Maxillary infiltration anesthetic techniques (with photos)

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Maxillary infiltration anesthetic techniques (with photos)

  1. 1. Maxillay Infiltration Anesthetic TechniquesHesham El-Hawary
  2. 2. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryMaxillary InfiltrationAnesthetic TechniquesDr Hesham El-HawaryAssistant professor OMFSwww.elhawarydentalclinic.com
  3. 3. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryThe main factors to be concerned are:1. Selection of a suitable syringe and needle2. Utilization of the proper L.A. drug3. Insertion of the needle in the correct site forinjection– Point of insertion– Direction of needle injection
  4. 4. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryLocal Anesthesia1. Topical anesthesia2. Local infiltration3. Field block4. Nerve block
  5. 5. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryLocal Anesthesia• Topical Anesthesia– Ointments, gels, sprays and pastes on mucousmembrane or skin– Application of a topical anesthetic agent on themucosa allows for the easy and painless insertionof the sharp needle– Affects free nerve endings
  6. 6. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryLocal Anesthesia• Local Infiltration– Flooding of the small terminal nerve endings withlocal anesthetic solution
  7. 7. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryLocal Anesthesia• Field Block– Referred to as local infiltration– local anesthetic solution is deposited in thevicinity of larger terminal nerve fiber– so a circumscribed area is anesthetized– Local anesthesia injection above a tooth apex isan example of a field block, in spite of beingreferred to as paraperiosteal or supraperiostealinfiltration anesthesia
  8. 8. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryLocal Anesthesia• Nerve Block– The anesthetic solution is deposited close to amain nerve trunk– Usually at a distance from the operative sitebefore the nerve divided into terminal branches
  9. 9. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryFactors affecting selection of thetechnique to be used1. Area to be anesthetizedDepending on the type of bone (density of bone)– Maxilla and anterior mandibular region• Cancellous bone with thin cortical layer• Infiltration anesthesia or field block anesthesia reaches the nervefilaments inside the cancellous bone– Posterior mandible• Thick and dense cortical bone• Nerve block anesthesia
  10. 10. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryFactors affecting selection of thetechnique to be used Cont.2. Extent of surgical procedure– Multiple extractions, nerve block anesthesia ispreferable• Allow anesthesia of the entire operative area• Prevent multiple needle punctures
  11. 11. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryFactors affecting selection of thetechnique to be used Cont.3. Duration and profoundness of anesthesiaNerve block anesthesia produces a more profoundand longer duration than infiltration anesthesia4. Age of the patientOlder individuals have dense bone, thus it is moredifficult for infiltration anesthesia to penetrate intothe bone
  12. 12. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryFactors affecting selection of thetechnique to be used Cont.5. HemostasisWhen required for the procedure, infiltrationanesthesia is recommended to allow thevasoconstrictor present with the localanesthetic to act directly on the blood vesselsand reduce bleeding
  13. 13. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryFactors affecting selection of thetechnique to be used Cont.6. Presence of infectionInfiltration anesthesia should be avoided toprevent injection into an infected area whichcan spread the infection7. Skill of the operator
  14. 14. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryINFILTRATION ANESTHESIAInfiltration Anesthetic Techniques
  15. 15. Maxillay Infiltration Anesthetic TechniquesHesham El-Hawary The most commonly used technique It is divided into Soft tissue infiltration Submucosal Paraperiosteal Bony infiltration
  16. 16. Maxillay Infiltration Anesthetic TechniquesHesham El-HawarySoft tissue infiltration anesthesiaIn this technique anesthesia is deposited intothe soft tissue in close proximity to bone whichis then absorbed via pores in the bone surfacetill it reaches the nerve filament inside thecancellous bone
