Maxillary anesthesia .pdf

Techniques of Maxillary Anesthesia Maxillary Basic Injection Techniques (1/3) Supraperiosteal Injection Technique Dr. Ahmed Mohammed Saaduddin Assistant Professor and Consultant of Oral Surgery Batterjee Medical College – Jeddah Monday 19 August 2024 LEARNING OBJECTIVES AT THE END OF THIS LEC...

Techniques of Maxillary Anesthesia Maxillary Basic Injection Techniques (1/3) Supraperiosteal Injection Technique Dr. Ahmed Mohammed Saaduddin Assistant Professor and Consultant of Oral Surgery Batterjee Medical College – Jeddah Monday 19 August 2024 LEARNING OBJECTIVES AT THE END OF THIS LECTURE, THE STUDENT SHOULD BE ABLE TO: 1 Memorize the nerve supply of the maxilla. 2 Differentiate between the different local anesthetic injection techniques 3 Enumerate different methods to anesthetize the maxillary teeth. 4 Discuss the steps of supraperiosteal injection technique. Lecture Content Types of Local Anesthesia Injection Techniques 1 Maxillary Injection Techniques 2 Supraperiosteal Field-Block Injection Technique 3 Anatomy Maxillary Innervation Palatal Innervation Innervation of Maxillary Dental and Paradental Periodontia: Nerve Teeth Soft Tissue Anterior Superior Alveolar Maxillary Incisors and Canine Labial soft tissues of incisors and canine Middle Superior Alveolar Maxillary Premolars and Mesiobuccal root of the first molar Buccal soft tissues of ipsilateral premolars Posterior Superior Alveolar Maxillary molars except the Mesiobuccal root of the first molar Buccal soft tissues of ipsilateral molars Greater Palatine -- Palatal soft tissues of molars and premolars Nasopalatine -- Palatal soft tissues of incisors and canines Techniques of Local Anaesthesia Infiltration Field Block Nerve Block Local Anesthetic Injection Techniques Local Infiltration Local Anesthetic Injection Techniques Basic Field Block Nerve Block Intraligamentry Supplementary Intrapulpal Intraosseous Local Anesthetic Injection Techniques  What is the main factor that determine the type of injection? The site of deposition of the anesthetic drug relative to the area of operative intervention. Local Anesthetic Injection Techniques Three major types of local anesthetic injection can be differentiated: 1. Local Infiltration 2. Field Block 3. Nerve Block 3 2 1 Local Anesthetic Injection Techniques (A) Local Infiltration  Definition: A local anesthesia injection technique in which the local anesthetic is deposited close to the Terminal Nerve Endings.  Indication: Only surface (soft-tissue) anesthesia.  Example: Local anesthetic injection in the interdental papilla before root planning. Local Anesthetic Injection Techniques (B) Field Block  Definition: A local anesthesia injection technique in which the local anesthetic is deposited close to the Terminal Nerve Branche.  Indication: Anesthetization of 1 - 2 teeth.  Example: Local anesthetic injection at or above the apex of the tooth INFILTRATION vs FIELD BLOCK In dentistry: The term infiltration is in common usage to define an injection in which the local anesthetic is deposited at or above the apex of the tooth to be treated. This is technically incorrect as this technique is a field block Clinically what is called “Infiltration” is actually the “Field-Block” Technique Local Anesthetic Injection Techniques (C) Regional Block (Nerve Block “NB”)  Definition: A local anesthesia injection technique in which the local anesthetic drug is deposited close to the Main Nerve Trunk.  Indication: Pain control in quadrant dentistry  Example: Local anesthetic injection near the main nerve trunk (e.g. Infraorbital NB – PSA NB - NPNB) Local Anesthetic Injection Techniques POC Infiltration Technique Field Block Nerve Block Point of Deposition Nerve Endings Nerve Branch Nerve Trunk Dose Very little Small Large Depth of penetration Few millimeters Shallow Needle penetration Deep Needle penetration Risk of Intravascular Injection Rare Possible High Small localized area Quadrant Dentistry involving Effective Anesthetized Area Surface Anesthesia 1 - 2 adjacent teeth ≥ 3 adjacent teeth Duration of Anesthesia Few minutes Short (30 – 60 minutes) Long (≥ 60 minutes) Example Submucosal injection Supraperiosteal injection Infraorbital nerve Block Basic Maxillary Injection Techniques  Basic Maxillary Injection Techniques # Injection Technique Recommended For 1 Supraperiosteal infiltration (Field Block) Limited treatment protocols involving only 1-2 adjacent roots. 2 Posterior Superior Alveolar (PSA) Nerve Block Management of several molar teeth in one quadrant 3 Middle Superior Alveolar (PSA) Nerve Block Management of premolars in one quadrant 4 Anterior Superior Alveolar (PSA) Nerve Block Management of anterior teeth in one quadrant 5 Maxillary (V2, second Division) Nerve Block Management of all teeth in one quadrant  Basic Maxillary Injection Technique # Injection Technique Recommended For 6 Greater (Anterior) Palatine Nerve Block Anesthetize the palatal soft tissue distal to the canine in one quadrant 7 Nasopalatine nerve block Anesthetize the palatal soft tissue from canine to canine bilaterally  Basic Maxillary Injection Technique # Injection Technique Recommended For 8 Anterior middle superior alveolar (AMSA) nerve block Management of palatal and buccal soft and hard tissues & pulps of anterior teeth. 9 Palatal approach ASA (P-ASA) nerve block Techniques of Maxillary Teeth and Buccal Hard Tissues Anaesthesia (1) Supraperiosteal Injection (Field Block) Technique Supraperiosteal Injection Technique ► Armamentaria (A) Supplementary Injection Armamentaria Surgical Sponge (Gauze) College Cotton Tweezer Topical Antiseptic Topical Anesthesia (B) Basic Injection Armamentaria 27-Gauge Short Dental Needle Local Anesthetic Cartridge Aspirating Dental Syringe Supraperiosteal Injection Technique ► Common Names: o Local infiltration (Incorrect description) as its correct description is field block. o Paraperiosteal Injection. ► Nerves Anesthetized: Terminal branches of the dental plexus. ► Areas Anesthetized The entire region innervated by the large terminal branches of the dental plexus that include: o Pulp of the tooth, o Root area of the tooth, o Periodontal ligament of the tooth, o Alveolar bone surrounding the tooth, o Buccal (periosteum, submucosal connective tissue, and mucous membrane) opposite to the tooth. Supraperiosteal Injection Technique ► Indications: 1. Pulpal anesthesia of the maxillary teeth when treatment is limited to one or two teeth. 2. Soft tissue anesthesia in a circumscribed area. Supraperiosteal Injection Technique ► Contraindications: 1. Infection or acute inflammation in the area of injection. 2. Dense bone covering the apices of teeth This is most likely happen when the apex of the tooth is located beneath a dense bone such as: - Over the permanent maxillary first molar in children, as its apex may be located beneath the zygomatic bone. - Apex of an adult’s central incisor that may be located beneath the anterior nasal spine Supraperiosteal Injection Technique ► Advantages: 1. High success rate (>95%) 2. Technically easy injection 3. Usually entirely atraumatic. ► Disadvantages: 1. Not recommended for large areas because of the need for multiple needle insertions and the necessity to administer larger total volumes of local anesthetic. ► Positive Aspiration: Negligible, but possible (