Maxillary Anesthesia Techniques Quiz

Maxillary Anesthesia Techniques

• Learning Objectives: Students should be able to:
  • Memorize the nerve supply of the maxilla.
  • Differentiate between local anesthetic injection techniques.
  • Enumerate methods to anesthetize maxillary teeth.
  • Discuss supraperiosteal injection steps.

Types of Local Anesthesia Injection Techniques

• Maxillary injection techniques
• Supraperiosteal (Field-Block) injection technique

Anatomy

• Diagrams of maxillary innervation are included.
  • Key nerves like supra-orbital, supratrochlear, anterior ethmoidal, lacrimal, frontal, ophthalmic, trigeminal, maxillary, infra-orbital, zygomatic, greater palatine, lesser palatine, and nasopalatine are shown and their relationship to the maxilla.

Innervation of Maxillary Dental

• Table showing nerve supply for maxillary teeth and adjacent tissues. Anterior Superior Alveolar, Middle Superior Alveolar, Posterior Superior Alveolar, Greater Palatine and Nasopalatine nerves are listed.

Types of Local Anaesthesia

• Infiltration: Local anesthetic injection near the terminal nerve endings, for surface (soft tissue) anesthesia.
• Field Block: Local anesthetic near terminal nerve branches, for anesthetizing 1-2 teeth.
• Nerve Block: Local anesthetic near a main nerve trunk, for quadrant dentistry.

Differences Between Infiltration and Field Block

• In dentistry, the term infiltration is used for field block procedures, where the anesthetic is placed above the apex of the tooth to treat.
• Technically, this is incorrect as it's actually a field block.

Regional Block (Nerve Block)

• Definition: A local anesthetic injection near the main nerve trunk.
• Indication: Quadrant dentistry pain control.
• Example: Infraorbital, PSA, and NPNB.

Local Anesthetic Injection Techniques (POC)

• Injection Technique - Comparison of technique types:
  • Point of Deposition (Infiltration vs. Field Block vs. Nerve Block)
  • Depth of Penetration
  • Risk of Intravascular Injection
  • Effective Anesthetized Area
  • Duration of Anesthesia
  • Example techniques

Basic Maxillary Injection Techniques

• A table of Injection techniques and their proposed treatments.
  • Supraperiosteal infiltration (Field Block)
  • Posterior Superior Alveolar (PSA) Nerve Block
  • Middle Superior Alveolar (PSA) Nerve Block
  • Anterior Superior Alveolar (PSA) Nerve Block
  • Maxillary (V2, Second Division) Nerve Block
  • Greater (Anterior) Palatine Nerve Block
  • Nasopalatine nerve block (Incision fossa, and branches, etc.)
  • Anterior middle superior alveolar (AMSA) nerve block
  • Palatal approach ASA (P-ASA) nerve block

Supraperiosteal Injection Technique

• Armamentaria: Lists equipment needed: Surgical Sponge (Gauze), College Cotton Tweezer, Topical Antiseptic, Topical Anesthesia, 27-Gauge Short Dental Needle, Local Anesthetic Cartridge, and Aspirating Dental Syringe.

• Common Names: Incorrectly referred to as Local Infiltration, but the correct name is Paraperiosteal Injection.

• Nerves Anesthetized: Terminal branches of the dental plexus.

• Areas Anesthetized: Entire region innervated by terminal branches, including pulp, root area, periodontal ligament, alveolar bone, buccal mucosa (periosteum, submucosal tissues, and mucous membranes)

• Indications:

  • Pulpal anesthesia of maxillary teeth (1-2 teeth).
  • Soft tissue anesthesia in a circumscribed area.

• Contraindications:

  • Infection/inflammation in the injection area.
  • Dense bone covering the tooth apex. (Examples include the permanent maxillary first molar in children and apex of an adult's central incisor near the ant nasal spine).

• Advantages: High success rate, easy to perform, and usually atraumatic.

• Disadvantages: Not suitable for large areas, may require multiple injections and larger volumes of anesthesia.

• Positive Aspiration: Negligible but possible.

• Alternatives: PDL, intraosseous, and regional blocks.

• Area of Insertion: Height of mucobuccal fold above the tooth apex.

• Target Area: Apical region opposite the tooth.

• Landmarks: Mucobuccal fold, tooth crown, root contour.

• Procedures: Steps for injection procedure.

• Bevel Orientation: Needle bevel should generally face the bone; the correct orientation of the bevel is not crucial, but other technical factors are.

• Aspiration: To prevent intravascular injection, aspirate on two planes. The first, with the cartridge at positive pressure; if this is negative, rotate 45° and aspirate a second time.

• Safety Features: Minimal intravascular administration risk, slow injection, and double aspiration in perpendicular planes.

• Failures of Anesthesia: Needle tip below the apex (leading to poor pulpal anesthesia). Needle tip away from the bone (leading to deposit in buccal tissues).

• Complications: Pain from needle insertion on the periosteum (corrected by withdrawing the needle away).

• Signs and Symptoms: Subjective signs (patient feeling numbness), Objective signs (probing, electric pulp tester, cavity test).

References

• Handbook of Local Anesthesia, 7th Edition by Stanley F. Malamed