  17. 17. Maxillay Infiltration Anesthetic TechniquesHesham El-Hawary
  18. 18. Maxillay Infiltration Anesthetic TechniquesHesham El-HawarySoft Tissue InfiltrationSubmucosal anesthesiaParaperiosteal anesthesiaSubperiosteal anesthesia
  19. 19. Maxillay Infiltration Anesthetic TechniquesHesham El-HawarySoft Tissue InfiltrationSubmucosal anesthesia Needle is inserted at a slightdepth just below themucous membrane In cases just needsuperficial anesthesia Hypertrophied tissue High muscle attachmentParaperiosteal Anesthesia Called local infiltration Mostly used for anesthetizing All maxillary teeth Lower anterior mandibular teeth It’s action depends on thediffusion of the L.A. solutionthrough the periosteum andthe minute foramina in thecortical bone
  20. 20. Maxillay Infiltration Anesthetic TechniquesHesham El-HawarySoft Tissue Infiltration• Subperiosteal injection– Not be attempted– Because of• Liability of needle breakage• Difficulty of forcing the anesthetic agent betweenperiosteum and bone
  21. 21. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryParaperiosteal AnesthesiaAdvantages1. High success rate2. Technically it is an easyinjection3. Usually it is entirelyatraumaticDisadvantages• Not suitable for large areas– Needs multiple punctures– Administeration of largeamount of L.A. solution
  22. 22. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryCHAIR POSITION – DENTIST POSITIONRIGHT HANDED OPERATOR – RIGHT SIDEInfiltration Anesthetic Techniques
  23. 23. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryZero position
  24. 24. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryAdjusting the backrestAdjust the head rest so that the head , neckand trunk become on the same straight line
  25. 25. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryAdjusting the backrestAdjust the head rest so that the head , neckand trunk become on the same straight lineThe back of the chair is tilted so that it make a45 degree angle with the floor
  26. 26. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryAdjusting the backrestSo that when the patient open his mouth theocclusal plane of the maxillary teeth makesnearly 45 degree with the floor
  27. 27. Maxillay Infiltration Anesthetic TechniquesHesham El-HawarySo that when the patient open his mouth theocclusal plane of the maxillary teeth makes 45degree with the floorThe occlusal plan of maxillary teeth near to theoperator’s shoulder
  28. 28. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryAdjusting the dental chair levelWorking in maxillary teethElevate the chair from the zero positionafter adjusting the back rest the occlusalplan of maxillary teeth near to theoperator’s shoulderN.B. the operator stands infront and to theright
  29. 29. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryAdjusting the dental chair levelWorking in mandibular teethElevate the chair from the zero positionafter adjusting the back rest so that Theocclusal plan of maxillary teeth near tothe operator’s shoulderN.B. the operator stands infront and tothe right except during working in lowerright posterior teeth
  30. 30. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryFor working in lowerright posterior teeththe chair is loweredand tilted enough toenable the operatorto have a clear viewto the field from rearright position
  31. 31. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryMAXILLARY BUCCAL INFILTRATIONANESTHESIAInfiltration Anesthetic Techniques
  32. 32. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryPulp , Investing structures & Labial (buccal) mucoperiosteumAnterior superior alveolar nerveAnterior teeth(1,2,3)Middle superior alveolar nervePremolars (4,5) &MB root of 1stmolar(6)Posterior superior alveolar nerveMolars exceptMB root of 1stmolar(6)Nerve supply of Maxillary teeth
  33. 33. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryPalatal mucoperiosteumNasopalatine nerveAnterior teeth(1,2,3)Greater ( Anterior) palatine nervePremolars(4,5)&Molars (678)Nerve supply of Maxillary teeth Cont.
  34. 34. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryMaxillary anesthesiaInfiltirationBuccal inf.Palatal inf.Nerve blockIncisive N.B.Anterior &Middle Sup. Alv.N.B.Post. Sup. Alv.N.B.Palatine N.B.Maxillary N.B.
