Podcast
Questions and Answers
What is a disadvantage of using one injection compared to three infiltrations?
What is a disadvantage of using one injection compared to three infiltrations?
What percentage of the population has the middle superior alveolar nerve?
What percentage of the population has the middle superior alveolar nerve?
What is a common complication that can occur due to needle positioning during the PSANB technique?
What is a common complication that can occur due to needle positioning during the PSANB technique?
What is the main function of the anterior superior alveolar nerve?
What is the main function of the anterior superior alveolar nerve?
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Which factor contributes to the failure of the PSANB technique when the needle is not high enough?
Which factor contributes to the failure of the PSANB technique when the needle is not high enough?
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What must be done if the needle is positioned too laterally during PSANB?
What must be done if the needle is positioned too laterally during PSANB?
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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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What is a necessary follow-up when performing PSANB on the first molar?
What is a necessary follow-up when performing PSANB on the first molar?
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What is a common reason for the lack of popularity of the anterior superior alveolar nerve block?
What is a common reason for the lack of popularity of the anterior superior alveolar nerve block?
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What is a significant risk when inserting the needle too far posteriorly during the PSANB technique?
What is a significant risk when inserting the needle too far posteriorly during the PSANB technique?
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Which nerve is NOT anesthetized by the anterior superior alveolar nerve block?
Which nerve is NOT anesthetized by the anterior superior alveolar nerve block?
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Why is it critical to pay attention to penetration depth during the PSANB procedure?
Why is it critical to pay attention to penetration depth during the PSANB procedure?
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When is the anterior superior alveolar nerve block indicated?
When is the anterior superior alveolar nerve block indicated?
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What happens if adequate pressure cannot be applied to stop bleeding during a hematoma in the buccal tissues?
What happens if adequate pressure cannot be applied to stop bleeding during a hematoma in the buccal tissues?
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What is a possible contraindication for the anterior superior alveolar nerve block?
What is a possible contraindication for the anterior superior alveolar nerve block?
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What does the infraorbital nerve block anesthetize?
What does the infraorbital nerve block anesthetize?
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What is the preferred injection technique for discrete treatment areas involving one or two teeth?
What is the preferred injection technique for discrete treatment areas involving one or two teeth?
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What is a significant advantage of the supraperiosteal injection compared to the infiltration technique?
What is a significant advantage of the supraperiosteal injection compared to the infiltration technique?
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What is the estimated percentage for positive aspiration during the anterior superior alveolar nerve block?
What is the estimated percentage for positive aspiration during the anterior superior alveolar nerve block?
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What is one of the disadvantages of the anterior superior alveolar nerve block?
What is one of the disadvantages of the anterior superior alveolar nerve block?
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What armamentarium is not considered basic for the anterior superior alveolar nerve block?
What armamentarium is not considered basic for the anterior superior alveolar nerve block?
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In what position should a patient be placed for an anterior superior alveolar nerve block?
In what position should a patient be placed for an anterior superior alveolar nerve block?
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Where should the tissue be prepared for the injection in the anterior superior alveolar nerve block?
Where should the tissue be prepared for the injection in the anterior superior alveolar nerve block?
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What is the first step in locating the infraorbital foramen for the anterior superior alveolar nerve block?
What is the first step in locating the infraorbital foramen for the anterior superior alveolar nerve block?
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What is a common subjective clinical finding after an anterior superior alveolar nerve block?
What is a common subjective clinical finding after an anterior superior alveolar nerve block?
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What is indicated by an absence of response to an Electric Pulp Tester during an ASANB?
What is indicated by an absence of response to an Electric Pulp Tester during an ASANB?
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What might occur if the needle contacts bone inferior to the infraorbital foramen?
What might occur if the needle contacts bone inferior to the infraorbital foramen?
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What should be maintained to avoid failure of the ASANB due to needle deviation?
What should be maintained to avoid failure of the ASANB due to needle deviation?
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Which technique can serve as a supplementary injection method during dental procedures?
Which technique can serve as a supplementary injection method during dental procedures?
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What is a potential complication of an anterior superior alveolar nerve block?
What is a potential complication of an anterior superior alveolar nerve block?
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What is suggested as a corrective measure if the needle contacts bone during ASANB?
What is suggested as a corrective measure if the needle contacts bone during ASANB?
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Which of the following is NOT a method to test for successful anesthesia in the ASA nerve block?
Which of the following is NOT a method to test for successful anesthesia in the ASA nerve block?
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What is the average penetration depth of a needle for an adult of average height?
What is the average penetration depth of a needle for an adult of average height?
