Dental Anesthesia Techniques Quiz

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Questions and Answers

What is a primary reason for the lack of popularity of the ASA nerve block?

General lack of experience and fear of eye injury. (correct)

It is more painful than the PSA nerve block.

It has a high risk of complications.

It requires extensive training.

What is the ideal position for the needle during the PSANB technique?

At a 30-degree angle to the maxillary tuberosity

Vertical position facing the floor

Horizontal position parallel to the occlusal plane

At a 45-degree angle to the occlusal plane (correct)

What is a contraindication for performing an ASA nerve block?

Presence of inflammation or infection.

Dental procedures involving more than two maxillary anterior teeth.

Dense cortical bone requiring penetration.

When treatment is focused on discrete areas of one or two teeth. (correct)

What advantage does the ASA nerve block have over infiltration techniques?

Longer lasting anesthetic effect and fewer needle punctures. Signup and view all the answers

What is the maximum volume of anesthetic solution that should be deposited during the PSANB?

1.8 mL Signup and view all the answers

Why is it important to retract the patient's cheek during the PSANB technique?

To minimize the risk of accidental needlestick injury Signup and view all the answers

Which basic armamentarium is NOT required for the ASA nerve block?

Topical Anesthetic and its applicator Signup and view all the answers

What is the recommended position for a right-handed dentist administering an ASA nerve block?

Standing directly facing the patient on the right side. Signup and view all the answers

For average adults, how deep should the needle be inserted during the PSANB technique?

16 mm Signup and view all the answers

What is a recommended correction if the needle is found to be too lateral during a Posterior Superior Alveolar Nerve Block?

Redirect the needle tip medially Signup and view all the answers

What should be done to prepare the tissue at the injection site for ASA nerve block?

Dry with sterile gauze and apply antiseptic. Signup and view all the answers

What is the goal of performing an aspiration test during the PSANB procedure?

To prevent injection into a blood vessel Signup and view all the answers

What is the positive aspiration rate for the ASA nerve block?

Negligible at 0.7%. Signup and view all the answers

What may result from a needle contacting bone inferior to the infraorbital foramen during anesthesia?

Anesthesia of the lower eyelid and lateral side of the nose Signup and view all the answers

When starting the PSANB technique, what initial action should be taken with the patient's mouth?

Partially open the mouth Signup and view all the answers

Which complication may arise from inserting the needle too far posteriorly during mandibular anesthesia?

Hematoma in the buccal tissues Signup and view all the answers

Which technique can be used as a supplementary method for maxillary nerve anesthesia?

Periodontal ligament injection Signup and view all the answers

What percentage of the population has a middle superior alveolar (MSA) nerve?

30% Signup and view all the answers

What disadvantage does the ASA nerve block have during dental procedures?

It does not provide hemostasis in the operative field. Signup and view all the answers

What type of needle is ideally used for the PSANB procedure?

Short Needle, 25- or 27-gauge Signup and view all the answers

What alternative technique can be used instead of PSANB?

Supraperiosteal Infiltrations Signup and view all the answers

Which of the following is NOT a terminal branch of the infraorbital nerve?

Mental Signup and view all the answers

How can temporary double vision resulting from anesthesia be prevented?

By applying pressure during and after the injection Signup and view all the answers

What is a common cause of failure in the administration of ASANB?

Needle deviation from the infraorbital foramen Signup and view all the answers

What is the clinical significance of properly managing the penetration depth during a PSANB?

To avoid hematoma formation Signup and view all the answers

Which of the following is NOT a complication associated with ASANB?

Permanent sensory loss in the upper lip Signup and view all the answers

What should be done to achieve successful Infraorbital Nerve Block (IONB)?

Allow anesthetic to enter via the infraorbital foramen Signup and view all the answers

What dental structures are primarily anesthetized by the anterior superior alveolar nerve?

Maxillary anterior teeth and premolars Signup and view all the answers

What is the correct action to correct needle deviation during maxillary nerve block?

Maintain needle orientation toward the foramen during advancement Signup and view all the answers

Which of the following procedures is classified as a basic injection technique for maxillary anesthesia?

Infiltration technique Signup and view all the answers

What complication is most concerning if a short needle is used incorrectly during mandibular anesthesia?

Continued bleeding from the pterygoid plexus Signup and view all the answers

What might occur if there is a medical error during the administration of ASANB?

Injury of the eyeball Signup and view all the answers

What is the primary purpose of the needle contacting the bone at the infraorbital foramen during the anterior superior alveolar nerve block?

To prevent puncturing the orbit Signup and view all the answers

When performing the aspiration test before administering local anesthetic, how should the syringe be adjusted for the second test?

Rotate the syringe about 45 degrees Signup and view all the answers

What amount of local anesthetic should be slowly deposited using a 25-gauge long needle for an effective anesthetic block?