  35. 35. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryKeep In Mind• Chair position (right handed – right side)• Dentist position (right handed – right side)• Nerve to be anesthetized• Armamentarium: Syringe (type) - Needle (size)• Landmarks (soft tissue – bony)• Technique– Point of insertion– Direction of insertion• Confirming the anesthesia (subjective – 0bjective)
  36. 36. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryBuccal infiltration anesthesiaPatient position• Head , neck and trunk on thesame straight line• The back of the chair is tilted sothat it make a 45 degree anglewith the floor• So that when the patient open hismouth the occlusal plane of themaxillary teeth makes 45 degreewith the floor• The occlusal plan of maxillaryteeth near to the operator’sshoulderDentist position• From infront and to theright
  37. 37. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryAcland’s DVD atlas of head and neck anatomy
  38. 38. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryBuccal infiltration anesthesia Cont.• Needle:– 25-27 gauge– Short needle• Syringe– Non-Aspirating syringe• The target area– The apical region of the tooth to be anesthetized
  39. 39. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryBuccal Infiltration Technique Cont.The point of needle insertionThe point of intersection of 2imaginary lines• 1st line is a vertical lineparallel to the long axis ofthe tooth• 2nd line is a horizontal linealong the mucobuccal fold
  40. 40. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryBuccal Infiltration Technique Cont.Direction of needle insertion• 45° with the buccal corticalplate of bone
  41. 41. Maxillay Infiltration Anesthetic TechniquesHesham El-Hawary
  42. 42. Maxillay Infiltration Anesthetic TechniquesHesham El-Hawary
  43. 43. Maxillay Infiltration Anesthetic TechniquesHesham El-HawarySteps for buccal infiltration The lip/cheek is retracted using dental mirror or yourfinger to make almost a right angle with thelabial/buccal aspect of the jaw The point of insertion is determined as mentioned The needle is inserted with its bevel toward the boneand making an angle of 45° with the buccal aspect The needle is pushed through the soft tissue untilthe bone is reached (within 2mm)
  44. 44. Maxillay Infiltration Anesthetic TechniquesHesham El-HawarySteps for buccal infiltiration Cont. The needle is held firmly and 1.5cc of the solution isslowly deposited for buccal/labial injection, and 0.3cc for lingual anesthesia The needle is then withdrawn gently and recap it Wait 2-3 minutes before starting your dentalprocedure Check your anesthesia using the dental probe(objective finding)
  45. 45. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryConfirming the Anesthesia• Subjective findings– No subjective findings• Objective findings– Probing does not lead to pain
  46. 46. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryMAXILLARY PALATAL INFILTRATIONANESTHESIAMaxillary Anesthetic Techniques
  47. 47. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryWhen you are performing any dental workexcept extraction then the buccal infiltration isenoughbutwhen it comes to extraction then also a Palatalinjection is to be given
  48. 48. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryPalatal Infiltration TechniqueThe point of needle insertion Midway between thegingival margin of the toothand the median palatineraphe Along the long axis of thetooth
  49. 49. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryPalatal Infiltration Technique Cont.Direction of needle insertion• 90° to the palatine bone
  50. 50. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryAcland’s DVD atlas of head and neck anatomy
  51. 51. Maxillay Infiltration Anesthetic TechniquesHesham El-Hawary
  52. 52. Maxillay Infiltration Anesthetic TechniquesHesham El-Hawary
  53. 53. Maxillay Infiltration Anesthetic TechniquesHesham El-HawarySteps for palatal infiltration A mirror is used to retract the tongue and reflect thelight to the point of insertion The point of insertion is determined as mentioned The needle is inserted from the opposite side making90° degree with the palate The needle is pushed through the soft tissue untilthe bone is reached (within 2mm) On touching the palatal bone deposit 0.3 ml. SLOWLY
  54. 54. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryConfirming the Anesthesia• Subjective findings– No subjective findings• Objective findings– Probing does not lead to pain
  55. 55. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryVariations in these techniquesBuccal anesthesia Injection for the maxillarythird molarMade opposite to themaxillary second molartooth to avoid injury to thepterygoid plexus of veins upper centralsInject a few drops to theapical area of the othercentral incisorPalatal anesthesia• Injection for maxillary thirdmolar should be at thepalatal root of the maxillarysecond molar to avoidanesthesia of the lesserpalatine nerves whichsupply the soft palate andmay lead to gaggingsensation
  56. 56. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryVariations in these techniques Cont.Buccal anesthesia Palatal anesthesia Upper centrals and lateralsGiven 0.5 mm along thepalatal long axis of thetooth while entering fromthe opposite side
  57. 57. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryBony infiltration anesthesia• In this technique anesthesia is depositeddirectly into the bone in close proximity to thenerve filaments inside the cancellous bone• Very rarely used
  58. 58. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryBony Infiltration Anesthesia(Intra osseous)Techniques• A special needle is used todrill and pierce the outercortical plate• Using rose head round bur(#2)Advantages1. Very profound anesthesia2. When other techniques havefailedDisadvantages1. The needle easily get clogged2. The needle could fracture3. Painfull4. Cause infection inside the bone
  59. 59. Maxillay Infiltration Anesthetic TechniquesHesham El-Hawaryhttp://www.cda-adc.ca/jcda/vol-67/issue-7/391.html
  60. 60. Maxillay Infiltration Anesthetic TechniquesHesham El-HawaryTHANK YOUMaxillary Anesthetic Techniques

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