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Maxillary Nerve Block and Infiltration Techniques
1.
2. 1- Intraoral techniques:
a) Local infiltration of nerve
endings (submucosal
analgesia).
b) Block of the terminal
branches (infiltration
anesthesia).
c) Anterior and middle superior
alveolar nerve block
(infraorbital).
6. Basic Injection Technique
Position the patient
Communicate with the patient
Prepare the tissue
Dry the area
Apply antiseptic
Apply topical anesthetic
Check flow of local anesthetic
8. Maxillary Anaesthesia
Maxillary bone is porous
and mainly cancellous.
Roots of the maxillary
teeth are covered only by
a thin layer of buccal
bone.
Highly vascular
9. Maxillary nerve distribution and LA
• Infiltration A.:
• Buccal Infiltration
• Palatal Infiltration
• Block A.:
• Posterior superior alveolar
NB
• Middle superior alveolar NB
• Infra orbital NB (Int. Ext.
oral).
• Greater Palatine NB
• Nasopalatine NB
• Maxillary NB (Int. Ext. oral).
10. Maxillary infiltration anaesthesia
1. Buccal Infiltration A.:
• For all Maxillary teeth
• Slow supraperiosteal injection
• Opposite to the tooth apex, at a
point made by the long axis of
the tooth and the buccal
vestibule
• Needle bevel toward the bone
• Onset is 3-5mn. and working
time is 20 – 30 minutes.
11. .Maxillary labial infiltration A. 2
• Opposite to the
tooth apex, at a
point made by the
long axis of the
tooth and the
labial vestibule
12. Palatal Anaesthesia
((infiltration & block
Nasopalatine nerve
infiltration
block
Greaterpalatine nerve
infiltration
block
No need for lesser
palatine A.
13. Infiltration - Palate
Nerves
Terminal branches - Greater Palatine nerve
Nasopalatine nerve
Area
Palatal soft tissue in area of injection
14. Infiltration - Palate
Indications
Limited area
Hemostasis
Contraindications
More than 2 teeth
Inflammation/infection
at site
Advantages
Hemostasis
Minimal area affected
Disadvantages
Potentially traumatic
15. Infiltration - Palate
Technique
Apply topical, pressure
Insert into gingiva in center of area
- 5-10 mm from gingival margin
Aspirate (positive results are rare)
Inject 0.2-.3 ml, slowly
16. Failures of Anesthesia
Quite rare
Failure of hemostasis
Inflammation
Lack of vasoconstrictor
18. Greeter palatine nerve block
Between upper 2nd
and 3rd molars.
Midway between
the median palatine
raphae and the free
gingival margin.
19. Posterior superior nerve block
Distal to the 2nd
molar, posterior to the
tuberosity, at 45
degrees
Aspirate first,
Pterygoid plexus of
veins.
Maxillary N B
Post. Sup. Alv.NB
Maxillary infiltration
20. Posterior Superior Alveolar Nerve
Block
Nerve Anesthetized:
Posterior Superior
Alveolar Nerve (PSA)
For maxillary molars
and buccal tissue
21. Indications for PSA Block
First or second maxillary molar
Supraperiosteal injection has proved
ineffective
Contraindication
Risk of hemorrhage is too great
(eg. hemophilia, coumadin)