0.9 ml to 1.2 ml Signup and view all the answers

What anatomical feature is found immediately inferior to the infraorbital notch?

A convex bulge Signup and view all the answers

What is the recommended action immediately following the withdrawal of the needle from the tissues?

Immediately make the needle safe Signup and view all the answers

When palpating the infraorbital foramen, what sensation is typically experienced by the patient?

Mild soreness Signup and view all the answers

What is the direction of the opening of the infraorbital foramen?

Downward and medial Signup and view all the answers

How long should finger pressure be maintained over the injection site after administering local anesthetic?

1-2 minutes Signup and view all the answers

Which of the following is a subjective clinical finding associated with an effective anterior superior alveolar nerve block?

Tingling and numbness in the ipsilateral lower eyelid Signup and view all the answers

What is the recommended height for needle insertion when performing an anterior superior alveolar nerve block?

Over the first premolar Signup and view all the answers

What is the average depth of penetration required for an anterior superior alveolar nerve block?

16 mm Signup and view all the answers

How long should a clinician wait after the anesthetic administration before commencing the planned dental procedure?

3-5 minutes Signup and view all the answers

In what position should the needle approach the infraorbital foramen?

From the medial side Signup and view all the answers

What indicates that the deposited anesthetic solution is adequate beneath the finger pad over the infraorbital foramen?

The administrator feels the solution beneath the finger pad Signup and view all the answers

What tissue structure should the index finger of the nondominant hand press against during the procedure?

The infraorbital foramen Signup and view all the answers

What is the ideal orientation of the needle during injection for an anterior superior alveolar nerve block?

Parallel to the long axis of the ipsilateral maxillary first premolar Signup and view all the answers

Study Notes

Maxillary Anesthesia Techniques

Techniques for maxillary anesthesia include Anterior Superior Alveolar Nerve Block (ASANB) and Posterior Superior Alveolar Nerve Block (PSANB).
Dr. Ahmed Mohammed Saaduddin, Assistant Professor of Oral & Maxillofacial Surgery, and Consultant of Oral Surgery at Batterjee Medical College, Jeddah, presented these techniques on August 25, 2024.

Maxillary Nerve Anatomy

The maxillary nerve has branches within the cranium, including the middle meningeal nerve.
Other branches are in the pterygopalatine fossa: zygomatic nerve (zygomaticotemporal and zygomaticofacial nerves), pterygopalatine nerves (palatine branches, nasal branches, orbital branches, and pharyngeal branch), and PSA nerve.
Branches within the infraorbital canal include MSA and ASA nerves.
Branches on the face include inferior palpebral, external nasal, and superior labial branches.

Posterior Superior Alveolar Nerve Block (PSANB) Technique

Other names: Zygomatic block, tuberosity block.
Nerves anesthetized: PSAN.
Areas anesthetized: Buccal mucoperiosteum over the maxillary molars, buccal and palatal alveolar plates of bone, periodontium of maxillary molars (except MB root of 1st molar), pulps of maxillary molars (except MB root of 1st molar), and adjacent lining of the maxillary sinus.
Goal: To deposit local anesthetic close to the PSA nerves, located posterosuperior and medial to the maxillary tuberosity.
Indications: Treatment involving two or more maxillary molars, ineffective supraperiosteal injection (e.g., thick zygomatic buttress), contraindicated supraperiosteal injection (e.g., infection, inflammation).
Contraindications: Infection at the site of injection, high risk of hemorrhage.
Positive Aspiration: 3% (high).
Alternatives: Supraperiosteal infiltrations, maxillary nerve block.
Armamentarium: Short needle (20 mm length, 25 or 27-gauge), aspirating syringe, local anesthetic cartridge (with or without vasoconstrictor).
Point of insertion: Height of the mucobuccal fold above the maxillary second molar.
Target area: PSAN as it enters the posterior surface of the maxilla (posterior, superior, and medial) to the maxillary tuberosity.
Technique: Open mouth partially, retract cheek with a mirror, pull tissues taut, insert needle into height of mucobuccal fold over second molar. Advance needle slowly in one (not three) movement: upward (45° to occlusal plane), backward (45° to second molar's long axis), and inward (45° toward midline and occlusal plane).
Depth of needle insertion: For average adults: 3/4 of short needle length (16 mm); for smaller adults and children: 1/2 of short needle length (10 mm).
Aspiration test: Two perpendicular planes; 0.9ml to 1.8ml of anesthetic solution over 30–60 seconds with aspirations during injection.
Needle withdrawal: Single hand scoop technique for recapping.
Post-injection time for treatment: 3 to 5 minutes.

Clinical Findings (PSANB)

Subjective: Tingling and numbness, difficulty determining extent, only some may report numbness opposite molars.
Objective: Absence of pain during probing, no response with maximal EPT output, no response with freezing spray, absence of pain during treatment.

