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Questions and Answers
What is a contraindication for a supraperiosteal injection?
What is a contraindication for a supraperiosteal injection?
Which method is recommended when the risk of hemorrhage is high?
Which method is recommended when the risk of hemorrhage is high?
What is the angle of needle orientation for the Posterior Superior Alveolar Nerve Block?
What is the angle of needle orientation for the Posterior Superior Alveolar Nerve Block?
What is the recommended needle length for the Posterior Superior Alveolar Nerve Block?
What is the recommended needle length for the Posterior Superior Alveolar Nerve Block?
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What should be done first when performing the Posterior Superior Alveolar Nerve Block technique?
What should be done first when performing the Posterior Superior Alveolar Nerve Block technique?
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Which of the following is NOT part of the armamentarium for the Posterior Superior Alveolar Nerve Block?
Which of the following is NOT part of the armamentarium for the Posterior Superior Alveolar Nerve Block?
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What should be done to minimize the risk of accidental needlestick injury during the PSANB procedure?
What should be done to minimize the risk of accidental needlestick injury during the PSANB procedure?
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What alternative injections can be utilized if supraperiosteal injection is ineffective?
What alternative injections can be utilized if supraperiosteal injection is ineffective?
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What is a primary advantage of the anterior superior alveolar nerve block compared to the infiltration technique?
What is a primary advantage of the anterior superior alveolar nerve block compared to the infiltration technique?
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What is the aspiration rate associated with the anterior superior alveolar nerve block?
What is the aspiration rate associated with the anterior superior alveolar nerve block?
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Which item is considered basic armamentaria for the anterior superior alveolar nerve block?
Which item is considered basic armamentaria for the anterior superior alveolar nerve block?
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At what anatomical landmark should the needle penetrate for the anterior superior alveolar nerve block?
At what anatomical landmark should the needle penetrate for the anterior superior alveolar nerve block?
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What position should the dentist adopt if they are right-handed while performing this nerve block?
What position should the dentist adopt if they are right-handed while performing this nerve block?
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Which of these is a disadvantage of the anterior superior alveolar nerve block?
Which of these is a disadvantage of the anterior superior alveolar nerve block?
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Which step involves preparing the tissue at the injection site for the anterior superior alveolar nerve block?
Which step involves preparing the tissue at the injection site for the anterior superior alveolar nerve block?
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What anatomical feature must be located before administering the anterior superior alveolar nerve block?
What anatomical feature must be located before administering the anterior superior alveolar nerve block?
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What is the recommended needle insertion depth for the Posterior Superior Alveolar Nerve Block in average adults?
What is the recommended needle insertion depth for the Posterior Superior Alveolar Nerve Block in average adults?
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During the PSANB technique, how long is recommended for slow deposition of anesthetic solution?
During the PSANB technique, how long is recommended for slow deposition of anesthetic solution?
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What subjective clinical finding might a patient report after a successful PSANB?
What subjective clinical finding might a patient report after a successful PSANB?
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What is the ideal aspiration technique during the PSANB procedure?
What is the ideal aspiration technique during the PSANB procedure?
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What is the maximum volume of anesthetic solution recommended for a full PSANB cartridge?
What is the maximum volume of anesthetic solution recommended for a full PSANB cartridge?
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Which of the following factors contributes to the low pain experience in the PSANB technique?
Which of the following factors contributes to the low pain experience in the PSANB technique?
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What should be done immediately after withdrawing the needle in the PSANB technique?
What should be done immediately after withdrawing the needle in the PSANB technique?
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What is the success rate of the PSANB technique as indicated in the findings?
What is the success rate of the PSANB technique as indicated in the findings?
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What is the primary reason the anterior superior alveolar nerve block (ASANB) is less popular than other nerve blocks?
What is the primary reason the anterior superior alveolar nerve block (ASANB) is less popular than other nerve blocks?
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Which teeth are primarily anesthetized by the anterior superior alveolar nerve block?
Which teeth are primarily anesthetized by the anterior superior alveolar nerve block?
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In what percentage of the population is the middle superior alveolar (MSA) nerve present?
In what percentage of the population is the middle superior alveolar (MSA) nerve present?
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What is the purpose of allowing the anesthetic solution to enter the infraorbital canal?
What is the purpose of allowing the anesthetic solution to enter the infraorbital canal?
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Which of the following is a contraindication for using the anterior superior alveolar nerve block?
Which of the following is a contraindication for using the anterior superior alveolar nerve block?
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Which branch of the infraorbital nerve primarily serves the upper lip?
Which branch of the infraorbital nerve primarily serves the upper lip?
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What type of dental procedures strongly indicate the use of the anterior superior alveolar nerve block?
What type of dental procedures strongly indicate the use of the anterior superior alveolar nerve block?
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Which facial nerve branches are anesthetized during an anterior superior alveolar nerve block?
Which facial nerve branches are anesthetized during an anterior superior alveolar nerve block?
