Maxillary infiltration anesthetic techniques (with photos)

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Maxillary infiltration anesthetic techniques (with photos)

  1. 1. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Maxillary Infiltration Anesthetic Techniques Dr Hesham El-Hawary Assistant professor OMFS www.elhawarydentalclinic.com
  2. 2. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary ‫االيه‬ ‫الزمر‬ ‫﴿سورة‬ ٣٨ ﴾
  3. 3. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary The main factors to be concerned are: 1. Selection of a suitable syringe and needle 2. Utilization of the proper L.A. drug 3. Insertion of the needle in the correct site for injection – Point of insertion – Direction of needle injection
  4. 4. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Local Anesthesia 1. Topical anesthesia 2. Local infiltration 3. Field block 4. Nerve block
  5. 5. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Local Anesthesia • Topical Anesthesia – Ointments, gels, sprays and pastes on mucous membrane or skin – Application of a topical anesthetic agent on the mucosa allows for the easy and painless insertion of the sharp needle – Affects free nerve endings
  6. 6. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Local Anesthesia • Local Infiltration – Flooding of the small terminal nerve endings with local anesthetic solution
  7. 7. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Local Anesthesia • Field Block – Referred to as local infiltration – local anesthetic solution is deposited in the vicinity of larger terminal nerve fiber – so a circumscribed area is anesthetized – Local anesthesia injection above a tooth apex is an example of a field block, in spite of being referred to as paraperiosteal or supraperiosteal infiltration anesthesia
  8. 8. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Local Anesthesia • Nerve Block – The anesthetic solution is deposited close to a main nerve trunk – Usually at a distance from the operative site before the nerve divided into terminal branches
  9. 9. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Factors affecting selection of the technique to be used 1. Area to be anesthetized Depending 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 nerve filaments inside the cancellous bone – Posterior mandible • Thick and dense cortical bone • Nerve block anesthesia
  10. 10. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Factors affecting selection of the technique to be used Cont. 2. Extent of surgical procedure – Multiple extractions, nerve block anesthesia is preferable • Allow anesthesia of the entire operative area • Prevent multiple needle punctures
  11. 11. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Factors affecting selection of the technique to be used Cont. 3. Duration and profoundness of anesthesia Nerve block anesthesia produces a more profound and longer duration than infiltration anesthesia 4. Age of the patient Older individuals have dense bone, thus it is more difficult for infiltration anesthesia to penetrate into the bone
  12. 12. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Factors affecting selection of the technique to be used Cont. 5. Hemostasis When required for the procedure, infiltration anesthesia is recommended to allow the vasoconstrictor present with the local anesthetic to act directly on the blood vessels and reduce bleeding
  13. 13. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Factors affecting selection of the technique to be used Cont. 6. Presence of infection Infiltration anesthesia should be avoided to prevent injection into an infected area which can spread the infection 7. Skill of the operator
  14. 14. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary INFILTRATION ANESTHESIA Infiltration Anesthetic Techniques
  15. 15. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary  The most commonly used technique  It is divided into  Soft tissue infiltration  Submucosal  Paraperiosteal  Bony infiltration
  16. 16. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Soft tissue infiltration anesthesia In this technique anesthesia is deposited into the soft tissue in close proximity to bone which is then absorbed via pores in the bone surface till it reaches the nerve filament inside the cancellous bone
  17. 17. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary
  18. 18. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Soft Tissue Infiltration Submucosal anesthesia Paraperiosteal anesthesia Subperiosteal anesthesia
  19. 19. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Soft Tissue Infiltration Submucosal anesthesia  Needle is inserted at a slight depth just below the mucous membrane  In cases just need superficial anesthesia  Hypertrophied tissue  High muscle attachment Paraperiosteal Anesthesia  Called local infiltration  Mostly used for anesthetizing  All maxillary teeth  Lower anterior mandibular teeth  It’s action depends on the diffusion of the L.A. solution through the periosteum and the minute foramina in the cortical bone
  20. 20. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Soft Tissue Infiltration • Subperiosteal injection – Not be attempted – Because of • Liability of needle breakage • Difficulty of forcing the anesthetic agent between periosteum and bone
  21. 21. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Paraperiosteal Anesthesia Advantages 1. High success rate 2. Technically it is an easy injection 3. Usually it is entirely atraumatic Disadvantages • Not suitable for large areas – Needs multiple punctures – Administeration of large amount of L.A. solution
  22. 22. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary CHAIR POSITION – DENTIST POSITION RIGHT HANDED OPERATOR – RIGHT SIDE Infiltration Anesthetic Techniques
  23. 23. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Zero position
  24. 24. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Adjusting the backrest Adjust the head rest so that the head , neck and trunk become on the same straight line
  25. 25. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Adjusting the backrest Adjust the head rest so that the head , neck and trunk become on the same straight line The back of the chair is tilted so that it make a 45 degree angle with the floor
  26. 26. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Adjusting the backrest So that when the patient open his mouth the occlusal plane of the maxillary teeth makes nearly 45 degree with the floor
  27. 27. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary So that when the patient open his mouth the occlusal plane of the maxillary teeth makes 45 degree with the floor The occlusal plan of maxillary teeth near to the operator’s shoulder
  28. 28. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Adjusting the dental chair level Working in maxillary teeth Elevate the chair from the zero position after adjusting the back rest the occlusal plan of maxillary teeth near to the operator’s shoulder N.B. the operator stands infront and to the right