Advantages (PSANB)

High success rate (over 95%).
Atraumatic, because target area is loose connective tissue and doesn't involve bone.
Minimizes number of injections.
Minimizes anesthetic solution volume.

Disadvantages (PSANB)

Risk of diffuse intraoral hematoma (buccal mandibular region).
Arbitrary technique because there are no bony landmarks.
Second injection sometimes required for full anesthesia (in approximately 30%).

Causes of Failures/Complications (PSANB)

Needle too lateral: redirect medially
Needle not high enough: redirect superiorly
Needle too far posterior: withdraw to proper depth

Anterior Superior Alveolar Nerve Block (ASANB) Technique

Other names: Infraorbital nerve block.
Nerves anesthetized: Anterior superior alveolar, middle superior alveolar (occasionally), terminal branches of infraorbital nerve (inferior palpebral, lateral nasal, and superior labial branches).
Areas anesthetized: Pulps of maxillary incisors, canine, premolars and mesiobuccal root of the first molar on the injected side.
MSA nerve presence: Present in about 30% of population; in majority, anterior superior alveolar nerve carries MSA nerve function.

Clinical Note (ASANB)

ASA nerve block generally less popular due to lack of experience and fear of injury to the eye.

Indications (ASANB)

Procedures on two or more maxillary anterior teeth (incisors through premolars) and their buccal tissue.
Ineffective supraperiosteal injection.
Inflammation or infection (when supraperiosteal injection contraindicated).

Contraindications (ASANB)

Areas of inflammation or infection.
When hemostasis in a localized area is desired.

Advantages (ASANB)

Minimizes anesthetic solution volume and number of needle punctures.
Provides a longer anesthetic effect.

Disadvantages (ASANB)

Doesn't provide hemostasis.

Basic Armamentarium (ASANB)

The basic armamentarium is a long needle, an aspirating syringe, local anesthetic cartridge with vasoconstrictor.

Auxiliary Armamentarium (ASANB)

Topical antiseptic, topical anesthetic, hemostat, cotton tweezers.

Patient Position (ASANB)

Position supine or semisupine with neck extended slightly.
Dentist stands on the right side (right-handed) facing the patient.

Tissue Preparation (ASANB)

Dry tissues with sterile gauze.
Apply topical antiseptic (optional).
Apply topical anesthetic for 1 minute.

Locate the Infraorbital Foramen (ASANB)

Feel infraorbital notch and move finger downward, applying gentle pressure.
Inferior to the notch is the convex bone, representing the infraorbital foramen.
Feel the concavity below the notch, which is the foramen.

Applied Anatomy (ASANB)

The infraorbital foramen is funnel-shaped, opening downward and medially.
Approach the area medially.

Needle Orientation (ASANB)

Needle parallel to the long axis of ipsilateral first maxillary premolar.

Depth of Needle Insertion (ASANB)

Average 16 mm (half the length of a typical long needle.)

Safety Measures (ASANB)

Advance slowly until bone contacted.
Bone contact at the infraorbital rim.
Do not palpate the needle; adjust path if it's too superficial.

Aspiration (ASANB)

Perform twice.
Rotate the syringe 45 degrees for second aspiration.
Bevel should not be inside a blood vessel.

Precautions (ASANB)

Estimate depth before injection.
Needle tip should contact infraorbital rim of bone.
Apply finger pressure over the infraorbital foramen.

Amount of Local Anesthetic (ASANB)

0.9 ml (1/2 cartridge) to 1.2 ml (2/3 cartridge) over 30–40 seconds using a 25-gauge needle.
Administrator should feel solution beneath finger on the foramen.

Completion of the Technique (ASANB)

Withdraw needle slowly from tissues.
Immediately make the needle safe.
Apply direct finger pressure over injection site for 1-2 minutes to improve anesthetic solution spread.
Wait 3–5 minutes before commencing treatment.

Clinical Findings (ASANB)

Subjective: Tingling, numbness in ipsilateral eyelid, side of nose, upper lip, teeth, and soft tissues along the ASA and MSA nerve pathways.
Objective: Absence of pain on probing facial mucosa of anterior and premolar teeth, no response to maximal EPT output, no response to freezing spray, absence of pain during treatment.
Causes for ASANB failure: Needle contacting bone below the infraorbital foramen, (lateral side of nose and upper lip anesthetics may be present). Needle deviating medially and/or laterally in relation to the infraorbital foramen.

Alternative techniques

Infiltration technique
Maxillary nerve block
Periodontal ligament injection.

Complications (ASANB)

Hematoma (across lower eyelid): prevent with pressure.
Temporary double vision/horizontal diplopia: due to anesthetic diffusion in the eye socket and extra-orbital muscle anesthesia.

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Description

Test your knowledge on the ASA and PSANB nerve blocks in dentistry. This quiz covers techniques, contraindications, and best practices for administering effective anesthesia. Perfect for dental students and practitioners looking to refine their skills.