Maxillary Techniques

Infiltration Techniques

Local Infiltration: Small terminal nerve endings in the area are flooded with anesthetic → PDl Injections or pulpal → Tx is done on same area in which L.A is deposited

Field Block: L.A is deposited near the larger terminal nerve branch so the area will be circumscribed and preventing the passage of impulses from the tooth to the CNS

Nerve blocks: L.A deposited close to the main nerve trunk at a distance to prevent operative intervention

Supraperiosteal

• Areas anesthetized

• Contraindication

• Armamentarium recommendations

• Technique

• Amount of anesthetic

Most frequently used for pulpal anesthesia in maxillary teeth → but used when only 1-2 teeth are being treated

• Areas anesthetized: crown, root, pulp, periodontium

• Contraindication: Acute inflammation to the area or dense bone on top of tooth

• Very high success

• Armamentarium recommendations: 27 gauge, short needle, bevel towards bone

• Technique: Inject at height of mucobuccal fold about the apex of the tooth, bevel down

• Amount of anesthetic: 0.6ml

Posterior superior AN BLOCK

• Area anesthetized

• Success rate

• Procedure

• Onset of action

• Indications

• Complications

• Amount of anesthetic

Area anesthetized: Max molar buccal gingiva, mucous membrane of sinus, pulpal tissue (except B cusp of 1st molar in 28% of patients →> use MSA block)

Success rate: 95%

Procedure: Insert at height of mucobuccal fold of Max 2nd molar (upward inwards and backward), insert 16mm (2/3 of short needle or half of long needle), bevel oriented to bone, aspirate twice, inject L.A

Onset of action: 3-5 min

Indications: Quadrant or sextant dentistry

Complications: Hematoma from pterygoid plexus

Amount of anesthetic: 0.9-1.8ml

Middle superior AN BLOCK (if present! 28% of pts)

• Area anesthetized

• Procedure

• Onset of action

• Amount of anesthetic

• Area anesthetized: Both max premolars +MB cusp of 1st molar

• Procedure: same as PSA but start above 2nd premolar

• Onset of action: 3-5 min

• Amount of anesthetic: 0.9-1.2ml

Anterior Superior AN BLOCK

• Area anesthetized

• Procedure

• Onset of action

• Amount of anesthetic:

• Area anesthetized: Max Incisors and canine + Premolars and MB cusp of 1st molar ( in 72% of pts- those w/o MSA)

• Procedure: same as PSA but insert bove 1st premolar until contacting bone

• Onset of action

• Amount of anesthetic: 0.9-1.2ml

Greater palatine N Block

• Area anesthetized

• Procedure

• Onset of action

• How to make it less traumatic

• Amount of anesthetic

• Area anesthetized: palatal mucosa behind maxillary premolars and molars

• Procedure: Insert needle slightly anterior to greater Palatine Foramen until contacting bone, deposit 0.5ml (or until blanching)

• Onset of action:3-5 min

• Apply pressure at site before and during injection

• Amount of anesthetic: 0.45-0.6 or blanching

Pre-puncture Technique

Technique used to minimize pain of greater palatine n block

• Bevel towards tissue and force L.A in before needle enters

Nasopalatine Nerve Block

• Area anesthetized

• Procedure

• Onset of action

• Amount of anesthetic

• Epi

• Area anesthetized: palatal mucosa and bone of the pre-maxilla

• Procedure: Insert lateral to incisive papilla, do not enter foramen; asprate and deposit 0.5ml or until blanching

• Onset of action:3-5min

• Amount of anesthetic: max 0.45ml

• Epi: 1:50,000 not recommended!

Multiple injection technique for Nasopalatine N block

If the buccal mucosa is already anesthetized, inject incisive papilla slowly from buccal aspect, then you can do nasopalatine N. block as normal but with less pain

Local Infiltration of the palate

Used when only 1-2 teeth are to be anesthetized

• Use overlapping sequence of needle penetrations

Anterior Middle Superior Alveolar Nerve block

• Area anesthetized

• Procedure

• Onset of action

• Complications

• When is it useful

• Amount of anesthetic

• Area anesthetized: palatal mucosa and bone of the pre-maxilla + behind premolars and MB cusp or 1st molar

• Procedure: Insert less than half way between bisecting line of incisive papilla and premolars; use whole cartridge over 2 min

• Onset of action:3-5min

• Complications: ulcer that lasts 2 days

• When is it useful: Cosmetic Procedures where lip must not be anesthetized

• Amount of anesthetic:1.4-1.8ml

Palatal Approach to Anterior Superior Alveolar

• Area anesthetized

• Procedure

• Onset of action

• Complications

• When is it useful

• Amount of anesthetic:

• Area anesthetized: palatal mucosa, pulp, crown and bone of the pre-maxilla

• Procedure: Insert needle at incisive foramen

• Onset of action:3-5min

• Complications: ulcer that lasts 2 days

• When is it useful: Cosmetic Procedures where lip must not be anesthetized

• Amount of anesthetic: 1.4-1.8ml

Maxillary Nerve Block High Tuberosity Approach

• Area anesthetized

• Procedure

• Onset of action

• Complications

• Amount of anesthetic

• Area anesthetized: all palatal mucosa of the quadrant, pulpal for all but max molars (except MB cusp), all buccal mucosa except that of Max molars (except MB cusp) → ONLY BLOCK THAT CAN ANESTHETIZE MOST OF THE QUADRAT AT ONCE

• Procedure: same exact thing as PSA except insertion is 30mm

• Onset of action:3-5 min

• Complications: Highest risk of hematoma and intravascular injection of all blocks, not recommended for inexperienced clinicians

• Amount of anesthetic: 1.8ml

Maxillary Nerve Block Greater Palatine Approach

• Area anesthetized

• Procedure

• Onset of action

• Complications

• Amount of anesthetic

• Area anesthetized: all palatal mucosa of the quadrant, pulpal for all but max molars (except MB cusp), all buccal mucosa except that of Max molars (except MB cusp) → ONLY BLOCK THAT CAN ANESTHETIZE MOST OF THE QUADRANT AT ONCE

• Procedure: Insert at greater palatine foramen, go 30mm and deposit cartridge slowly

• Onset of action: 3-5 min

• Complications: perioptical swelling, diplopia and ophthalmoplegia from possible optic nerve block, horner’s syndrome, L.A going into nose

• Amount of anesthetic: 1.8ml