  29. 29. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Adjusting the dental chair level Working in mandibular teeth Elevate the chair from the zero position after adjusting the back rest so that The occlusal plan of maxillary teeth near to the operator’s shoulder N.B. the operator stands infront and to the right except during working in lower right posterior teeth
  30. 30. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary For working in lower right posterior teeth the chair is lowered and tilted enough to enable the operator to have a clear view to the field from rear right position
  31. 31. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary MAXILLARY BUCCAL INFILTRATION ANESTHESIA Infiltration Anesthetic Techniques
  32. 32. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Pulp , Investing structures & Labial (buccal) mucoperiosteum Anterior superior alveolar nerve Anterior teeth (1,2,3) Middle superior alveolar nerve Premolars (4,5) & MB root of 1st molar(6) Posterior superior alveolar nerve Molars except MB root of 1st molar(6) Nerve supply of Maxillary teeth
  33. 33. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Palatal mucoperiosteum Nasopalatine nerve Anterior teeth (1,2,3) Greater ( Anterior) palatine nerve Premolars (4,5) & Molars (678) Nerve supply of Maxillary teeth Cont.
  34. 34. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Maxillary anesthesia Infiltiration Buccal inf. Palatal inf. Nerve block Incisive N.B. Anterior & Middle Sup. Alv. N.B. Post. Sup. Alv. N.B. Palatine N.B. Maxillary N.B.
  35. 35. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Keep 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 Techniques Hesham El-Hawary Buccal infiltration anesthesia Patient position • Head , neck and trunk on the same straight line • The back of the chair is tilted so that it make a 45 degree angle with the floor • So that when the patient open his mouth the occlusal plane of the maxillary teeth makes 45 degree with the floor • The occlusal plan of maxillary teeth near to the operator’s shoulder Dentist position • From infront and to the right
  37. 37. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Acland’s DVD atlas of head and neck anatomy
  38. 38. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Buccal 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 Techniques Hesham El-Hawary Buccal Infiltration Technique Cont. The point of needle insertion The point of intersection of 2 imaginary lines • 1st line is a vertical line parallel to the long axis of the tooth • 2nd line is a horizontal line along the mucobuccal fold
  40. 40. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Buccal Infiltration Technique Cont. Direction of needle insertion • 45° with the buccal cortical plate of bone
  41. 41. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary
  42. 42. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary
  43. 43. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Steps for buccal infiltration  The lip/cheek is retracted using dental mirror or your finger to make almost a right angle with the labial/buccal aspect of the jaw  The point of insertion is determined as mentioned  The needle is inserted with its bevel toward the bone and making an angle of 45° with the buccal aspect  The needle is pushed through the soft tissue until the bone is reached (within 2mm)
  44. 44. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Steps for buccal infiltiration Cont.  The needle is held firmly and 1.5cc of the solution is slowly deposited for buccal/labial injection, and 0.3 cc for lingual anesthesia  The needle is then withdrawn gently and recap it  Wait 2-3 minutes before starting your dental procedure  Check your anesthesia using the dental probe (objective finding)
  45. 45. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Confirming the Anesthesia • Subjective findings – No subjective findings • Objective findings – Probing does not lead to pain
  46. 46. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary MAXILLARY PALATAL INFILTRATION ANESTHESIA Maxillary Anesthetic Techniques
  47. 47. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary When you are performing any dental work except extraction then the buccal infiltration is enough but when it comes to extraction then also a Palatal injection is to be given
  48. 48. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Palatal Infiltration Technique The point of needle insertion  Midway between the gingival margin of the tooth and the median palatine raphe  Along the long axis of the tooth
  49. 49. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Palatal Infiltration Technique Cont. Direction of needle insertion • 90° to the palatine bone
  50. 50. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Acland’s DVD atlas of head and neck anatomy
  51. 51. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary
  52. 52. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary
  53. 53. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Steps for palatal infiltration  A mirror is used to retract the tongue and reflect the light to the point of insertion  The point of insertion is determined as mentioned  The needle is inserted from the opposite side making 90° degree with the palate  The needle is pushed through the soft tissue until the bone is reached (within 2mm)  On touching the palatal bone deposit 0.3 ml. SLOWLY
  54. 54. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Confirming the Anesthesia • Subjective findings – No subjective findings • Objective findings – Probing does not lead to pain
  55. 55. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Variations in these techniques Buccal anesthesia  Injection for the maxillary third molar Made opposite to the maxillary second molar tooth to avoid injury to the pterygoid plexus of veins  upper centrals Inject a few drops to the apical area of the other central incisor Palatal anesthesia • Injection for maxillary third molar should be at the palatal root of the maxillary second molar to avoid anesthesia of the lesser palatine nerves which supply the soft palate and may lead to gagging sensation
  56. 56. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Variations in these techniques Cont. Buccal anesthesia Palatal anesthesia  Upper centrals and laterals Given 0.5 mm along the palatal long axis of the tooth while entering from the opposite side
  57. 57. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Bony infiltration anesthesia • In this technique anesthesia is deposited directly into the bone in close proximity to the nerve filaments inside the cancellous bone • Very rarely used
  58. 58. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary Bony Infiltration Anesthesia (Intra osseous) Techniques • A special needle is used to drill and pierce the outer cortical plate • Using rose head round bur (#2) Advantages 1. Very profound anesthesia 2. When other techniques have failed Disadvantages 1. The needle easily get clogged 2. The needle could fracture 3. Painfull 4. Cause infection inside the bone
  59. 59. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary http://www.cda-adc.ca/jcda/vol-67/issue-7/391.html
  60. 60. Maxillay Infiltration Anesthetic Techniques Hesham El-Hawary THANK YOU Maxillary Anesthetic Techniques

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