PSANB Technique in Dental Practice

Questions and Answers

What is the recommended depth of needle insertion for average adults during a PSANB?

10 mm

12 mm

16 mm (correct)

20 mm

What is the maximum volume of anesthetic solution to be slowly deposited during PSANB?

0.5 mL

1.0 mL

2.0 mL

1.8 mL (correct)

What subjective clinical finding indicates the effectiveness of the PSANB?

Absence of pain during treatment

Numbness of the buccal mucosa opposite to maxillary molars (correct)

No response to electrical pulp tester

Presence of tingling sensation

Why is the PSANB considered an atraumatic technique?

The target area consists of loose connective tissue. Signup and view all the answers

How long should one wait after administering the PSANB before commencing dental treatment?

3 to 5 minutes Signup and view all the answers

What is the success rate of the PSANB technique?

Greater than 95% Signup and view all the answers

What is one of the objective tests used to assess the effectiveness of the PSANB?

Response to electrical pulp tester Signup and view all the answers

During the aspiration test in PSANB, how many planes should the aspiration be conducted?

Two perpendicular planes Signup and view all the answers

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

30% Signup and view all the answers

Which nerve provides sensory supply to the maxillary incisors and canines?

Anterior superior alveolar nerve Signup and view all the answers

What is a major reason the anterior superior alveolar nerve block (ASANB) is less popular than the posterior superior alveolar nerve block (PSANB)?

Fear of eye injury. Signup and view all the answers

What is the main reason to perform an anterior superior alveolar nerve block?

For procedures involving more than two maxillary anterior teeth. Signup and view all the answers

Which of the following structures is anesthetized by the anterior superior alveolar nerve block?

Mesiobuccal root of the first molar Signup and view all the answers

What is the primary anatomical landmark for performing the anterior superior alveolar nerve block?

Infraorbital foramen Signup and view all the answers

Which of the following conditions contraindicates the use of a supraperiosteal injection?

Inflammation or infection Signup and view all the answers

Which terminal branch of the infraorbital nerve supplies the lateral aspect of the nose?

Lateral nasal nerve Signup and view all the answers

What is a potential complication of Anterior Superior Alveolar Nerve Block (ASANB)?

Temporary double vision (Horizontal Diplopia) Signup and view all the answers

How can temporary double vision during ASANB be prevented?

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

What is a medical error in the context of dental anesthesia?

Failure to complete the intended plan due to deviations from standard care Signup and view all the answers

What might happen if the IONB is applied incorrectly?

Injury to the eyeball Signup and view all the answers

What justifies the patient experiencing temporary double vision during ASANB?

It results from anesthetization of motor nerves innervating orbital muscles Signup and view all the answers

What is one advantage of using a single injection method over multiple infiltrations?

It reduces the total volume of local anesthetic solution administered. Signup and view all the answers

What might occur if the needle is too lateral during a Posterior Superior Alveolar Nerve Block?

Injury to the pterygoid plexus of veins. Signup and view all the answers

Which technique is advised when a needle is not placed high enough during the PSANB?

Redirect the needle tip superiorly. Signup and view all the answers

What critical factor must be monitored to avoid complications during the PSANB?

The exact depth of penetration. Signup and view all the answers

What can happen as a result of inserting the needle too far posteriorly?

Injury to the maxillary artery. Signup and view all the answers

What is the shape of the infraorbital foramen?

Flattened funnel with opening directed downward and medially Signup and view all the answers

What should be done to correct needle placement when it is too far posterior during PSANB?

Withdraw the needle to the proper depth. Signup and view all the answers

Where should the needle be inserted for an anterior superior alveolar nerve block?

Height of the mucobuccal fold over the first premolar Signup and view all the answers

Why is the risk of diffuse intraoral hematoma significant in the buccal mandibular region?

Due to the absence of bony landmarks during injection. Signup and view all the answers

Which finger is used to apply pressure over the infraorbital foramen during palpation?

Index finger of the nondominant hand Signup and view all the answers

What is a common consequence of improper placement of local anesthetic during mandibular anesthesia?

Tongue and lower lip anesthesia. Signup and view all the answers

What should the orientation of the needle be when approaching the infraorbital foramen?

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

What sensory experience might a patient notice when the infraorbital nerve is palpated?

Mild soreness Signup and view all the answers

What is the primary purpose of tissue retraction during an intra-oral superior alveolar nerve block?

To allow better visibility of the foramen Signup and view all the answers

When locating the infraorbital foramen, which anatomical feature relates to its position?

It is aligned with the pupil of the eye when the patient looks straight forward Signup and view all the answers

Which tooth typically provides the shortest route for reaching the infraorbital foramen during a nerve block?

First premolar Signup and view all the answers

Study Notes

Posterior Superior Alveolar Nerve Block (PSANB) Technique

Needle insertion should angle medially at 45 degrees toward both the midline and occlusal plane.
Average depth of needle insertion for adults: ¾ of short needle length (16 mm).
Depth for smaller adults and children: ½ of short needle length (10 mm).
Perform aspiration test in two perpendicular planes before injection.
Deposit 0.9 mL to 1.8 mL of anesthetic solution over 30 to 60 seconds, with intermittent aspirations.
Make needle safe immediately after withdrawal using single hand scoop technique.
Commence dental treatment after a 3 to 5 minute wait for anesthesia onset.

Clinical Findings

Subjective findings: Patient may report tingling and numbness, though the extent of anesthesia is often difficult to assess.
Objective findings:
- Probing test: No pain during probing of facial mucosa of maxillary molars.
- Electrical pulp testing: No response observed at maximal output (80/80).
- Ice testing (e.g., Endo-Ice): No response indicates effective anesthesia.
- Absence of pain during treatment confirms anesthesia success.

Advantages of PSANB

High success rate (> 95%).
Atraumatic as it targets loose connective tissue and avoids bone contact.
Requires fewer injections (one instead of potentially three).
Minimizes volume of local anesthetic needed (1.8 mL equivalent to three infiltrations).

Disadvantages of PSANB

Risk of diffuse intraoral hematoma in the buccal mandibular region.
Lack of bony landmarks can lead to technique variability.
Approximately 30% may require a second injection for effective first molar anesthesia.

Causes of Failures & Complications

Needle too lateral: Redirect medially.
Needle not high enough: Redirect superiorly.
Needle too far posterior: Withdraw to proper depth.
Potential hematoma risks due to improper deposition of local anesthetic or needle placement close to the pterygoid plexus or maxillary artery.

Anterior Superior Alveolar Nerve Block (ASA) / Infraorbital Nerve Block (IONB)

MSA nerve present only in 30% of the population; majority rely on ASA for action on maxillary anterior teeth.
ASA nerve block success hindered by lack of experience and fear of ocular injury, though it is generally safe when protocols are followed.

IONB Applied Anatomy

Accurate administration requires anesthetic solution entry into the infraorbital canal.
Anesthetizes multiple nerves: anterior superior alveolar, middle superior alveolar, and terminal branches of the infraorbital nerve.
The infraorbital foramen can be felt as a concavity in the bone, approached medially with the needle.

Complications of ASANB

Hematomas may occur across the lower eyelid; can be mitigated with pressure application post-injection.
Temporary double vision can arise, resulting from diffusion of anesthesia into orbital areas.
Medical errors, including potential eyeball injury, must be avoided by adhering strictly to recommended techniques.

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Description

This quiz covers the essential techniques and clinical findings relevant to the Posterior Superior Alveolar Nerve Block (PSANB). It includes details on needle insertion angles, depths, aspirating techniques, and how to assess anesthesia effectiveness in patients. Perfect for dental students and practitioners looking to refine their skills.