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What is a common subjective clinical finding following an Intra-Oral Anterior Superior Alveolar Nerve Block?
What is a common subjective clinical finding following an Intra-Oral Anterior Superior Alveolar Nerve Block?
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What does a positive response to the Electric Pulp Tester indicate?
What does a positive response to the Electric Pulp Tester indicate?
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Which of the following corrections should be made if the needle contacts the bone inferior to the infraorbital foramen?
Which of the following corrections should be made if the needle contacts the bone inferior to the infraorbital foramen?
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Which alternative technique can be used if the Intra-Oral Anterior Superior Alveolar Nerve Block fails?
Which alternative technique can be used if the Intra-Oral Anterior Superior Alveolar Nerve Block fails?
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What is one possible complication resulting from an Intra-Oral Anterior Superior Alveolar Nerve Block?
What is one possible complication resulting from an Intra-Oral Anterior Superior Alveolar Nerve Block?
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What is indicated by an absence of pain during a probing test of the anterior and premolar teeth?
What is indicated by an absence of pain during a probing test of the anterior and premolar teeth?
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What adjustment is necessary if the needle is deviated medial or lateral to the infraorbital foramen?
What adjustment is necessary if the needle is deviated medial or lateral to the infraorbital foramen?
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What is a proper depth of penetration to ensure effective anesthesia during the procedure?
What is a proper depth of penetration to ensure effective anesthesia during the procedure?
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Study Notes
Supraperiosteal Injection
- Ineffective in cases with thick zygomatic buttress over the apices of first molar.
- Contraindicated with infection or acute inflammation at the injection site.
- Contraindications include infection, risk of hemorrhage (e.g., in hemophiliacs or patients on anticoagulants like Coumadin, Plavix).
Posterior Superior Alveolar Nerve Block (PSANB) Technique
- Positive aspiration rate is high at 3%.
- Alternatives include supraperiosteal infiltrations and maxillary nerve block.
- Required armamentarium: short needle (20 mm, 25- or 27-gauge), aspirating syringe, local anesthetic cartridge (with or without vasoconstrictor).
Technique for PSANB
- Point of insertion is at the height of the mucobuccal fold above the maxillary second molar.
- Target area is PSAN entering the posterior surface of the maxilla.
- Needle orientation: advance needle upward, inward, and backward in one motion.
- Upward at 45-degree angle to occlusal plane.
- Backward at 45-degree angle to long axis of second molar.
- Inward at 45-degree angle toward midline and occlusal plane.
Needle Insertion Depth
- Average adults: ¾ of the short needle length (16 mm).
- Smaller adults and children: ½ of the short needle length (10 mm).
Injection Technique
- Perform aspiration tests in two planes.
- Deposit anesthetic solution slowly (0.9 mL to 1.8 mL) over 30-60 seconds, with aspirations during injection.
- Remove needle and recap using single hand scoop technique.
- Begin dental treatment after a wait of 3 to 5 minutes.
Clinical Findings
- Subjective: Tingling and numbness noted; patients may report numbness of buccal mucosa opposite maxillary molars.
- Objective tests: absences of pain during probing; electric pulp tester shows no response (80/80); freezing spray results in no response; absence of pain during treatment.
Advantages and Disadvantages of PSANB
- Advantages: High success rate (>95%), atraumatic technique with minimal pain due to loose connective tissue and no bone contact.
- Disadvantages: Limited hemostasis and potential complications.
Anterior Superior Alveolar Nerve Block (ASANB)
- Recommended for procedures involving multiple maxillary anterior teeth and associated tissues.
- Contraindications include localized treatment areas and situations requiring hemostasis.
- Advantages: Minimizes anesthetic volume and punctures compared to infiltration; longer anesthetic effect.
ASANB Technique and Armamentarium
- Requires long needle, aspirating syringe, local anesthetic cartridge, optional topical antiseptic and anesthetic.
- Patient should be positioned supine or semisupine with slight neck extension.
Infraorbital Foramen Location
- Identify infraorbital notch, apply pressure to locate the foramen which is slightly inferior to the notch.
Clinical Findings for ASANB
- Subjective: Tingling and numbness in lower eyelid, side of nose, upper lip, and corresponding teeth.
- Objective: Absence of pain during probing, no response to electric and thermal tests, absence of pain during treatment.
Causes for ASANB Failure
- Contacting bone during injection; correction involves keeping needle aligned with foramen.
- Needle deviation medial or lateral; correction is maintaining appropriate orientation toward foramen.
Alternative Techniques
- Basic injection techniques: infiltration technique and maxillary nerve block.
- Supplementary techniques: periodontal ligament injection.
Complications of ASANB
- Possible outcomes include hematoma across lower eyelid and temporary double vision (horizontal diplopia).
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Description
Test your knowledge on dental anesthesia, focusing on supraperiosteal injections and their contraindications. Understand when this technique may be ineffective and the specific scenarios where it should not be used. This quiz is essential for dental students and professionals.