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Questions and Answers
What is the recommended depth of needle insertion for average adults during a PSANB?
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?
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?
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?
Why is the PSANB considered an atraumatic technique?
How long should one wait after administering the PSANB before commencing dental treatment?
How long should one wait after administering the PSANB before commencing dental treatment?
What is the success rate of the PSANB technique?
What is the success rate of the PSANB technique?
What is one of the objective tests used to assess the effectiveness of the PSANB?
What is one of the objective tests used to assess the effectiveness of the PSANB?
During the aspiration test in PSANB, how many planes should the aspiration be conducted?
During the aspiration test in PSANB, how many planes should the aspiration be conducted?
What percentage of the population typically lacks a middle superior alveolar (MSA) nerve?
What percentage of the population typically lacks a middle superior alveolar (MSA) nerve?
Which nerve provides sensory supply to the maxillary incisors and canines?
Which nerve provides sensory supply to the maxillary incisors and canines?
What is a major reason the anterior superior alveolar nerve block (ASANB) is less popular than the posterior superior alveolar nerve block (PSANB)?
What is a major reason the anterior superior alveolar nerve block (ASANB) is less popular than the posterior superior alveolar nerve block (PSANB)?
What is the main reason to perform an anterior superior alveolar nerve block?
What is the main reason to perform an anterior superior alveolar nerve block?
Which of the following structures is anesthetized by the anterior superior alveolar nerve block?
Which of the following structures is anesthetized by the anterior superior alveolar nerve block?
What is the primary anatomical landmark for performing the anterior superior alveolar nerve block?
What is the primary anatomical landmark for performing the anterior superior alveolar nerve block?
Which of the following conditions contraindicates the use of a supraperiosteal injection?
Which of the following conditions contraindicates the use of a supraperiosteal injection?
Which terminal branch of the infraorbital nerve supplies the lateral aspect of the nose?
Which terminal branch of the infraorbital nerve supplies the lateral aspect of the nose?
What is a potential complication of Anterior Superior Alveolar Nerve Block (ASANB)?
What is a potential complication of Anterior Superior Alveolar Nerve Block (ASANB)?
How can temporary double vision during ASANB be prevented?
How can temporary double vision during ASANB be prevented?
What is a medical error in the context of dental anesthesia?
What is a medical error in the context of dental anesthesia?
What might happen if the IONB is applied incorrectly?
What might happen if the IONB is applied incorrectly?
What justifies the patient experiencing temporary double vision during ASANB?
What justifies the patient experiencing temporary double vision during ASANB?
What is one advantage of using a single injection method over multiple infiltrations?
What is one advantage of using a single injection method over multiple infiltrations?
What might occur if the needle is too lateral during a Posterior Superior Alveolar Nerve Block?
What might occur if the needle is too lateral during a Posterior Superior Alveolar Nerve Block?
Which technique is advised when a needle is not placed high enough during the PSANB?
Which technique is advised when a needle is not placed high enough during the PSANB?
What critical factor must be monitored to avoid complications during the PSANB?
What critical factor must be monitored to avoid complications during the PSANB?
What can happen as a result of inserting the needle too far posteriorly?
What can happen as a result of inserting the needle too far posteriorly?
What is the shape of the infraorbital foramen?
What is the shape of the infraorbital foramen?
What should be done to correct needle placement when it is too far posterior during PSANB?
What should be done to correct needle placement when it is too far posterior during PSANB?
Where should the needle be inserted for an anterior superior alveolar nerve block?
Where should the needle be inserted for an anterior superior alveolar nerve block?
Why is the risk of diffuse intraoral hematoma significant in the buccal mandibular region?
Why is the risk of diffuse intraoral hematoma significant in the buccal mandibular region?
Which finger is used to apply pressure over the infraorbital foramen during palpation?
Which finger is used to apply pressure over the infraorbital foramen during palpation?
What is a common consequence of improper placement of local anesthetic during mandibular anesthesia?
What is a common consequence of improper placement of local anesthetic during mandibular anesthesia?
What should the orientation of the needle be when approaching the infraorbital foramen?
What should the orientation of the needle be when approaching the infraorbital foramen?
What sensory experience might a patient notice when the infraorbital nerve is palpated?
What sensory experience might a patient notice when the infraorbital nerve is palpated?
What is the primary purpose of tissue retraction during an intra-oral superior alveolar nerve block?
What is the primary purpose of tissue retraction during an intra-oral superior alveolar nerve block?
When locating the infraorbital foramen, which anatomical feature relates to its position?
When locating the infraorbital foramen, which anatomical feature relates to its position?
Which tooth typically provides the shortest route for reaching the infraorbital foramen during a nerve block?
Which tooth typically provides the shortest route for reaching the infraorbital foramen during a nerve block?
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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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