PM wk 5 max injections

Superior dental plexus nerves

Dental nerves, interdental branches, interradicular branches

Asa/msa category

Infraorbital branch of v2 max

PSA risk

Overinsertion of needle distally=hematoma

+Aspiration ~3.1%

PSA mandibular possibility

Deposition too for laterally = pt tongue / lower lip numb

PSA optimum pen site and depth/angle

@ Height of MBF posterior to zygomatic process of max (visually aprox DF 2nd mol root)

Upward 45°, inward 45°, 16mm (1/2 of long 7/4 of short)

IONB area

Pup and buccal ging from max central to premol and MB root of 1st mol in 78%, overlying buccal its ve

IONB disadvantages

Anatomic landmark hard to identify, psychological (scared of touch eye)

IONB artmaterium

25 or 27g short, 10 o'clock, .9-1.2ml, 16mm

MBF over max 1st premol

Maintain firm pressure during and after for 1 min = forces LA into foramen

IONB precaution and safety’s

Prevent overinsertion by estimating depth of pen prior

Needle contacts bone (roof of IO foreman), finger positioned over IO foremen helps direct needle in right direction

Anterior middle superior alveolar AMSA NB

Pulp (not molar), buccal, palatal

Palatial approach anterior superior alveolar PASA

Bilateral pulpal, palatial, lingual

Canine → canine

Requires C-CLAD system