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Where should the needle contact to prevent over-insertion during an anterior superior alveolar nerve block?
Where should the needle contact to prevent over-insertion during an anterior superior alveolar nerve block?
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What is the recommended procedure for aspiration before administering local anesthetic?
What is the recommended procedure for aspiration before administering local anesthetic?
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What should be done after feeling the needle during the procedure?
What should be done after feeling the needle during the procedure?
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What is the typical amount of local anesthetic to deposit during the procedure?
What is the typical amount of local anesthetic to deposit during the procedure?
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What is the purpose of applying finger pressure over the injection site after administering the local anesthetic?
What is the purpose of applying finger pressure over the injection site after administering the local anesthetic?
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What is the maximum amount of anesthetic solution to be deposited over 30 to 40 seconds?
What is the maximum amount of anesthetic solution to be deposited over 30 to 40 seconds?
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Why should the syringe be rotated 45 degrees during the second aspiration test?
Why should the syringe be rotated 45 degrees during the second aspiration test?
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Study Notes
Anesthetic Techniques Overview
- Minimum injections needed: one injection versus three infiltrations
- Total volume minimized; three supraperiosteal injections equal 1.8 ml of anesthetic
- Risks include diffuse intraoral hematoma in buccal mandibular region and no clear bony landmarks for needle insertion
- A second injection may be needed for first molar anesthesia in about 30% of cases
Posterior Superior Alveolar Nerve Block (PSANB) Technique
- Common issues leading to failures:
- Needle too lateral → redirect medially
- Needle not high enough → redirect superiorly
- Needle too far posterior → withdraw to proper depth
Hematoma Considerations
- Hematomas may arise from injecting anesthetic outside the desired location
- Injury to pterygoid plexus or maxillary artery can occur if needle is inserted too far posteriorly
- No accessible intraoral area for applying pressure to stop hemorrhage
Anterior Superior Alveolar Nerve Block (ASA/Infraorbital Nerve Block)
- MSA nerve present in only 30% of people; ASA nerve compensates in 70%
- Provides anesthesia for maxillary incisors, canine, premolars, and mesiobuccal root of first molar
- Terminal branches affected include inferior palpebral, lateral nasal, and superior labial nerves
Clinical Insights
- ASA nerve block less popular due to inexperience and fear of eye injury, despite high success and safety when properly administered
- Indications:
- More than two maxillary anterior teeth involved
- Ineffective supraperiosteal injections
- Cases with inflammation/infection (cellulitis may require maxillary nerve block instead)
ASA Block Protocol
- Advantages: minimizes volume and number of punctures for anesthesia with a longer effect
- Disadvantages: does not provide localized hemostasis
- Positive aspiration rate negligible (0.7%)
Armamentarium Required
- Basic: Long needle, aspirating syringe, local anesthetic cartridge, possible vasoconstrictor
- Auxiliary: Topical antiseptic, topical anesthetic, hemostat, cotton tweezers
Injection Procedure
- Position patient in supine/semi-supine position with neck extension
- Dentist's position: right side of the chair for right-handed dentists
- Prepare injection site: dry area, optionally apply antiseptic and anesthetic
Locating Infraorbital Foramen
- Identify infraorbital notch and pressure downwards to detect the convex bone of the infraorbital foramen
- Average needle penetration depth: 16 mm for adults
Safety Measures
- Advance needle slowly until bone is contacted to avoid over-insertion
- Aspiration recommended at least twice to confirm no blood vessel contact
Injecting Anesthetic
- Deposit 0.9 ml to 1.2 ml using a 25-gauge long needle over 30-40 seconds
- Maintain pressure on injection site for 1-2 minutes post-injection
- Wait 3-5 minutes before starting the dental procedure
Clinical Findings
- Subjective: Tingling and numbness in the affected regions
- Objective:
- Probing tests show no pain
- No response with electric pulp testing or thermal tests
- No pain during treatment
Causes of ASANB Failure
- Incorrect needle contact with bone below infraorbital foramen results in anesthesia in areas but not the teeth
- Needle deviation from foramen during advancement can lead to inadequate targeting
Alternative Techniques and Complications
- Basic injection options: infiltration technique or maxillary nerve block
- Supplementary options: periodontal ligament injection
- Complications may include hematoma under the eyelid and temporary double vision (horizontal diplopia)
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Description
This quiz explores various techniques of administering local anesthesia, comparing the effectiveness and volume of solutions required for procedures. It discusses the advantages and disadvantages of using one injection versus multiple infiltrations, highlighting potential risks and considerations for practitioners.
