Maxillary Anesthasia

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Maxillary Anesthasia

  1. 1. MAXILLARY ANESTHESIA By Dr shabeel pn
  2. 2. Techniques of Maxillary Anesthesia <ul><li>Local Infiltration </li></ul><ul><li>Field Block </li></ul><ul><li>Nerve Block </li></ul>
  3. 3. Maxillary Injection Techniques <ul><li>Supraperiosteal </li></ul><ul><li>Periodontal ligament </li></ul><ul><li>Intraseptal injection </li></ul><ul><li>Posterior superior alveolar nerve block </li></ul><ul><li>Middle superior alveolar nerve block </li></ul>
  4. 4. Maxillary Injection Techniques <ul><li>Anterior superior alveolar nerve block </li></ul><ul><li>Maxillary (second division) nerve block </li></ul><ul><li>Greater (anterior) palatine nerve block </li></ul><ul><li>Nasopalatine nerve block </li></ul>
  5. 5. Supraperiosteal Injection
  6. 6. Indications <ul><li>Pulpal anesthesia of one or two maxillary teeth </li></ul><ul><li>Soft tissue anesthesia when indicated </li></ul><ul><li>Hemostasis </li></ul>
  7. 7. Contraindications <ul><li>Infection or acute inflammation in the area </li></ul><ul><li>Dense bone covering apices of teeth </li></ul>
  8. 8. Advantages <ul><li>High success rate (>95%) </li></ul><ul><li>Technically easy injection </li></ul><ul><li>Usually entirely atraumatic </li></ul>
  9. 9. Areas Anesthetized <ul><li>Entire area innervated by the large terminal nerve branches: </li></ul><ul><li>Tooth pulp and root area </li></ul><ul><li>Buccal periosteum </li></ul><ul><li>Mucous membrane and connective tissue </li></ul>
  10. 10. Disadvantages <ul><li>Not suitable for large areas </li></ul><ul><li>Multiple needle insertions </li></ul><ul><li>Large volumes of anethetic solution </li></ul>
  11. 11. Percent Positive Aspiration: <ul><li>Negligible, but possible (<1%) </li></ul>
  12. 12. Alternatives <ul><li>Periodontal ligament injection </li></ul><ul><li>Regional nerve block </li></ul>
  13. 13. Technique <ul><li>Apply topical </li></ul><ul><li>Landmarks - mucobuccal fold </li></ul><ul><li>long axis of tooth </li></ul><ul><li>Insert needle at height of mucobuccal fold </li></ul><ul><li>Target area - apex of tooth </li></ul><ul><li>Aspirate, deposit approx. 0.6-1 ml solution </li></ul>
  14. 19. Signs and Symptoms <ul><li>Numbness </li></ul><ul><li>Absence of pain during dental therapy </li></ul>
  15. 20. Safety Feature <ul><li>Minimum opportunity for intravascular </li></ul><ul><li>administration </li></ul>
  16. 21. Failures of Anesthesia <ul><li>Inadequate needle penetration </li></ul><ul><li>- not adjacent to tooth apex </li></ul><ul><li>Needle too far from bone </li></ul>
  17. 22. Posterior Superior Alveolar Nerve Block <ul><li>Nerve Anesthetized: </li></ul><ul><li>Posterior Superior Alveolar Nerve (PSA) </li></ul><ul><li>- for maxillary molars and buccal tissue </li></ul>
  18. 24. Indications for PSA Block <ul><li>First or second maxillary molar </li></ul><ul><li>Supraperiosteal injection is contraindicated </li></ul>
  19. 25. Contraindication <ul><li>Risk of hemorrhage is too great </li></ul><ul><li>(eg. hemophelia, coumadin) </li></ul>
  20. 26. Advantages <ul><li>Atraumatic </li></ul><ul><li>High success rate </li></ul><ul><li>Less number of injections </li></ul><ul><li>Minimize amount of local used </li></ul>
  21. 27. Disadvantages <ul><li>Risk of hematoma </li></ul><ul><li>Does not anesthetize first molar completely </li></ul><ul><li>No bony landmarks </li></ul>
  22. 28. Positive Aspiration <ul><li>Approximately 3.1% </li></ul>
  23. 29. Landmarks <ul><li>Mucobuccal fold </li></ul><ul><li>Maxillary tuberosity </li></ul><ul><li>Zygomatic process of maxilla </li></ul>
  24. 30. Area of Insertion <ul><li>Mucobuccal fold above maxillary second molar </li></ul>
  25. 31. Technique <ul><li>25 gauge, long needle </li></ul><ul><li>Position patient and identify landmarks </li></ul><ul><li>Advance needle upward, inward and backward </li></ul><ul><li>Aspirate, inject 1.8 ml of solution </li></ul>
  26. 34. Failures of Anesthesia <ul><li>Needle too lateral </li></ul><ul><li>Needle not deep enough </li></ul><ul><li>Needle too far superior </li></ul>
  27. 35. Complications <ul><li>Hematoma </li></ul><ul><li>Mandibular anesthesia </li></ul>

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