Lab Slides - Supraperiosteal-MSA PDF

MAXILLARY NERVE ANESTHESIA  Maxillary Facial Injections:  Posterior Superior Alveolar (PSA) block  Middle Superior Alveolar (MSA) block Natalie Ferrigno - DH 327  Anterior Superior Alveolar (ASA) block  Infraorbital...

MAXILLARY NERVE ANESTHESIA  Maxillary Facial Injections:  Posterior Superior Alveolar (PSA) block  Middle Superior Alveolar (MSA) block Natalie Ferrigno - DH 327  Anterior Superior Alveolar (ASA) block  Infraorbital (IO) block  Supraperiosteal Injections  Maxillary Palatal Injections:  Nasopalatine (NP)  Greater Palatine (GP) Slide 1  Natalie Ferrigno - DH 327 SUPRAPERIOSTEAL INJECTION Slide 2 Infiltration SUPRAPERIOSTEAL INJECTIONS = LOCAL INFILTRATIONS = FIELD BLOCK  Recommended to use when: Natalie Ferrigno - DH 327  pulpal anesthesia is needed on a limited number of teeth  anesthesia of the periodontium is needed in a localized area  Supraperiosteal injections can be successfully administered on every tooth in the maxillary quadrant Slide 3  Natalie Ferrigno - DH 327 Supraperiosteal injection 1. Know area to be anesthetized 2. Insert at the height of mucobuccal fold at tooth apex Slide Darby M, Walsh M: Dental hygiene theory and practice, ed 3, St. Louis, 2010, Saunders. 4  Slide Natalie Ferrigno - DH 327 5 CORRECT ANGULATION = PARALLEL TO THE LONG AXIS OF ROOT Natalie Ferrigno - DH 327 Slide 6  Natalie Ferrigno - DH 327 Supraperiosteal injection of maxillary central incisor Needle gauge and length: 27-gauge, short Landmarks: Mucobuccal fold or lingual surface of selected tooth or teeth Needle insertion point: Apex of selected tooth at height or depth of mucobuccal fold or lingual surface Depth of needle penetration: Approximately 3-5 mm or 1/4 the depth of short needle Slide Amount of anesthetic: Approximately 0.6 mL or 1/3 (one third) cartridge 7 Length of time to deposit: Approximately 30 to 60 seconds MANDIBULAR SUPRAPERIOSTEAL INJECTION Natalie Ferrigno - DH 327 Slide 8 SUPRAPERIOSTEAL INJECTION COMPLICATIONS:  Pain due to needle against periosteum  Withdraw needle and reinsert farther away Natalie Ferrigno - DH 327 (lateral) from the periosteum  Inadequate anesthesia due to depositing solution inferior to apex or if dense bone covers the apices  Seen around maxillary central incisors where apex lies beneath the nasal cavity  Mandibular teeth  due to bone density (not likely to get pulpal) Slide 9  Natalie Ferrigno - DH 327 MIDDLE SUPERIOR NERVE BLOCK Slide 10 MSA MIDDLE SUPERIOR ALVEOLAR BLOCK (MSA)  Teeth anesthetized: Maxillary first & second premolars and mesiobuccal root of maxillary first molar in (28% of population) Natalie Ferrigno - DH 327  Other structures anesthetized: Periodontium of anesthetized teeth and buccal soft tissue of premolar region Slide 11  Natalie Ferrigno - DH 327 Target area for MSA Height of mucobuccal fold at apex of maxillary 2nd premolar Fehrenbach MJ, Herring SW: Illustrated anatomy of the head and neck, ed 3, St. Louis, 2007, Saunders. Slide 12  Natalie Ferrigno - DH 327 Operator position Operator position for MSA block. Right-handed: 8 -9 o’clock Left-handed: 4-3 o’clock Slide 13 Patient - SUPINE  Natalie Ferrigno - DH 327 Syringe stabilization for MSA Slide 14  Injection site for MSA Natalie Ferrigno - DH 327 Landmarks: Height of Maxillary mucobuccal fold ; maxillary second premolar Needle insertion point: Height of mucobuccal fold at apex of maxillary 2nd premolar Needle gauge and length: 27-gauge, short Depth of needle penetration: Approximately 5 mm or 1/4 the depth of short needle Deposit location: Superior to apex of maxillary second premolar Slide 15  Natalie Ferrigno - DH 327 Solution Amount: Approximately 0.9 – 1.2 mL or 1/2 – 2/3 of cartridge Length of time to deposit: Approximately 60 to 90 seconds Slide Needle penetration for MSA 16  MSA COMPLICATION: ANATOMY  Presence of buccal frenum at injection site  Technique adjustment: Natalie Ferrigno - DH 327  Insert needle more posterior to injection site and retract frenum more anteriorly  Avoid injecting through the frenum  Avoid moving injection site so posterior as to lose maxillary premolar coverage Slide 17 MSA COMPLICATION: PAIN  Upon insertion  Withdraw needle and reinsert farther away (lateral) from periosteum Natalie Ferrigno - DH 327  Injecting too rapidly  Inject slowly – the acidic nature of the anesthetic agent and too rapid of injection speed both contribute to patient discomfort Slide 18 MSA COMPLICATION: INADEQUATE ANESTHESIA  Causes:  Injecting inferior to apex of maxillary 2nd premolar  Dense bone covering apices Natalie Ferrigno - DH 327  Injecting into an area of infection  Increase risk of needle-tract infection  Technique adjustment:  Increase depth of penetration and deposit just superior to apical region of 2nd premolar  Administer Infraorbital block Slide 19 REFERENCES  Fehrenbach MJ, Herring SW: Illustrated anatomy of the head and neck, ed 3, St. Louis, 2007, Saunders  Logothetis, Demetra D. Local Anesthesia for the Dental Natalie Ferrigno - DH 327 Hygienist, St. Louis, 2021, Mosby Co. 3rd Edition.  Malamed, Stanley. Handbook of Local Anesthesia, St. Louis, 2013, Mosby Co. 6th Edition. (ISBN#9780323074131)  Darby M, Walsh M: Dental hygiene theory and practice, ed 3, St. Louis, 2010, Saunders. Slide 20