive aspirations common

-Coronoid process in the way

-Hard to see angles back there

What will the posterior superior alveolar nerve (PSA) block anesthetize?

-Pulp of molars, EXCEPT MB root of 1st molar is only sometimes (30%)

-Bone of alveolus to MB root of 1st molar

-Buccal gingiva + mucosa

-NO PALATAL TISSUE

T or F? The MB root of the 1st molar must be infiltrated SEPARATELY from the PSA block.

TRUE - because 30% of PSA's will NOT anesthetize this area

What will the middle superior alveolar nerve (MSA) block anesthetize?

-Pulp: premolars

-Buccal gingiva + mucosa

-NO PALATAL TISSUE

How is a middle superior alveolar nerve (MSA) block given?

-Aim for above the apices of the premolars, depth of vestibule

-Supraperiosteal, but close to periosteum without touching it

-Deposit 3/4 to 1 carpule slow

What will the anterior superior alveolar nerve (ASA) block anesthetize?

-Pulp: MB root of 1st molar to the midline (premolars, canine, incisors)

-Buccal gingiva + mucosa

-NO PALATAL TISSUE

Will the anterior superior alveolar nerve (ASA) block numb the premolars every time?

NO - will get premolars 72% of the time, the rest you will need to add the MSA block

How is an anterior superior alveolar nerve (ASA) block given?

-Aim over the 1st premolar, depth of vestibule

-Near infraorbital foramen

-Deposit 3/4 to 1 carpule

How is an infraorbital nerve block given?

-Place tip of needle into vestibule above 1st premolar

-Insert needle until it touches bone, this means we are near the foramen

-ASPIRATE

-Deposit 3/4 to 1 carpule

-Place finger over infraorbital foramen extraorally

What will the infraorbital nerve block anesthetize?

-SOFT TISSUE ONLY!!!

-Sometimes ASA will get numb too because of diffusion of the LA (so teeth will be numb)

-NO PALATAL

How do we locate the greater palatine foramen?

Use a q-tip and run it posteriorly under pressure until you feel the depression (foramen!)

How do we anesthetize the greater palatine nerve?

-Apply topical + pressure anesthesia over the foramen

-Insert needle tip anterior to foramen

-Deposit 1/4-1/2 carpule extra slow

What will the greater palatine nerve block anesthetize?

the PALATAL gingival, mucosal, and osseous tissues from premolars to posterior of hard palate

What will the nasopalatine nerve block anesthetize?

PALATAL gingival, mucosal, and osseous tissue from the maxillary central incisors to the canine.

How do we anesthetize the nasopalatine nerve?

-Apply topical + pressure anesthesia over the foramen

-Infiltrate near the labial frenum first

-Next inject slowly through the papilla

-Then after "blanching" the papilla, inject near the foramen

-Deposit 1/4-1/2 carpule extra slow

Can you give palatal infiltration, tooth by tooth, similar to our other supra-periosteal infiltrations?

YES! Use pressure anesthesia, and only deposite 1/4 carpule

What will the anterior middle superior alveolar nerve (AMSA) block anesthetize?

anterior teeth from incisors to premolars, palatal mucosa premolars to midline, and buccal ginigva and mucosa (NOT the lip!!!)

How is an anterior middle superior alveolar nerve (AMSA) block given?

-Apply topical + pressure anesthesia over the foramen

-Inject 1/2 carpule extra slow

A V2 block will anesthetize all of V2 nerve. How do we give this block?

1.5 inch needle through the palatine foramen to the base of the skull... has associated complications